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HomeMy WebLinkAboutTR-10391A Glenn Goldsmith,President ®F s®�/j� Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President ,�®� ®�® P.O. Box 1179 Eric Sepenoski8 Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 COU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 2093C Date: October 15, 2023 THIS CERTIFIES that the clearing of a 10' wide path through property for trucks to gain access for purposes of ?round testing; At 2020 Bay Avenue, Mattituck Suffolk County Tax Map#1000-144-3-40.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated May 26, 2023 pursuant to which Trustees Administrative Permit#10391A Dated June 14,2023,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 clearing of a 10' wide path through propeAY for trucks to gain access for purposes of ground testing. The certificate is issued to Joseph P Vermaelen&Kathleen Powers-Venmaelen owner of the aforesaid property. m Authorized Signature Glenn Goldsmith, President ®F SO Town Hall Annex A. Nicholas Krupski,Vice President ��� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski AL 13r Southold, New York 11971 Liz Gillooly C G Telephone(631) 765-1892 Elizabeth Peeples rn ® a® Fax(631) 765-6641 ®��C®UNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 10/6/23 INSPECTED BY: C , C_;v1k%A* Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection COMMENTS: o`, �0< off' G. 10391 A CERTIFICATE OF COMPLIANCE: Glenn Goldsmith, President �Qf 80 Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Elizabeth Peeples � ® � Telephone(631) 765-1892 Fax(631) 765-6641 co BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed When project complete, call for compliance inspection; Glenn Goldsmith, President ®�*®� so Glenn Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ® P.O. Box 1179 Eric SepenoskiR Southold,New York 11971 Liz Gillooly 412C Telephone(631) 765-1892 Elizabeth Peeples ® .® Fax(631) 765-6641 coum BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10391A Date of Receipt of Application: May 26, 2023 Applicant: Joseph P. Vermaelen & Kathleen Powers-Vermaelen SCTM#: 1000-144-3-40.1 Project Location: 2020 Bay Avenue, Mattituck Date of ResolutionlIssuance: June 14, 2023 Date of Expiration:June 14, 2026 Reviewed by: Glenn Goldsmith, President Project Description: Clear a 10' wide path through property for trucks to gain access for purposes of ground testing. 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 Joseph P. Vermaelen, received on May 26, 2023, and stamped approved on June 14, 2023. 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 v {I)UYA+!Tn:wt7jl,ALIF.R,nr1ON C4'13M III TC-Ars SURVEY 5 A NOLARIN W SECTION 77f'd OF"IF'N[Nr PORN STATE EDIR:ATKN Llw.(21 gcTAN^['•,Irhp,HF,, FRN P-Z-ERTY ZINC-TO F4-MW'-T CT1W,ARF Tri!A'rE7'IC—Pr.05E AND ARE NO-TO R::!;,0 r."E3_A4L1'1 recx'HrY LIN"6t"clffCIIEN r FEACfs.(3)COKS W,IAS SIIPL -IµW NOT BEARMD " LANU S7MitY(tY5 NICD SEAL 11 ENUn63 1 SEM AWE NCI BE CCtMERED M Or A VALID WE COPY.(4)CrRTnCAT*N INIV-40)1YR.:CN S11-l' NUN ON_Y I)M ITRSON FOR Nod!TIE SIMVT•+•IS VWPARCD BE WD ON HS HALF TC TF'E TITLE COP+N•,C4'V-RNNFN-A1 ••7 rM.`•AG`tENi;al(:As0TY 1U 'N "• 'isrvo .L()N,AND Al;y; AS141:110ES OF fit LIM)14-IN-IN-7-HU-11M1M!!SR'.4TRMI•:IRC Nr, RW,,r,_Rm A3V TO♦DomA:-MSTm nags OR suenr0UEnT O"NcAi (S)Tw LQP.ATII,N d'wLt3(7),cpnC TANKS(ST)R CEWMS(OP)91O5N NEW"ARE FWW RE1.0 OOSM-ATICNS AND OR DATA OETAI P,FFO!0DfMS. HEALTH DEPARTMENT USE 400 Ostrander Avenue, Riverhead. New York 11,101 �'"`� tel. 631.7272305 fax. 631.12?.0144 adminOyoungenglrneering.com � �� � y� 1�{�y n y or f orme''�y 4�t�4•(� �, V��l(� now a E.SntdEr.Jr. CMF Georg ,�•- � I J Howard W. Young,Land 5urveuor _ - Thongs G. Wolpert, Professlonal Engineer Douglas E. Adams, Professional Engineer Robert 0. Tost, Architect Robert 5tromski, Architect 3 _�> SITE DATA --- - imi.1.4 iim l4t former, AREA = 40,086 5Q. FT. V _ } now oIF M very' II o re -Cr o S L.DAIllM _ =NAVD 1988 a� evoodb,e t ) f!!Ay 2 6 2021 R ' ct APPROVE BY n' BOARD OF 4I RUSTEES I LEGEND TOWN OF SOUTHOLD naRn+iam:xr CLF =CHAIN LINK FENCE ..