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HomeMy WebLinkAboutTR-10560A Glenn Goldsmith, President ®F so Town Hall Annex ®a� ®� 54375 Route 25 A. Nicholas Krupski,Vice President t� P.O. Box 1179 Eric Sepenoski 9�B 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 ®r so � 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 C®U6�9T�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10560A Date of Receipt of Application: April 15, 2024 Applicant: Mattituck Park District—Wolf Pit SCTM#: 1000-107-4-11 Project Location: 5005 Wickham Avenue, Mattituck Date of Resolution/Issuance: April 17, 2024 Date of Expiration: April 17, 2034 Reviewed by: Board of Trustees Project Description: Ten (10) Year Maintenance Permit to clear bittersweet and wild rose from east side of lake to allow a foot path around the lake; damaged tree limbs to be removed but trees to remain; install hay bales and silt fencing near town overflow pipes to prevent further erosion and trap sediments from road runoff; removal of the following invasive species: Wild Rose, Japanese Honeysuckle, and Bittersweet; initial removal will be around the landward perimeter of the walking trail with further removal along the water's edge to coincide with planting of native species; trimming or removal of large wild cherry tree if necessary; removal of pressure treated (CCA) railing that has failed and not to be replaced; plant various native species over the next two (2) years to include: Myrica Pensylvanica (Northern Bayberry), Solidago Sempervirens (Seaside Goldenrod), Solidago Canadensis (Canadian Goldenrod), Prunis Maritima (Beach Plum), Asclepias Tuberosa (Butterfly Weed), Vaccinium Angustifolium (Lowbush Blueberry), Conoclinium Coelestinum (Blue Mist Flower), Pycnanthemum Muticum (Mountain Mint), Symphyotrichum Novae- angliae (Purple Dome), Chamaecrista Fasciculata (Partidge Pea), Monarda Punctata (Spotted Beebalm) as indicated on the survey, prepared by Ward Brooks Land Surveyor, received on April 12, 2024 and approved on April 17, 2024. 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 Frederick Robert Weber, Architect, received on January 31, 2024, and stamped approved on February 14, 2024. 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 LN SEE N 8 FD DETAIL 732.17' LN FD 24� 48�• TREE s 0.4'N 0.9 S FD FD ' r f r P.O.B. STK FD r f r E r r r DETAIL f r r r r (SEE TIE DETAIL) � r err f �L A K rr fr SCALE: 1"=20' rrf rrf rr ffr frr • ,00,' . POSS. NO f f r r r r f ,J rf r r J r •. �42-5938"E frr��r f fr frr frr rr "'N�^ fr rr rr rr-' rr rr �? ' • r r, r f fry f fr frr frr ffr f frfr a� °� .. Cm rrr r r rrr rrr rrr rrr r r r r r r r r �5��O�l Zo FD r rrr rrr frr rrr rrr rr frr rrr, r Opo�`G9 '.. 04 f fr fr r f frr ffr fr f frr frr rrr frr rrr r ��C rr f f f f frr frr r f r r f rrr frr ffr frrrJfr frf fr =f 0�9� . vi rrrffr fr f fr rrr- frr frr frrr K E r ff f f frf rff rr �.,� o f rr frr frr frr r fr rrr rrr rr ' L A fr rr r r' o0 a rr frr fr r frrf rr frrfr Jrf rr rrr fr rf rrf rrf frr �Np4s UPOr rr rr frrfr frrrr' f rrrrrf rrr rf frr rf rr J rf rr, Jr rrr rr rf rrr f rf rfr rJ frfr r r , p Sk- 15W ., RR�pyv cv o r r r f r r r r f r r E CV z r f fr frrf fr frr frr frrff f frf f f frr p�a�KRBEtyGH C~ f r r-' r r r f r � r r � �, r� � r f f r f r GUY pNRp QP• M�N� M r r r BOTTOM OF SLOPE BENCH HANDRAIL UP WE�p • MEt _8 'pPJ� Z CM NF-P cow,PPv� FD O TOP OF SLOPE ° ° WV WM _ , ' CONC. PILLARS " OF R=615.14' , EDGE CONC. PAVE MENT•: e a S 49010'53"W' "EDGE 340.78' oF' -------- VENUE - -''s��,. A- A /� -i-'- OLD MIDDLE ROAD WICKH M P.O.B. aFi - s (ELLSWORTH TUTHILL RD) AREA=2.424 AC c E � Is E WP EN�� � TIE DETAI SCALE: 1"=250' SCALE 1"=60' U SCTM 1000-107.00-04.00-011.000 SURVEYED:JANUARY 17,2024 APR 1 2 2024 DETAIL:JANUARY 27,2024 DESCRIBED PARCEL (WOLF PIT LAKE) -- SITUATE AT MATTITUCK = A" ���` LAND SURVEY LONG ISLAND. Ong j TOWN OF SOUTHOLD own ':':BOARD OF TRUSTEES �e� vv-r,;p,.; Southold T WARD BROOKS LAND SURVE O. l "` r Board of Trustees �O.WN_ �OF. SOUTHOLD ' —'` \"`SUFFOLK COUNTY, NEW YORK �� CERTIFIED TO: MATTITUCK PARK DISTRICT? - 11 OCEAN AVENUE DATE. AP 1 �� aoa � ,:�� •�}�K.:.