Loading...
HomeMy WebLinkAboutTR-10114A Glenn Goldsmith,President ®``�Q� SQ�� Town Hall Annex A. Nicholas Krupski,Vice President ® 54375 Route 25 P.O.Box 1179 Eric Sepenoski JIF Southold,New York 11971 Liz Gillooly G � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 C®UIdT`�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1997C Date: January 18, 2023 THIS CERTIFIES that the repair of the existing 44'x20' stone patio with raised planters constructed around perimeter, At 375 Lighthouse Lane, Southold Suffolk County Tax Map#1000-70-6-29.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 31, 2022 pursuant to which Trustees Administrative Permit# 10114A Dated April 13,2022,was issued and Amended on January 18, 2022 and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for repair of the existing 44'x20' stone patio with raised planters constructed around perimeter. The certificate is issued to Frederick B. Pollert& Elizabeth Buzash-Pollert owner of the aforesaid property. Authorized Signature Glenn Goldsmith, President ®��®v- s® �® Town Hall Annex A. Nicholas Krupski,Vice President a\ Ile P.O. ® Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 ®l�c®UNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 19, 2023 Frederick B. Pollert Elizabeth Buzash-Pollert P.O. Box 578 Southold, NY 11971 RE: 375 LIGHTHOUSE LANE, SOUTHOLD SCTM#: 70-6-29.2 Dear Mr. and Mrs. Pollert: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 18, 2023: RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit#10114A for the as-built raised planters constructed around the perimeter of the 44'x20' stone patio; and as depicted on the project plan prepared by Frederick B. Pollert, received on December 14, 2022, and stamped approved on January 18, 2023. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, -�'5V a Glenn Goldsmith President, Board of Trustees GG:dd SURVEY OF PROPERTY ofoo 51TUATE: 5OUTHOLD TOWN: S UTHOLD o N SUFFOLK COUNTY, NY SURVEYED 03-II-2016 �GW E SUFFOLK COUNTY TAX # 1000 - 10 - 6 - 29.2 s CERTIFIED TO, vas ti FREDERICK POLLERT 11 DEC 7 4 2022A Boast of Tms°^es O 1 � s J���SFn Pcgr�liyy� x slow V DAY A Os 6 APPROVED BYA9- BOARD OF i RUSTEEP TOWN OF SOUTHOLO; DATE �, $ ZOO o . 1 a5phait driveway 1 1 1 S 1 Goldsmith,President �0�o cOG$ Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski P.O.Box 1179 Liz Gillooly �y • ��� Southold,NY 11971 Elizabeth Peeples � e �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 2.3 Completed in field by: EI;Zalo-bIln Pttnte-S FREDERICK B. POLLERT & ELIZABETH BUZASH-POLLERT requests an Administrative Amendment to Administrative Permit#10114A for the as-built raised planters constructed around the perimeter of the 44'x20' stone patio. Located: 375 Lighthouse Lane, Southold. SCTM#: 1000-70-6-29.2 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed w jrk falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment VAdministrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Ivi Indust review o- Elf, sA -scAut4 4-o 121b12Z s4r_ visijr- Slydt4ll► 6wuY Present Were: G. Goldsmith N. Kru ski E. Sepenoski L. Gillooly E. Peeples 4 Glenn Goldsmith, President so Town Hall Annex A. Nicholas Krupski,Vice President a® 54375 Route 25 P.O. Box 1179 Eric Sepenoski W Southold,New York 11971 Liz Gillooly G � Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: I2 02Z INSPECTED BY: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection COMMENTS: 0.s-bvi Lk Analy dor Mmir►4ra6n Ame_tk MeA+- fnr ad h-Ma nlah con a tr oavn CERTIFICATE OF COMPLIANCE: Frederick Pollert PO Sox 578 Southold, NY 11971 December 14, 2022 Re: Administrative Amendment to Permit Number: 101 14A Pursuant to a request from the Southold Town Trustees, 1 am requesting an administrative permit for the addition of a raised planting around the perimeter(except for the access steps to the patio) of the repaired 44 x 20 foot patio. The raised plantings were constructed to capture and prevent rain water run off from the patio from flowing onto the lawn leading to the water. The raised plantings have so far successfully accommodated 3/4 inch (approximately 410 gallons) of rain runoff. The side planters are approximately 35" wide and 9" high. The