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HomeMy WebLinkAboutTR-10225A Glenn Goldsmith,President Z� so Town Hall Annex ®� ®� 54375 Route 25 A. Nicholas Krupski,Vice President ® P.O. Box 1179 Eric Sepenoski JIF Southold,New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples oe` ® �® Fax(631),765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 7117/2,3 INSPECTED BY: G, 601 d SM�'�"' Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1 st day of construction % constructed 'V Project complete, compliance inspection COMMENTS: 0< g� G © G $VI �1\ o,cco c a"ee 'V4 10225A aA p\av s ,�o•�� 10/1 C1/2Z CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President �OF so Town Hall Annex ® 54375 Route 25 A. Nicholas Krupski,Vice President �® �® P.O.Box 1179 Eric Sepenoski l� Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 couPfT`1,�1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 2048C Date: July 17, 2023 THIS CERTIFIES that the replacement of existing treated boardwalk with new 4'x400' long boardwalk constructed with 6"x9"pavers; At Marlene Lane/Peconic Bay Blvd.,Mattituck Suffolk County Tax Map#1000-126-6-16 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 12, 2022 pursuant to which Trustees Administrative Permit#10225A Dated October 19, 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 existing treated boardwalk with new 4'x400' long boardwalk constructed with 6"x9"pavers. The certificate is issued to Marlene Lane Civic Association owner of the aforesaid property. e Authorized Signature Glenn Goldsmith,President �Q� S®(f_� Town Hall Annex A.Nicholas Krupski,Vice President ,�®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski 9Y Southold,New York 11971 Liz Gillooly Elizabeth Peeples � � � Telephone(631) 765-1892 Fax(631) 765-6641 cou'111,� 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 '/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith,President ®f solm., Town Hall Annex ��* 54375 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 4 11A BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10225A Date of Receipt of Application: September 12, 2022 Applicant: Marlene Lane Civic Association SCTM#: 1000-126-6-16 Project Location: Marlene Lane/Peconic Bay Blvd., Mattituck Date of Resolution/Issuance: October 19, 2022 Date of Expiration: October 19, 2024 Reviewed by: Glenn Goldsmith, President Project Description: Replace existing treated boardwalk with new 4'x400' long boardwalk constructed with 6"x9" pavers. 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 project plan prepared by Michael A. Kelly, received on September 12, 2022, and stamped approved on October 19, 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. Genn Gol mith, President Board of Trustees EMMONS on 0 NMI OMEN MEMEN MEN 0 M ON N MEMO 0 ME MEN ME 0 0 MEN NoMEC MENEM g - - a E MENmi ON MEESE MEENE No ONENESS MEN ME 0 0 ENE ME o . No M Glenn Goldsmith,President ¢ SUFFD(� OQ Town Hall Annex A.Nicholas Krupski,Vice President �a� y< 54375 Route 25 Eric Sepenoski y ? P.O.Box 1179 Liz Gillooly �y • o� �Y Southold,NY 11971 Elizabeth Peeples ��� �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed infield by: 6, e!�Z,USr►A MARLENE LANE CIVIC ASSOCIATION requests an Administrative Permit to replace existing treated boardwalk with new 4'x400' long boardwalk constructed with 6"x9" pavers. Located: Marlene Lane/Peconic Bay Blvd., Mattituck. SCTM#: 1000-126-6-16 Tof area to be impacted: 7Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: ✓ Chapt.275 Chapt. 111 other Typ 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/Eta.: � r- yj Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples fr a. ....:. ,gip.+P •. .•. jr .0 tW4a.4 ff Y- }1,(j�l'rf� � ��• ._ � .t,�..�.. .,r...s:.,yo ..�.u',""r..""'."""' .. ��s `- r 44 5.11• �r `s �^ "M' .. ....«• 'w��._. .. :«.. .. w y n.y..a�.ewri- M/nWk�rYMMi!�.• . �i i --_— LINE SEE SEC. NO. 122 ——— MATCH LINE � 18 G' �6 17 S� �Q 3AA(c) 2-6A(c)'S 'S • P� MATTITUCK PARK DIST. MATTITUCK 1 �• r � 1� ' ��° +6�loa '�''�I• PARK- DIST 6 �t� 1 /06 b S a 40 12 �6 i2,�v . b• 10 133 11.5A(c) Q 1 vl r ri 1Cco 20.1 O �' 131 ve k 4.9A(c) 4v MATTITUCK.PARK DISTRICT / lb SEE SEC_NO. 134 4P 8 Q 0r j. � •�a� - _� - : 'ecoMc:; ;_ ngbt-a ise � MCC- ALL of3md e. New Yoff%bounded=d dmad-W�� as ftiIIaw� �.'.� �-TO ffrt-of-- BGRMG gt a post ft zvjo r_.. BW200.20 feet ee�Igs �sd3mefromt�,eN .... .:. -. vfsar Ian a►fHar _a oiWh 24 d earaw 23 00savcads .feed= c ::';..... PeLAAFAM 8e<�P mark ofG w said. ° P=Bd to and 10.0*a to Peea�ac B mem dem r peea�c gay 13ouie - - Pk�vpa as: i4��3�ame�3lcl��?