- -�� ' ` ICMIF DATE sing, 14, Z04-13 CMF =CONCRETE MONUMENT FOUND _ CM5 =CONCRETE MONUMENT SET p CSW =CONCRETE SIDEWALK I p •"'^-'- EOP =EDGE OF PAVEMENT b Q OL =ON PROPERTY LINE U, RID =ROOF OVER RCS = REBAR&CAP SET WIF =WIRE FENCE now or fen WDF =WOOD FENCE A ¢Arlc stef ruCh I W5F = WOOD STAKE FOUND 5he��Y ' { ENGINEER'S CERTIFICATION WSS = WOOD STAKE SET UTILITY POLE lAr { "I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL • =END OF DIREM- ON/DISTANCE _ - SYSTEM(S)FOR THIS PROJECT VIER'nESIGNED BY ME O?,1JNDE9 MY t DIRECTION.BASED UPON A CAREFUL AND THOROUGH�i3�`%3T�N OiL, WETLAND FLAG&NUMBER /"` SITE AND GROUNDWATER CONDITIONS,ALL FA Ei-Vi $;AS-PPoPO5Fb;�. CONFORM TO THE SUFFOLK COUNTY DEPARTME O F�EAL Fl f�SEIii4,CE�i- CONSTRUCTION STANDARDS IN EFFECT AS OF.-�}FIJ1A�E" Ott /J• /�/ 'k't-. { mer ',``-. oW or or aeken g$ ' `�` ri v 'ra �e�eri 162 (� i I HOWARD W.YOUNG,N.Y.S•L.S.NO.45893n :•, Qeter r�ever . ,_/ I _.1 ' I THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483 l,�n/�,,E ,� ear+ QyC+ng� ,r Ile DOUGLAS E.ADAMS,N.Y.S.P.E.PENO. I 1 E Cyr Y -3-' Elk °��zNA _IAAjDq ; r SURVEYOR'S CERTIFICATION_ r{ormer y� no o mae�e tn� " WE HEREBY CERTIFY TO JOSEPH P. VER , Atm; T \ o \ 1 1 ver = g. / SURVEY WAS PREPARED IN ACCORDANCE WITH GE)DE"QF�PRdCTtGEF� _ 3.74 (o \ (31 t r\G15 P" d�, EI LAND SURVEYS ADOPTED BY THE NEW YORK STAF E X�S.56CIATION d '\ -`?�� _. o Q -'y4.o3 l~ cs O �� rf bra „E ,� SEA IL I 0, / '� PROFESSIONAL LAND SURVEYORS. iH G •rr. \ — T r 1 ' 0 4Q, , c at)5 '(� '," 6.05 - !� s' �17�95 1>`- m`~15 N'4 (i N V Fd J �!ER VV ', RC 5b' 1 I ' R✓C./�-- �`\ Pte ': POW 0 "64 78.•l/ r 60 �b"10 fry SE` —J.- Nr tt3 1^ �T �:,, l ��•3 x ¢.' 93- 15 A T of gtz I l►`�-`, _ `, ' -L � HOWARD W.YOUNG,N.Y.S.L.S.NO.45893 `.,� ----�''�•,`` +3.22 i 2-89 t.WV) AOD AS 1ry8/2 at5 I�4`.-� j 6.41) 4 r r 7 t�cj`v WEIL +2.76 6.d4,\�\CP d�,+ \ , oo_ SURVEY FOR � ' � ra PO 0� �i Z`� - ---- __ � +•t.74 ,h �`a Ga 0 �Q 0 ''c .22( p � n tri r-' _ ` ` JOSEPH P. VERMAELEN �` P� ✓ ,Sd / V�OOb 4.49 .35 J t h O� 1 +5 !n.— — 66 �� ► \ ' 17.29 \ i 4.87 =T ` - at Mattituck, Town of Southold S Nh 1 Jam`\ i / 4.1 \ �, — i ' , 74�; \ 6 Suffolk County, New York � _d_ r _ , � f e\no - 5b I 1 EAS ba J \ g / 1\011ar ora �a �� f f v �o�9� �-- �� P BUILDING PERMIT SURVEY County Tax Map District 100 Section 144 Block 03 40.1 40.1 FIELD SURVEY COMPLETED SEPT.12,2022 MAP PREPARED SEPT,13,2022 >N or dorm Grakolls \ - a ft 1aS p, 64 r cMF � 1_� Record of Revisions r a ass " 04, �tG 0 `DWQ11itL95� I \ \ f REVISION DATE Q 0 R+Z Z --- — ` °h P•' GA m 6 �G i 0 p 40 .0 20 40 80 120 - p1�cVJoterZ -- - -- -- — --- ----- a \f by)eUingo Scale: P = 40' JOB NO.2022-0155 DWG. 2022_0155_bp 1 OF 1 E Glenn Goldsmith,President �� �'OG Town Hall Annex A.Nicholas Krupski,Vice President. c y� 54375 Route 25 Eric Sepenoski ,? P.O.Box 1179 Liz Gillooly �y • o!� Southold,NY 11971 Elizabeth Peeples ��� �a Telephone(631)765-1892 Fax 765-6641 Southold Town Board of Trustees Field Inspection Report r Date/Time:�j2/23 Completed in field by: JOSEPH P. VERMAELEN & KATHLEEN POWERS-VERMAELEN request an Administrative Permit to clear a 10' wide path through property for trucks to gain access for purposes of ground testing. Located: 2020 Bay Avenue, Mattituck. SCTM#: 1000- 144-3-40.1 of area to be impacted: Typ Saltwater Wetland Freshwater Wetland Sound vlBay Part of Town Code proposed work falls under: --/C hapt.