front planter is approximately 44"wide and 9" high. The attached survey shows the planters in red. Enclosed is a check in the amount of$100 for the administrative permit. Thank you for your consideration in this matter. Feel free to contact me at 631-94$ ` 7019 if you require any additional information on this matter. <P �( p E FIVE OEC 7 4 pmt OFFICE LOCATION: O��OF so MAILING MAILING ADDRESS: Town Hall Annex O P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 • Q Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From:` Mark.Terry', AICP LWRP Coordinator Date: ;April.5, 2022 Re: LWRP Coastal Consistency Review for FREDERICK B. POLLERT & ELIZABETH BUZASH- POLLERT SCTM# 1000-70-6-29.2 FREDERICK B. POLLERT & ELIZABETH BUZASH-POLLERT request an Administrative Permit for the repair of the existing 44'x20' on-grade stone patio. Located: 375 Lighthouse Lane, Southold. SCTM#: 1000-70-6-29.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Glenn Goldsmith, President ®� so Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ®� �Q`� P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 "', 11, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed When project complete, call for compliance inspection; Glenn Goldsmith,President 0%1: so Town Hall Annex A. Nicholas Krupski,Vice President ,�®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples ®l� Fax(631) 765-6641 COum,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10114A Date of Receipt of Application: March 31, 2022 Applicant: Frederick B. Pollert & Elizabeth Buzash-Pollert SCTM#: 1000-70-6-29.2 Project Location: 375 Lighthouse Lane, Southold Date of Resolution/Issuance: April 13, 2022 Date of Expiration: April 13, 2024 Reviewed by: Elizabeth Peeples, Trustee Project Description: For the repair of the existing 44'x20' stone patio. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by John C. Ehlers Land Surveyor received on March 31, 2022, and stamped approved on April 13, 2022. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees 5URVEY OF PROPERTY 51TUATE: 5OUTHOLD TOWN: 5OUTHOLD 0 N 5UFFOLK COUNTY, NY SURVEYED 05-I I-2016 ,p60\1 c SUFFOLK COUNTY TAX # 9 I000 - ro - 6 - 29.2AY s 61� GERTIFIED TO: FREDERICK POLLERT �O %tie y4- %d 4-% 5 \ \k3 w vol ` o O 1 1 Q�i\l I \ T c 5 p\\° L N I j°N�P UO.. 6 � f 1 DAY v1 2 � A O zo GpRw® -7 ' A Q 30. 6 tin! O � i � I ' I � I asphalt driveway I 1 � ' � I 1 � i � I � l � � I 92W I Z�+ i f 1 s � _SphQtooadWay i 11 °R°r Porrr'er�y i Land Asa �OdgS°n ECEIVE I I i 1 � 3 MAR 3 1 2022 r Q Z Sr°i_ I Southold Town d o o Board of Trustees ao fl � I I n fl NOTES: 0 3 3 O �� ® .D V MONUMENT FOUND D co O I Q s µ s 1 B ARD OF Tt�:U TEES AREA = 3Q,064 50 FT OR O.aO AGRES I 3�- TO.WN OF"SOt�THOl:D WETLAND IDENTIFER BAGHARUS BUSH ®ATS I ELEVATIONS REF. NAVD '88 DATUM lEPkIL I?1 WETLAND FLA65 5ET BY SURVEYOR ON DATE OF SURVEY - j ' EI�i .E v,®orw .a awrm a mom,m a o.,ay j CIO ct 9w kad Awpd"d OW b.amMa-ad to Lv �t .�,�. VLos4 kv Lad 14ec SFD SAND �� mdw.ir.�"'�m m row.. JOHN C. EHLdERS AND SURVEYOR 6 FAST MAIN STREET N.Y.S.LIC.NO.50202 6RAPHIG 5GALE I"= 40' RIVERHEAAD,N.Y. 11901 369-8288 Fax 369-8287 REF.C:\Users\Tohn\Docwments\My Dropbox\16\16-133_fie1dpro se m evo-w Glenn G ',mith, President 0 . CpG Town Hall Annex A Nicholas kCiupoki, Vice-President �� yam, 54375 Route 25 Eric Sepenoski y P.O. Box 1179 Liz Gillooly o ^+ Southold, NY 11971 Elizabeth Peeples y� aol� Telephonee',4631) 765-1892 r Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time:_Ram y�1 to i 2o22 3.15 Completed in field by: 9•'?P_M�es FREDERICK B. POLLERT & ELIZABETH BUZASH-POLLERT request an Administrative Permit for the repair of the existing 44'x20' on-grade Stone patio. Located: 375 Lighthouse Lane, Southold. SCTM#: 1000-70-6-29.2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5'. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening:,50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100-feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 V Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission ✓ Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: E. Peeples L. Gillooly G. Goldsmith N. Krupski E. Sepenoski Other . . - _ . . :� �.._ '= - _ . : L LK CC1 .