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HomeMy WebLinkAboutTR-10390A Glenn Goldsmith,President Qv soy Town Hall Annex 54375 Route 25 A. Nicholas Krupski, Vice President ,�� ®�� P.O. Box 1179 Eric Sepenoski i Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples ® Y Fax(631) 765-6641 10u Ti 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 '/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith,President ®� S0 Town Hall Annex A.Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski J�L Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples �� Fax(631) 765-6641 COU , BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10390A Date of Receipt of Application: May 24, 2023 Applicant: Barbara Greenfield SCTM#: 1000-90-1-24 Project Location: 550 West Lake Drive, Southold Date of Resolution/Issuance: June 14, 2023 Date of Expiration: June 14, 2026 Reviewed by: Elizabeth Peeples, Trustee Project Description: Replace failing (collapsed) block cesspool with an Innovative Alternative OWTS and Geotextile sand filter leaching system. 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 Thomas A. O'Dwyer, PE, received on May 24, 2023, and stamped approved on June 14, 2023. Special Conditions: Installation of gutters to leaders to drywells on the dwelling. 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 A5-BUILT SITE INFORMATION: -SUFFOLK COUNTY TAX MAP ID:1000-90-0I-24 OF NEW y -EXISTING 3 BEDROOM HOME NO PROPOSE CONSTRUCTION.FAILING BLOCK CESSPOOL EMERGENCY SEPTIC REPLACEMENT. r P% -LOT AREA:ACRE 0.24 y} {T '> ^ .• -PROPERTY LOCATED AT WEST LAKE DRIVE LIN p SOUTHOLD,TOWN OF SOUTOUT HOLD,SUFFOLK COUNTY.NEW YORK � ��_ �—MaFn—�.am xu KA1ER—�1,aE1tr x ° & -SURVEY PROVIDED BY:TIDE WATER CONSTRUCTION II-0I-1985 -VERTICAL DATUM-NAVO'1988 DATUM C9 PROPOSED 20"POLY-LOK -PUBLIC WATER SERVICE DISTRIBUTION BOXALL HOMES WITHIN I5Q ONPROPERTY PROPERTY CONNECTED TO PUBUC WATER SERVICE. SURFACE W1OFESSIONP� $. '+".,• • GENERAL NOTES: 1.EXISTING 3-BEDROOM HOME MTN FAIUNG BLOCK CESSPOOLS.NO PROPOSED CONSTRUCTION. DRIVEWAY CRUB,FE 2.VA OWT5 SANITARY EMERGENCY REPLACEMENT DESIGN-SUFFOLK COUNTY 51P GRANT PROJECT. "+a}OLLARD,OR EQUA HICLE 3.51TE PLAN AND REFERENCE ELEVATIONS TO BE USED FOR VA OWT5 SANITARY SYSTEM ��� ETERRENT TO BE I ALLIED CONSTRUCTION ONLY.EXACT PROPERTY BOUNDARIES.UTILITY LOCATIONS AND ELEVATIONS sss""" S NECESSARY ARE NOT GUARANTEED. 4.ELEVATIONS BASED ON PROPERTY SURVEY BASED ON COUNTY G15 AND ENGINEERS FIELD / ! " MEASUREMENTS. F 5.ONSITE UTIUTYMARK-OUTS TO BE PERFORMED BY CONTRACTOR PRIOR TO PERFORMING 51TE PROPOSEDSTH °•S ° G.WORK. ' lr SOIL TEST HOLE DATA PROVIDED BY HOMEPORT ENGINEERING PC 3-28-2023 FUJICEN-5 VA OWTS WI 7.EXISTING SANITARY CESSPOOL5(5)TO BE PUMPED AND REMOVED AS NECESSARY PER 5CDH5 wDEADMEN FOR ANTI-BUOYANCY STANDARDS. 0 ev y / u• PROP.INFILTRAT PROP05ED VA OWTS SEPTIC SYSTEM FOR UP TO 4 BEDROOM RESIDENCE: a � - ATL GEOTEXTILE ND 1.ONE(I)FUJI LEN-5 1/A OWTS WITH DEADMEN FOR ANTI-BUOYANCY W P t FILTER TRENCH (2X) 2.ONE(I)FUJI MAC80R BLOWER,VENT AND FUJI CONTROL A55EMBLY SET ON ELEVATED LU LU r EXIS.SANITARY BLOCK •' 35'X4'ROWS- PLATFORM ABOVE FEMA ELEVATION. Y r- CESSPOOLS TO BE PUMPED AND $,' e" EXCAVATE DO O 3.ONE(I)POLYLOr.DISTRIBUTION BOX. CO Q )- REMOVED PER BCD PORCH `<. NATIVE SAND( ROX. 4.7W0(2)35'ROWS OF INFILTRATOR ATL GEOTEXTILE SAND FILTER(GSF)3 BUNDLE OPTION. Z STANDARDS. CO ;K y"I 80 YARDS OFF TOTAL OF 801F ATL GSF MATERIAL. 