HomeMy WebLinkAboutTR-10181A Glenn Goldsmith,President rig SO Town Hall Annex
543 75 Route 25
A. Nicholas Krupski,Vice President
P.O. Box 1179
Eric Sepenoski Southold, New York 11971
Liz Gillooly Telephone (631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD 7� Ict
Seeft �rd�
Permit No.: 10181A
Date of Receipt of Application: July 1, 2022 6tpn Qr
Applicant: Annamarie leraci & John Nastasi
SCTM#: 1000-35-4-18
Project Location: 706 Wiggins Lane, Greenport
Date of Resolution/Issuance: July 13, 2022
Date of Expiration: July 13, 2024
Reviewed by: Eric Sepenoski, Trustee
Project Description: Install an 18'x20' stone paver 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 site plan prepared by
Salty Roots, dated June 30, 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
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Glenn Goldsmith, President 'of soo Town Hall Annex
A. Nicholas Krupski,Vice President ® d®�� 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
UNTI
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
1I day of construction
% constructed
When project complete, call for compliance inspection;
Glenn Goldsmith, President soUr� 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 a® Fax(631) 765-6641
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 10181A
Date of Receipt of Application: July 1, 2022
Applicant: Annamarie leraci & John Nastasi
SCTM#: 1000-35-4-18
Project Location: 706 Wiggins Lane, Greenport
Date of Resolution/Issuance: July 13, 2022
Date of Expiration: July 13, 2024
Reviewed by: Eric Sepenoski, Trustee
Project Description: Install an 18'x20' stone paver 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 site plan prepared by
Salty Roots, dated June 30, 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
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Glenil'goldsmith,President g�FFO(,y coG - _Town Hall Annex
A.Nicholas Krupski,Vice President a 54375 Route 25
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Eric Sepenoski ? P.O.Box 1179
Liz Gillooly 5 • O�� Southold,NY 11971
Elizabeth Peeples ! �� Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time: Ci Zaz-c+. Completed infield by: ��,
ANNAMARIE IERACI & JOHN NASTASI request an Administrative Permit to install an
18'x20' stone paver patio. Located: 706 Wiggins Lane, Greenport. SCTM#: 1000-35-
4-18
Type of area to be impacted:
;Saltwater Wetland Freshwater Wetland Sound r Bay
Part of Town Code proposed work falls under: x Chapt.275 Chapt. 111 other
Type of Application: Wetland Coastal Erosion Amendment
_Administrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: Yes No Not Applicable
Info need LL.ed/Modifications/Conditions/Etc.:
Present Were: G. Goldsmith N. Krupski Y E. Sepenoski
L. Gillooly E. Peeples
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OFFICE LOCATION: so yO MAILING ADDRESS:
Town Hall Annex �� to P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor.Main Rd. &Youngs Ave.) N
Southold,NY 11971 • a0� Telephone: 631765-1938
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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 ANNAMARIE IERACI &JOHN NASTASI
SCTM# 1000-35-4-18
ANNAMARIE IERACI & JOHN NASTASI request an Administrative Permit to install an 18'x20'
stone paver patio. Located: 706 Wiggins Lane, Greenport. SCTM#: 1000-35-4-18
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
Glenn Goldsmith,President ® f/ Town Hall Annex
fs� ti .54375 Route 25
A. Nicholas Krupski,Vice President � '
'` :e P.O.Box 1179
Eric Sepenoski t Southold,New York 11971
Liz Gilloolyr Telephone(631) 765-1892
Elizabeth Peeples " y4• Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
This Section For Office Use Only
Coastal Erosion Permit Application
Wetland Permit Application
Administrative Permit
�Amendment/Tran sfer/Extens ion
Received Applicat]'on:_ 7•� .2�
Received Fee:::$' 199•
Completed Application:. 7• �Y
Incomplete:
SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec.
Lead Agency Detennination Date:
oordination:(date sent):
FR
t/LWRP Consistency Assessment Form Sent: Y
CAC Referral Sent: ,
Date of Inspection: JUL 9 2022 VV
Receipt of CAC Report:
�1 echnical Review:: _
Public Hearing Held;, 3•ZZr SootholdTown
Board of Trustees
Resolution:
Owner(s) Legal Name of Property (as shown on Deed): Annamarie leraci and John Nastasi
Mailing Address: 706 Wiggins Lane Greenport NY 11944
Phone Number: 917-579.1814
Suffolk County Tax Map Number: 1000 - 035.00 - 4.00 - 018.000
Property Location: .706.Wiggins Lane Grehnport-NY 11944, 0.3.miles from Main Rd./Route 25
(If necessary, provide LILCO Pole#, distance to cross streets, and location)
AGENT(If applicable):• Eric Martz
Mailing Address: PO Box 894 Mattituck, NY 11952
Phone Number::91,7.916.3724„ _ _ „__ _" . _.Email:eric@saltyrootsny.com " .