��' � .:a=f ©COPYRIGHT 2024 WARD BROOKS.ALL RIGHTS RESERVED.DUPLICATION OF THIS DOCUMENT IS A VIOLATION OF FEDERAL COPYRIGHT LAW. BLUE POINT NY. 11715 `1 THIS SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. " pg 577 31 r CERTIFICATION SHALL RUN ONLY TO THE PERSON,THEIR INTEREST AND/OR ASSIGNS. (631 ) 576-7794 (631) 363-3179 CERTIFICATIONS ARE NOT TRANSFERABLE. 7. ` THE EXISTENCE OF RIGHTS OF WAY,AND/OR EASEMENTS OF RECORD,IF ANY NOT SHOWN ARE NOT GUARANTEED. ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209.2 OF THE NEW YORK STATE EDUCATION LAW. WARDBROOKSO@GMAIL.CO ' DO NOT SCALE FENCES.OFFSETS SUPERCEDE. FILE#11478 A r�o. los4o Issued To l`!�a�l't.��ck Pa��c �•s�:, Date 4/�� /�►� Address 5ot� 5 IV:c�c1 Gam, . Avg .: J�la�fi:-f�ck THIS NdTICE MUST':BE DIS�lAYtD BURIN"G. CONSTRUCTION ;TOWN TRUSTEES OFFICE;TOWN OF ,SO.UTHOLD SOUTHOLD, N.Y. 11971 " TEL.: 765 1892 Glenn Goldsmith,President ®F SOU� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President ,�®� ®�® P.O. Box 1179 Eric Sepenoski6 Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples � �� Fax(631) 765-6641 C®UNTV,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10660A Date of Receipt of Application: April 15, 2024 Applicant: Mattituck Park District—Wolf Pit SCTM#: 1000-107-4-11 Project Location: 5005 Wickham Avenue, Mattituck Date of Resolution/Issuance: April 17, 2024 Date of Expiration: April 17, 2034 Reviewed by: Board of Trustees Project Description: Ten (10) Year Maintenance Permit to clear bittersweet and wild rose from east side of lake to allow a foot path around the lake; damaged tree limbs to be removed but trees to remain; install hay bales and silt fencing near town overflow pipes to prevent further erosion and trap sediments from road runoff; removal of the following invasive species: Wild Rose, Japanese Honeysuckle, and Bittersweet; initial removal will be around the landward perimeter of the walking trail with further removal along the water's edge to coincide with planting of native species; trimming or removal of large wild cherry tree if necessary; removal of pressure treated (CCA) railing that has failed and not to be replaced; plant various native species over the next two (2) years to include: Myrica Pensylvanica (Northern Bayberry), Solidago Sempervirens (Seaside Goldenrod), Solidago Canadensis (Canadian Goldenrod), Prunis Maritima (Beach Plum), Asclepias Tuberosa (Butterfly Weed), Vaccinium Angustifolium (Lowbush Blueberry), Conoclinium Coelestinum (Blue Mist Flower), Pycnanthemum Muticum (Mountain Mint), Symphyotrichum Novae- angliae (Purple Dome), Chamaecrista Fasciculata (Partidge Pea), Monarda Punctata (Spotted Beebalm) as indicated on the survey, prepared by Ward Brooks Land Surveyor, received on April 12, 2024 and approved on April 17, 2024. 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 Frederick Robert Weber, Architect, received on January 31, 2024, and stamped approved on February 14, 2024. 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. 4v-- 4" Glenn Goldsmith, President Board of Trustees SOUTHOL' D a moo.. 1os4o1�TRUSTEES := Issued .Address .�,, crc. THIS. NOTICE MUST BE DISPLAYED DURING CONSTRl3CTlON TOWN 'TRUSTEES OFFIC�.T01lVN OF SOUTHOLD `. . 5�1UTFtOLD, N.Y. 11971 TEL.:, 7654892 Glenn Goldsmith, President �®� S® � 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 C®UNTI,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/2 constructed When project complete, call for compliance inspection; OFFICE LOCATION: � SU!