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HomeMy WebLinkAboutFarino, Anthony Glenn Goldsmith, President �QF S0(/TTown Hall Annex A. Nicholas Krupski,Vice President �Q� ��� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III J�[ Southold, New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 �yCOUN N BOARD OF'TOWN TRUSTEES TOWN OF SOUTHOLD April 14, 2021 Jeffrey Patan'jo P.O. Box 582 Bohemia, NY, 11716 RE: ANTHONY & CHRISTINE FARINO 515 GIN LANE, SOUTHOLD SCTM# 1000-88-4-5 Dear Mr. Patanjo: The Southold Town Board of Trustees reviewed the site plan prepared by Daniel R. Falasco, P.E., P.C., last dated March 10, 2021 and determined that the proposed construction of a 25'x35' addition to existing dwelling, and to remove existing sanitary system and replace with new upgraded sanitary system is out of the 100 foot Wetland jurisdictional area under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code, and also as Per Town , Code Chapter 2754A.(1)(m) Exceptions— Operations landward of a public road whereby the public road is located between the water body that is the source of the Trustee jurisdiction and the operations. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary, or within 100' landward from the edge of vegetated wetlands, without further authorization from`the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. Sincerely, 4 Glenn Goldsmith, Presi ent GG:ec II FRESHWATER POND FFL 14.2 I COVER TO GRADE IF LOCKING CAST-IRON FINISHED GRADE I DROP "T" IS USED� ON INLET COVER TO GRADE ELEV 8.3 CLEANOUT 20" MIN. CHIMNEY N z DWELLINGS WITH 20" MIN. LOCATE DROP "T' UNDER PUBLIC WATER ACCESS FOR MAINTENANCE a,: WLET ELEV 7.17 INV. 7.0 150' to 6 ® ® ® ®m o OUTLET INLET ® ® ® ®a0 WATER MAIN ® ®ao cq E� ® ®m❑ WM WM M WM WM WM M MIN.,4" DIA. SDR 357FLOW BAFFLE INV. 6.67 INV. 6.58 - GIN LANE PIPE OR EQUAL MIN. 4' DIA. SDR 35 HOUSE INVERT PITCHED 1/4" /FT. PIPE OR EQUAL 1 ,� A (7.4) PITCHED 1/8" PER FOOT LEACHING GALLEY (TYP.) e=;� 3' COLLAR BACK FILL 10' MIN. EDGE OF PAVEMENT 10' X 4' 10' MIN. y4 N io;�%`' MATERIAL TO BE �:„ -••¢ CLEAN AND GRAVEL I BOTTOM OF ,i; :ia{� �•y .;: U.P. (SEPTIC TANK 4 %Y•R�W n Pj N.37°54'10"E 112�.0' EL 3.3 W M. 450.00' `'� it �r.n,�4�r z ® ® ®00 z rn BOTTOM OF LEACHING POOLS a a. ^;;•}_ EL 4.0 :r"tir •j f, ri``.:a. 'Z w w z S w Cl1 I ''i k+ tip•. CA I HIGHEST EXPECTED WATER EL 1.0 CA CA S N ¢a `+ 6' MIN. PENETRATION G1 I �n I O I tj I INTO A VIRGIN STRATA O I SANITARY CROSS SECTION OF SAND & GRAVEL ' N.T.S. ELEV. 5.3 WOOD GARAGE OL DR BROWN SANDY LOAM 0.5' NOTES: UNDER PROPOSED trj 1. AREA 15,625.00 SQ. FT. OR 0.36 ACRES GF 5.6 25'x35' BROWN — 2. FLOOD ZONE X 0.2% CHANCE ANNUAL FLOOD DWELLINGS WITH 1 STY ADDITION DWELLINGS WITH CL CLAYEY 1.3' I 3. THE WATER SUPPLY, WELLS, DRYWELLS AND DWELLING PUBLIC WATER #515 FFL 14.2 ►� SAND — CESSPOOL LOCATIONS SHOWN ARE FROM FIELD 150' I FFL 14'2 I 100' BROWN OBSERVATIONS AND OR DATA OBTAINED BY OTHERS. o VACANT 125' SP SAD 1.2' 4. ELEVATION DATUM NAVD88 GRAVEL E C E U E C:, — C.O. BROWN c DRY l CL CSD 1.3' HIGHEST EXPECTED JDI z WELLS — GROUND WATER EL 1.0CL CLAY 1.0' I v 15'MIN. LP LP LP 8'M�N S , �� CL WATER IN 1.5, GROUND WATER EL 0.0 LOT MAR 18 2021 14A LP LP LP EXISTING SANITARY TO BE O CLAY 0 ABANDONED AND BACKFILLED O SW MEDIUM 6.0' MAP OF O_ co EXP EXP EXP WITH CLEAN COARSE SAND I SAND - BAY E �'N Board ofSouthoTrustees o n FEB. 1, 2021 SITU ;�' 2.0 ; K. WOYCHUK LS - -- - - - - - - - - SOUTHOLD S 37054'10'• w 125.00'T TOWN OF SOUTHOLD PROPOSED 5 BEDROOM SYSTEM DWELLINGS WITH I SUFFOLK COUNTY, NEW YORK 1500 GAL S.T. PUBLIC WATER FILED: JAN. 22, 1959 10'0 X 4'(3'EFFECTIVE DEPTH) �-- 150' —� (6)GALLEYS,3'DEEP MAP NO: 2910 SCTM#. 1000-88-4-5 SITE PLAN SCALE: 1"=30' O F NEW Y �P ��LR• Fq� QDANIEL R. FALASCO , P .E . , P . C . s CONSULTING ENGINEER a �o CL- 94 STEUBEN BLVD., NESCONSET, NY 11767 C� I (516) 317-7209 F��FpPNO. 05699 DATE 03-10-21 SCALE DRAWING NO. R�FESSIONAS NOTED � SUFFOLK COUNTY !DEPARTMENT OF HEALTH SERVICES l C:) 3% T AREA = 15,625 SQ. FT. N Cn7 M MAI N B-AYVI EW ROAD coo o LOT NUMBER 21 d- S 52'05'50"E 125.00' FC FC SET 3.4'Nmeandering wire fence I0.1'E STK x_"�_ x x - - / 0.4'N SET SET FC --- STK STX0.4'E 0.3'S _\ asphalt drive I o o rW C 40' N 0) 30.4' cV gar N under r. W N cv wd landing (n L J �/and steps C Z O 9.1' 1 STY 4. 