Board of Trustees Appl:' ,tion
GENERAL DATA
Land Area(in square feet): 25,242.43
Area Zoning:„ R-40 Dwellinq
Previous use of property:_ Single Family Residence
Intended use of-property: . Single-Family Residence .
Covenants and Restrictions on property? Yes _No
If"Yes", please provide a copy.
Will this project require a Building Permit as per Town Code? Yes, No
If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review
and Elevation Plans will be required.
Does this project require a variance from the Zoning Board of Appeals? Yes No
If"Yes",please provide copy of decision.
Will this project require any demolition as per Town Code or as determined by the Building Dept.?
Yes % No
Does the structure(s) on property have a valid Certificate of Occupancy?.--V--Yes No
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?—V _No Yes
If yes, provide explanation:
Project Description (use attachments if necessary): Install 18'x20' stone paver patio.
Board of Trustees Appli, `::ion
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:_Stone paver patio.
Area of wetlands on lot: 0 square feet
Percent coverage of lot: . 0 %
Closest distance between nearest existing structure and upland edge of wetlands: 37' 4" feet
Closest distance between nearest proposed structure and upland edge of wetlands::58' 10" feet
Does the project involve excavation or filling? . No Yes
If yes,how much material will be excavated? 6.67 cubic yards
How much material will be filled?. 6.67 cubic yards
Depth of which material will be removed or deposited: 0.5' feet
Proposed slope throughout the area of operations:, 0% (Level Patio).
Manner in which material will be removed or deposited: .Small skid steer, and by hand.
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):
No negative impacts to the wetlands or tidal waters of the Town of Southold
are anticipated.
617.20
Appendix B
Sliort Environmental Assessment Form
Instructions'-for Conip:Cetiria
Part I -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 l 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
Name of Action or Project:
706 Wiggins Lane
Project Location(describe,and attach a location map):
706 Wiggins Lane Greenport NY 11944
Brief Description of Proposed Action:
Install 18'x20' stone paver patio.
Name of Applicant or Sponsor: Telephone: 917.916.3724.
Eric Martz E-Mail: eric salt rootsn .com
Address:
PO Box 894
City/PO: State: Zip Code:
Mattituck NY 11952
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 lr J Ell
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Doesthe 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:
da
3.a.Total acreage of the site of the proposed action? x;58 acres
b.Total acreage to be physically disturbed? _,008 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 0.58 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) [:]Industrial [:]Commercial Residential(suburban)
❑Forest ❑Agriculture ❑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? ❑ (�/i L
b.Consistent with the adopted comprehensive plan? ❑ ;❑
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape?
❑ M
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: n
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:
❑ M
10, Will the proposed action connect town existing public/private water supply? NO YES
If No,describe method for providing potable water: N/A
:u
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: N/A
12: a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? El
b.Is the proposed action located in an archeological sensitive area?
11 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:
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
.❑Shoreline ❑Forest ❑Agricultural/grasslands 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?
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, �ry
a.Will storm water discharges flow to adjacent properties? ❑NO [JYES U, ❑
b.Will storm water discharges be directed to established conveyance systems'(runoff and storm drains)?
If Yes,briefly describe: []NO ❑YES
Y
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: j/1
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name:-Eric Martz Date: 6�. �D, Z 2
Signature:
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? a
3. Will the proposed action impair the character or quality of the existing community? El
4. Will the proposed action have an impact on the environmental characteristics that caused the ❑
establishment of a Critical Environmental Area(CEA)?
S. Will the proposed action result in an adverse change in the existing level of traffic or
affect 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? El
7. Will the proposed action impact existing:
a.public/private water supplies? a-
b.public/private wastewater treatment utilities?
8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ a
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air duality,flora and fauna)?
Page 3 of 4 ..
text here
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? El F—I
11. Will the proposed action create a hazard to environmental resources or human health? ❑ E1
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 ifyou 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)
Page 4 of 4 ... :. .
Board of Trustees Appli; tion
AFFIDAVIT
oln� �Sg; �fla�/ � Iel'G�,'' BEING 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
ANDD 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.
i
i
Sign ure of Property Owner Signatu)&llroperty Owner
SWORN TO BEFORE ME THIS 7 DAY OF `JUS- , 20.
otary Public
ANNA MONGELLI
NOTARY PUBLIC OF NEW JERSEY
ID # 50147784
My Commisslon Expires:Jan.08,2026
Board of Trustees Applin, ;ion
AUTHORIZATION
(Where the applicant is not the owner)
I/We,, 3<14&i Nns- N$I 1peT + l ,
owners of the property identified as SCTM# 1000-035.00 -.4.00 -018.000 in the town of
C� 41�`zl ,.New York,hereby authorizes_ Eric Martz
.to act as my agent and handle all
necessary work involved with the application process for permit(s) from the Southold Town
Board of Trustees for this property.
PropertOwner's Signature Pr er',s Signature
SWORN TO BEFORE ME THIS
7 DAY OF 7% , 20
Noxy Public
ANNA MONGELLI.