/T�,plO MAILING ADDRESS: Town Hall Annex P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) w Southold, NY 11971 OQ Telephone: 631 765-1938 olycou LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: April 15, 2024 Re: LWRP Coastal Consistency Review for Mattituck Park District Wolf Pit Lake SCTM# 1000-107-4-11 Wolf Pit Lake restoration plan. 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 LWRP Policy 6 and, therefore, 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 maffftuck Hattiluck Blopstrict Patk Distict Park 11280 Great Peconic Bay Boulevard PO Bog 1413 � �y _ .�! Mattituck, New Fork 11952 � (631)-298-9103 ® [ Q E APR 1 5 2024 Board of Trustees Town of Southold Southold Town Board of Trustees Per your site visit on 04/09,here is our proposed scope of work for the Wolf Pit property on Wickam Ave. in Mattituck. 1) Clear bittersweet and wild rose from east side of lake to allow a foot path around the full perimeter. Damaged tree limbs will be removed but trees are to remain. 2) Install hay bales and silt screen near town overflow pipes to prevent further erosion and trap sediments from road run off. 3) Removal of the following invasive species; Wild Rose,Japanese Honeysuckle, Bittersweet. Initial removal will be around the landward perimeter of the walking trail with further removal along the waters edge to coincide with planting of native species. 4) Trimming or removal of large wild cherry tree due to safety concerns, we will only remove if trimming indicates it is necessary. S) Removal of pressure treated(CCA)railing that has failed,there is no further need for a structure in this location. 6) Planting of the following native species over the next(2)years - Myrica Pensylvanica(Northern Bayberry) - Solidago Sempervirens (Seaside Goldenrod) - Solidago Canadensis(Canadian Goldenrod) - Prunis Maritima(Beach Plum) - Asclepias Tuberosa(Butterfly Weed) - Vaccinium Angustifolium(Lowbush Blueberry) - Conoclinium Coelestinum(Blue Mist Flower) - Pycnanthemum Muticum(Mountain Mint) - Symphyotrichum Novae-angliae(Purple Dome) - Chamaecrista Fasciculata(Partidge Pea) - Monarda Punctata(Spotted Beebalm) Board of Commissioners Kevin Byrne,Chairman Denise Geis and Alexandra Getches,Commissioners Mattituckparks.com \J { N LN SEE FD DETAIL 732-iT LN 2g06170.. FD ?6 F TREE SiK OWN 0.9'S � FD STK FD DETAIL P D SCALE:1"=20' NO SS. N 42 59'38"E ^^ <O Fp N 0p 0° UPp oM°F s RP �0 A�Wi p01 C7 HANDRAIL "pP�M UP Z CM BOTTOM OF SLOPE Epp -, G pPugME FD f VVVO WM TOP OF SLOPE----'-" v v coC.PI. . . OF EDGE R=615.14. CONC.PAVEMENT ,340.77'. OF' - ✓ " S 49'10'53"W AGE: • WICKHAM AVENUE AREA=2.424 AC SCALE 1"=60' SCTM 1000-107.00-04.00-011.000 SURVEYED:JANUARY 17,2024 DETAIL:JANUARY 27,2024 DESCRIBED PARCEL(WOLF PIT LAKE) SITUATE AT MATTITUCK LAND SURVEY LONG ISLAND.COM TOWN OF COUNTY,,OUNTY WARD BROOKS LAND SURVEYOR SUFFOLK C NEW YORK N CERTIFIED TO:MATTITUCK PARK DISTRICT 11 OCEAN AVENUE ©COPYPJGHT2024WARD DROOKS.ALL RIGHT RESERVED.DUPLICATION OFTHIS DOCUMWT ISAVIOLATION OFFEDERALCOPYRIGHr LAW. BLUE POINT NY. 11715 THIS SURVEY HASSEEN PREPARED IN ACCORDANCE WTTHTHECODE OF PRACTICEADOPTED DY T THE NEWYORK STATE ASSOCIATION OFPROFESSIONN.LANDSUM&YORS. (631) 576-7794 (631) 363-3179 CERTIFICATION SHALLRUN ONLYTO THE PERSON,THEIR INTOMSTANDIOR ASSIGNS. CERTIFICATIONS ARE NOTTRANSFERABLB. , THE OOSTENCE OF RIGHTS OF WAY,AND/OR EASEMENTS OFRECORD.IFANY NOTSHOWN ARE NOT GUARANTEED. �{ ANYALTERATIONOR ADDRION TOTHIS SURVEY IS AVIOLATION OF SECTION 72W2 OFTHE NEWYORKSTATEEDUCATION Wt. _ WARDBROOKSO GMAIL. COM DO NOT SCALE FENCES.OFFSGIS SUPERCFOE. (� �,l f.� l 1 FILE#11478 A �� uTls APR ► 5 2024 Southold Town Rnard of Trustees .� �Sl1FF0(, Glenn Goldsmith,Presiaerii �Cak���. Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 o Eric Sepenoski ,? P.O.Box 1179 Liz Gillooly �y • o�� Southold,NY 11971 Elizabeth Peeples �01 �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed in field by: Ben Heins on behalf of MATTITUCK PARK DISTRICT -WOLF PIT requests an Administrative Permit for a Ten (10) Year Maintenance Permit to clear bittersweet and wild rose from east side of lake to allow a foot path around the lake; damaged tree limbs to be removed but trees to remain; install hay bales and silt fencing near town overflow pipes to prevent further erosion and trap sediments from road runoff; removal of the following invasive species: Wild Rose, Japanese Honeysuckle, and Bittersweet; initial removal wile be around the landward perimeter of the walking trail with further removal along the water's edge to coincide with planting of native species; trimming or removal of large wild cherry tree if necessary; removal of pressure treated (CCA) railing that has failed and not to be replaced; plant various native species over the next two (2) years to include: Myrica Pensylvanica (Northern Bayberry), Solidago Sempervirens (Seaside Goldenrod), Solidago Canadensis (Canadian Goldenrod), Prunis Maritima (Beach Plum), Asclepias Tuberosa (Butterfly Weed), Vaccinium Angustifolium (Lowbush Blueberry), Conoclinium Coelestinum (Blue Mist Flower), Pycnanthemum Muticum (Mountain Mint), Symphyotrichum Novae-angliae (Purple Dome), Chamaecrista Fasciculata (Partidge Pea), Monarda Punctata (Spotted Beebalm). Located: 5005 Wickham Avenue, Mattituck. SCTM# 1000-107-4-11 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.: Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples 4/15/24.8:49 AM IMG_3241.jpg A �� y/�ti•� 1. ��i;t t/�' t!" r rs=A. :}►!\ .v. � 1a: ��1/ d � .. e q ,{�'�`�,,� / ,n� � , r�y�.����� _ �y{y�}���:���r. � r, r.. 'Et ���' - �kOAV` t•* ;�fi �✓ ic o .,) r � 6tF y r a?•�,t� ••,..�1 EY^i�iY;V�.1 v '' ,GSr�rR'tT� �vc ■ f i r--i APR 1 5 2024 'outholcl Town Ord of Trustees https://mail.google.com/mail/u/O/?tab=rm&ogbl#inbox?projector=1 1/1 4/15/24,8:51 AM IMG_3230.jpg �.` x1 'l / �• '�i� ,/ "i1. 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Box 1179 Eric Sepenoski 13 Southold,New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 V E BOARD OF TOWN TRUSTEES APR 1 5 2024 TOWN OF SOUTHOLD This Section For Office Use Onty Southoldw uthold Ton Board of Trustees Coastal Etosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: I aA Received Fee: $ Completed Application: i Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): __*_LWRP Consistency Assessment Form Sent: 155 CAC Referral Sent: ,_Date of Inspection: 4101 a Receipt of CAC Report: Technical Review: _Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): Nj UG Fq C k C)I A r,i J Mailing Address: 0. BOX tL l_3 !MM-uCL PH Phone Number: Suffolk County Tax Map Number: 1000 - Property Location: - O,0 5 AV-el xzil-A ta (If necessary, provide LILCO Pole #, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Email: r ,ard of Trustees Applicati_ GENERAL DATA Land Area(in square feet): 0 11900 Area Zoning: en 5 CE R< Ctg 6 n Previous use of property: Intended use of property: Px r Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes 'Y_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 'X No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _X_No Does the structure (s) on property have a valid Certificate of Occupancy?Ayes 4Z4 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? No Yes If yes, provide explanation: Project Description(use attachments if necessary): S2 C gi4ckeol lard of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ptU�n +kc co f d . 