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HomeMy WebLinkAboutTR-10183A Glenn Goldsmith,President Z� so 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 e0UNT1,� 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 X 1 st -ee tr reg Ti tot OF 'V6 Dy 114-MM-10d % constructed When project complete, call for compliance inspection; Glenn Goldsmith, President *®F S®�jy, Town Hall Annex A. Nicholas Krupski,Vice President ®� ®I®P .O. Route 25 P.O. Box 1179 Eric SepenoskiB Southold, New York 11971 Liz Gillooly _ A= Telephone (631) 765-1892 Elizabeth Peeples ®�� �® Fax(631) 765-6641 evu V BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10183A Date of Receipt of Application: June 14, 2022 Applicant: Cutchogue New Suffolk Park District SCTM#: 1000-110-7-13 Project Location: 55 West Road, Cutchogue Date of Resolution/Issuance: July 13, 2022 Date of Expiration: July 13, 2024 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Ten (10) year Maintenance Permit to trim vegetation at top of bank to no lower than three (3) feet. 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 site plan prepared by Ken Quigley, dated June 12, 2022, and stamped approved on July 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 Glenn Goldsmith,President �0�0 ea Town Hall Annex A.Nicholas Krupski,Vice President c <� 54375 Route 25 Eric Sepenoski ,? P.O.Box 1179 Liz Gillooly �A • p�� Southold,NY 11971 Elizabeth Peeples ! ��" Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: ZZ Completed in field by: Ai,K*Q,10 CUTCHOGUE NEW SUFFOLK PARK DISTRICT c/o DAVID BERGEN, COMMISSIONER requests a Ten (10) Year Maintenance Permit to trim vegetation at top of bank to no lower than three (3) feet. Located: 55 West Road, Cutchogue. SCTM#: 1000-110-7-13 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound �Bay Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: etland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples ECEIVE 0 o JUN 1 4 2022 v 0EQ ASH 0 1 0 Southold Town Board of Trustees LU 0 Ly Z Z (,0 < Q) ai A? 0 o 0- 00 0 'GjiTE I 0 z LU --PARKSIGN (9 0 0 OIL - 11 M 2 0 C) .------FLAGPOLE 0 0 U, 0 nxi ROV APP ED- BY < CL M 0 1-- Lu 0 2 SOAR® OF I RUSTEES -::-,I PCLSTAND—.--- Dam a RAIL FENCE TOWN'OF-SOUTH L DATE II II 0 II .._fl- O Site Plan 0' 10' 20' 40' 1 01 FJ E JUN 1 4 2022 5ou ? Id Tr,tvn 72°25 90 PC' rJpSh _ arK 14, � ' C'r��' Ad aY led. R 1r tj `'d �] �J Wes • `;fir; s .• 5� ` fid : "�� �� `_ -�_� r^•T :-4 /�Q�� /tJ -WO�f S 20 7 YyM l�rbf��s�d..8 _ 6f S� _ • r hogs row •as �� :;: 09 � . �b M.4��, t /I Lx"1.1 y � ;�'�; lo� 6- �1C�°G�l �1J1�O/X A:7,-,-1(- !✓!,' i`%' �j. pftOj 1C, DAY Ce o�q�on� % -' Con shrUc B o' 0.7c. H. E N T � - ... o } NEW YORK sky _. evr,s�pns h.i l.�y ..N...Y... . .....State Lrc.. &Ad Surveyor. 1fes,-pt�ose :. '4�'M `� Ds► . , IV) ` ": � _ Md" r_ f 'fit c� df,3 (Z2- • OV \� /'S rySOu I - \ 1� --- - i �� l� d��fi: lV • �✓ " •i ✓ �I J � { a i �i� rµ CUTCHOGUE—NEW SUFFOLK PARK Ch 763 CnoheowNew Stam& Pc x '' CHAFMM .. „;to ��,"' " .dArtr7 Rim 6f soutiwta, Cutcho=e-New sutfoik the�n amd estab- to be administered for the coutlau Dark district in _the town - dministered by ase ed existence of such districts vtding for the separate board of co �Lilft} flea orappurtenances acquisition, construeti commissioners,and pro. ' for es or recon park Durposes for su structlon of taco!- Ber�11e a laW ADrii 21 960,With district. / fi Effective April 21.1960. the approval of the Governor. Allf �( '` D'W't --- • The People oft e to of Near York, "Presented in S Assembly, do enact as follows: mate and > '. Seetiou I. The creation tt3 ,fTolk Park district ' and establishment of the town of Southold by the the Cutehoglle-New ,t a resolution adopted on May twent wn board of such s ".%'q�ht, Pursuant to Y-eighth, nineteen hundred 3 the laws of the town law and chapter seven hundreir #!; zed nineteen hundred fift n + va&dated, ratified and co y eight,is hereby in all respects ";:•ion, irregularity or defect in nfirmed, notwithstanding nay lz ou and establishment. Until otherwise relating y Itriet shall continue to include the wise Provided g to such crea- `� ,,,• . .