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HomeMy WebLinkAboutTR-10182A Glenn Goldsmith,President ®� S®(Ir� 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 Fax(631) 765-6641 00 NV' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1944C Date: July 13, 2022 THIS CERTIFIES that replacement of existingsanitary system with a new Innovative&Alternative Wastewater Treatment System further landward than existing; At 675 Private Road#12, Southold Suffolk County Tax Map#1000-87-4-7 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 15, 2022 pursuant to which Trustees Administrative Permit# 10182A Dated July 13, 2022,was issued 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 replacement of existingsanitary system with a new Innovative& Alternative Wastewater Treatment System further landward than existing. The certificate is issued toRo rt&Donna rummond ow er of the aforesaid property. .�6s�e � d` ..Jc z^ Authorized Signature Glenn Goldsmith,President �� Town Hall Annex A. Nicholas Krupski,Vice Presidents ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly coTelephone(631) 765-1892 Elizabeth Peeples Fax (631) 765-6641 U 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 1 st day of construction % constructed When project complete, call for compliance inspection; Glenn Goldsmith,President ®F S®U� Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski s. Southold, New York 11971 Liz Gillooly eta Elizabeth Peeples � � � Telephone(631) 765-1892 a Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10182A Date of Receipt of Application: June 15, 2022 Applicant: Robert & Donna Drummond SCTM#: 1000-87-4-7 Project Location: 675 Private Road #12, Southold Date of Resolution/Issuance: July 13, 2022 Date of Expiration: July 13, 2024 Reviewed by: Elizabeth Peeples, Trustee Project Description: Replacement of existing sanitary system with a new Innovative & Alternative Wastewater Treatment System further landward than existing. 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 Jeffrey Patanjo, received on June 15, 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. 4,— Glenn Goldsmith, President Board of Trustees i N22_58'10"W I 210.81' - - - - - - -- - - - - - - - - EEV. DOCK 4.2OA \ AREA = 10,709 SF 1st STORY \ OR 0.246 ACRES STORY DECK�O RES EX.VONO DRAIN � o, sem` '�y�o S�pR� SAN ORppMs� GARAGE DRIVEWAY G.F. ELEV. 6.3 `� g.2 wok a N V`p BPS�M�N� 0 �n WAT R P,PROVED� BY S� Q Q r r •--r r r r SERVI �O BVARp OF RUSHES C.O. SOIL BORING TO 10' WATER ryoa�s y \ ELEV. 1 ELEV. 5.3 2 TOWN®F. SOUTHOLD � 4.7 50% DAT - - ABANDON EXISTING FAILING / O 00 - E �F1G �ZZ SI 30'00"E - SANITARY SYSTEM ELEV. EXPO g �► 75' MIN. — — 4.7 ,,, �n ELEV.4MIN. SHED ELEV. .5 . 100' MIN. — _ _ 4.3 SEPTIC TANK—/ (2) 23' GEOMAT 199.97' STAAR I/A TREATMENT UNIT o� y s PROJECT 3'a�, LOCATION I V E o © 71C. Fes ' a$ PROPERTY OWNER: JUN 5 222 + J 2 r, 'ii ti� o ROBERT H. DRUMMOND DONNA K. DRUMMOND Southold1dwn 106 CENTRE AVE. Board ofTn,stees 5outhol Tow EAST ROCKAWAY, NY 11518 'rard of Trustees R h C5 x' `�r J1 3 Kok, y y PREPARED BY: iso°rie4yl 'a >,� � E a` JEFFREY PATANJO ' P.O. BOX 582 BOHEMIA' NY 11716 �. Cr3eek �y < r , 1 675 Windy Pont Ian u '�; SOUtNOId N�Yi1197r '� is ' 631-484-9332 t 9 - SANITARY SYSTEM REPLACEMENT SCALE: .. JJPatanjo@gmail.com 1„=2 0' PROPOSED PLAN NOTES: DATE: 1. ELEVATIONS REFER TO N.A.V.D. 1988 DATUM & LOCATION MAP 1-1-21 675 PRIVATE ROAD #12 PROJECT LOCATI0N MAP 2. PORTIONS OF PLAN FROM SURVEY PREPARED BY: AKA 675 WINDY POINT LANE N.T.S. JOHN MINTO LAND SURVEYOR SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: LATEST DATED JUNE 18, 2008 TAX MAP N0. 