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 needed/Modifications/Conditions/Etc.: needed/Modifications/Conditions/Etc.: Aan S OU A La- CAN *e_ SOA, CkAlla Olt 0'%'/ay TY be1+ Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples o'. r \• - 3pm t <l :��.,. - `"„�,- .l iii F f?, i •'\.` _ wIrIll 2� n� �p T \, V. N` 1 .'o S .0 �• t { �Y `t a l / 1 r:. < L rw ao / 4. • ; 1 \ / cl IA V\ ,�o-/' / \s r• ` \ t� '4� a \ w \ \>/ \ 'yam\, /�e�a` :" ` 03 ) •'�'.'.z".'�, \. .. .CP• {Y \ 0�».� p` '. ,•\.mow $ �o r e >/-, { � , s+ y � E y ...i`:�. ..vs r/,.�/1}$:^ Y d r \\ %,r, �+ ,y r x rpt, \T"� n\ 9\'. 'y K, p i {'•.4 1'`�4 �,.• P> : a� IK It, �r ,•Rdf�i �s\ m\°� � � \, ��'�:° 't .I -.i ---- �' _r'C <•• rv" z /o-, 2 \� � \ `Ys e>tl\/\ �,=/'y, ��(��•' g a• "a ,� s i'�� ��." �''�.. �!. ,'e.:, �=(k itl lle lo \/ rr .t••. x /(� \xb\w \\ r a,',/ 3{l �\\ �'L.% '0^ a �\;• `y i N n i r' d Z \ a r o y� \ a� e m a6 ,.fir � .';'� •,�� � \ r e o• a„ M1a '1 t x� o _ a/ r � o• M1 a , F• \ i S 6✓ d� { r e\ �d >\ 0 P\, j y7 R , C, G fiF d r"'} O. G �:f , E , , , E:'�.' ... ..,,- ,�� :,x^.'.,T;_:, ',', /T/`/��♦� a ..\, , a` i +x L ,�»,•• - COUNTY OF SUFFOLK© N rraricE K �., {000 SECf10N w Rcal Pr,perty 7a:S—icc Agency w#E44 N , �___ __ _ __ `� �_- y.»., u . i�C'rNnhMt avanq,V'I1901 511PWtCUhfYTAx AY➢61}YN&iFD , ___ y. �rra[ a0vrr r• Cantrell, Elizabeth From: Terry, Mark Sent: Wednesday,June 14, 2023 2:36 PM To: Goldsmith, Glenn; Cantrell, Elizabeth Subject: FW: Phone Message - Liz from Trustees I do not have these plans. I did not see on LF RALPH GUERCIA &VINCENT D'ALESSANDRO, JR. request an Administrative Permit to install a two-row split rail wood fence; a 6' high stockade fence and a 4' high black aluminum fence; to remove dead trees; plant native plants; grade disturbed area and bring in topsoil/fill; establish a 5' wide buffer with blue stone. Located: 1605 Middleton Road, Greenport. SCTM#: 1000-41-2-13.2 Is CONSISTENT— increase buffer width. JOSEPH P. VERMAELEN & KATHLEEN POWERS-VERMAELEN request an Administrative Permit to clear a 10' wide path through property for trucks to gain access for purposes of ground testing. Located: 2020 Bay Avenue, Mattituck. SCTM#: 1000-144-3-40.1 Is CONSISTENT — BARBARA GREENFIELD requests an Administrative Permit to replace failing (collapsed) block cesspool with an Innovative Alternative OWTS and Geotextile sand filter leaching system. Located: 550 West Lake Drive, Southold. SCTM#: 1000-90-1-24 Is CONSISTENT—I would just check the distance to surface waters. What type of system — FUJI Clean is most effective in removing N. From:Westermann, Caitlin<caitlinw@southoldtownny.gov> Sent:Wednesday,June 14, 2023 1:04 PM To:Terry, Mark<mark.terry@town.southold.ny.us> Subject: Phone Message-Liz from Trustees Hi Mark, While you were away, Liz was trying to reach you about the statuses of these LWRPs: - Groenfield—90.-1-24 - Vermaelen—144.-3-40.1 - Guercia—41.-2-13.2 Get back to her whenever you-can she leaves for lunch at 1:30 and Diane already left for the day. . Let me know if you have any questions, Caitlin Westermann o o Time Office Assistant Southold Town Planning Department P.O. Box 1179 i to NV Glenn Goldsmith,President Town Hall Annex , A.Nicholas Krupski,vice President54375 Route 25ir`d f� P.O.Box 1179 Eric Sepenoski i [ Southold,New York 11971 Liz Gillooly Cl- Telephone 631 765-1892 Elizabeth Peeples ra�'• t`' p ( ) ., Fax(631) 765-6641 JK BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office jJse Only , -z Coastal Erosion Permit Application Wetland Permit Application Administrative Permit MAY 2 6 2023 _ Amendment/Transfer/Extension K�Received Application: 5.?