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HomeMy WebLinkAboutTR-10602A � Z� so �� Town Hall Annex Glenn Goldsmith, President 54375 Route 25 A. Nicholas Krupski, Vice President P.O. Box 1179 Eric Sepenoski �i Southold, New York 11971 Liz Gillooly —,--C Telephone (631) 765-1892 Elizabeth Peeples �� Fax (631) 765-6641 eo NV, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTCEMENT OF THE AC THE OFFICE OF THE BOARD IV T ES CHECOKED OFFEES 72 HOURS PRIOR TO COMMEN 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 ®� s®(��� Town Hall Annex ®� ®� 54375 Route 25 A. Nicholas Krupski,Vice President h ® P.O. Box 1179 Eric Sepenoski l Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples � a0 Fax(631) 765-6641 C®UNT1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10602A Date of Receipt of Application: June 27, 2024 Applicant: Country Estates West Creek Homeowners Association SCTM#: 1000-76-1-15.1 Project Location: Between Bayberry Lane and Smith Drive North, Southold Date of Resolution/Issuance: July 17, 2024 Date of Expiration: July 17, 2027 Reviewed by: Board of Trustees Project Description: Construct a 4' wide gravel path from association park land to the shoreline to launch paddle boards; leave shoreline grass intact. 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 Rick Rogg, Association President, received on June 27, 2024, and stamped approved on July 17, 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 oldsmith, resident Board of Trustees S.C.T.N. N0. DISTRICT: 1999 SECTION: 75 BLOCK: I LOT(S):15.1 V\ 7 VV� 1^ � SIIi 1�� 1 C9T' ,ea lryRavU;Jy,,,ziYai p2:cWv�K� aa�p ii*NiJ v_ OvihfAv�i Q i2 K �v 04K irc ii 1K Yt� 3T'VS tL9WGG:AU' a irK D EIVE z JUN 2 7 2024 APPROVED BY z W BOARD OF TRUSTEE �d ToyM TOWN OF. SOUTHOLD DATE MAIN BAYVIEW ROAD THE WATER SUPPLY, WELLS DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. ELEVATION DATUM: UNAUTHORIZED ALTERARON OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TIRE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 774EREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDIT70NAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF:COMMON ROADWAY of New CERTIFIED TO: COUNTRY ESTATES AT WEST CREEK MAP OF: RERISI—MATASSA PLAT AS-APPROVED BY Ali ��N M wOy'"o� HOMEOWNERS ASSOCIATION; FILED: TOWN OF SOUTHOLD PLANNING DEPT. 4 z SITUATED AT:SOUTHOLD x TOWN OF: SOUTHOLD ,� KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK 2s C C188' Professional Land Surveying and Design N / J P.O. Box 153 Aquebogu@, New York 11931 FILE (/223-4$ SCALE:I��=2D' DATE:DUNE 26, 2D21 PHONE (831)298-1588 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 metntelning the record,of Robert J.Henn-ey k%,meth Y.Noychuk : . - - - v sslued :T1�6 Address _ _ = T.BE DISPLA1fED DURING �CONSTRUCTI �N. . TH:IS.,NOTICE MUST IJS ; TEES SOU'T'�'HOLD R _ s TOWN TR'U:STEES OFFLCE,TOWN:OF. SOU;THOL:D. UTH.OLD NY. 1�1971 SO_ -- - : 8.92' TEL 76:5-11 , Glenn Goldsmith,President �0�. OGZ Town Hall Annex A.Nicholas Krupski,Vice President � 54375 Route 25 Eric Sepenoski CO ,? P.O.Box 1179 Liz Gillooly �y • 0!� Southold,NY 11971 Elizabeth PeeplesOl ��' Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:Jyly 12 i 2n24 Completed in field by: GV0, beA-V% Peep t e S COUNTRY ESTATES WEST CREEK HOME OWNERS' ASSOCIATION requests an Administrative Permit to construct a 4' wide gravel path from association park land.to the shoreline to launch paddle boards; leave shoreline grass intact. Located: between Bayberry Lane and Smith Drive North, Southold. SCTM# 1000-76-1-15.1 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 Type of Application: Wetland Coastal Erosion Amendment ✓ Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info need ed/Modii1fications/Conditions/Etc.: S't'r'AIQIYI"FbifWAK�I Ab011GA�0�11 Present Were: G. Goldsmith N':-Kru ski E. Sepenoski L. Gillooly E. Peeples f ' �� �Si i vr4t1 �j�; �'� pV' ,,...r,,,yy�•T!„ - +�' � �I +t4� - '♦ •1`�• •L{�i +�111?.�[ 4 r4 ".1.. ..tfkr.� vV. ..'� l�+c.;`.� �Pr'Yl✓ c` ,r.�wri��� •� IN A. Moil :tom ;.: Ca�� ��Ki �p t �. •.K' =Y. _ ,f�. `. pa h„ +• � �� .�,', it s. ,Y,�,,�' a z� ^ ,,:,. _ ._ � _ "� y-:. •,..,�._9 ' N� -� '+Y ACC•,'� � ! .'