1000-87-4-7 1 OF 1 Glenn Goldsmith,PresidentCOGy� Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 Eric Sepenoski ,? P.O.Box 1179 � Liz Gillooly �y • o� Southold,NY 11971 Elizabeth Peeples 'h01 �� `` Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 1 111 12.2 Completed in field by: 61*1?Abeik Pr_tpleS ROBERT & DONNA DRUMMOND request an Administrative Permit for the replacement of existing sanitary system with a new Innovative &Alternative Wastewater Treatment System further landward than existing — as previously approved under Emergency Permit#9804E. Located: 675 Private Road #12, Southold. SCTM#: 1000- 87-4-7 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 Typp of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: S�ya1 gh}�1yvw a� Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly vE. Peeples SYMBOL LEGEND O MONU%ENT FND 0 MANHOLE 0 TEST HOLE BEARINGS SHOWN HEREON ARE BASED 0 LP./19.RID ®'a-IIUET 1B TREE ON LIBER 12842 PAGE 0141 ® I.P./I.B.SET ®'B•-INLET ®SHRUB RSA UTILITY POLE ®YARD INLET • BOLLARD �— GUY V'JE ®YARD IH ET 0%ETLAND MG UTILITY POLE WNCHT ©ELECTRIC METER CANT.CANTILEVER .h LIGHT POLE ED GAS METER FE.FENCE 4 SIGN IF]WATER METER MAS.MASONRY —o--PVC FENCE(PVC) D4°0 GAS VALVE PLAT.PLATFORM —o—STOCKADE FENCE(SM) WATER VALVE W.W.VANDOW WELL CHAIN UNK FENCE(QF) B/W BAY WINDOW xrPARE FENCE 0/H OVERHANG C/E CELLAR ENTRANCE +ia FIRE HYDRANT R/0 ROOF OVER 0 CROSS CUT D.C.DEPRESSED CURB Z A/C UNIT OA ON LINE G.O.L.GENERALLY ON LINE A STAKE EL ELEVAY N FF EL FIRST FLOOR ELEVATION CF GARAGE 12ATION T LANE �, POIN WINDY •,�-,�.6°°`�• ��-',�'�� O .�� x46° 14! gar}7I 0°v 0 n� , TAX 0 It off y� :b 4 rE ElEE 1 5 2022 1— � 1F )� o IAff SCUUMId Town Board of Trustees 66' 'b ns G � C FLOOD INFORMATION: BY GRAPHIC PLOTTING ONLY,THE PREIASES IS LOCATED IN FIRM ZONE••AE`•(SPECIAL FLOOD HAZARD AREAS SUBJECTTO INUNDATION BY THE 1%ANNUAL CHANCE FLOOD,BASE FLOOD ELEVATION DETERMINED,EL 6)AS PER MAP NUMBER 361030 166H, 8 EFFECTIVED SEPTEMBER E LD TNG WAS PERFORMED TODETERMINE ET RMINETHISZONE,AN ELEVATIONGRAPHIC SCALE CERTII'TEMAY 5ENDTOVERIFYERMMATIONOR OO 0 15 30 APPLY FOR VFROM THE FEDERAL EMERGENCY MANAGEMENT AGENCY. ( IN FEET 1 inch = 30 fL *ALL ELEVATIONS REFERTO NAVD88'DATUM LOT AREA 9.745 S.F. 1 10 27 2021 ELEVATIONS AND FLOOD ZONE ADDED DB JDL 0.19 AC. REV DATE DESCRIPTION BY CHK tEOFNCO/ y SCALICE SURVEY OF PROPERTY O 09 land surveying SITUATE m2 0 mjslandsurvey.com P:631—957-2400 SOUTHOLD, TOWN OF SOUTHOLD LP�.O 050736-JQJ DR:MC CREW.:JM SCALE: 1" = 30' 1 TAX MAP NO. SUFFOLK COUNTY, NEW YORK kA NDS 0100-087.00-04.00-007.000 DATE SURVEYED:10/11/2021 JOB NO.S21-3166 m:a.u.o.m rxamr w.mm.w m may nn m.oc..m®ve meson sa.s.°anm:Q rxew a�A c•.m�c.:s,o.v.s_a!mwiw w.w a.a mwa!ca.°.ws.eK nc aamn o�m r..Nc maaa wa.n warm mr®w nW awasa wma n...m wroL !q mmmam w as mucor agar ur msr w x,✓m rmwan.mann¢..w v oswr amm ms v rwc rw w nana mrt°n mxm6 rc iec mu°mw arum m ivm0 rw eKr ra olein mM,al a M/�m M S:I[mv°aM,m M 0.MMtaUL rDR.r0 m i)[IW'f0 A511EIttr iNFc w>B bo➢nr artb ar.