�i•� —Received Fee: Completed Application: 2 .2'3 LL " Incomplete: SEQRA Classification: Type I Type lI Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: _ ,Eoordination:(date sent): ✓✓LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report:— _ Technical Review: Public Hearing Held: •/ •T.a Resolution: Owner(s)Legal Name of Property (as shown on Deed): Joseph P. Vermaelen, Kathleen Powers-Vermael� Mailing Address: 389 Second Avenue, Bayport, NY 11705 Phone Number: 631-472-2839 &V (p 3 j-(PA1'6_Lel 3 3 Suffolk County Tax Map Number: 1000- 144.-3-40.1 _ Property Location: 2020 Bay Avenue, Mattituck, NY 11952 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: _ Phone Number: Email: kpvermaelen@gmail.com Board of Trustees Appli(-_-ion GENERAL DATA Land Area(in square feet):. 40,075:2 Area Zoning:.R40 Previous use of property: Residential Vacant Land 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 TownCode? Yes _allo 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 _2 _No If`'Yes", please provide copy of decision. his project re 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? 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? NoYes If yes, provide explanation: Project Description(use attachments if necessary):Clearing.a 10' wide path for large truck access, for the purpose of introducing,equipment to do ground testing required (septic, engineering) prior to applying for a building permit. Board of Trustees Applii__-- =iota WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To clear a 10' wide path for large truck access, so that equipment may be brought onto the property for engineering and septic system testing that must be done before applying for a building permit. Area of wetlands on lot: appx. 4,000 square feet Percent coverage of lot: appx. 10 Closest distance between nearest existing structure and upland edge of wetlands: � feet Closest distance.between nearest proposed structure and upland edge of wetlands:_ feet Does the project involve excavation or filling? 0 No Yes If yes, how much material will be excavated? cubic yards How much material will be filled?. cubic.yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): None. The pathway will.not enter the wetlands area of the property. . 617.20 Appendix B Short Environmental Assessment Form Instructions.for.Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of theapplication for approval or funding,are subject to public review,and may be subject to further verification. . Complete Part I.based on information currently available. If additional research.or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. .. Part 1 -Project and Sponsor Information Name of Action or Project: Pathway clearance, 10' across, from roadway to the back of the property Project Location(describe,and attach a location map): Path to run along the southern boundary of the property. Brief Description of Proposed Action: Removal of trees/vegetation to allow access for large trucks withground testing equipment Name of Applicant or Sponsor: Telephone: 631-472_2839 Joseph Vermaelen & Kathleen Powers-Vermaelen E-mail: kpvermaelen@gmail.com Address: 389 2nd Ave. City/PO'. State: Zip Code: Bayport NY, 11705 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 may be affected in the municipality and proceed to Part 2. if no,continue to question 2. 2: Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES if Yes, list agency(s)name and permit or approval: ❑. 