#�t�ici..'#"•"t l �'7' AIF' AF G;11? P Y _yA� I- � �^ '`r ff�j\{ �_ TY . q fit' (+,�y _ 1� Si ° ,'LJ g r ,r ,f f .• _3'-i,�r�.. ;.v-. .,i�,..- ,".. _ �.� }•.� y- ,. br°+: z• - Sci� t - - s x - ,.,, ' .. I € i t �ty ;�`� r i i k '� }' f 1 s 1 � r F J i+^d; l ,s - ,, d yc�x..-` - - -1 �s. � 6 p,.._.f- i , l i . .t� � if v' 9 � `.a F� y a 9. �°"�,;.'>�..:},m,.., ._ , , '� i - - - K a - &,X2, ,d. - � � .:�A .- M - - - t n-. _ -� r-i--, r - I `te1. r, !* V4(A'tFA S 1PF' .Y As a S A JIBS }SAL t`t x MA //¢} (� - iy�.I{ r ti. _ - l . _ . ,yam-' .. � -,. -�.:: ,. S�rS�t'�mq- - R. TFUS° # SI�'}kNtt �V�t6.Li.' P - 1L _; P+��' - ,� 1 Cltq � = � �NDARPS �.. ''SME" . �,Q i - - . .o>p 4 u60*& .cQ dEPT. aF MEAL'S' [ - #A-VlC _P:. I. �ikN- .10. r ,�f - �``/` -I... "nh - - ...' .4~ ,,. -"t--_, :w�iLR.9"��1f .`-'-01.tt�[Yr -Y '. hJT, EtAI.!}"�' "I f f1� • � X _ - .. � 17::!.i—_X.,A . ( y 1.. �, `` {, 11 . :z �ll .. QEF S '- S O z 4. AIZF_AA; 40 cloo -:i—'/, � �, � +lr- / it , ' ` ?u'�c , ; ' :., -`." -'-..._.,;� _ r'f i' t a_� P .j ,�`, ,, . ,333Yi -S�I�F(,I::K�O.°TAF A ' D ,S' ISI 'i'tCC AZ �F. F A1. /_� " ,,. - I, MM05AD ._ . 1. , �. . � , . 4 J� .-. A, .l �"'4.1�,-' ,k'1 - _fl r - - ✓e - v i ti_ {t; .fes . - ..� x�} '"STJ 1. / - /N . . ,0 -, .I " ,e . � , ��. �... I . / " .- . .-'--* --t �,- -- _: . .� . . , . - —� -1. -, . @@yy 1. (' •�s `� - -— PC"`J T„rA - __ Y - 'v - } - �^r�4E` yr. -- . .� `.,l” s- ;i +-Sim.. i! ('i LP1. ''� . . " .- '.'` 1. • � '� " - - - - .'�. -. fI iA THE 'S`RVE7 IS A'YfOLA Q VIL 0 Z'� -I ` - u s u t t L� �`� E T.10!l?^C9 OF`tNE'IdEYG'i i3RI�STAT€' EI x a.., Ir- U i )D ED ION_LAw. I . G•,... - x=r - F. I. A 3 F _ y y Y� , �,ff I .. j 7 _ 11,,p R; 4 2022 }. .. .. . . ._-. .: F ', IVl A COPIES OE THIS SURi EY P AR.'NOT GEARING` /^6 - ,. ,etc .e �`>rs ;.'` ,�,. fl .. 1,� A z�:. > ' .i? a �s T,(JE 'Np'SiJ Yt31r® .'S Jt�'i-t6SEAE' C3, z,. `; r �a' w { r .. - F'-' .s-. 'i r+ rx, PS _ E ED r1/ FA OS `SE A J07 d D R k E $D SH L E. o' - 6 -CP,N,y, - aY 4 Al �:, _ A �'_ 4' / rti � .. )% .f .rr - r, - } J k s. TO'`B A VALID:TGI7P COPY — �i c v 5.° $y�� 151-''.-. V. i- . r r mm�• . �t @ ,ir - A �`- - P X07 `l' F"- C y. r S- , Lj- ' ' �.t. 4i 4h`py 6 Y ,i - I—, _ �a y _ ,r< - GN G ARA T ALL_R - - !t ti EES t[.-'D'-ATED �R.� ASK x x:. £ H ESN '= � a' �>BriardJifT- tr _: - .`( ! ..:- _ ^_ ... .... _s:. .,. _._ ...�: — -1i�`, `L t� - �ONLY:YO-K.,-c�E" ,1: •iHE'5URV .. , - , ..-.. .. ., ry .-„ s.. x ,e 's' SCJ .FOR Pl(Ji0%r1 E5 1 . , t - r . -� - -v_ - TS`FR�PARED-'A�twD- 1S.♦ 'F`'f6-HE . s . .,,Y••:. .. N....;•. .,y• -lw - --k : ll :; t .f: O, HtS`�iCTi.'4� r - ...r. - -. e Wiz_: a. .. :.=:'r.' �t� ;g -n. .-t T, �1.w. f ,. .. >.. t... .. . �"^,•. - x-.l TIfiLEt-C'�-MPA JY °``Y A 1 CW'A.. .: - i• ,r- - s.. .? ,>,n 'r ^•fit. P v,. eTii'J,Y;EtSJi'Ai. .Ci I'{0' F: .<.t y a x �_.. 4 F :r -Yt'' 5• .. ,. .,S , .Yrs%. .. .;r; 1. �. ' �,a - e, ' 'w - Y,: :T6 - =s`+ L `D` FJ x . END G `5T bif 2)�L T QN, JAN -. a..N -. ... .. F• G14-11 _ r ;_a T "fA,ies ���TQ E� i 'J.5 �. 7. `A illi) -S Cf 3ME'lEP NG �. A-, 'r k-:.. t 7 K ` - .,11 < "i - - _s x� t11 .r; U- _ bFeRABI:E =v .,.-- - .• a TPOIG.��C'vttARA?•T'ESI:[:E- T THAN t' t .Y` I -n .r- 4 - ,. t .. .. ..-,.'.,. - 1'- l- �., Sr' �l •3 :r - 'EN9 r.1' - - - UBSE-U - r _TA.AU�iTr TAL�t�:'S'fifl3, `OR 5 Q '1 ' J > ": s i . i' a3. ERS: .may : r • ,u w • 7. . .. �-t- �. '4 - 1F ,- �} p 5 r :s. r` !. s < . y� - [ `�, -4P J ,.a P .. ,. - } - _ . - -_t' 'n _ t Wit.:,, ✓ - �y�� .y�py} .. N. :CJf , r. s : :. .. �,.:. ..�. f ,: -N:J '0. ' x... i„tYi 't '•¢: . , -. . , ,i :� Vii... ...v, r, :\.'• Z' �. 4! , = ;''� X: - a. - - - . .. i F xu r C i .. . ♦ - r �'' { G ,t ,, ,.� 1. , 4� 't ', _ 6. ,'G - . 4 'TA e .r, l- , f 3 \' f. "i ' jf} S �v r. a , R ., .�,,'.. a. �: 3, x p, J: i h w S S iii- J i ',i l j J S� - a. - - - . . - k - - ti o ?-' _ k .. E' R� 4 1. ;� I P 1. �•� 'A t . 11 _ `\.. 1 -c l ,� ` . - �to f{ j.J���� $. o-F Y` XY .. ,.. . 4•' 4E �j' �Jt .lar .a.- _ _`F*!- #L... S - '- '.. 1. . ,_,-r,-,,_..- ,. -.r - ,v pr-, 7 ;, F {[�� k :, c x _. F.. �- r .: .� ".__w . . _ �. : . _ �, , .. - o. - '^' --- ' t a .^ 3 r " : ?: : .t , ir > jfi - .. '( ,rte 7 - `Y L t'''Ar - t. }"h .is a.