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HomeMy WebLinkAboutTR-10488A Glenn Goldsmith,President ®F S0 Town Hall Annex ®�� ®® A.Nicholas Krupski,Vice President 01 54375 Route 25P.O. Box 1179 Eric Sepenoski ,g Southold,New York 11971 Liz Gillooly e� Telephone(631) 765-1892 Elizabeth Peeples ® � Fax(631) 765-6641 eouNv BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD r CERTIFICATE OF COMPLIANCE #2137 C Date: May 30, 2024 I THIS CERTIFIES that the repairing of existing 5'4"x6'2"(32.89sq.ft.)shed; At 100 Salt Marsh Lane,Peconic Suffolk County Tax Map#1000-68-3-11.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 19,2023 pursuant to which Trustees Administrative Permit#10488A i Dated November 15,2023,was issued land conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the repairing of existing 5'4"x6'2"(32.89sg.ft.) shed. The certificate is issued to DEBORAH L. MCKEAND I& SHANNON J. GOLDMAN owners of the I aforesaid property. Authorized Signature I I i Glenn Goldsmith,President 0 S0 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 BOARD OF TOWN TRUSTEES, TOWN OF SOUTHOLD DATE OF INSPECTION: r , 2-U_ INSPECTED BY: E1aa f OK ?ef P�U Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection COMMENTS: Qrni ec ' tS couvt wig e�rmi� 10��gA� . okay -4v `sSye Cu-�i�icci�c OP Cohn64hCL CERTIFICATE OF COMPLIANCE: ,IJP 4 Glenn Goldsmith, President W, so Town Hall Annex 54375 Route 25 A. Nicholas Krupski, Vice President oe®� ®�� P.O. Box 1179 Eric Sepenoski S Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 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 ®F S®(/�' Town Hall Annex �� A. Nicholas Krupski,Vice President �® �® 54375 Route 25 P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly �. Telephone(631) 765-1892 Elizabeth Peeples �® ® a® Fax(631) 765-6641 COUIVT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10488A Date of Receipt of Application: October 19, 2023 Applicant: Deborah L. McKeand & Shannon J. Goldman SCTM#: 1000-68-3-11.1 Project Location: 100 Salt Marsh Lane, Peconic Date of Resolution/Issuance: November 15, 2023 Date of Expiration: November 15, 2026 Reviewed by: Elizabeth Peeples, Trustee Project Description: Repair existing 5'4"x6'2" (32.89sq.ft.) shed. 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 survey prepared by Kenneth M. Woychuk Land Surveying received on October 19, 2023, and stamped approved on November 15, 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. .'� 44;-'4X Glenn Goldsmith, President Board of Trustees 1 S.C.T.M.# DISTRICT 1000 SECTION fib BLOCK 3 LOT 11 . 1 LONG ISLAND SOUND c N 51°29'09" E206.74' MW LINE 4.0 i 0 0N ZONE VE(EL 16) ' o -- tv p — -- ZONE BpUNDAR/ o FlR'' ZONE VE(EL 14) t /hM00D LIMIT OF BEACH ! j 6'A507 10.I T 69 wOOD ! POST �/ Oji 4 % i UA �0 U-% fill 111, 91,111 1 + ZONE VE(EL 14) ( + r — 14- 1 11 11 Fl E Bo i LAIIU I1/1' OF ,HAR011 LOVE r oil ,EMIT OF MODERATE ZONE AE(EL 9) ! I WAVE ACTION 1 BOUNDARY -- � ,� FIRM ZONE BOUNDARY s' 1 1 �/� '�•. ZONEX -' �j11 „r _ _ 0XE 111 1. r Y 1 �� 2.8'W 0'•'E::: ��?° ' SHED \ .� 1 'x c 5.4 8.2 S AREA S.OPIlJO E QUALO OR GREATER TWW 20X �, •6 . O RISING GREATEIR TwW 2D. , MON. .-..�..�.. -..............-..�...�...... �0`1 � 9� 0' 10.3 W - COASTAL EROS N ►0 HAZARD BOUNDARY O I' `h CO 5.5 X � �..•�.::'"•'�`��� 1,:: 4.0APPROVED BY • LANG 0/F OF TM o° 00 1 BOARD OF 1 RUSTEES YVOINIE k ;ALL.A;HEH ° O O o TOWN OF SOUTHOLD 1HREVOCABLE THIICT �,, 1020 DATE If11(oU�/It�i2. 15 2023 '� '� �' �'oao� ;�'J� � qi y o tz / ./00 2Q.--� w.M. � \ GUY .•�''" y .rte �O PIPE �O�°391 O P.' O.H. W RE ��} U.P. LIBER DE R PSC.O5 WAY _aT - Q J:a: 3 i ' o moo,ti - \ • xl. w,s f woo woo, ,�` 56.7 MON -- 7Wow �. 