'IS iP P p �,p i q C 0 J P_ r na U V-G ��� �P W k 1 I P c, l I�zJ 1�l -�o� ��S ( IC r I-D Y-) Area of wetlands on lot: 0-1 3 S1 square feet Percent coverage of lot: 67 Closest distance between nearest existing structure and upland edge of wetlands:-yam="feet Closest distance between nearest proposed structure and upland edge of wetlands: ✓r A feet Does the project involve excavation or filling? 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): em,,,e-1 a-� invaSiv2 S PcWS Gn0t tbeif, f-e erceme I 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: D M h1.4'1tt/C•K 1olf 1 �5�c-1C vo Project Location(describe,and attach a location map): -S 0 Q�s WA czr,\ Ave Al Brief Description of Proposed Action: ll P Ke lr ov'2 ir11l�Si f je?r& �r.or� dq ke �`dSe ) de4 r �- fh �J�1- rJeb,c-; s a4 d4w)zisc-4 h(obsn fi164 nAilG4 JC Ci�" TO t.ep�e,ce_ c--eVNov�c ir)VgSIV'�S . L.rS� ar �IgYnA' Ci-,e Name of Applicant or Sponsor: 9� Telephone: 01_ �� ��1 D3 1�d�Tltuck Path. (Dlsfr-lc_p E-Mail: Address: City/PO: State: Zip Code: Ni q Itu A /(/Iy 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? c;acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? A z 36 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) []Industrial ❑Commercial WResidential (suburban) ❑Forest gAgriculture El Aquatic ❑Other(specify): Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ {� ❑ b.Consistent with the adopted comprehensive plan? ❑ � ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If 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 near the site of the proposed action? © El c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? � ❑ 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: IX ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: /UI -- 410 SA*ucJyrn +a M ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: o reS'Irno�vi3 ch ❑ 51 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? ❑ VN 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? 1gl ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: El Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional © Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? 17 ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ ❑ a. Will storm water discharges flow to adjacent properties? ❑NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES 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: ❑ 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: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE 1 {�Applicant/sponsor name:_ rug �, �C Pig"� V154'C1� / F��n%)AlieW1)ate: Signature: 1411 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 Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 0 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 ❑ El of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ 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: 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? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 t ) 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 ❑ Elproblems? 11. Will the proposed action create a hazard to environmental resources or human health? El 0 Part 3 Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. ❑ Check this box 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 Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT I Page 4 of 4 ,3rd of Trustees Applicati AFFIDAVIT 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 RFQUIRED 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. Signat 'r of Property ner Signature of Property Owner SWORN TO BEFORE ME THIS 1�_DAY OF �Prj' , 20 r� o�y Public EVE I...GATZ-SCHWAMBORN NOTARY PUBLIC.STATE OF NEW YORK Registration No.OIGA6271029 Qualified in Suffolk County Commission Expires Dec.24.20`�7 � 'ard of Trustees Applicati;, AUTHORIZATION (Where the applicant is not the owner) I/We, IL 1tvll —0<wSe— �4S owners of the property identified as SCTM# 1000- to'Z;t�(j^O`t. 00 Oft'0ion the town of New York, hereby authorizes . fj e n c1 