5.APPROXIMATELY 80 YARDS OF CLEAN SAND FILL FOR USE BENEATH SANITARY LEACHING (n 0 STRUCTURES.EXCAVATE TO NATIVE SAND(517/5W)BENEATH LEACHING SYSTEM. W J p Tg GENERAL SANITARY SYSTEM AND INSTALLATION NOTES: Q �` • > R 1. VA OWT5 5EPTIC SYSTEM DESIGNED FOR OF TO 4 BEDROOM HOME PER SUFFOLK COUNTY `� _ qy - DEPARTMENT OF HEALTH 5TANDA.RD5(5CDH5). LL O 2. SANITARY GRAVITY DRAIN PIPE TO BE 4-INCH CAST IRON AT FOUNDATION PENETRATION AND Z LO ~ FUJI CONTROL PANEL,MAC BLOWER II ; 4-INCH PVC 50835 DOWNSTREAM OF FOUNDATION. W LO ASSEMBLY,AND VENT LOCATED ON p " 3. I/A OWT5 SHALL BE TESTED FOR WATER TIGHTNF55 PRIOR TO ARRIVING ONSITE U51NG THE U-1 O METHOD APPROVED BY MANUFACTURER. co RAISED PLATFORM ABOVE FEMA FLOO 1 g: ELEVATION AS NECESSARY INVIEW OF INFER SHALL OVERSEE THE OWT5 DURING SYSTEM STARTUP. (7 SANITARY SYSTEM. Fy; y > 'tiI 5. THE OWT5 INSTALLER FOM 5CDH5 AND BE A �q `� FUJI AUTHO ZE 6g 2 G. THE OWTS" T GI,!Q�.Rgg b T T1 SYSTEM WITH SC H5. THE DESIGN E' S ID Ec.L�I O DOESA MAINTENANCE 0ER AND THE t o €€€��� AN OPERATION AND MAIM A j c FFF PROPAGAIN WT WkTE tt WNER(///SLLL{MAALLLLL 15E PROVIDED TO 5CDH5 FOR VA OW75. + O: DZ�TICS, TIM. CONTRA O 5 B TIBT:II I a9 AS NECE55 RY PRIOR TO W g $• 1NS� N F HE PR 5E IC SYSTEM.{I��°f�J� `p 11.7HE�1 NG AREA OF NG ANY NEC SCARY n DE-V✓A N I I ING M R U DWATER IS- ICIPATED TO n7 Q' BE APPROXIMATELY G'±BELOW NATIVE GRADE 1 U 5. 'd M V'n ;y 12.N TO BE VENTED THROUGH 2 CH CARBON 0O f' _j n v + m LL < T FAIN O-FOOTSjy TaATL'w (n R.Ii mva F U Y Q v w.°°K';°,� -mss co &p = Z o¢C co Q <c evv r ~ n SANITARY SITE PLAN SCALE= 1:20 [ J DATE:05-09-23 i SCALE:1:20 0 20' '40' MAY 2 42023 �! DESIGNER:TAO Ll SHEET: ` SoLKPr,+I_l Tbveia Board of Trdstee� S�fFO(� Glenn Goldsmith,President � Town Hall Annex A.Nicholas Krupski,Vice President o < 54375 Route 25 0 Eric Sepenoski ,? P.O.Box 1179 Liz Gillooly �y • ��� Southold,NY 11971 Elizabeth Peeples l �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Jvne 5, U23 Completed in field by: (es 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 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: S va 4 e�S k Au-{X1; +o b-c co n e c TA +o Ie&AeK A"wr llS M k ay X Present Were: G. Goldsmith N. Kru ski E. Sepenoski L. Gillooly ► E. Peeples Ram �m OS1]-01 � �zzm g" ,s TOYM OF '4 SOUTHOLO W zanct) Q, �\ :,xorvFn - POr/VT nn ra -------- f to _-___ M _ f3 3\ / TOVrti OF 0 OEDq souTHotn. ,/ O a, 3 fe x TOWN OF souTHofn n,n ) R PO)lyr. l zoA(q a�>«.•,..>.., ..% e ' \ a'^' ,� . fs6) ro,� WEST � P n n., .\ w n zq � OFO ,u �Ft. ,✓ s U n —__ �0 ,a iLL'm•+�uw ww iq�l___- \ a , TOWNOF ' pe ,> q n. >°' N fi t b � WUIROtD V mn � ZS t5w m DR( if)Nc) ,e 1) fe fa N Z' NOG! `'`--- �`/ o n.�— .n A v mu iia ..o• i,i P n � � "w nm� t,w� nw �� —.._.._ NECK -- BAY _. "a E1211 �Y� __">'__ NOTICE y COUNTYOFSUFFOLK © E am °f SOUTNOLO SECTION NO G, _ __ a Y�Real Property Tax Service Agency v Nr -"—_ ptunrvce�ravt�.a.rvYtt�t M 090 p...qw zz w �zrp a12 w w —_ o..u. --.-- .,.�..o..nu.--vvw-- rz ew A )zc,iu° 100D t'nRt ----- �y P fv PROPERTY MAP 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 - G ue rcia—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 West&wann o o Fid! ime Oifiee Assistant Southold Town Planning Department P.O. Box 1179 i i Glenn Goldsmith,President ,: �,'�� 88(/11,.. Town Hall Annex A.Nicholas Krupski,Vice President +' ,`O D ' 64$76 Route P.O.Box 11799 Erie Sepenoski Southold,New York 11971 Lis Gillooly `'• '' Telephone(681) 766-1892 Elizabeth Peeples • •`,�,�.y�, Fax(831) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use O Coastal Erosion Permit Application g�� Wetland Permit Application DD T ministrative Permit MAY 2 4 2023 _ AmendmentlTransfer/Extension eceived Application: 5--24.23 eceived Fee:S ZSD.Oa soo[rc;i;+gown Board of Trustees Completed Application: TZL•Z� Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec._ ry Lead Agency Determination Date: Coordination:(date sent): _7': LWRP Consistency Assessment Form Sent: CAC Referral Sent: _ Date of Inspection: Receipt of CAC Report: — T'echnical Review: _ ✓✓ Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): Barbara Greenfield Mailing Address: 306 West 38 Street New York,NY 10018 suite 1101 Phone Number: 2129719210 � 0-- �3`1 Suffolk County Tax Map Number: 1000- D 5S0 �ES-V l.(kitE n,21vE Property Location: My (19-71 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: W_".