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? 0:070417. acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? •92 acres 4. CheI land us"' at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) industrial.Commercial ©Residential (suburban) Forest [:]Agriculture Aquatic Other(specify); Public.Athletic Fields Parkland Page 1 of 4 5. is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent With the predominant character ofthe 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 Area? NO .'YES. 1f Yes,identify:. ❑ `8. A.Will.the proposed action result in a substantial increase in traffic above present levels? NO. YES;. b.Are public transportation service(s)available at or nearthe site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? Ev( - .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: 30. Will the proposed action connect to an existing public/private water supply? NO # YES If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities?. NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places?. f b. Is the proposed action_located in an archeological sensitive area. I 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. ntify the typica bitat types that oc�Suburban n,or are likely to be fon t roject site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional Wetland Urban 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? ✓ 1 I F1 16.4 the project site located in the 100 year flood plain? NO YES 5T17.Will the proposed action create storm water discharge,either from point or non-point sources? qN0 If Yes, a. Will storm water discharges flow to adjacent properties? RINO OYES b:Will storm water discharges be directed to established conveyance systemsff anm drains)? If Yes,briefly describe: ZNO ES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO . YES. . water or other liquids (e.g.retention pond,waste lagoon, dam)? If Yes,explain purpose and size, {, - Z: .❑ 49.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:_ a I AFFIRM:THAT,THE INFORMATION.PROVIDED ABOVE IS TRUE AND ACCURATE TO THE.BEST OF:MY KNOWLEDGE Applicant/sponsor name: Jose . Vermaelen,:... _. Date:5/24/23 Signature:._,. _1�1. � .......�.,._. _.,._,. 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 3 small to large impact impact .may may occur occur I. Will the proposed action create a material conflictwith 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? ❑ i. Will the proposed action impair the character or quality of the existing community? a o 4. Will the proposed action have an impact on the environmental characteristics that caused thee, establishment of Critical Environmental Area(CEA)?. ❑ 5. 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? El ❑ 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 o po,rtunities? 7. W ill the proposed action impact existing: t a. public/private water supplies? b.public/.private wastewater treatment utilities? a ❑: . 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural.or aesthetic resources?,.. El E 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? �. I f Page 3 of 4 No,or. Moderate small to large impact impact may may occur occur. 10. W ill the proposed action result in an increase in the potential for erosion,flooding or drainage; �''"� (� problems ? El U 1.]