� a` k f. - ' � .. .r +�...e-`..-v ,iipp�� fit{•}�yi� f/^�� .. {` in. 7 { 62: . -� 3 7' E l' �`♦ uk _ , , x 3 ' � y't. .G f e ' t •a a� I . ,•,.-r •may ((, +,�` •,\ {ii MAR ' 2022. t .. SOUWd Tonin ' Board of Trustees ' E f _ ' --..Mww.. .,.., . .. ... .. . .. .. ...�,...,.. .,..' ,.__.._. ... .. .,, ....- ....,♦.r.,. .,a..........._r. .. ... ,.. ... ...,.^..._.,.... .»... ._,.^ ....._..__ .___ ...._....-,i,t.,r ..,...- .:v-,. _ r,. .-. _..... .,_ . . . .. •.... .. .r._. ., ., ,.._..... ..... ..,..,_.,....<. _ .. . .,_ � G ii • _ - ,�,. ,._,�«- .;.. {.. .h, � .. . .. ...... ... _ _ . � � ..J.:,,,.,,; � +"" �,,�. -�' k, •� ,q S:�s �. �w .\.r�� fir_ t � ' �/r i E� ' . J 4: gg >•.�,.._. -.�,RF.., ,.a. ..»n `:^�::'G+s '-p,i�t�."-- - .- .. , .. -�....�� :. 4 .,.._ ... .... ...Y .,,. ..__.. -,,.,..._._...._...w....alds.,. .,. ,•�' `"�' ,�'J' - ' _trip _._ iI . 1 % �' � � ' ,>i" N �.. �• - �. . � t '\ '� �� ' ,' 't�sl'*Jr�:'•. f''g!'".r"""".",.,"�. ,drC' •�1•i.,,1�1 /O,V�//�/�/�/"f Y i( � .� 4� • ....•....•..r.n.....__.,..Jr._-,+....,.._,••�..... n � p' .P.. "`.��+ r'���,.'°.:Jw.'I�r:r ,.r,s (��' :..tiY „t'•+.r� '�'j „(��� ;�"� ....�...._.. ", , ,�+', K.L.ff{ (�{�"'"' � ,� }1 ... ,r"�,�t� !"l yr}� r�(y}ry,�+ 4 '- _... Y . '�_ � �r7'i�..:�.•� �� ��".��.=' r�.,�,(,,M'� ..G / ) ,!!' `• tea,..�/ � p t V r'i a '�'��a an •'Y . 'I ...iw. I LLQ'' ,y " J, .. ., a .._., , ..a. ! ..• rv.u,«_,.. • .- .. E, ,• I,A I�,�,y r..>:-,.. , ,., �.�, a..,� is p..x:,.,.r a-...•w-,nw.'4 , 4 s moi: .. .- .. ''�:'.�': n.. ',-, t':V ,w.,,iiri+•Jr»rt� r'"l"'lk:..h'A. ' 'i:>`,:I:Y ..,r r...., e� ,�,,. `T'M'rwwr .•�w .w. � rt •Fw ., • .� -H. , 4r_ ,.,_„♦, i111I•%� � .••:••sr�r•-'- �. .�".�°;i.. .M� •(S• 'k�tif/�r7/..•,r '„rMn+-�.ft•�+ � .'•e.,�,�Tw..Ji._', _,.t ,r Y,1':,ri:!t"F,.:rT.::rar.,':� �. )�L, t. r N { �1 , T Y5 ffU" 1't ijlt LL � . - _ { Y' , 7 -M1 t- 1 'w py =Y ) Il " � .. ' :Y{.P /•n`"" .7at�,/.Y.(�,�.t,N�f' .P :-•l�„'� C :. :y , 'e A � ,f •rlvt. :r,+:r.,r., ;Lr ,.le..w• ,4 .»��� 1 :G I + K�" '0PY�A'' t.,yv..'"d.'4^'..3, ,/�A•N'.,rw,, j Irlb t ( t� 1 1 _ t `.• ''� •r C J t]r •t � lora it a ••' - 'wK' c' 1 • a r v , - '°r• •1• :MIPs , , 7 {} 6' } Ht. ` � • V ,✓T-�AF „WI y `iSr's 1 w ir' i 1 •L FW' 'w.a.w�.alw-f Cw4 i' S�t "t!{.. '4•� •i-'• t c ty r. i' , Y ' v • 4 r ' C•Y» •F a, Y 1 F., i� d q xi1� M- , :arr ^i S 7' 1 S i i r , Y^ ty wk' !t l lM}KuM 4 't ._ fit i .(. 1•'i S lryY+' "'4F :t .r " t r :Y A .., t 3 !r 1 •r t,1't # 1 W -h- i' ..,,f,..• "='�- 'max'. i� t� ��• t�•; �• e. •arra '�..:• f, ,f it / r •�. `�t1: f �•i S �T. <4 F ,. - _v- "`.a„' "�,:N t idJ •: '.'�'"'�,�� � �,. �Y.�,,.' � ,. r•1`� .. `,��' •r.;r" - PJM a` .+t' �•J/f/YY,1 t.[V'/,�' r� � �'�H( Y�9 s y//y,/,, /E.,ly ,'f •jX�' � aiv .7'i K..�,+i,M rrw1•r •��-3 +I^s "\I ,r�y.7'I M'' `' •l •'e .. - �5' S _ .;�' S" A•'"Y ':�•r^�,• �`�, ;:+E'' '"�1. `�r. �t r�..�'�;,•...' �r.l „ , ,fr - y, 'I'C�� r {y�F',��r , ,i•'�. w � ' _ '' : 1 - � , �� i'Y f )� ` � F f� '��'f'f' !%'�1 •yy I 0 r , � :1'W' {s .. l�',�,; � 'r -t i� �I ,W ) V, .y.r is ,r 4 Y » ��••� ek P ''yY tir i• X s •.G p 1 �'•� r Zt ^�•y 4% •� 'syr. t '„�t:.4 .ir+,wi+'s::: M �y v S , r e . r .. s x d.. , �"F, .w.#.•*Fa. _.'it2' .allllr'IIJ.„1 �1�, t .w i r t i r M1 r }y y r F •r4` t x P' aa77 ^4 'it • i �w ,C jc 7 S• _ t� Y L t W� , r : ,.K 'Si,>• r Y ✓'i. -t 1 V . , t FRr- / tt J• .. - "�''� ,, •syr. .!, hyry r�, tl��y' .�d t•, �f✓ J•y Y'� F' t � - Wr • s• i, e1� : 1pLL ',nom �•# `}. „ may/'/' t' ♦ ':t,::f 1 { (�{,� •L:F-L'-- (�W'�t♦ .L -`:T .Jk♦r� KY }$�{y1 t - •i3 3 "Y' `4 b' i *'S!• !sig>..v tr, dr-r �• s t ¢ a' q .e F y . CPI �.•,�� 4• , zS .t � j 1 '�Y � i ,--!>, � O..Y"'! c�{.✓!. � .,!^fir .p, /fT d r•I^' "-'..�y wP.w ..F �•A iF 1 J -1• r� 4 tT 4 �• F^ t. � Rr► :J.. ,�,,.,:,_ :'*e,'• ��' �' is 16 Y $t 14 'x 1: s A, ,. •4a f r• �^ i' .,u t t •A i la.•' :4ti' y� c r' 'ir.• r a 1; S _'!•'a""^"^" •'!, psi$.. '"1i - ''.h• -✓6 Y. ''4 �/21r {Yy i, t• , ya ,R P - i ,s r:Q ` w..m,rr•wn. P44b= iJ ,S 4r •S 4 1 .L .. r 1 I f E: �,t f �t S .r. h . a ( ( .I� 1111 rm. rte. r z i e Z t F r Ya rv,r. .i ir,J •7'1P Y;• t � 4 e , t •- 4 g „ Y \ l w S' t �t •�• L i..,- iFn. J e '.p8•w .�r1' ki .