(O M mnluaa ruw.E:m mw[auL 6)M,a[nw ,mt�n omcvmr�s w�•'wmomf rrt,slams rxw uo cop um¢mw].C Yrr nWodco:Wn9.viv w mnar.to K mar(w gmSVy am rv°w rta as maa'ma .7 lyo �aY �o •��� g���'�+ � � to YY. E iL S rim 4 u o - `° SUR VE Y OF PROPERTY• c o n o GpTFNpVEtS A T BA YVIE .4- Za TOWN OFF SOUTHOLD SUFFOLK COUNTY, N. Y. \� b 1000 - 87 - 04 - 07 \\ '• scale 1" = 20' Sept. 18, 1990 JUMF i8. 2006 I JUIN 1 5 2022 „ �$outholctTUw[t Board:ofiTnfstees d ECE 4 4 � CPI JAN 2 5 ;t5 AREA =,10,588sq.ft- Southold Town ;hb0 d� I Board of Trustees •.hracIFRAIYSY03!•DCtrQYro7YS9,A�ETUA►T :774N OF SF�A64 Tc09 tr Tf r fk7 Y0.1 JrATE&tZ,•;A LAd ,. FX(kFT 15 ftp SECTfpY TFf19•S7PI.�YSUY 2:.LL CFRJ'?LSiTY.S , t;ori+.•:, 1G'a:AY AhE VACID rA3 TT:3lIeP, AVID !J Cfi'r�'^S TIERELK'0.41'G '�•. ` 0 Ofl�OFC-39fiiR R�" SSTD SDL Cr M5 SL^iieYQ4t�. A4Y.S:_��/L•' N6. 45 .or.aor.ae LL:rc° i. yI i J, a-ts9i mae.a9 o3a1-m 0}31-07-. u leaz loq/ri It Iloa h1arGN U.. m x.as - p a .2- 7" si1 ove cn Dunl sD '(� ° 5 of DLA �»a 5��, � �S� TONN OF SOUTH fix) �� fi 214 y SnQaiEO (9Y141 Q {,a i, 1 reaµcl 1tl1� ♦�lcl � ,1 �'h .P � -a�}. � ' l Tffi} eL'[ 31 f1 32 sourHD�D 3k t' 2 .oa��t ., ,,' v -- n.nacr FE)26 l D 43 •o-, � . pC, 7t, f. v, cb+r 3 121 4- „ C IHTr of BUFF— $P .. __ rDVM DF souTHaD�'. / i E —e— .• M-_mn� ,.„„ O �°...d,. -z-— COUNTY OF SUFFOLK D NLIIGE (21) . (eerP' R bn4.M1Y/m,l \ aq�rteD M ���087 �� A OFFICE LOCATION: �O��oE S0(/JyOI MAILING ADDRESS: Town Hall Annex P.O.Sox 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 • COQ Telephone: 631 765-1938 �y00UNTy,�� 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 ROBERT & DONNA DRUMMOND SCTM# 1000-87-4-7 ROBERT & DONNA DRUMMOND request an Administrative Permit for the replacement of existing sanitary system with a new Innovative &Alternative Wastewater Treatment System further landward than existing —as previously approved under Emergency Permit#9804E. Located: 675 Private Road #12, Southold. SCTM#: 1000-87-4-7 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 1 .. Town Hall Annex Glenn Goldsmith, Presidents , Oi 54375 Route 25 A. Nicholas Krupski,Vice President P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion,Permit Application D EC E I VE Wetland Permit Application dministrative permit �� ,� 5 Amendment/Transfer/Extension 2022 Received Application: eeeived Fee $ ....149, Southold Town Completed Appli catio n ....._-. .� .Z:... ::<; Roam otTrustees , Incarriplete SEQRA Classification Type I Type II Unlisted Negative Dec. Positive Dec-... Lead Agency Determination Date,.. : oordinahon. (datesent) LWRP Consistency Assessment Form Sent r. AC:Referral Sent- Date.of Inspection Receipt of CAC Report:, echrical Review Rublic:Hearing Held Resolution;' Owner(s) Legal"Name of Property (as shown on Deed);: Mailing Address:, ®� r_-7"j � �� • ® �' y , f�_Y< ���f Phone Number: '�1� � 7 Suffolk County Tax Map Number: 1000 - 7 ® a 7 rQ Q Property Location: . �'7.