NOTARY PUBLIC OF NEW JERSEY
ID # 50147784
My Commission Expires:Jan.08,2026
AP]PLICANUAGENUREPRESENT',A.TIVE
TRANSACTIONAL DISCLOSURE FORM[
The Town of Southold's Code'of Ethics prohibits conflicts of interest on the part of town officers and emnlovees.The purpose of`
this form is tit provide information which can alert'the town of noksible conflict
of interest":and atloiv it to take whata4er action`is
necessary to avoid same.
YOURNAME: il✓�d � +CMp2l�
(Last name,first name,Middle 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 X
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other',name the activity.)
Do you pc-sonally(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 bus'incss.interesIL`'Business interest"means a<business,
including a partnership,in which the,town otficzror employee hzs'even a partial ownership of(or employment by,)a corporation
in which the town otTtccr or employee ownssmore than 5%of the shares.
YES NO X
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: N•n-
Title br 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 Iegal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this o f' � 200 2�,
Signature
Print Name of
Form TS 1
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code'of Ethics prohibits conflicts of interest on the part of town ofticers and employees.The purtiose 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: . �AS 4 \\
W ..� b� ��l a �k^OIAV
(Last name,first name,griddle 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 reldfionship with any officer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or busincss.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. WX-
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
• Submitted t ' �� �f 200
Signature
Print Name
Form TS 1
APPLICANT/AGENTAREPRESEr7'TATIV
TRANSACTIONAL DISCLOSURE FORM
The flown ofSouthold's Code.-ofEthics prohibits conflicts of interest on thc•0rt-of town 6fficers-and cmbloyees.Tiie iauroose of-
this fomi is to-provideInformation which can olert the town ofpossible conflicts of int&esi and allow it to take whatever action`►s
,.necessary 16 avoid same.
YOUR NAME: .. Eric Martz
(Last name,first name,middle 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 1
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map. Planning
Other
(If"Other",name the activity.)
Do you peis6na113 (or through your company,spouse,sibling,..pamii4.or:child)have a relationship«ith any ofticer.,ar employee
of the Town bfSouthold? "Relationship"includes by blood,►tparr►age;or busi►iess:►riterest "13usine5s interest'`mcans'd(usmess;
including a partnership-,.in which the town ufficeroremployee hfs'everi,a'parti l otrnership'of.(orempioy►rient by)
:a
including
in which the.totvn:offiger or employec'otvns�merc than'5°lo 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
Submitted this 5.r day of �'^�'- 200CZ.
Signature .
Print Name -
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�nifigu t.
beneficial and adyeise:effects upov_tlie coastal Nada fwhicli;intludes all of Southold Towti
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. :Th is eacli.-answer must be.explained iiidetiilg listing both supporting and non-
stiftortift facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions,.it shall.noi 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#035.00 . 4.00 - 018.000
PROJECT NAME, 706 Wiggins Lane
The Application has been submitted to (check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees l r J
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:
Install 18'x20' stone paver patio.
Location of action: 706 Wiggins Lane, Greenport, NY 11944
Site acreage: 0.58 acres
Present land use: Single Family Residence
Present zoning classification: R-40 Dwelling
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: Eric Martz
(b) Mailing address: - PO Box 894 Mattituck, NY 11952
(c) Telephone number: Area Code( ) 917.916.3724
(d) Application number,if:any: A
Will the action be directly undertaken,require funding, or approval by a state or federal agency?
Yes El No V1 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 LVVRP Section III—Policies; Page 2 for evaluation
criteria.
Vj Yes F No ❑ Not Applicable
.'Project will make beneficial us of coastal location, and minimizes adverse effects of development.
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LUMP Section III—Policies Pages 3 through 6 for evaluation criteria
Yes No Not Applicable
Project will have no negr., impact on.historic or archaeologf, _ ^resources.
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
0 Yes :0 No V Not Applicable
Project will have no negative impact on on visual quality or senic resources.
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 V Not Applicable
Project will have no negative impact onflooding or.erosion.
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 0 No V1 Not Applicable
.Project will have no negative impact on water quality or supply.
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—PoIicies; Pages 22
through 32 for evaluation criteria.
__0 i
Yes No N ..Applicable `--
Project will have no negative impact on Town of Southold ecosystems.
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.
j Yes E] No , Not Applicable
Project will have no negative impact on air quality.
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LVVRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
0 Yes : No I"J Not Applicable
Project will have no negative impact on the environment.
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.
0Te No u Not Applicable
Project will have no negative impact on public access.
Attach additional sheets if necessary
WORKING COAST PGL_''IES
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.
0 Yes No g Not Applicable
:Project will have no negative.impact.on.water-dependent uses...
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 :0. No I r 1 Not Applicable
Project.will have no negative impact on marine resources.
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.
0 Yes 0 No 9 Not Applicable
Project will,have no_negative impact on agricultural lands.
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.
0 Yes _0. No RI Not Applicable
Project will have no negative impact on energy of mineral resources.
PREPARED BY Eric_Martz TITLE DATE vC.. 3v.Z Z