�►Yark, • - ;r I ui 1st: ir•,fl •"^r �." l 1 iy e. Y, I ,- �t { C� Earth y os, ,re J✓ SEE fiEC NO,a _ „-41m x �1 wTCN lME � wTCN .IME x ,�oo, 'Y°j •t ran PLL.No. ` �+ s+ � O wTTm,ac x w p�LN ,ob . 4,2 31411 M.sT-ae �° A o,.n ” �T•c"r, . r M1+ Ferry, ' 6 b O I4xM OIMN / �' i rr J O Ntl,�u 1 dd ,..`H4 r z MVq •' fir,'' .x / ,/ l ran PCL.No W., °r zEE sEc NO iaM 031N / AUMq / 1° 1MIc1 / lip )/. J / O '© i pl. / roN Pcl no / \ YWONm / \ '" wTCN - LINE SEE SEc:.No.,m 'E w. R — — —' -• ——x^—— �u ——^—— m,s NOTICE ii;tti COUNTY OF SUFFOLK © N touTHoLD SECTION NO G —�— �, i Q _ —_ �_ —�,_ �jReal Property Tax Service Agency v ,M c:., 126 p....w n x. �a�ya. iN �— —__— u..�.. --.-- Pw.��--wn-- rer r•,yiy P,�/ m P rxic,xu loco PROPERTY MAP tt,4m r OFFICE LOCATION: �O��Of SOUTy0l001 MMAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) cn �e Southold, NY 11971 �pQ Telephone: 631765-1938 COUNTY, 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: October 7, 2022 Re: LWRP Coastal Consistency Review for MARLENE LANE CIVIC ASSOCIATION SCTM# 1000-126-6-16 MARLENE LANE CIVIC ASSOCIATION requests an Administrative Permit to replace existing treated boardwalk with new 4'x400' long boardwalk constructed with 6"x9" pavers. Located: Marlene Lane/Peconic Bay Blvd., Mattituck. SCTM#: 1000-126-6-16 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 proposal is CONSISTENT with LWRP Policies and 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 Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly c� = Telephone 631 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application E C E Wetland Permit Application X Administrative Permit 4mendment/Transfer/Extension SEP 1 2 2022 ✓ Received Application:.- 1 d2 ZZ• ......Received Fee:$ 06.Ob.._.._. ... . ...... ...... ....:..................:.`:_....,; sarrtho►a rowsCom leted Applications Baard of Trustees Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent): LWRP Consistency Assessment Form Sent: ._ CAC Referral Sent:.. Date of Inspection:. Receipt of CAC Report; Technical Review: ,.. __ ... . Public Hearing Held:,. 16116 Resolution: Owner(s) Legal Name of Property (as shown on Deed) ,Mn r(&n e, L,tivY -.. s_s oG ie, Mailing Address:. © 6 j2x 1,062 f1 et t+ i �'L 4 N Phone Number:Pre-S igen f I.: Sca s A n ae.-.,t'O 11% �31—z`I�' �/.��E' �^acs uy°Qr Suffolk County Tax Map Number: 1000 !26 -&f.1 /to . Property Location:.. or..l�,,�..l..G �,z. :..h�.�a r► ,�.: _ 1.3 vc _ (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable):::..._.._ ... , .. ..... Mailing Address: _.:_:... ...... ...........: ..;:..,::.Phone-Number _....:.......__._.. .....__...:.::.....:::.._........:.,._:....:.�..:..::.. ......_.. .Email :<�.._...:.v_.�........::....-.....,...:.:........� ..:,......:.....__.-.......,...-..:___:. .::: :.:. ...x_,...,- and of Trustees Applicati__ GENERAL DATA Land Area(in square feet): - 2-i 3 0O Area Zoning: Previous use of property:. St, e � e_ Intended use of property:, h�a� ; � - � e _-_ ..._.CC�'a,(...�<(,y�i.N I � . (�e _ Covenants and Restrictions on property? Yes X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? -Yes ._X}X.:-:.-No If"Yes", be advised this application wilt 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 iNo Does the structure(s) on property have a valid Certificate of Occupancy? Yes No No llo S4-Prior permits/approvals for site improvements: Agency Date oa r� I►^teeVv1 ZQ 2-00 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_C_No Yes If yes, provide explanation:. Project Description(use attachments if necessary): T ec4 eel l ea rA wcc 6�� CC WA ya Oc� .... w a [usC .avc� �u�Ct- . 2 )ard of Trustees Applicata WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:,-...... .. .. wa4 Area of wetlands on lot:Go'x!o = 6 o o square feet Percent coverage of lot: . Z.r % Closest distance between nearest existing structure and upland edge of wetlands: 6o feet Closest distance between nearest proposed structure and upland edge of wetlands: N feet Does the project involve excavation or filling? .L.. _No __..... ... .._Yes If yes,how much material will be excavated? lel 19 cubic yards How much material will be filled?_. cubic yards Depth of which material will be removed or deposited::_ N.�!�_. feet Proposed slope throughout the area of operations? N. ,/d9.-- ... .. -,: .. . . Manner in which material will be removed or deposited:. .. R1A , ... 