``'n adopted ori Ilia Pursuant to law, such 'i^kr. Y twenty-eighth territory as described is such resolu- LS other,vise provided in ,nineteen hundred fifty-eight. -rt district established this act, such discreet shall kept town ctaw, Pursuant to the be deemed to be a ' and the Provisions of article twelve of act shall a Provisions of such article not inconsistent with Pply to such district. t 3 ? In accordance with the m rtl en of the laws of provisions of chapter seven hundred ,i,listcred by a separate board o Qed fifty-eight irovided ' ,such district-shall be ,LL✓' 1n this act the ro mmissiOners and,except as other- ?" +hall apply to such district vlslons of article th' y -effective date of this net who Theco n of the town districinsioners. ' in oftice on Nil's were respectively elected for terms of �+,hrr and three years at the annual election of anec di '. the a fifth, nineteen hundred fif strict held on tea of theirspeetive eight, shall continue in office un- x.R 7 terms of office. > nn y aPPoiut a tNa"ed a The town board ` „•• f'Om the expiration of the arm of the dthe vtccoa jet at such annuBI election y office tt'd to fill such vacant for a one year term. mmissioner l t •lr,,,t Sixt y shall hold office until January Person so ap_ b .t„•r sixthY ne. At the anuary first,nineteen h ' annual election of such district-held on De- ' , nineteen hundred t I "-hall elect-one co qty the qualified voters of sIIeh Vie_ IL--i"mer for mmissioner for-a term of two _ a term of three years Yy'PY. rc "1 and Otte coni- ""Roller shall be electedcera At each annual election thereafter Y•�t!":Drovieiona of for a term of three article thirteen of the Of three years in accordance >' t'• Whenever ft •-,Ei shall detorn�e it to be in the ' 1 ie 1i`anng as hereinafter provided the to a nae'..uiil,r,ri�c pnb2ie interest after ,,� t,t the aconisr r oonsiructwn or recown ns and of such town ? 1 p°r£enances or park P os fructiott.of facile- 11' `'•', land ol�rigllt5 in land,`f shings£oeq p,h district, including provided however- dist sn 1111 the y such he , machinerY and ; p approval in writing wring shall be ca . .provided in section g of a mn�orety of-such board of com- "t'Ce of such hearingtwo hundred sixteen of the to , pro[/osed or the loeaon of describe in general to town law. by any lands to be acquired shall specify 6"+ttans stf=}{Ee�� , specify 1255 ,E ' i ice'. C16- 763 LAWS OF NEW YORK 19G0 the estimated expense thereof and state the time when and the 1. '? where the town board will meet to hear all persons interested in the sill,. r phlfB ti tic ject matter thereof. Such notice shall be published and posted in the manner prescribed by section one hundred ninety-three of the town }us If the town board shall deEernune, after such hearing and u on i^ § Y' dente giverl thereat, that it is in the public interest n au h11 tie nna poll such puzpose, it may delegate to such board of commissioners the eon. cr!' II duct of all further proceedings thereon as provided in and subject to the I Y Lll:r. t1w limitations of section two hundred sixteen of the town law. Any rest or expense incurred pursuant to this section shall be a charge ,nac1 such district and assessed, levied and collected in the same marinera., sl a l r other charges against such district, but no cost or expense shall be ill. 1 aur{ carred for any purpose in excess of the amount stated in the notifier o[ r' the hearing held in relation thereto. Nothing herein contained 1. prevent the financing of any such cost or expense, in Whole i in paid` 3 pursuant to the local finance late. § 4- This act shall take effect immediately. ,i Superintendent of Public Works—Land for Geneva Lake I �. Front: East Highway Connection _I CHAPTER 7.64 An Act to authorize the superintendent of public works to enter into n ' contract relative to certain land in the town of Waterloo. cou,, 1 Th of Seneca, appropriated for the Geneva Lake Front: E Highway Connection and to authorize the board ust Highway of ocommissioners of the land 4 tpce to grant and convey a parcel of land now or formerlyi( water in Seneca lake at Geneva in connection therewith to Alar r tional-U. S. Radiator Corporation or its successors in interest, to Became a lacy April 21, 1960,with the a ` liar` pprovat tithe Governor. .� >✓ifectiee April 21, 1060. The People of the State of New'Yorlc, epreaented in Senate andI.� Assenably, do enactas,#t?flows, k< Section 1. The superintendent Of/public works is hereby to enter into a contract for and on�beh�.lf and in the name t f thest'.l With National-U, S.�adiator Cordorution, its successor or suecesso►; interest for the rcicas of the rightaitle and interest of the �z to a portion of the Iarip's now q17 formerly under water, described n:1114 tion two of this act, as ZA of the consideration to be paid Iry the stag 3I ,. for certain other lands r ieh have heretofore been a ` National-U.S.Radiaior Corfrt�ration by appropriation appropriated 1'rr,u• !