000 � o p � . C;,I 1 �, P U-1 LANV N/F OF HONALL) kOTHMAI1 p�' C SUBJECT TO COVENANTS, EASEMENTS, AGREEMENTS MON. �( AND RESTRICTIONS OF RECORD, IF ANY. p _ - ---- - -... --- -- - --- -------- - ---- --- ---------- FEMA MAP#36103CO161H ° i O� 7 COASTAL EROSION HAZARD AREA MAP SHEET 7 OF 49 gyp6. w PHOTO No.57-559-83 4- - ELEV. 17.5 0ODR BROWN OL LOAM SM BROWN FRESHWATER WETLAND AREA: 4,972 S.F. SILTY SAND AREA SEAWARD OF COASTAL EROSION HAZ. BOUNDARY: 56,240 S.F• �� �'`� s`� MON. 8.0' T BUILDABLE AREA: 49,076 S.FPALE . S 54°33'0011 Wr SP BROWN AREA: 110,288 SQ.FT. or 2.51 ACRES (TOTAL) ELEVATION DATUM' NAVD88 80 SAND � -- 15' UNAUTHORIZED ALIERAAON OR ADDIAON 7r1 THIS SURVEY IS NOLATION OF SECTION 7209 OF INE NEW YORK STATE.EDUCATION LAW. COPIES OF THIS SURVEY SC CLAYEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY. GUARANTEES/NpI COrED HEREON SHALL RUN HIGHEST EXPECT. ONLY 70 IEE PERSON FOR WHOM THE SURVEY/S PREPARED AND ON HIS BEHALF 7O 7H ATLE COMPANY, GOVERNMENTAL AGENCY AND LENDING /NS717NALL 15'3SAND ' WATER EL 2.2 LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS17TU710N, GUARANTEES ARE NOT 7RANSFERABLE THE OFFENDS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUC7tlRES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE' 7HEY ARE SC WATER IN NOT lNIFND£D TO MONUMENT 7NE PROPERTY LINES OR TO GUIDE INE AND/OR SUBSURFACE STRUCTURES RECORDED OR UNREEREC710N OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS BROWN CORDED ARE NOT GUARAN7PED UNLESS PHYSICALLY£NDENT ON THE PREMISES AT THE 7RM£ OF.SURCY CLAYEY SURVEY OF-DESCRIBED PROPERTY SAND -- 19, CERTIFIED T0: SHANNON GOLDMAN• DE6i MCKEAND; WATER IN MAP OF: ; (,1' ,'i;'! ' 'i,' FIDELITY NATIONAL TITLE INSURANCE SER'ICES, LLC; PALE .� ,t �.I 'i� N'-) SP BROWN ')y� t 'YO'N MORGAN STANLEY PRIVATE BANK, N.A.; '` FINE SITUATED AT:PECONIC t t �'� �, ; SAND TOWN OF:SOUTHOLD '—••—' 19 ' �'.'•.'�,� ' SUFFOLK COUNTY, NEW YORK '.'r �,'; KENNETH At ?TOYCHUK LAND SURVEYING, PC GARAGE FND. LOC 02-22-23 JUNE 1, 2015 LL Professional Land Surveying and Design McDONALD GEOSCIENCE 1, P.O. Box 153 Aquebogue, New York• 11$31 THE WATER SUPPLY, WELD DRYMMS AND CESSPOOL �� X220-158 SCALE:1 -40 DATE:NOV. 15, 2020 - / ' " , LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS M YS. L/SC. N0. 050882 PHONE (031)298-1388 FAX (831) 298-1568 AND OR DATA OBTAINED FRAM OTHERS: r•. II ____n Goldsmith,President �OSI r4OGy Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski ,? P.O.Box 1179 Liz Gillooly �y • �� Southold,NY 11971 O Elizabeth Peeples � �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: I 1 is Completed in field by: �1�7,abtn Petal DEBORAH L. McKEAND & SHANNON J. GOLDMAN request an Administrative Permit to repair existing 5'4"x6'2" (32.89sq.ft.) shed. Located: 100 Salt Marsh Lane, Peconic. SCTM#: 1000-68-3-11.1 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 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/Mo ifications/Conditions/Etc.: Present Were: G. Goldsmith N. Kpski E. Sepenoski L. Gillooly ✓ E. Peeples � e +�� fir_ r`•rk. � :'a'' n: CURRENTSHED jwSir 1 f. I�ph +'R' I I •� . INTERIOR-RAISED PLATFORM VIEW LOOKING NORTH, • LOOKING WEST,AUGUST 28,2023 AT 9A NEW SHED USE SAME FOOTPRINT GABLE ROOF 5'-4"W X 6'-2"L ------------------------ 1004/2"H CEDAR ROOF (USE LEFTOVER AYC SHAKES FROM DETACHED GARAGE BUILD) 78"H i I - --------------- -------- 72"H j 6"VERTICAL PLANK CEDAR j SIDING I I I ' i I I SURFACE MOUNT DOOR LATCH J i i I i FRONT VIEW SIDE VIEW S'-4"W 28"W CENTER DOOR AkKemal 1:.Wnun 16.W.mo IknnalFm WorMARLS T-aass 16W bb IN O \\ SEE SEC ro 050 04 '` m wra o' POR—CEL ro • aEE W NO os aiv aQ 1 . 1 y ae°o,m,., ,z,s,s OtT asm mrx sue-.—LCTN°.SEREPRECE E ° / \ w �roRTH RE°R n�E ro ae, IL N d r tx�.� t16 / ,y ,C carwrr or sum �sva +y��� y a� ,ez O -- -- ! • / ` EOR—= , L.N0. xs K au GO OWI—S ML ET xa n.Nn w.y rrer�uwu '� .xFs.mr�YVosaBB�R 1.4 1-5 ,.M + � zz.eycl 1ROelFESaTHE \`_ TONN OFSWTxILO alb r > \ •��0� Tom, --- � ,.�. Teiuq \\ 4 Wo .owa ez t e o a a iro..,.a.�oPr�.uo cNo X.T. po' sEE scc s SEE ssc.NOoT. \s `ro NA 1 _�— -� - p,l - - - _ �-- -- -- NOTICE 'y COUNTY OF SUFFOLK © x souTxoEn sEcrRx,No G m u.eo. 2 vu. __.__ sru. . ' +r✓.R'r"...