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): J MARLENE LANE CIVIC. ASSOCIATION PO BOX 1082 MATTITUCK, NY 11952 9/12/22 Ms. Diane DiSalvo: This letter will confirm that Michael A.Kelly is Treasurer for the Marlene Lane Civic Association. Sincerely, Susan MacLellan President—Marlene Lane Civic Association RECEIVED SES' 14 Sou thold Town Clerk p ECEIVE SEP 15 2022 Souriraid TMM Board ofTnrswo 617.20 Appendix B Short Environmental Assessment Form Tustritet.io issor Cb&6 tfAt 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 1-Project and Sponsor Information t �h_��/►i�h[/lN� Cl UlCesDG 1G�`�'fDo^ -- — --.. Name of Action or Project: kcjl lGtGL Project ooaion(describe;and attch a location map)i : ec-.O..N.t.G ..__.. GL Brief Description of Proposed Action: �2ep[�c� zXts �e 44,e,. c000J boUwd�cq(� -'Q- ce—, P et vers .... .. .. ..... . . . ...... ........ ........... __. _ l Name of Applicant or Sponsor: Telephone: �- 4t nE-NIai1 r�t�el n..eC+v�� nSSVG. l i � ��Lj. -lrnet4jt)Pet• Address:. PC) 13 toff.:_.. -- ._ .. ---- ----- -...... . City/PO. _. I _._-- State: Zip Code: _ 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordi ce, NO -:_YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that FYI may be affected in the municipality and proceed to Part 2. If no,continue to question 2. . -. - - - - -- - .. - 2. Does the pi=oposed actiori'require a permit,approval or funding from any other governmental Agency? NO . .YES" If Yes,list agency(s)name and permit or approval: 12 El _- --.._ _- ..:... ..._._.........___._...:.:-:.. .. -------------- -- A"i 3.a.Total acreage of the site ofthe propos action. - _..... .: :::::._,acres b.Total acreage to be physically disturbed? .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 WIResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): (p"Parkland Page..l...of.4 ._,.._..... .. .....:: ... ... :... .. .: ..:....:............. .._:_._. . .:::...,..::. 5. is the proposed action, NO _ .YES N/A a. A permitted use under the zoning regulations? 0_ 2 .El. 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? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Aiea.-. " NOF'-- YES If Yes,identify: - - 8. a.Will the proposed action result in a substantial increase in traffic above resenf levels? b.Are public transportation service(s)available at or near the site of the proposed action? o :a c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? FV-1 ;� ..._ ....... 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: - �: 0, 10., Will the proposed action connect to am existirig 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 forg rovidin wastewater treatment: ( ;j Imo! P 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? -❑ _.._........ _ .. - ...... ._:.... 0 I—l= J.a.Does any portion o e 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 El Forest ❑Agri cultural/grasslands El Early mid-successional 91 Wetland ❑Urban ❑Suburban _ I5.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, a.Will storm water discharges flow to adjacent properties? D NO DYES a: El b.Will storm water discharges be directed to established conveyance systems(MNO off and storm drains)? If Yes,briefly describe: DYES Page 2-of 4 r 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:.. ...... ... .._.._............_. ..._ . ... --. _ 19.14iis 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-. E! - I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: m �. _. Date:: .�(�/ l Z 2— Signature: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?" 0 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? EJ ^r• -.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 establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or 7 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 incorporateF U1 (�( reasonably-available:energy.conservation.orrenewable.energy-opportunities? 1—t. ........... -_ ._- 7. Will the proposed action impact existing: ( a.public/private water supplies? !L-� ❑' b.public/private wastewater treatment utilities? ❑_ 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? El 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? '. :,.a.::::_.:.,..,:.:_..:.. ...........:,.:..,�......_:....r.: Page-3�of4 y ...._:_.._... ................... ...... ....... No,or Moderate small to large impact impact may may occur occur . 1 Q. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? E El 11. Will the proposed action create a hazard to environmental resources or human health? El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or 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. n -C.heck this boz if you have determined,based on the information an 4nalysis 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. nCheck 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 -lame of Lead A gwend 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 ,: .. ... . .: . ..... . ..... P 4 of 4 _.... . .........: ... aQe. .. ;ard of Trustees Applicati_ AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS 'HAT'HEAHE 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. L Sign tore of Property Owner Signature of Property Owner QP AG�r SWORN TO BEFORE ME THIS 6... DAY 13► e No.o1N06 Qualified in Suffolk COU22 , ..:::...................