� � 8 � . . ✓ -z'i�►. �� �-� ®�17ij�f _ ,. Sri (If necessary, provide LILCO Pole #, distance to cross streets, and location) AGENT (If applicable): _ Mailing Address: Phone Number: __ 1. Board of Trustees Application GENERAL DATA Land Area (in square feet) _ 0 _ ...., Area Zoning Previous use of property Intended use of property s Covenants and Restrictions on property. ✓ Yes No A'O,, �71A_r4 &444e If"Yes", please-provide a copy. Will this project require a Building Permit as per Town Code? No- Yes 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,pSo ect requ anydemolitionas per Town Code or as determined by the Building Dept.? Does the structure(s) on property fiave a valid•Certificate _f>OccupancyT Yes Prior permits!approvals f6" Ate Agency Date. LA Q�K/F� �r 5 -7 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?--/—k- No Yes If yes, provide explanation:,_ _ Project Description(use attachments if necessary):. ���•Com-_ `e�C► '1R� �': ^-, Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA . Purpose of the proposed operations '� �� ' '� SA.� _. leArea of wetlands on lot:.., . square feet _. Percent coverage of lot % r y Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands.: '/0' feet Does the project involve excavation:or filling? No G�_ _:Yes If yes, how much material will be excavated _ cubic yards Hove 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: .. 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): t ezt"q _ Short Environmental Assessment Form Part I -Project InfoPwaflon Instructions for Completing Part 1—Project Infotmation. 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 1—Project and Sponsor Information Robert Drummond Name ofAction or Project: 675 Wndy point Lane-Southold Project Location(describe,and attach a location map): 675 Windy Point Lane-Southold Brief Description of Proposed Action: Remove existing tailing sanitary system and replace with now UA type system In accordance with SCDHS requirements in a new location further landvrard ofextsttng bulkhead.. Name.of Applicant or Sponsor. i Telephone• 516-860 8738 Robert&Donna Drummond V--Mail: rdrumm@aptonlinenet Address: 106 Centre Drive City/PO: State: Zip Code: East Rockaway ivy 111518 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 ofthe intent ofthe proposed action and the environmental resources that ® ❑ may be affected in the municipality and proceed to Pad 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:NYSDEC t SCDHS/Town of Southold Trustees ❑ Q 3, a.Total acreage ofthe site ofthe proposed action? 0.245 scars b.Total acreage to be physically disturbed? 0.030 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.245 acres 4. Check all land uses that occur on,are adjoining or new the proposed action: 5. ❑Urban ❑ Rural(non agriculture) ❑ Industrial ❑ Commercial ® Residential(suburban) ❑Forest ❑ Agriculture ❑ Aquatic ❑ Other(Specify): ❑Parkland 5. Is the proposed action, NO YES NIA a. A permitted use under the zoning regulations? ❑ ❑ b. Consistent with the adopted comprehensive plan? ❑ ❑ NO YES 6. Is the proposed action consistent with the predominant character of the existing built or natural landseape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental A=? NO YES Name.-Corey Creek,Meme Peconie Bey and Environs,Reason:SlgniBcant coastal fish$wildlife halftt, If Yes,identify ReasomProtact publia health,crater,vegetation,&scenic beauty,Ageocy.Southold.Town of,Agency Suffolk ❑ aunty, NO YES 8, a. Will the proposed action resulfin a substantial increase in traffic above present levels? b. Are public transportation services available at or near the site of the proposed action? 