- E Cyt i Real Property Tax Service Agency r E uu -N-__– 13�xp 'rix Cwnlr C.nM R�rRIwsLNrt,N, M aN WV R�,r °""•" • "� • . '. . ]]i'N t!;syY[[++Yy P � 'mPROPERTY fMP INc.xP OFFICE LOCATION: �� SU(/�y0 MAILING ADDRESS: Town Hall Annex �� �O P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold,NY 11971 Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: November 15, 2023 Re: LWRP Coastal Consistency Review for DEBORAH L. McKEAND & SHANNON J. GOLDMAN DEBORAH L. McKEAND & SHANNON J. GOLDMAN request an Administrative Permit to repair existing 5'4"x6'2" (32.89sq.ft.) shed. Located: 100 Salt Marsh Lane, Peconic. SCTM#: 1000-68-3- 11.1 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 action is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney Glenn Goldsmith,President fLa�,Of SO(flyr. Town Hall Annex A.Nicholas Krupski,Vice President4�' 54375 Route 25 P.O.Box 1179 Eric Sepenoski jog Southold,New York 11971 Liz Gillooly G h Telephone(631) 765-1892 Elizabeth Peeples • YD i Fax(631)765.6641 enuo Y BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use .I� Efps � � �.e Coastal Erosion Permit Application _ E i Wetland Permit Application Administrative Permit OCT 1 9 2023 Amendment/Transfer/Exten ion 4 —UReceived Applicatio ,Received Fee: S Z60.` sr.•u"idd ✓ Completed Application: Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): --T-LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: _ Technical Review: Public Hearing Held:����✓ — Resolution: Owner(s)Legal Name of Property (as shown on Deed): Deborah L. McKeand and Shannon J. Goldman Mailing Address: PO Box 346, Peconic NY 11958 Phone Number: 917-691-9159 Suffolk County Tax Map Number: 1000- 68 - 3 - 11.1 Property Location: 100 Salt Marsh Lane, Peconic NY 11958 (corner of Huntington Blvd and Salt Marsh Lane) (If necessary,provide LILCO Pole 4, distance to cross streets,and location) AGENT(If applicable): Mailing Address: Phone Number: Email:_ _ Board of Trustees Application GENERAL DATA Land Area(in square feet): _ 110,288 Area Zoning: R-40 Previous use of property: Residential Residential Intended use of property: Covenants and Restrictions on property? Yes __D_No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? E—Yes ELNo 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 _21_No If"Yes",please provide copy of decision. W' his projectmany demolition as per Town Code or as determined by the Building Dept.? Yes X No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No N/A (it's a shed) Prior permits/approvals for site improvements: Board of Trustees permit#10256 Issued November 16, 2022 Agency Date Building Dept permit#48629-Detached Garage Issued December 20,2022 and Closed August 30,2023-received CO DEC permit#1-4738-04890/ 00002 Issued July 25, 2022 ZBA permit#7682 Issued October 25, 2022 ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?JE—No ❑ Yes If yes, provide explanation: Project Description(use attachments if necessary): Repair existing shed in existing footprint. Repairs include new siding and roof. Current shed materials are rotted. See photos provided. Shed is depicted on the survey at the toe of the bank along the footpath to the beach. The shed measures 64"x 6'-2"which equals 32.89 square feet or 0.00076 acre. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To make the shed usable (currently leaking due to rotted materials)for dry storage of beach chairs, umbrellas, life jackets, oars, etc. Area of wetlands on lot: 4972 square feet Percent coverage of lot: 3.21 % (shed 0.07%) Closest distance between nearest existing structure and upland edge of wetlands: 100+_feet Closest distance between nearest proposed structure and upland edge of wetlands: 100 + 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): r . 