� Email: _ Y_ Board of Trustees Applica `on GENERAL DATA Land Area(in square feet): , 10, S s +!r Area Zoning: 0,7-NT I AL Previous use of property: RIE5 I M14T I h L Intended use of property: Covenants and Restrictions on property? Yes _allo if"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? JaYes FV1 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. is project71�17NO y demolition as per Town Code or as determined by the Building Dept.? Yes Does the structure(s)on property have a valid Certificate of Occupancy? Yes 7 No Prior permitstapprovals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permittapproval ever been revoked or suspended by a governmental agency?J1 No_n Yes If yes,provide explanation: Project Description(use attachments if necessary): ut �O Lk �'�WT-Y RCCLh/P oy( 1-/A-TCP­ • SF?Tic. S7 s i 0h eNojrZCf AI PL-A-C(A,C F41UuG 6CDLL It PSg:Q) 5 L OCA t C'eSs poa t. 1.,,4 rH 1/A o'vT"5 W0 GfOV.4T+cE Shivo F 1 L TT1\_ L.q A-C(+1rf 6 Sy ST PM . /✓O C I+RNbfi s t+onk� ,vo +001 n oN Board of Trustees Applica jri WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: EXIST 04 CE5 9 F b c i-- IS Coo_utPS►►v t. C�uOiTt oN S . Area of wetlands on lot: 4 square feet Percent coverage of lot: % h Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 32 feet _r Does the project involve excavation or filling? ❑ No Yes If yes, how much material will be excavated?— d cubic yards How much material will be filled? 7 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 4 S_'Jo Manner in which material will be removed or deposited: f-K N 11*102, `''►l_L FQ10 V C ()N AgokdocW C, Isflpj6 CiSSi'Dot.- 51A-►vp/ &()SF E-k1571WG 51t.T Aviv f3 06 50tt-S 13iftow P(.uV0560 WAC 1111v6 5}RvcTu1kt.5 7e, GC &rC*'-AtUV) A1y17 400-AC10 L,/(-Tf Ct_CkN sA(Vf) F►{-L Pati 57C41t-s 5!fNy0MA05, 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): ?'A-F '&JE&�- 1/ � ©LJT3 5 f T 1 C 5-7STVI Is +Iv i���w�►�+6,c r 1/S CV1 S i1NG CESS CODL. % VV--tS X141. JJZJ T 'To A- 4VIbt+r/\_ 5 i f-}►JoAAo (3[,FofLV I0JSC1+df1.GJA/G !r fNTe 1+11 61WA10 V(A r`y lineAov ) LeH-c.wA dysi cri , 0VfakLA- aA.1v►IZo -"UfvFA-L )3ENrzF/)7 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project 1nrormation. 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 3 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: I/A 4,J STOT w�S�i` . Vh�E p4OJC Soni A-GLO )�Jk Project location(describe,and attach a location map): 550 VE5T- E,n-hC O elyp 5-0,,r+t0 0 1-/Y Brief Description of Proposed Action: l2 TL/l-c:E 641LIA16 Qu.octi CE1sPvci. vrrH [/A.. pwrs . sur-r-OL 1 AV-cwvfr' our G G-krfas nP•N1' Name of Applicant or Sponsor: Telephone: E-Mail: City1P0: State: Zip Code: l.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: ,j 0,045 — 61 xA uwlvcy t16 p,,�rS. F-1.0Ffit FO'- CC'v� Ty rlyiCLR-1M ()J 1_ trk t IFA, 3.a,Total acreage of the site of the proposed action? 0 2't acres b.Total acreage to be physically disturbed? O. D 5 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0-Z-'1 .acres 4. Chei ILa 11 land us at occur on,adjoining an ar the propowd action. Urban Rural(non-agriculture) Industrial Ucominercial ffResidential(suburban) Forest agriculture Aquatic QOther(specify): Parkland Page I of 4 5. Is the proposed action, NO I YES I NjA a. A permitted use under the zoning regulations? i b.Consistent with the adopted comprehensive plan? 6. is the proposed action consistent with the predominant character of the existing built or natural NO YE landscape? 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: GoN�C._ (3A-i El 10 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation servioe(s)available at or nearthe site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site ofthe 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: --------- - 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Sill✓m t 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment; N�'`r //h tis SySSarl ❑ 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? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? 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 typi bitat types that oEn,or are likely to be found on t"roject site. Check all that apply: Shoreline Forest Agriculturallgrasslands Early mid-successional Wetland HUrban 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 Y S 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes, i - i" ^ ❑ a.Will storm water discharges flow to adjacent properties? O ES b.Will storm water discharges be directed to established conveyance systems a, pff an drains)? If Yes,briefly describe: ✓ NO L.YES .......... - -- .-._..... - ..__._........_.__.,._.. Page 2 of 4 l8.Does the proposed action include construction or other activities that result in the impoundment of NO J YES I water or other liquids(e.g.retention pond,waste lagoon,dam)? I 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: __�_ ___._ �WW __ __ _ I"� ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name:.,..._.- . --_. _-_----..,...... _ . . Date: 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 I 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 i small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? a ❑ j 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the(nvi mental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? LJ 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? U J 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate (�J� reasonablyavailable ene conservation or renewable ene o rtunities? u ❑ 7. Will the proposed action impact existing: a.public/private water supplies? 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 ❑ j 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, El i waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? ^11. Will the proposed action create a hazard to environmental resources or human health? y _ 7 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. QCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency —J Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Applica M AFFIDAVIT 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 AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Uwner Signature of Property Owner SWORN TO BEFORE ME THIS Z DAY OF ' 20 Notary ,Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. OID1475593 Qualified In Suffolk County My Commission Expires April 30, 20Z1.0 APPLICANTIAGENTME-PRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics oeobibbs conflicts of interest on the ma of town often and owRig es.The mmose of this fWM 11 to 0mvift information which n it to l@hwhgW=&Wgnj Iry to avoid same. .YOUR NAME: Greenfield,Barbara,L (Last name,fust name,jtiddle initial.unless you are applying in the name of someone else or other amity,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 6mW Erosion Approval of plat Mooring Exemption fiern plat or official map Planning (titer Administrative permit: Replacement of failing cesspool (If"Other",name the activity.) P P g P Do you personally(or through your company,spouse,sibling,parent or child)have a relationship with any officer or employee ofthe Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business intecosr means a business, including a partnership,in which dee town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owes more than 5%of the shares. YES _ NO If you answered"YES",complete the balance ofthis form and date and sign where indicated Name of person employed by the Town of Southold Title br position of that person Describe the relationship between yourself(the applicant/agentImpresemative)and the town officer or employee.Either check, the appropriate line A)through D)and/or descr(be in the space provided. no town officer or employee or his or her