07 ❑ c. Are any pedestrian accommodations or bicycle routes available on or near the site ofthe proposed ❑ ,❑ action? 9. Does the proposed action meet or exceed the state energy code requirements4 NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 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 bas been determined by the ✓ Commissioner of the NYS Office of Parks,Recreation and historic Preservation to be eligible for listing on the El❑ State Register of11istorlc PlacesT 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 IMstoric 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? ❑ Z 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: Pagc 2 of.) Y t l , 14. Identify the typical habitat types that occur on,or are likely to be Found on theproject Check all that apply: ❑Shoreline ❑Forest ❑Agricoltuml)giasslauds ❑Early mid-successional OWetland ❑ Urban m Suburban 15. Does the site ofthe 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 17. Will the proposed action create storm water discharge,either from point or non-point sources? NO YES IPYes, ❑ a. Will storm water discharges flowto adjacent properties? b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? ❑ . If Yes,briefly describe.- 18. escrbe: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: W1 El .19. Has the site of the proposed action or an.adjow—mg property been the location of an active or closed solid waste NO YES management facility? If Yes,describe: ❑ ❑ 20.Has the site of the proposed action or an 4oining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? 7f Yes,describe: ❑ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spon !name: Robert&Donna.Drummond Date: signature: Title:Owners PRINT FORM Parte 3 of 3 F _ EAF Mapper Summ'-. Report Friday,January 1,20212:18 PM _ Disclaimer: The EAr Mapper is a screening tool Intended to assist protect sponsor and reviev ing agenelm in preparing anenvrronmental 7 v41 "3 ? { ~ t '4- answ re coy t a bot all quesffodd)Uonns asked in the EAF anyE q j r �. G --•,,. 7 f 7�"r F ` ) per.Add!llonai infortna4on on any EAF r7 7 r .'.- 't.• r' .� f Jj( e' J✓ ' 1 y consufting the EAF Workbooks.Although r ."� Y �"� r J r, t ` •� n i v, rovldes the EAF Ma er the most u pp, p p-to-date digital data ayaltabfs to y _ +ll DEC,you troy also neod to contacttocal or other data sounes.in order # ,i. •? { t n t to obtain data not provided by the Mapper.Digital data Is not a t t1 substitute for agency detennlnaBons. Y s Y l rsC`o 5 t �t i —2 ��1 v i,'i.�. ri:..t� r^'�-5 rtfl-5- 41...tCil�Cal Fr t',•`S't7-n^iY 33 x �i �' �y tna yr f l Toronto { vY i.=. r•_,.,__• n .-:TKS7' • r _5`�r`1 a:'S` �x" d^' -f'r.:.`-.-rJ�� ;t. Fr..:.4 1 cyr![3v `l� s:tl i - •� r j'J i;;h�ttn�t fes. f _ .;gc.;trtt v �� SrtirfY�d c• �r1 'E'rr�tifeh�'E .,;^ayj,� '•ss c;f �F�,f '. � a "� '• �+7+,) v�-�c�.-c c 'C+as r•`�,: �� "�J � v> g"*r'6 ?' 'i�i u , R 'car `y�;,t t ..r i7 �.+. }. ,�� �t it ��2'• lc S*= � r c�a•my �G+te r: � r -t.,..u�.. *.:rt y ..*'•.�rt�'i �a c� ' r. r �.a}•y! z� i'''YG �.w 'z Y `+'.�,t{+ ,•r ���''Jr�dl., .. "f_rtrt t Gr a Rhltad4ipltia �annrtt r!Si;S Gtt�rmap It1Lr:EI+tEPn R i'lRatt EsnJapan t.IETI Esn t htfta iH��t47t'�ttZ'.Fn, TEt�tEtlTFm� t; atrt17 atl t1Ell, h�htna iH�i�71.4nttr,Esn {�,y�tr�a�,Esta[1)�1t�1tt�.11a,C,.R;��pu1S.b'>:�#lcla�tnf7tttf�Uk�x.