61 Z20 Append&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 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 l-Project and Sponsor Information Name of Action or Project: McKeand/Goldman Shed Repair Project Location(describe,and attach a location map): Toe of bank along footpath to beach Brief Description of Proposed Action: Repair existing shed in existing footprint. Repairs consist of new siding and roof. Current shed materials are rotted and need to be replaced. Shed is 5'-4"x 6'-2" (32.89 square feet). Per DEC, due to the size of the shed and distance from the Tidal Wetland Boundary, repairing the shed siding and roof within the existing footprint is a No Permit Necessary(NPN)Activity. Per Town of Southold Building Dept, since shed is less than 144 sq ft, a building permit is not required. Name of Applicant or Sponsor: Telephone: 917-691-9159 Deborah McKeand and Shannon Goldman E-Mail: deb@worktablenyc.com Address: 100 Salt Marsh Lane, PO Box 346 City/PO: State: Zip Code: Peconic NY 11958 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 ❑ R 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: R ❑ 3.a.Total acreage of the site of the proposed action? 0.00076 acres b.Total acreage to be physically disturbed? 0.00076 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor`? 2.51 acres 4. Che 11 land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) Ljlndustrial Commercial ®Residential(suburban) Forest ❑Agriculture ❑Aquatic ❑Other(specify): Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. a.A permitted use under the zoning regulations? X 1 1 b.Consistent with the adopted comprehensive plan? [HlilH 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? TTIX 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: a ❑ S. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 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: ❑ ❑ N/A 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Shed is for storage only.No plumbing. Fil ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Shed is for storage only.No plumbing. E ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? X b.Is the proposed action located in an archeological sensitive area? X 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? X b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? HX If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14HWetland Identify the typic bitat types that oc n,or are likely to be found on th -project site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? X 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO lul If Yes, El ❑ a. Will storm ❑water discharges flow to adjacent properties? X NO ES b.Will storm water discharges be directed to established conveyance systemsff an"m drains)? If Yes,briefly describe: 5O 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: R ❑ 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: R ❑ 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: ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE 5t+Af,M0r4 � (O O YOAI-I Applicant/sponsor name: D��01�' V rnG 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 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 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 ❑ ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: El Ela.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? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ 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? 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. 0 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 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-Hoard of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 measures 5'4"x 6'-2"which equals 32.89 square feet or 0.00076 acre. Board of Trustees Application AFFIDAVIT DC-0b9A4+ L MCWNP 4 5H)WK W'T 6vL0(0BEING 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. 