�k �+�•�§ ;moi •A h " ,F•� c" r ,-iKAi rt •ter � 4' � }„ �,.. , r t, s w • x ;�yy N : , '✓ k i s �R• :' Rte;: ,�.: _ $ , Y f .v. r• Y 6. r t r , A y ryic Jt J r S f < r'!•- i�� �•I Z(r •A �.t Y'! rA: 1 1 .x .r .- a t-:,.. .,• '.r .... c r.: a ."' _ ..;.,,< ..y:' �>.- 'i 'b .. '1 ., "�` ,A sx'. :�:'! .r .tom•• •R r rt •Ji'r _ r• n�" 1 'C flvrFi N. #' c• c.i. xY: i 1 �2 rK. ��p _ x f i a'• 'i�F; t tu s r4� I � �y ? i :1 ,Y it r `4d - ro4- j ( ,� r r. f wp_ 5 I } V Y riL•.t , } i "t Nn, , } a• �II r z F •"C•f d� •.Iw,'yip _ =l ,I'lA. 9• F :•'4' is�Y..F:r. '. 5 ir' .i 'Y' C J^ 'S�• Y' r=t 6� , •'sJ' A. Y 'N -Nr• j Y , .r r• r , r P` S Y•n." ,,,K P i , . .:: �. : :: •, _..a .. .. - •t .. a : .: .u� r«' , (( •W' `cl"� /�H,tr_'nu :.h.i3J,' "YWN.♦.w.- , T• , - •,.G_,..-. ..Y ':§,.. `.i"° !i.. - d^, ,.c:."erg. ii'..ii 'L''• `y' r l v - �.^xh �'f ,!� 1•' 1 1 C• - r . Ir y\ • •r»h �Qtt1� i� _ I .A i• f r 1 - is ■ ♦ r • � 1 }" �qrci 3 •j t� •,M'•} y�,,��(( ���)f► yy1�'�•�r a- ... ,9cr�y �V3 � /P+ j(r. I r �`,,:.f f! i'J 4a•'t, f"4' n ir�..�!'4}+V.,A.' ir�t�''+{Y`' .{. ,�..V',�r✓-,Yh}t- \ '.TsrJ•.wJ4#'A"/• .'F. •t'. �•:tz!`t^'."�,V;�;•-1- i���r���- .y '_y'•�^`.iJ•' � } i , • .. i" �.9•� 'Et: j.•: , ��--•••• C---.�-+f•4 t! .r! t $s - , ,i'.i� , -xsdnwu'Irwn+t' 'f"•...,...:(.....,, �`.,,�)� ,.�'„., t„„�y.,f'.MF rf,s. r ,/{.1'. ! ��, r+-c k.1': ,.._ F,•"••:.'>{r,(. A,,;��i,'.. -- • 'y, >, . . •{ :,i- y. ,J - i .♦w1IJ ter''/ „r,,,' .:k:«.4.f'�`,':"�, r. :f,%',:�, ,r�• r'>s. r • '} .� ,. ... `::t., '<'aF• ';q%•;k;Mt'�,dV,.f .. 7yt � f - .. , � Y .. j''� ... r u ,. .• .f f �/f f�T t -P .3 � r� J aP�i �•'�-.",r... - �. �� �.•�': (- /.a(a t (,.+ r' "IFw. ,.,n L.• �:.�+'r' 'fi',C.".L.f,�' p� ,. r ,,.G •,••.,p� mrwiP>h•r'w t r4r..r. ,..- i�: ,;"4e'f'l:. �' ,•r' ,.'/la-' r :¢s...r„ r 1 g • - •� ��^'': ••yc_ �'S"�`1 ir;;'X21,. ..a„-....�"...,.•r+� ' ' _ t. :fir "�.-'• ''''".»'r=r � :,,_ J .. . . � t° . '^'""+"'"' .. .... x' 'i, )/,�:�.�':} -'s r .•Y ., y�'' is i:: w�'/,% �:h -� 'w 1 A I,�,. .;,�,;,.,by,. "'ra'��.. •:.{���'`4yV>' .ar:.•r' �°°�.:�.� ,a'1: ...l�,r,,.•�, ^i•1-,.. !'t.,: '+�} - _ , � n ,'r' ray: r F'• .. - � " { I Y"'t k.)!�t ���.=A a ? +'.' ,.✓�.p f•�� FIE etc • � ., ''•�' ...1,�,,c•� ..., - -' - .. - - - ti e" t .n,t,.,.n...°e...+,,,.rc,rn+.s.,<.+nm:,nw,,.rr.:.:.e,..•te-,n..v.in...Y.,..,,n,. .."..r,t .. , ... .. a^'a rt ,'tsM »si ' rr. 1.m• ...r.rw:1•wwr.r..'.•.w'+•rs'�lr .a+�.ew.!+' rw.ai++o+nr��+r. a.+t'xu+aR '"^'�rt" .�+,...-..�...-...._ .'-,..•�•,.__..,_.n„,...,..,.,,_-._.,,.-......,.J...-•rr.,,.......,..._,.......,.,..a...._......,...-..�.. -_......,.,•..._.,...........-...._....._,..a...._. ,. �r'� s�,,� CO -- - �_R...��} :.a.��'1'• _....,. . t_ -r« _ ._ ,.,: ...a._..-,_..,_._... � - ��''�� ��.. ,, d�Y,'s>.Sr�'lk��k°��a'' s G,f's}'_} 1'?; � ` ,.-_..._._.,.....-..._.._-+•.,_, ,.._._ .•.....,_..c.._„«-+..y.._,. _..L.Ir.nt,r.. -..»_-,.......•_...__...._. ,,. _+,_,_.._ -:-'IM1.'. `u/ � M MAW $°�t's�i�.• �4,.�' L s e• 4i y�"Pyp Y t F�° w�•�m 't F Y ., - a.,•-.'... ,«r .n•-.•...___.-........ ._ ,,.... "..,, .... ,. ..i...v :..... ...,. r.. ,..__ .. ... ,..._,._.»..,.,,..., .,.,«y..r..r,,.»_.^.n._...�..,..,✓,. .. .,-••-.. _ e ...,<-,.,..,_ .... ,w ,+.,,...n. -� x •' ., _. .. .. .,. - ,.. .....,. _r.. „._,. ...._, .,,.. ..._ .......�y,.. • •-f� ..�'` 1 4! 5Ge !�'.�,��•=. ,.. ....-.. ,.xrs _ ,.1°C'-;•',t,....t«.--� �' ,.,a.-, "'y'�"^' .'t:.�X4eSY:,G'E,'A`.'C:?3{a!:4'a[f3'- 5'rki: l Y.,442°R, MMAk:+r6bi'0 2s . . ..:5�!�Yt^",�!J;--'moi• ._. „ _. __,.:t•..'�"�°"°c' »:,a..ti,.r��r��r�,"*a„,...:,.:�,m'- ,�s'� .�r^u;r.^.as�;"�" ^_'a =..rra'..;rs__....._tw.zs';c.;y.'rn-c�e�r" �s�: rs�s��;m oar ta�nai�. swurk.A�nz. - .w.+•,-+„•.wr".".,*�++ ��..�...'�'�..t "'rw•',.^.M'.�.,. .,.-,. ._,..,,...•..... -•_ �,.>w•c ..,,-,w.. .n'rn•.•ro.,. ..wa,.....r-.,,F.. - r '�. nI' - ,"•T', - .- �:'_•r..'c:c-�,:�^- X .w.r..r< ..'".�~ .., S�:f:•rA9i,.:.:"-�"m.._... :'yam.'::,a,�.''.:,`c1�..�•�,'••.�.;«a.••�•;: .,,r,..M.w.,.,,w,: _. .. ... ._ . .,,._ ._ ., .-,.,,_...,.�_...,....'�♦'-":'.':.`+ +"-.-,...•<.-w,...._:.." Y .. .. - .. i r..assv'r-,cmas'rr'a' w,•�r�r,.atr.,w•�'xa,xx��tm.:ii ,�'' p•C 4p`fir/,"c'r i � �'�f.' ,Sr,� , ,{�\ !",�y.pFi `5 1 t ,j - ,� .S - t -,fw^..._«h.._..• , _..T.-,....,,,_...,_..._.-.,� ... .�.,,..,.e...__�C _ ....................,.....,..