. Will the proposed.action create a hazard.to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible foe 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 theproject sponsor to avoid or reduce impacts. Part 3 should also explain how the leadagency 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 Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adyerse impacts and an Elenvironmental 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 VSignature.of Prepares(if different from Responsible Officer) PRINT Page 4 of 4 -� Board of Trustees Applies--ion AFFIDAVIT Joseph P. Vermaelen & Kathleen Powers-Vermaelen BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES_ . THE APPLICANT AGREES TO HOLD THE TOWN OF.SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD.OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION.OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 0--hSiatiureeofPperty Owner *Sligature of Pr&perty Owner SWORN TO BEFORE ME THIS — DAY OF MARY CATALANO NOTARY PUBLIC,STATE OF NEW YORK No. 01 CA6361483 Notary Public Qualified in SUFFOLK County Commission Expires JULY 10,2025 Board of Trustees Applin; ion AFFIDAVIT Joseph P. Vermaelen .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 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. OignVreof Prope Owner Signature of Property Owner SWORN TO BEFORE ME THIS���C--- —DAY OF V\� ,.20 7— MARY MARY CATALANO NOTARY PUBLIC,STATE OF NEW YORK No. 01 CA6361483 Qualified in SUFFOLK County Notary Public Commission Expires JULY 10,2025 Board of Trustees Applic . _ ion AFFIDAVIT Kathleen Powers-Vermaelen BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF.HISIHER 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 TRIS 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. *iae of Pr erty Owner. Signature of Property Owner SWORN TO BEFORE ME THIS��DAY OF-10t ____, 20 MARY CATALANO NOTARY PUBLIC,STATE OF NEW YORK Notary.Public No. 01 CA6361483 (Qualified in SUFFOLK County Commission Expires JULY 10,2025 APPLICANT/AGENT/REPRESENTATIVE. TRANSACTIONAL DISCLOSURE FORM J.he Tow :o S uthold' Codq(tthigg iirwbitjc 'cts of irate es o a e part oftown.officers and;eMnlov&&Theepg=se of this form-is to prodideinfonnition which can alert the:town o€.possible conilicis of interest acid allow.it to take whateveraetibri is necessa�to,nvoid same:. YOURNAME: Powers-Vermaelen, Kathleen (Last name;first name,#iiddleinitial,unless you are applyingli.the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other',name the activity.) Do you personally(or through your:company,spouse,sibling,parent;or child)have a relationship With:any;officer or:employce of the Town of:gouthold? "Relationship"includes by blood,ariarriage,.or business interesC".$uSiness interest'means a business, including a:partnership,in,which the.towrtofficer or employce,,has.even a.partial.ownership of(or empioyment�y)a corporation in which the lawn;off cer or employee owns more than..51lo of11 shares. YES �W1 NO n 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 Eileen A. Powers Title or position of that person Southold Town Tustice 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): _ELA)the owner of greater than 5%ofth.c shares of the corporate stock of the.applicant EL (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity.(wheii the �2applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP We are.. first cQu.sins. Submitted thisday o fmau 2102-3 , Signatur®_ Print Name� L�-��►_(p pin �GC1A��Z _=.' G Foran TS I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town 6f5outhgld's Co&gEEthlcs glohibiti,4flicts of int4stop;the partoftowhofficersand�einnlobees.The nuroose.of. this form is to provide inforinatioti,4hicti can•alertthe town of.nbssible conflicts of interesrai allow.ii to take whateveraction is it a bssary to avoid same: YOURNAME: Vermaelen, Joseph P. (Last name,first name,.jpiddle initial,unless you are applying in,the name.of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally:(or through