4'x3.6 _x Z F` � FR encf room on O DWELL 12.0' roised deck no c r- O foundation t J wood deck h N z '- 33.3' 43.0' (n oi FC 4'N FC FD wire deer fence w FC f 1'E MON evergreens behind fence 1-6-N MON 1.1'N x fence on top of wall wolf wall 77 2.3'W 6 3. 'W -- , - -- ----- -- - --- -- - -- --— - --- _ - 1.4S -- - N 52"05'50"W 12500' 1_0s LOT NUMBER 19 TW OOMM OF MW OF,WAYS AW OR EISFIdFMS OF F ANY,NOT MW ARE NOT MM MMM. 1 ams(M 0"Mmon)me" "am" nm ME srrc amw To Im t -*M FOR A etc Pvi�ee AND USE AND TFIOMFUM ARE Wr JOB No. 12-82 FILE No. BAY HAVEN . i0'vi K,7W OMMk r of Ft71OM,fttA**pats.Pools. Fffi , Pula r A oto" SURVEYED FOR ANTHONY JOHN & CHRISTINE J. FARWO mw m mm At17Omm oR ADt1 om 7o mms sw&y r.A.vaArm of soma+ LOT NUMBER 20 rng-o r iFE NEw sm7E oouram Lw -' MAP OF BAY HAVEN AT SOUTHOLD t#1liRMREES MOlG1TFa MMMSWIt1 RUN 0le.Y TD 7WPER9DN FOR MM 7W MtRvt:Y IS PRE MW,*0 ON tel t7F?W 70 7W ME 00WW, 0MOO MAL SITUATED` AT SOUTHOLD AGOW NO LOON I(MM UM 1eMMK 40 70 7W AS91OW of 7W An Nar iwaF&,#aE TO mmmm wraunow TOWN OF SOUTHOLD, SUFFOILK COUNTY, N.Y. COM OF TW SWM MW M)r eVWW TW wo SURWMn MW WX OR SCALE 1" = 30' DATE 4-24-2012 EleB089E7)suL s wL mur ix COMEM TO BE A•SAW MM COPY. FILED MAP No. 2910 DATE 1-22-1959 CERTIFIED ONLY TO: TAX MAP No. (REF ONLY) 7000--88-4-5 DISK 2012 ANTHONY JOHN & CHRISTINE J. FARINO STEWART TITLE INSURANCE COMPANY J P MORGAN CHASE BANK N.A. HAROLD F. TRANCHON JR. P.C. - a LAND SURVEYOR P.O. BOX 616 ✓ � 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 N.Y. L{C. No. 048992 631-929-4695 'HA--'ROLD F. TRANCHON JR. PENtV. LIC. No. 2115-E 1P. Sat/ �', Town Hall Annex Michael J.Domino,President h'd` . John M.Bredemeyer III,Vice-President h} ,, 54375 Route 25 P.O.Box 1179, Tenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �r Telephone(681)765-1892 Gre Williams ` , ' i Fax(631),765-6641 B(DAIRD OF TOW'TRUSTEI&S TOWN OF SOUTHOLD This section For Office Use Only Coastal Erosion Permit Application �/� Administrative Permit - ® V Amendment/Transfer/Extension X--Received Application: 3,18.21 MAR 18 2021 X Received Fee: $ 2 5V,0 V- Completed Application: 3,t •y) Incomplete: -Southold Town SEQRA Classification: Type,I _ Type II Un ' O '�vetes P sitive Dec. Lead Agency Determination Date: Coordination:(date sent): _ _LWRP Consistency Assessment Form Sent: _CAC Referral Sent: X Date of Inspection: Receipt of CACReport: Technical Review: k Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): ��'�hon � C k r I STS ne Fa.t^t r i a Mailing Address: Phone Number: Suffolk County Tax Map Number: 1000- $8 " y Property Location: 5-15- U t n 44 n e (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): J e'r(re ?0t tr r► )o Mailing Address: Phone Number: ,p3I ' q p y -933;- { boara ox rusuees hipp-.a.ca-r. on GENERAL DATA Land Area(in square feet): Area Zoning: S Previous use of property: l s' Intended use of property: (mss Covenants and Restrictions on property? Yes '✓ No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? ✓Yes No If"Yes", be-advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s)on property have a valid Certificate of Occupancy_? V/ Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes,provide explanation: ce x k4 acA Project Description(use attachments if necessary): SLr� i RE: 515 GIN LANE-SOUTHOLD SCTM No. 1000-88-4-5 PROJECT DESCRIPTION Project includes the removal and replacement of an existing failing sanitary system with a new upgraded sanitary system in rear yard of existing residence. In addition, application includes the construction of a 25'x35' addition to existing residence. All work will be over 100' from,existing freshwater pond located on north side of Gin Lane. l $7V014 VS bi Yr7 VOGe� b�Yv�r��vc^vrv�� WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on Iot: � square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 1 I Z feet Closest distance between nearest proposed structure and upland edge of wetlands: //Z feet Does the project involve excavation or filling? ✓ No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? M1,+ cubic yards Depth of which material will be removed or deposited: "let feet Proposed slope throughout the area of operations: °-3 Manner in which material will be removed or deposited: N)4 Statement of the effect,if any, on the wetlands and tidal waters of the town that may result by reason,of such proposed operations (use attachments if appropriate): 'I hem w.11 ke nv e"f AFFIDAVIT Ah.tk'A-j -13� Ehr 1 S t1 c -FA{-(yvv BEING DULL'SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PER?MT(S)AND THAT ALL STATEMENTS TS�CO�NTAgI�I.