__ „S�t,LV 'T 4.;7! sy c' 7A, ..y `� , ,� C,:+.: 1 t k' ylk.s � �-J +.1 FS"SC t r ^.f�'n n... ,. ti ,i` '. . . .yt.;r 't;1 ffl+:�'f � ;y�%fit n(1'[ ,� .. ._.,.. _ .••,_ .,..,r..."r,.��� _.,...-..,_........,,i.._.... -,.__.y._._,,.,.r...,«„ -y,-.., .....,' ,�:... .., a_,rr.,.r.,. ..,. '\ ♦ �.~ �+ :'4 ,d. - °Y. u b . , . . ., •.:•.. r ��'• n i l'r ,/ " `5� n� «� �.. 'roti �•3� ,4 � _��` J , _-._ ______..,__...._._-_._ k ..,,,.i.«••..,. •r,"f„+,••,,.,re.:...--,._,..r.n,+,.,.-+,.w.,. -.w,.::... F�! ..,a_.�,.....•,..... r.r�'._4,w,�^ .._.... .,.,.,•«.. . y1¢. •uy� r'1,''. .•4g_ ('", APPROVED BY ,'i, :r-. , -- .. .. ., , - ,'.1 ` .. § .. ._ �<« ....,,+... ) F ,%r' 'r'+Fb r'g' '�i• �/•_ ' er 5Cni.F; l,L�.' DlinwN ti'r r r` f—ter 7• .. ,.. $� Ztf'..'"'.�rit'�yl } S.' f�.r - t ,app{^ -x. ?.��x.,y '/ �''. �'� ''+w.�;,�([!i .�...._�__.._.-_.,.�+�, • rt - � •; # t + a► t li � @7{�: �i` ti,.� .�, I _ � .h,u ;• y� -�t;"r ter,^4�r �, ., ,.. • -ii ,. _ f t i.lj. - - ._ - .- .. F �� }�' .}!; }x ,r ,t;'s DATE ,..,,,.t.a,,.• �' NFVISE:J � ' '"11 f 7 1 +✓ � ...1) may, PI 7 ei .. -1 !, .M' $,`7 k' ' ` 1'. _ r. a••r' � Ir,T" X ' -1"' . ., @, ts'r,. r• r ` 4 !� :� i�n' .��+at•,«I .`�1 �i�r SY��' �!au�q.,,rr '�� rte'` ¢`., •: ., -e , i Z „ r �fl'3'._`:i `i �;';:�IQP ;'1 ` '""' �' ;'p '`� t ',�r'sd ;;,,,, "` �` 1•✓' Y'�r � 9 J 'r.. t.., ^ "i~p ,rel �-'..a , :i, a }i r» � �` r,,� ^ .8•z� A "�r.1,�'",3d'�:_•IA,"; ,.. ,r1. a Y*.- a...-^�,,...I! e'. `'z.,r•..r•r� �•°�.w.'{'' j 1�t,,,. �... ! t ,. ' � 1 .,'rat i.3�j}.i'- {f� ''-.i�' ,. r "�' +' �i s.'�w r1'a dLx� '"�i. E',K, fi }} �� �Y'`�a, 4 rA�'-,',. /4y•,• ; ^''•�`' y(ff,� ,:, DRAWING Nt19t7 Fi F:ti lee 'A. �..y,•.Y?YittM7?RtK$r+JR:'!f. •h^M'S7i5SF1:�!sT!9i,wAWkr!T..b+iY�'MA57'�"+'.ts41i•MR/6•:k1R76F;*.Sfi4H9A+,�1.lpebX'SiP4!•>I^ f[7PH'�.°+V'tplM .. .. -t .. ' -_ , , i• ` � AE&°t�19iVt?�ft34,"h,5fld°117Y>w`�!3'kfii '11t�i'i(k,�'a�v'3:3 !r tArMOe !pt � � BEE 9EC.NO.Oe, 11NE - ' N ST 1N1 ao-x]m mei O ', �_ ,�� bm' EP` 9 3 a Ro 'yy 3r• �+ a T—N or—D 0.2601 T� I 3° ,1 I> " 6 •b .° J, a6,0o, `6� . 2 ..• ,y'm,J' Baa Oi tu1U ,:eryU 72 W.) TOs02 05 3 - � - 21602 ! , T SO,IIMOLOs O g9,NICTNO.b b +^ a e,• '•1! y 6 n .� ''>+,..� / / oxao0, asasa, 31-05 tl Qa ! 63 P ' WA&11 13 b ! � �onema 0� 1.6"4cl eW°�ETr ` � � p4NA I,li CHEER >q_ ,B ,S 213 x1.1 � . �� i „r !, fl3,+ 3,:f ,e RJ. 1 6 ` .. - •. 0.^kl �v uw s; ° � +bANA ' ,! 6 2��t" / SOI/IHIX.O eOBIEm+�, M' ,.Wcl .o.r"� ± �,M a •,s, i 6AY c m • .a M � > ��- m 1 E s wM .rw >��! '80 N J e ! a ! ! ,! ,+ I.uM(c .,`� 1 !' !' O,R1E110 w m E,u § M+6 I� 11• T 1. P�- 3iNU ,- 3x NEnc , 2 t 6 9y 1 ° pie ^• ,. � tem �a'.9 " st. ! - x 4 ." y0i:li. ,� � 1° ' owx aB „ . w " e to m5 .s � ., ^•,T b .'J ,� m,H g 16°•Ds��' ` 11 '6'a +93 BDIlI11IXD ,3 a x] 29 x5 1B^^' 9 , _ wr ° • + r y ,' '4 10,1- 12°.0 .g t0 p0 ti� ��n'i. & 2ry � ! " S 3 ,. S. n � � •pm ,e m ,g �c 1 9, .,e 3a.m N.B..,., 10 s., m z3 19 r31 • � �a.c ,.Wc) R3 s 5! e ,2 m R •M'E az ' °' . ,� 9 — - 1WU m N u, m e e 03 m 8 g raA x3..No °�Y 0]601-09b N Towr,or egOx¢o �� ' BOOTNOlO Z + i N EMRH 1NE e -----' NOTICE COUNTY OF SUFFOLK © e of l011x1101D SECTION NO c�>,,. —� __ —_ —_—_ _ Real Property Tax Sernce AgalN.y y_ oA m 070 Uw..r> M1M1n r ,z, siz'N•I ,� ___ °�`� --r-- o.,>�--,>-- mw Y� caws N Yt,wt P OA OA Nc,w 1000 PROPERTY OFFICE LOCATION: ��OF SO(/�yO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25. Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) ®Southold,NY 11971 • Q Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees t . From: Mark,Terry;`AICP *LWRP Coordinator Date: April.5, 2022 Re: LWRP Coastal Consistency Review for FREDERICK B. POLLERT & ELIZABETH BUZASH- POLLERT SCTM# 1000-70-6-29.2 FREDERICK B. POLLERT & ELIZABETH BUZASH-POLLERT request an Administrative Permit for the repair of the existing 44'x20' on-grade stone patio. Located: 375 Lighthouse Lane, Southold. SCTM#: 1000-70-6-29.