n 1 q �Vl � to act asi my agent and handle all " necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Prop&ty Own'V ignature Property Owner's Signature SWORN TO BEFORE ME THIS 1 0) DAY OF �' , 20 o a v ublic FNOTARY -SCHWAIV[BOR]RK ,STATE OF NEW Y No.01GA6274028n Suffolk Countyxpires Dec.24,20 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Code of Ethics rohibits conflicts of interest on the part of town officers and employees.The pumose of this form is to provide information which can alert the town of ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: Mr,14 I)CIC e',q< k (Last name,first name,zniddle 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,inarriage,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%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200_ Signature Print Name Form TS I s 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 significant 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 explained in detail, listiniz both supportiniz 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 SCTM# f0vgp - lo7a� - Oqr oD- 11,OC PROJECTNAME Mcftd'ue-V Pgsk DisiyiJ VQlq Pii tgke Resorct�(Jl) 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: 1 ' v Location of action: `J��� w'��� Av-e, Site acreage: 2,36 ru-r--e 5 Present land use: F'c a' 141 Present zoning classification: Ryr-k-C' 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: dV trM J"C L 1 r t'L Q, (b) Mailing address: R0, D-0 H13 MCA11-urk piy I (c) Telephone number: Area Code 63)) ;tig^ (©`5 _. (d) Application number, if any: Will the action be directly undertaken,/require funding, or approval by a state or federal agency? Yes ❑ No V\I 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. ©Yes ❑ No ❑ Not Applicable Tht �moV ' tnil�S�v� �o '� w i�� 4 a rk I!)- x,_%si sc' r a-4 i v it ca ��zn 11�� v, S►�l re5 Av�" F off' Aalluci vJ Lcuccl in 1567, 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 ❑ No-X Not Applicable r ' Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable �, �j l� inifa e nor) in�, i nu- (are 5 �� v, vti� �' �ea� l,p l� 5 we« S3 Ci CP�Scib� , r,r T�r neivg D L1 va- 6 4-Ftha�,'!nC e ujdC �oS jj ��.,r� , e 1s> .�1 c .I f ) lerrInc lac4d,Ae J i � •C1�� lam® tl ��' �- I� ��a `J -'3E'�" Cl��S rJ I ,or'P_ GE'1 �t' Pn .l� r r-e': he u iC. Attach additional sheets if neces NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Y 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 lv Yes No ❑Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. rV ❑ ❑ Yes No Not Applicable -7h0S o() e (5 clkI S h"A e 40 C(--OS r�_-1nL'Ci��v `i L<:i�S vo Cn icr�c ieY� . Q�CP es 'c-i tY� 1 f'f).vG 'Fj 14m) n r '�(� ' .r o i will (-Gvi" ie "q ra R-e'- h'e iG; r'e rr ly- CiPel C"S 6- Va'riW5 IS hnawi'�r'ac% 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 ❑ Not Applicable All was r. �c�� �1tie c-ove' sc-1q� �,.i�l fir. r�,r~nave o �� 0w+\ So was s7 CKC.C.a r d Cn CC. vv i I o CG, a<` 4Ad -ed-e r-4 I CW ►o h I ,e c" 4 , 'Ut (,LT- t`,C. �S sla'AA tin ctr - sstvf reC -011 oU CiC C r�S ltY S .s ACT i r S �f 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. rV YeF-1 No❑ Not Applicable -his ro ecd 'mot ( rtivrn At -A io C'7 �IAV Weit qYc rar-eei. Y )� �p 'Q,- owi-,e b It J1 . .1 Uc� Pcr k. ►'s r;C. ' d.1 ,6,�� 1 W. L r a] t'►'1 Q 4A, fWr) r sic-te 5 j°Ccls ��-n,ryt o G1Pr .e, 6— G'nW V( Si --r5 Ft-9Y'%'% r7LA o--foWf) Attach additional sheets if necessary WORKING COAST POLICIES y 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. J Not Applicable ❑ Yes ❑ No 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. l� Yes ❑ No ❑ Not Applicable Rrmou tA'iy1V"SIB Dion) 1" ( lave12 r- V( Co �n3 O nq !ive s I prcit S n qa 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 X 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 TITLE DATE