�y�EI➢7IH HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEFS AND THAT ALL WORD WILL BE DONE IN THE FANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY TIDE SOUTHOLID TOWN BOAR OF TRUS'T'EES. THE APPLICANT AGREES TO BOLD THE TOWN OF SOUTHO]LD AND THE B®ARD OF TRUS'T'EES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. INCOMPLETING THISAPPLRCATION,II HEREBYAUTHORIZE THE TYpSTEES9,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO VY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO EN'T'ER ONTO My PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. r - cgnature Pope Owner aature oProperty Owner SWORN TO BEFORE ME THIS 1__DA'Y OF ,-CL 20J No a Public MARGARET NAPIPI NOTARY PUBLIC,STATE OF NEW YORK Registration No Ol NA6374843 Qualified m Suffolk County Commission Expires May 07,2022 �veisu vs s�us L��a ,�slugaa.l.�:a�.a.vsa A UTHORIZAT HO (Where the applicant is not the owner) I/We �,��hony ChresTnc -�.►rt�o --- , owners of the property identified as SCTM# 1000- in the town of 5 ov ®l C) ,New York,hereby authorizes Te(--fir c to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. I ale r A Property 0 s Sigha@re Property Owners Signature SWORN TO BEFORE ME THIS DRY OF nGl,c-L a 20 No ry ublic MARGARET NAPPI NOTARY PUBLIC,STATE OF NEW YORK Registration No.OINA6374843 Qualified in Suffolk County Commission Expires May 07,2022 TRANSACTRONAL DISCLOSURZ FORM The Town of 'Quthold's Code of Ethics prohibits conflicts of interest on the cart of town officers and emnloyecs The purpose of this form is to ple in atio w tch can alert a tow of ssible conflicts o and allow it to ake whatever actio n is neexessary to avoid same. . YOURNAME: !r4 (Last name,first name, fiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee a� Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally.(or through your company,spouse,sibling,parent,or child)have a rolationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,Marriage,or business interest"Business interest»means a business, including a partnership,in which the town ofCtcer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or-employ=owns more than of the,shares. YES NO . If you answered"YES",complete the balance of this form and date and sign where indicated. Name ofperson employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal orlteneficial owner of any interest in a non-corporate entity(when,the applicant is not a corporation); C)an otlicer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitt i d ' 204 Signat Print Name Form TS 1 s/ APPLICANT/AGENT/RE-PRESENTATIVE TRANSACTIONAL DISCLOSURE FORM e To o u S th d's ode o csta' hib' c ict f' tc Y o of ow em to a o f this foM Lq to id which siert a to o s We a e t low't take w at r ct' ' tneceM to avoid same. YOURNAME: IF74!t "+ +�v�'1'l�®rt•� (Last name,fust name,.rpiddle initial;unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval ofplat Mooring Exemption from plat or official map Planning Other (If"Other",nine the activity.) Do you personally(or through your company,spouse,sibling„parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including,a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than-5%of the shaa,--;zr YES NO X. — if you answered"YES",complete the balance of this form and date and sign where indicted. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 51/6 of the shares of the corporate stock of the applicgnt (when the aapppiicant`is a corporation), l3)the legnt or-beneficial owner of any interest in-8 non-corporate entity(when the applicant is not a corporation); ' C)an officer,director,partner,or employee of the-applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of L' 204 Signature P Print Name�� Form TS 1 AI?PLICA>T/A(C.ENT/RIEIPRF,SENTATM TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethicsrpm hibit ponfl ets of interest on the part oftown-'1'r s and erctployees 'i ize rnnnose of this form is to provide infarination which can alert the town of possible conflicts of interest and allow it to tape whatever actio is g„eoegW tb avoid same. YOUR NAME: - ep�t (Last name,first nun .piddle initial,unless yOq are applying in the name of someone else or other entity,such as a company.if so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance _ Building -- — Variance Trustee Change of Zone Coastal Erosion Approval ofplat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally.(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,igarri e,or business mierest"Business interest"means a business, including a partnership,in which the town officer or employee W even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%o e shares. YES NO if you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlapent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe In the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%v of the shares of the corporate stock of the appl iept (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 1:� day of .A Za Signature Print Name Form TS I { v dry Short Environmental Assessment Form Part I -Project Information Instructions for Compledw Part 1—Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to Hilly respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1.You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1—Project and Sponsor Information Name of Action or Project: 515 Gin Lane-Southold Project Location(describe,and attach a location map): 515 Gin Lane-Southold Brief Description of Proposed Action: Abandon existing sanitary system and install new sanitary system and proposed second story addition Name of Applicant or Sponsor. Telephone: 516-605-8092 Anthony Farino E-Mail • anthonyjohn.farino@gmaii.com Address: 18 Ron Ct, CigVPO: State: Zip Code: Commack W 11725 1. Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other government Agency? NO YES If Yes,list agency(s)name and permit or approval:SCDHS/NYSDEC/Town of Southold Trustees ❑ 3. a.Total acreage of the site of the proposed action? 0.36 acres b.Total acreage to be physically disturbed? 0.01 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.36 acres 4. Check all land uses that occur on,are adjoining or near the proposed action: 5. ❑Urban ❑ Rural(non-agriculture) ❑ Industrial ❑ Commercial ® Residential(suburban) ❑Forest ,® Agriculture ❑ Aquatic ❑ Other(Specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ n ❑ b. Consistent with the adopted comprehensive plan? ❑ ��'�JJ ❑ NO YES 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES Nameftoonic Bay and Environs,Reason:Protect public health,water,vegetation,&scenic beauty, If Yes,identify: Agency:Suffolk County,Date:7-12-88 ❑ NO YES 8. a. Will the proposed action result in a substantial increase in traffic above present levels? r._, b. Are public transportation services available at.or near the site of the proposed action? n ❑ c. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed 7Z ❑ action? 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ a 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 11. Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district NO YES which is listed on the National or State Register of Historic Places,or that has been determined by the Commissioner of the NYS Office of Parks,Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places? b.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? 13. a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: Page 2 of 3 1 14. Identify the typical habitat types that occur on,or are likely to be found on the project site.Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑Wetland ❑ Urban ❑✓ Suburban 15. Does the site of the proposed action contain any species of animal,or associated habitats,listed by the State or NO YES Federal government as threatened or endangered? Piping Plover,Least Tem ❑ 16. Is the project site located in the 100-year flood plan? NO YES a 1 17. Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑✓ ❑ a. Will storm water discharges flow to adjacent properties? F b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? ❑ If Yes,briefly describe: 18. Does the proposed action include construction or other activities that would result in the impoundment of water NO YES or other liquids(e.g.,retention pond,waste lagoon,dam)? If Yes,explain the purpose and size of the impoundment: ❑ ❑ .19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NO YES management facility? If Yes,describe: � ❑ 20.11as the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO I YES completed)for hazardous waste? If Yes,describe: � ❑ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor/ : Antpopy Farino Date: Signature: / Title:Owner PRINT FORM Page 3 of 3 EAC Mapper Sumi y Report Monday, March 8,2021 10:30 PM Mdalmer: The EAF Mapper is a screening tool intended to assist 1 gg_�25 project sponsors and reviewing agencies in preparing an environmental assessment form(EAF).Not all questions asked in the EAF are n_ answered by the EAF Mapper.Additional information on any EAF $8.4-24 question can be obtained by consulting the EAF Workbooks. Although t the EAF Mapper provides the most up-to-date digital data available to ` V p` DEC,you may also need to contact local or other data sources in order F e 88.-4-4 yf �' to obtain data forag agency t provided by the Mapper.Digital data is not a r° Jt 88:4-237, f , Toronto :R ; C +�thaAia `` x 88,-4-+ � 4 ' 9'(?.- �Ji l �„>o... _'f;' 3's: = " � 1` a--� �,t�m'i t #t t ({#1., tBadelphia ' mitt(CI3G5�interma6,INCR 41E�dTP,NRCa Esti Jap`Tj,',vTEn,Esn China f fang Yonc��Esn :IE LAR;r�tz tw all tY1Eil Fs0-Chma JHon Wl tib fii' Thiltal�k OW-C-7W OpgiStr�edtvtap+conttibUtI s andthe GlS,LrS&-�aVA)''tuvV ; 1e 615""othi r' Part 1 /Question 7 [Critical Environmental Yes Area_] Part 11 Question 7[Critical Environmental Name:Peconic Bay and Environs,Reason:Protect public health,water, Area-Identify] vegetation, &scenic beauty,Agency:Suffolk County, Date:7-12-88 Part 1 /Question 12a [National or State No Register of Historic Places or State Eligible Sites] Part 1 /Question 12b [Archeological Sites] Yes Part 1 /Question 13a[Wetlands or Other Yes-Digital mapping information on local and federal wetlands and Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15[Threatened or Yes Endangered Animal] Part 1 1 Question 15[Threatened or Piping Plover, Least Tern Endangered Animal-Name] Part 1 /Question 16[100 Year Flood Plain] No Part 1 /Question 20[Remediation Site] No Short Environmental Assessment Form -EAF Mapper Summary Report 1 Part 2-Impact Asse, nt. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 usi� a information contained in Part i and other mater, abmitted by the project sponsor or otherwise available to tur reviewer. When answering the questions the revie _ hould be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" .W ? No,or Moderate small to large impact impact may may occur occur L Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 0 11 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? El 4. Will the proposed action have an impact on the environmental characteristics that caused the {� establishment of Critical Environmental Area(CEA)? LJ 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ i-1 affect existing infrastructure for mass transit,biking or walkway? (---J 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7_ Will die proposed action impact existing: El El a.public/private water supplies? b:public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, r architectural or aesthetic resources? 9_ Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? lo. Will the proposed action result in an increase in the potential for erosion:flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or wil I not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation. that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees _ Name of Lcad Agency Date i President i Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Town of Southold �LWRI'CONSISMNCY ASSESSMENT FORM A. XNSTRUCTIONS 1. All applicants for permits' including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor-exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Lazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program A Rroposed action will be evaluated as to its sin�ficant beneficial and adverse effects upon the coastal arealwhich includes all o£Southold Town). 