14 Signature of Property Owner Sign"e of Property Owner SWORN TO FO ME IS l DAY OF O)dj _,20_-Q NR1chaM D None otVY PubtNState W Now yP* MY OW ed in S�ufto�lk IGb� / ary blicmtssion Expires ��:2 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: McKeand, Deborah L and Goldman, Shannon J (Last name,first name,Middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%ofthe shares. YES F-1 NO if you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,of child is(check all that apply): _aA)the owner of greater than 5%of the shares of the corporate stock of the applicant _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 Allay G 20 Signature Print Name Form TS I P9bA4lLk Urn -9i 09rJ Cr00004 A-4 Richard D.Nonearmw Notary Public State of New York NO-Qualified in Suff k County / My Commission Expires June 2f�202 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list,policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its si ign ficant beneficial and adverse effects upon the coastal area(which includes all of Southold Towny. 3. If any question in Section C on this form is answered "yes" or"no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office,the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION 1000 68 3-11.1 SCTM# - - PROJECT NAME McKeand/Goldman Shed Repair The Application has been submitted to (check appropriate response): Town Board ❑ Planning,Board❑ Building Dept. ❑ Board of Trustees I. 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: Repair existing shed in existing footprint.Current shed materials are rotted.Repairs to include new siding and roof. Location of action: Shed is located at toe of bank along footpath to beach Site acreage: 0.00076 Present land use: Residential Present zoning classification: R-40 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: Deborah McKeand and Shannon Goldman (b) Mailing address: PO Box 346,Peconic NY 11958 917-691-9159 (c) Telephone number: — — Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No 0 If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. a Yes ❑ No ❑ Not Applicable We will repair a shed in its existing footprint. This will preserve the natural landscape and terrain with minimal impact. 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 ❑X No❑ Not Applicable There are nohistoricor archaeological elements associated with the shed design or area where e Shed issituated. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI-Policies Pages 6 through 7 for evaluation criteria ® Yes ❑ No❑ Not Applicable The currents ed materials have deteriorated and become unsightly. By repairing the shed with new wood roof and siding, we will restore this structures eau n y maintaining the shed s existing footprint, the. size and scala. of the shur-tuie feels appropdate in the landscape without any diSFUptien te the existing vegetation. 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 ❑X Yes ❑ No❑ Not Applicable The shed is not considered an erosion control structure. Native plants and vegetation-surround the Shed offering stabilization o the ban , bluff and dunes. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section HI -Policies Pages 16 through 21 for evaluation criteria ❑X Yes ❑ No ❑Not Applicable _ The shed is for dry storage and will not have any plumbing The storm water will naturally be absorbed by the sand. The building materials will be natural cedar shingles and planks. Xt-tach 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 IH-Policies; Pages 22 through 32 for evaluation criteria. -1 Yes ❑No ❑ Not Applicable The nalive plants and surrounding vegetation will remain undisturbed since the shed will be repaired in its existing footprint, protecting the natural habitat of wildlife, birds and insects that live in this area. Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑No❑ 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 ❑X 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. ❑ Ye❑ 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 LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No❑X Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No 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 X❑ Not Applicable PREPARED BY DCbft L/ytG ? TITLE �4r/xG� J. P T 04 3 S/�N�v T Gaznwt�rJ G'�� 161y - ary ubl c,State p N�y0*, Qualified No. m Su Suffolk Cou jy ""00MMIssion Expires June 2f�2p-