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation'in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney GlennGoldsmith,President ®F ®�f�y Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 COu��v,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use.Only Coastal Erosion Permit Application D C E IV E Wetland Permit Application Administrative Permit Amendment/Transfer/Extension MAR 3 1 2022 Received Application: 3.31.22 Received Fee: $ 100,00 Completed Application: 1.2Y Southold Town Incomplete: Board of Trustees SEQRA Classification: Type I Type I1 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oord ination:(date sent): LWRP Consistency Assessment Form Sent: AC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: .13•Z7, Resolution: FAj'W eA, e 1'2j, )--20 u C F-m-7- C l.l?r4GCT+� Owners) Legal Name of Property (as shown on Deed): 13vZA-,,Y Y301, e4-7) P Mailing Address: �s 0• �� �x �7� . d�T �s� ivy Phone Number: 3 -/I p 2-1 0 /v 31 - !4 3 - n, g Cce Suffolk County Tax Map Number: 1000 - 70 , ' & Z 9• z Property Location: L 1�'���•f0'�5 L i4-�/� �0 u r � �V f/ (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: ,in Board of Trustees Applica�, GENERAL DATA Land Area(in square feet): 3 fi O(pq Jiv C1 , 1«� Area Zoning: Previous use of property: Intended use of property: 4�NTr9� Covenants and Restrictions on property? Yes 1/ 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 ny 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? 1/ Yes No Prior permits/approvals for site improvements: Agency Date J Dock rrv�—_ reuseslib 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: Project Description(use attachments if necessary): C�''4''�� R4-no & IAr-tyw Board of Trustees Applica .:)n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: IA-Vo Com;mlerr-b k/;, i IrWr (1 VV7k1t,1-rq) has c1e1L;ey1wt4.ed li..� o-f,e- a,.,.d Aas ,e)-pye- bt-2n re1Aa/VPJ- . W RT'AQ i S 900z-.,1^/4 0 N TW IF /7#"0 0-Nt? / n/Av ,N'no Tr-f SR'fut'L 03) Area of wetlands on lot: square feet Percent coverage of lot: % C��3�o6, sotz jo) Closest distance between nearest existing structure and upland edge of wetlands: 7`f feet Closest distance between nearest proposed structure and upland edge of wetlands: ioo 11 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? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: N Manner in which material will be removed or deposited: 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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 I based on information currently available. If additional research or investigation would be needed to fully 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: �3�5�C t�r�nfuvse irj,� Project Location(describe,and attach a location map): Brief Description of Proposed Action: 1PeVj0411e. �RTiJ C'oNST2✓c �D 49-4 PT O G S 1 11 f�'�,�ovT, �L��t�✓�.f �Ee�R-+� .!'Te.Cca�� .v� /�S+rio Name of Applicant or Sponsor: Telephone: ��_TG•✓�-2J0 L Fi2Jz1GK .v CLiZ✓�'�jF/ !"oLlCs 2�— E-Mail: 01I�t^fG Lev/ •�Oiri Address: City[PO: State: Zip Code: S® f/.74-0c-P /19-2 J 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 nj F] 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 governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 0 ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? D acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? D acres 4. Check all land uses that occur on,adjoining and near the proposed action. Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial Residential(suburban) ❑1~orest ❑Agriculture EJ Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ VJ b. Consistent with the adopted comprehensive plan? 1:1 1:1E 1� 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ V1 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed 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: �;/,� El n 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 site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Z ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 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? ® E]If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 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/grass lands El Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 2 ❑ 16.Is the project site located in the 100 year flood plain? NO YES 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? [2-NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: F]NO ❑YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applic t nsor name: �l '�l!