` teen; Parcel number twenty-three-GeneLake rrontap number ser,•r,. I'' �: Conueetion, in tll' town;6f Watlj loo in the count of Seneca llr� li hu;l: New York. Such,"'conti—det may pro -de for such exec tions r }' and conditions of or iri respect to th and described in seetionrtxo ' this act as the superintendent of public',works deem protect the inteiests4 of the state. Such cont'-- shall not become , /I rng upon the state until a `. o>iice pursun.nt to,4he provisions approved thestatefinance lase d Bled in Lr. t land alilrroprir►'tc&by the stater by appropriation map nurlrberrseei'en th. parcel number:tAventy-three shall be approved by the attorney- Upon eertifica�t}'�6n I the state superintendent of public works tIg;,t,-,jal I 1 Coll)IlliNsiont:l'S of file'land office of a co I" rn tp sud description of lands now or p0 of contract, togcfhrr u;;t leftscd, the said board of commissioners shall eau letters patc'under -%va0l utbP issued granting and Conveying regardless of u land osvnorshi p p fill ri_Ire, 1256 Changes or additions In text are Indicated by andorlin, de F 7 1! 4 Nnicn uNE r Y \ fMm ND. 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Yr,perry `uc:a1ti ,.y wnrrwrE.nrew'wN eaE a, r _. w N E oMm�ncNv°,w mm�nN ar nE nm wNu. sounwtc 110 E �p»rJL_— r - wr f M4 ..�� rrt._�_.�— �. —_— ur a >r.a. it.n,r .r,M.a•Mw,>'� elFf0lw OGN,v TN MW 6,KM*EE M N( N 121) '...}e 46. Ndrt ", stNte,aecv r _— OFFICE LOCATION: O��Q� SU(/ryO MAILING ADDRESS: Town Hall Annex l0 P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) N ell- Southold,NY 11971 • �O� Telephone: 631 765-1938 oly/)UU ,� 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: July 6, 2022 Re: LWRP Coastal Consistency Review for CUTCHOGUE NEW SUFFOLK PARK DISTRICT c/o DAVID BERGEN, COMMISSIONER SCTM# 1000-110-7-13 CUTCHOGUE NEW SUFFOLK PARK DISTRICT c/o DAVID BERGEN, COMMISSIONER requests a Ten (10) year Maintenance Permit to trim vegetation at top of bank to no lower than three (3) feet. Located: 55 West Road, Cutchogue. SCTM#: 1000-110-7-13 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: Honorable Lori Hulse, Attorney i t Glenn Goldsmith,President �QF so(/ry Town Hall Annex Michael J.Domino,Vice-President ,`O ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III l [ 1 Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 e4UNT`I,� D E U C V 9' BOARD OF TOWN TRUSTEES JUN 14 2 TOWN OF SOUTHOLD This Section For Office Use Only Board of Nstees Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amend ment/Transfer%Bxtens'on 'L X EReceived Application: �O•��.ZZ- eceived Fee: $ 100.E d Completed Application: •l •ZY Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: f-oordination:(date sent): 1 LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: 7,131Z2, Resolution: Owner(s) Legal Name of Property (as shown on Deed): Mailing Address: c ,> c k Phone Number: 16 ` 21 If Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: Cc!�u-r/l c c s `T' I d e�•� �� 3'�j (If necessary,provide LILCO Pole#, distance to cross streets, and location) C � � �� ����r� C,:;>n � s � c> � �- Mailing Address: T a t' n Y_V Phone Number: - -r l 6 `91�c _ G `(3 9 t 3oard of Trustees Applical,' n GENERAL DATA Land Area(in square feet): d `�cm c. Area Zoning: f� 'i D Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes --2< No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes _l io 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 _ NoI Does the structure (s) on property have a valid Certificate of Occupancy? Yes No L`1 �- Prior permits/approvals for site improvements: Agency Date Tr t ,--# 3(T 2 S —( /<? I 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): Tirc rK. V 4e la a. � - G� 17 �e�v f 3oard of Trustees Applica -,n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: A oar C4 J- � Area of wetlands on lot: � C9 e) square feet Percent coverage of lot: 6 % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: ILIA 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: Manner in which material will be removed or deposited: C4 1-4 e'e J 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 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 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 I -Project and Sponsor Information /4 _ t�� r maces a 1 / ac f 1/ Name of Action or cject: ProjectLocation(describe,and attach location map): -5� �'�e,5 1 R J C,4<-(x e, , r ., in Brief Description of Proposed Action: t N+Gtr `y C-'%C. �L�.7.CS✓JCf`^ �0'�hs� �� �(11�1. .v �_ �j • 1 G. f�>'1 C� / e © d 6 �Ci��eJ di G' rl Q e Name of Applicant or Sponsor:. Telephone:$f ` ( �"c < ct E-Mail Address: �i v tGa V city/POi State: Zip Code: t Ce #127 53' 1.Does the prop ed action only involve the legislative adoption of a plan,local law,ordinance, NO I YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and.the environmental resources that FV I 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: FKA ❑ 3.a.Total acreage of the site of the proposed action? y acres b.Total acreage to be physically disturbed? r Cj,j' acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? �( acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial El Residential(suburban) El Forest ❑Agriculture ❑Aquatic ❑Other(specify): Parkland Page I of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ [M ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ki 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: V'e o 0'7� g es S 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? Pq ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ KI 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 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? n A 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? �{ ❑ b.Is the proposed action located in an archeological sensitive area? �J ❑ 43.