spouse,sibling,parent;or child is(check all that apply): E,A)the owner of greater than S°!o of the shares of the corporate stock of the appueeat _n (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corpomte entity(when the EIapplicant is not a corporation}; CJ an officer,director,partner,or employee of the applicant;or D)the actual applicant: DESCRIPTION OF RELATIONSHIP l Submitted ft 24 day Ra 02`3 Signature Print Name Barbara Greenfielffl Form TS 1 Town of Southold LWRP CONSL43TENCY 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 gnosed_action will be eyalu&W as to its sipnficant beneficial and adverse effects upon the coastal area(which_includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or"no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be em alained in detail= listing both suauorting and non- suoaortine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.north%rk.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 Z1�j}/' SC 1000 -9O eJ PROJECT NAME S50 LEST Lf+h E 0A1,1L SOUT'i v uo 91EAG01vLY 1/� o vrJ 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: E Nature and extent of action: grQ►.A(,rL-rACfv' C>iF Aril-ANG Cu fogy-+- coir (tact rr► n�rl �kT&2 t,nn�-T �l�o;rc�' Location of action �j S o �5 r L—All i4 Ni Site acreage: •Z`'� Present land use: f k-1 fs'1lys tt on f Present zoning classification: Rli S)Y)if&rTl/k L 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Will the action be directly undertaken,require finding,or approval by a state or federal agency? Yes ❑ Nom 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 we of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development, See LWRP Section III--Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ❑ Not Applicable Proposed emeruncncy casspool replacement will=lace an old.failing cesspool with new advanced system.The coastal location of the property means this increase in watertreatment capacity will mitigate impact of coastal development on coastal water nutrientad. 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 ❑ Yea 0 No 2 Not Applicable I Attach 0906nal sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No Fvl Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, sti-nctures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ 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 for evaluation criteria 21Yes ❑ No sot Applicable New septic system will protect and improve quality of both groundwater and bay water through increased filtration. ttaadditfo-nal 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. El Yes nNo ❑ Not Applicable Location of dwelling is near wetlands and peconic bay.Replacement of failing septic system with modern one willdecreasenitrogen input res Tong in less pianicton production anct consequen y greater fishery and weffla-M—reffillience Attach additional sheets ifnecessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑No 12 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 evaluatiop criteria. ❑✓ Yes ❑ No ❑Not Applicable Replacement of old,failed septic system with modern,evaluated model will decrease domestic runoff. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational we of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III-Policies;Pages 38 through 46 for evaluation criteria. ❑ Ye[:1nn No❑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 LWRP Section III-Policies; Pages 47 through 56 for evaluation criteria. M Yes ❑ No ❑Not Applicable New septic system will decrease nutrient load into coastal waters resulting in less p iiiEon pro eration; increasing Me Mile of so-Mold's coastfff ecosystem services. Attach additional sheen if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III-Policies; Pages 62 through 65 for evaluation criteria. ❑Yes El No ✓❑ 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 BY Barbara Greenfield TITLE Owner DATE 05/24/2023