3. If any question"in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. 'Thus, each answer must be exulaln6d in dela% Ustina both sulgPorting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall nt be undertaken.. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net),the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B, IDESCRIpTHON OF SM AND PROPOSED ACTION SCTM# - pRojzCT NAmE G o? C4e.1c The Application has been submitted to(check appropriate response): Town Board ❑ num ing board❑ Building Dept. ❑ ]Board of Tnmtees E 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permiit,approval,license,certification: Nature and extent of action: SSG a+�a64eo( CL Location of action: Site acreage: D 3 6 Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: -71 (c) 'Telephone number:Area Code - (d) Application number,if any: I1 A Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 9 No❑ If yes,which state or federal.agency?—5;c DNS )I' Ce Evaluate the project to the following policies by analyzing how the project will-further support or not support the policies. Provide all proposed Best Management Practices that will further each Policy. Incomplete answers will require that the form be returned for completion. D LOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes effieaent use of imfrastrereture,makes ben efndial use of a coastal location,and mrirnarm izes adverse effects of development. See LWRP Section M—Policies;Page 2 for evaluation criteria. Yes No N®t Applicable Attach additional sheets if necessary Policy 2e Protect and preserve historic' and archaeological resources of the Town of Southold. See LYRF'Sectiorn M—Policies Pages 3 through.6 for evaluation-criteria ElYes ❑ No 1"1 loot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality annd Protect scenic resources throughout the Town of Southold. See IL TRP Section ffi—P®flicie Mages 6 through 9 forevaluation criteria ❑ Yes ❑ N Applicable Attach additional sheets if necessary NATURAL COAST PO LIICE&S Policy 4. iQ WMize loss of life, structures, and natural resources from flooding and erosion. See L VMP Section M—Policies Pages through 16 for evaluation criteria ❑ Yes ❑ No loot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold.See ILWRI?Section M —ZPages 16 through 21 for evak tion criten is s M No CQ Not Applicable ro;'eCA rv„c Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation 'tterria�. ❑ ❑ Yes No NL,_t pplicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LVW Section In — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No[g" Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in 'Down of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluatioU criteria. ❑ Yes ❑ as No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold., See LWRP Section In—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No D Not Applicable Attach additional sheets if necessary VT O18MG CYi`L"iSST P®^ VH.B:S Policy 10. Protect Southold'S water-dependent uses and promote siting of neer water-dependent uses in suitable locations � RP Section 111--Policies;Pages 49 through 56 for evaluation criteria. -1yes El leo loot Applacable Attach additional sheets if necessary Policy 11. Promote sustainable use of living mane resources in Long Island Sound, the Peconie Estuary and To"7Not See LSP Sections ffi-Policies; Pages 57 through 62 for evaluation criteria. des ❑ T�10 Applicable Attach additionalsheets if necessary Policy 12. .Protect agricultural lands in the Town of Southold. See LWRP Section M--Policies; Pages 62 through 65 for evalua ' $n criteria. ❑'Yes ❑ Into Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Sections M-Policiiees�Pagn 65 through 68 for evaluation criteria. _ F] Yes ❑ iso LJ loot Applicable P REPARED BY TITLE ''�' DATE i March 15, 2021 Town of Southold Trustees 11 Town Hall Annex Buildings-.� 54375 Rte. 25 P.O. Box 1179 MAR 1 8 2021c=— Southold, New York 11971 RE: 515 GIN LANE-SOUTHOLD Boa"(!of;rusfees SCTM No. 1000-88-4-6 APPLICATION FOR PERMIT Dear Trustees: We hereby submit one (1) original and three (3) copies of the proposed plans, application, deed, previous surveys and check for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very tr ly yours, v Je rey Patanjo P.O. 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