your company,Spouse;sibling,parent,or child)have a relationship:with,any officer or employee of the Town of Southold? "Relationship"includes by•blood,marriage,:or bpsiness.interest•"Business interest"means a business, including a partnership,:ip.which the town officer or employee;has even,a:partial ownership of(or employment by)a coiporation in which the(oi Per or employee:owns more than:5%ofthe shares. YES _ NO . ... n 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. Eileen A. Powers Title or position of that person Southold Town Justice 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): _aA)the owner of greater than 5%:ofthc shares of the corporate stock of the appliccnt -n (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, oZy d o 207-S Signature _ PrintNee 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. Beforeanswering 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,protiosed 'action:, -ill :be evaluated as to As sijbiifi6ant beneficial andadverse effects:upon the coastal area.fwhich: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: :ea&.answer must:be explainM.in.detail;:listing both supporting:and non supporting-facts. If an action cannot be certified as consistent with the LWRP policy standards and cond tions,,it'ahall not be'uuderta *eh : 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 Trustee's Office, the Planning Department, all local libraries and the Town Clerk's office. D. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 144. „3 x.40.1 PROJECT NAME Pathway Clearance 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: To clear.a.pathway,. 10. across, to allow large truck access to the property for... testing the round/soil.for engineering and se tics stem evaluative purpQse,5. . Testing is needed prior to building permit application. Location of action: 2020 Bay Avenue, Mattituck, .N.Y 11952 Site acreage: •92 Present land use: Residential Vacant Land Present zoning classification: R40 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.ofapplicaint Joseph P. Vermaelen.& Kathleen Powers-Vermaelen (b) Mailing address: 389 Second Avenue, Bayport, NY 11705-1309 4 (c) Telep hone number. Home: 631-472-2839. , 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' P®LICY 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 LNVRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No. Z Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LN6W Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No ❑✓ Not Applicable Attach aii8iti6nal 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 ❑ NoP/ Not Applicable Attack additionai 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 5 through 16 for evaluation criteria El Yes ❑ No ❑ 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 forevaluation criteria 11. Yes.E J No ONot Applicable Atit—ach,additional sheets if necessary Policy 6. Protect andrestore 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. 0:Yes ❑No Fv—(] Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ,l Yes. ❑No Z Not Applicable Attach additional sheetsif 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 Z 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. nn Y00 No 0 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LMFRP Section III-Policies; Pages 47 through 56 for evaluation criteria. Yes ❑ No 7 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 M—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes 0 No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See,LWRP Section III— Policies; Pages 62through 65 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No❑✓ Not Applicable PREPARED B TITLE DATE J