+Q/el<_ ����xr Date: Signature: �eu�'�^ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El El 3. Will the proposed action impair the character or quality of the existing community? 1:1 E 4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El El existing infrastructure for mass transit,biking or walkway? 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 the proposed action impact existing: 0 0 a.public/private water supplies? b.public/private wastewater treatment utilities? El 11 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ 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)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage F] ❑ problems? 1.1. Will the proposed action create a hazard to environmental resources or human health? 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 will 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. ElCheck 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 Lead Agency Date President 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) PRINT Page 4 of 4 Board of Trustees Applic4s_2,on AFFIDAVIT �e�e- �I/� � BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER 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. Signature of Property Ownei /;ignature of Property Owner .r' 1 S� SWORN TO BE F E THIS / DAY OF20 .Atc�h>and O:N N ,I�Public Stat 4 06wYO* a1'i ied in Suffolk County otary ublrc 09trimission Expires June 21,20— APPLICANT/AGEVT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: �G('� ��� �t 'bL%2 IG�/� ►�j (Last name,first name,sliiddle 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 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 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 shares. YES NO V 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 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 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 Submitt his �1 1 .day of Y✓ Signature Print 1%R,t7�LrcQ PK / c�GClL r Form TS l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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 Hazard 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 proposed action will be evaluated as to its si r ificant beneficial and adverse effects upon the coastal area(which includes all of 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 explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not 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. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# e - 9 4 2- PROJECT PROJECT NAME TO rKrl T Nlf The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 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) Permit, approval, license,certification: Nature and extent of action: Location of action: 3 T� 6fFr'�i`°c/s� � 5', -�-�<y Site acreage: Present land use: �L rT7C — 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: a • �c r 7 (c) Telephone number: Area Code( ) 3/-I `4 -yO ro 3 l--7G 4--Z J v A-- (d) (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No� If yes, which state or federal agency? C. 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. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. ❑Yes ❑ No , Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-�Poylicies Pages 3 through 6 for evaluation criteria ❑ Yes 1:1 No I� Not Applicable J Attach additional sheets if necessary Policy 3., Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No 2Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria ❑ Yes ❑ No allot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No Not Applicable 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 criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No ZF Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ElYes 1:1a No 2 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 III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye Dn No 0 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No ZNot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ NoETNot Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 forevaluation criteria. F-1Yes ❑ No u Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No [Not Applicable PREPARED ✓� ~ TITLE DATE 13/Ac?z/