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: ,J r Z.✓.rG 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest ❑Agricultural/grasslands E3 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? F ❑ 16.Is the project site located in the 100 year flood plain? tJ A NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, rt-9 ❑ a.Will storm water discharges flow to adjacent properties? ❑NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO DYES 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: F ❑ 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 hazardousrite? If Yes,describe: (4.-% 1 1 y ❑ F1 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname• �2csrcl Date: Signature: Q 41 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? ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 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 1:1affect 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: Ela.public/private water supplies? b.public/private wastewater treatment utilities? El 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ E1 architectural or aesthetic resources? J� 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 ❑ ❑ problems? 11. 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. 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 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 - 3oard of Trustees Applica, n AFFIDAVIT �9 cd a (3C r' e-t, BEING DULY SWORN DEPOSES AND AFFI S THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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 Signature of Property Owner 0Ger IV ssR fq e-0- S WORN TO BEFORE ME THIS DAY OF J Uy\e , 20 a Q— b�`�cvid�! erge►� d�l�. t y ublic F Z-SCIIWAMBBRN ,STATE OF NEW YORK No.OIGA6274028 n Suffolk Countyxpires Dec.24,20� Cutchogue-New Suffolk Park District P.O. Box 311 Cutchogue, NY 11935-0311 June 131 2022 Board of Trustees Town of Southold P.O. Box 1179 Southold, N.Y. 11971 Dear Trustees: David Bergen is a Commissioner of the Cutchogue New Suffolk Park District. Very truly yours, Fre . talin r. Clerk APPLICANT/AGENT/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. /f YOUR NAME: (Last name,first name,ip ddle initial,unless you are applying is 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 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 orbeneficial owner of any interest in a non-corporate entity(when the- applicant heapplicant 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 -1�h c 200 z7— Signature- Print Signature-Print Name e-c•} Form TS I 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 siuig ficant 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# PROJECT NAME - 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: N Nature and extent of action: j ^ l�e- �.J��Pfl,C 4 f D ✓- in-,�/` �r vt'CA rl� �,,. 1�C� C1 P C-.>(7-1 Asa^ It Lc-:) -3 4,,. cl®s.., d e,G.92 {i w-3 • C_ �. Location of action: pa,r 6C y Site acreage: o Present land use: pea a-d� 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: C4 ILS—5� (c) Telephone number: Area Code y-.3g (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 [5§,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—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Not Applicable 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 ❑ Not Applicable 4 _ Lt9 a 1 G� GoalPer, T' -4 f; O j f� e Fl o al G'P1G �C/ r D 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 8 through 16 for evaluation criteria Yes ❑ o ❑ Not Applicable e Y3.1 ce gn)16 /--/j L�,�c 4:!— 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 1c::400fi CL-1c Q S rim Ire 1 4.e gae-, 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�1 Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wanstes. See LWRP Section III-Policies; Pages 34 through 38 for evaluation criteria., 1:1 Yes F-1NoNot 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❑ No ❑ Not Applicable { + C16 :2 Attach additional sheets if necessary WORKING COAST POLIO 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 R Not 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 ❑ No Not 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 for evaluation criteria. ❑ Yes ❑ No DNot 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. r ❑ Yes ❑ No Not Applicable PREPARED BY TITLE DATE 1,5J7