- ... bion Expires June 7f;2f� � :K6ii Public and of Trustees Applicati__- AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000-. .12- in the town of New York, hereby authorizes ......:...::...:.. ....... _. .�rG.._Asoe4 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. Propelty Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF.... ..__.. t' .. ,20 Q 02�-- Rdcl W 0.Ncdicarrow A tdry Public,Stafei'-6 Nqw Yt&;a: _ No.01 N06224106'' Notary ublic mmi�on Expires June 21,20� 9 APPLICANT/AGENT/REPRESENTA.TWE TRANSACTIONAL DISCLOSURE FORM Thi~Towtrof S6 tlibi&g Code'ofl thtcs' rahiliIts c nilicts of interest oMhe art of t6wi officer and eM16y- sTfie burn.6se'®f is eif A town ofpossilile conf cts,ofilitersti auitallc�w3t td take idbate�er aatibn.is _necessarXta avotd`satn _ YOUR NAME::--.... L�..IClLt,�-OI.... �..'.. J��i �re-it's(1ne,r-, (Last name,first name,4iiddle initial,u4as you are applying iathe name of someone else or other entity,such as a dompany.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 yov pei anally(oi through your.cainpany,spouse,sibling,parziit;-or`child)Have.a.rclafions lup:z nth_iuiy.officer dr:etnglayce: of the Town of SQut inld? "Relationship"includes.by blood,t,tarriage,or bussness:itere5t`Busini Ss ii�tei sf'iriearis:a lyus nets, including a parinership:in which thelo"officer or-employee has eveta partiat:oivrizrship o£(ot employment by)a corpacation: in which the own of£c r or employee o�vnsmore than 51o:of the shares. YES NO 1!�...... 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 day of 200_ Sign Print Name_._... Form TS I h yYJ it,Lilie 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. piroposed action..Will _be<.:evaluated -as_..to its =sircant . . beneficial>and adverse effects::unon tTte coastal area,(wlucli::uieludes all°af Southold fiowri) 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; .earl ausw,- 6r-aniist be..e'x' iued fi i-detail:lW1fi:=.._bothsupporting and.non .suoportivaActs. If an action cannot be certified as consistent with the LWRP policy standards and conditions,:it Aatnot:berundertaken. 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 PROJECT NAME_._ v,� �� I _ v�► t> ce ._�cz�� �c w .�e����i.. _._[':t 0- 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: El Nature and extent of action: �i p. Location of action: Mor.-, t Loa), "o-, P,-,en�� �3 0 �1✓� Site acreage: IO Present land use: .... �o��lLtii4y 6 eL, CT 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: ^a%" .L.�ki e—.. ._L t v, �) Mailing address:........._:P.D - y ... 109.2 VYI�► - �rr�(� N )' L C C1 S-2— (c) Telephone number: Area Code 72 q -,S Ila y. . ml ;d Aplication number ifar Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes NoUR; If yes,which state or federal;ageicy?. ..... 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. Yes F] 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 .0 No Not Applicable �Z 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;Q No R01 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 NoEO 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 YesNo F;�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 AYt,.:cable 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. D; Yes No 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. E] YeED. No RNot Applicable Attach additional sheets if necessary i�/ WORKING COAST POLICL,.� 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. [D'Yes E] No Not Applicable ... . ....... ............ ........................... Attach additional sheets if necessary Policy ecessa ryPolicy 11. Promote sustainable use of living marine resources in Long Island Sound, the Pec"onic Estuary and Town waters. See LVVRP Section M—Policies; Pages 57 through 62 for evaluation criteria. QYes O' No� Not Applicable .............. .. .......... ............. ..........- . ..... ..... Aftkh additional sheetsif necessary Policy 12. Protect agricultural lands in the Town of Southold. See LVVRP Section III— Policies; Pages 62 through 65 for evaluation criteria. .0 Yes No Qd Not Applicable .......... ttac . .. .... .... ........... W�-aZn-al sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See .LV*%P Section III—Policies; Pages 65 through 68 for evaluation criteria. [D Yes Ej No PI Not Applicable ......... ... . ....... PREPARED BY -TITLE 1-44, -----DATE&Jq13JI,�2� ......... ............... .......... ........