�ati�1�}�.,�ISU�rt"n)p���n�ti��(rttiGt'p�tiScT��htais'tol�7b •:� • '��l�k1SY���Stttnt�u�>r� !.� .Y =.a�. .ex,.. a.R`..'t✓1'."'.�/ .S`:r...-_'7S`3,..;. � "1r, �1'Ir.l.F L'.e^.4 l_.k... �a.Y{•.:Gsa..�4_ 1' 'h.�. Part 1/Question 7 [Critical Environmental Yes Part 1 /Question 7[Critical Environmental Name:Corey Creek,Name:Peconic Bay'and Environs,Reason:Significant Area-identify] coastal fish&wildlife habitat,ReasomProtect public health,water,vegetation, &scenicbeauty,AgencySouthold,Town of,Agency:Suffolk County,Date:3-9- 90,Date-7-12-88 Part 11 Question 12a [National or State No Register of Historic Places or State Eligible Sites] Part'I /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 11 uestio; 1'5[threatened or Piping Plover,Least Tem Endangered Animal-Name] Part 1 /Question 16 1100 Year Flood Plain] Yes Part 1/Question 20[Remediation Site] - No ~ Short Environmental Assessment Form-EAF Mapper Summary Report r i ,Board of Trustees Applicaz;Ldn AFFIDAVIT a"-1111ArKl%X#%1PhdBEING DULY SWORN DEPOSES AND AFFIRMS 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 Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS j� DAY OF C , 20 JANE 0 PARIENTE Notary Public-State of New York NO.01PA6363516 Qualified in Nassau County Notary Public MY Commission Expires Aug 21,2025 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 puroose 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: rt/twwt vti� �a�et� �'. �r fit awl ov�0� i ���1✓►A - (Last name,first name,rpiddle initial,unless y6d 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"OtheC',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 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 r 0R-2SSubmitted thi l day of 3" e 20R-20— Signature 1 ignatures f Print Nar e � � yt4 0 yn G( Form TS 1 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 fg�u icant 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 �"e�7�I C 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: K SySte" Location of action: 7 °�`�� ��'S� ��� t -5ti gO I�i , 7f Site acreage: . Present land use: CZI 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: �" e` e` n n vlG M wlO Yr (b) Mailing address: i� Cc 4-t r-r OVe✓i U (c) Telephone number: Area Code 7--2, (d) Application number, if any: /A 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—Policies Pages 3 through 6 for evaluation criteria ❑ Yes No Not Applicable i 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 R Not 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 8 through 16 for evaluation criteria ❑ Yes ❑ No N Not 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 NotApplicable 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 M 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. Yes ❑ 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 III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YesD No[N Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES v 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 K 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 Pq 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 [Q% Not Applicable PREPARED BY TITLE "'��r DATE 1 j