�S- `'r • _, - - f.. r - .. \ �� r Za � r irk. N + - �; it ty +1� � i`„- r 4. �.+fr. � r'� ••f ) �i�Jyyy� .�� Yt :.L tie 'Z�1�1{.rl t ra�'aA � .• ,t .'', r .. 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'�+.`'t �. ��,ry It �1V 1 OW i ... ...... R 4 t i — �'j i -- 14 /f .a s :o '".,,/ R w w r •�•a�'y ,s, u,,\ Q \�.o\ r \ ii Y \J - o b d f .; 1.f: ��. :ti.•��' �g �.� �� \� aka. i! y 'u 4tq4y F BMW ift -- COUNTY OF O SUFFOLK(:J rar�e ,000 ------ �— .... i: rasa _ .�+ •... Real Ner ep I' � .e,\ke076 ncy ruxrz,waa k,eaaion v,.Y M , A a June 4,2024 Andrew&Andrea Weisbach 497 Ripple Water Ln Southold, NY 11971 Dear Trustees, As an owner in the Estates On West Creek home owners association I am sending this letter in support of the following improvements. Maintain a 4ft wide pathway to the edge of Wast Creek in the subdivision park ares on tax map 1000-076-00-01-00-015-003. Install a 4 foot wide pea gravel path on the park land to gain access to the water to launch kayaks and paddle boards. The scope of work in outlined in the application package. Sincerely +p �Yn►s �-� eF��I?�JLy era(L-j fU L CIIERYL GOLDSTEIN NOTA1tynmuC,STATE OF NEW YORK getim ioo No.02M3502l4 Qualified in Nano Cw" Commission Espkes November 7,20U July 6, 2023 Esteves Holding 105 Ripple Water Ln Southold, NY 11971 Dear Trustees, As an owner in the Estates On West Creek home owners association I am sending this letter in support of the following improvements. Maintain a 4ft wide pathway to the edge of Wast Creek in the subdivision park ares on tax map 1000-076-00-01-00-015-004. Install a 4 foot wide pea gravel path on the park land to gain access to the water to launch kayaks and paddle boards. The scope of work in outlined in the application package. Sincer , Paui Simmons Notary Public,State of New York No.01 SI6411786 Qualified in Suffolk county commission Expires 11/30/2024 June 4, 2024 Esteves Holding 465 Ripple Water Ln Southold, NY 11971 Dear Trustees, As an owner in the Estates On West Creek home owners association I am sending this letter in support of the following improvements. Maintain a 4ft wide pathway to the edge of Wast Creek in the subdivision park ares on tax map 1000-076-00-01-00-015-005. Install a 4 foot wide pea gravel path on the park land to gain access to the water to launch kayaks and paddle boards. The scope of work in outlined in the application package. Sincerely mmons gNbllc SI e e of New York o.01 S I6411786 Qualified in Suffolk county Commission Expires 11/30/2024 June 4, 2024 Jeanine Fitzgerald Richard Rogg 285 Ripple Water Ln Southold, NY 11911 Dear Trustees, As an owner in the Estates On West Creek home owners association I am sending this letter in support of the following improvements. Maintain a 4ft wide pathway to the edge of Wast Creek in the subdivision park ares on tax map 1000-076-00-01-00-015-002. Install a 4 foot wide pea gravel path on the park land to gain access to the water to launch kayaks and paddle boards. The scope of work in outlined in the application package. Sincerely C CD�iV1� SvQ`� CAROLINE M MACARTHUR Notary Public-State of New York NO.01MA6384635 Qualified in Suffolk County My Commission Expires Dec 17,2026 �1zylZ� r June 4, 2024 Kim & Bryan Boudreau 850 Ripple Water Ln Southold, NY 11971 Dear Trustees, As an owner in the Estates On West Creek home owners association I am sending this letter in support of the following improvements. Maintain a 4ft wide pathway to the edge of Wast Creek in the subdivision park ares on tax map 1000-076-00-01-00-015-006. Install a 4 foot wide pea gravel path on the park land to gain access to the water to launch kayaks and paddle boards. The scope of work in outlined in the application package.' Sincerely z• � �UN'L.. 'a-aa.'� Nota ry Y PWbAV ft ot,New York #011iA0019317 Qualmw inwamu County My,Comnas WE%pita�08/2'/2. OFFICE LOCATION: MAILING ADDRESS: `O r Town Hall Annex ' `' 4' P.O.Box 1179 54375 State Route 25 - Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Telephone:631 765-1938 Southold, NY 11971 '�• __ �0:' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: July 10, 2024 Re: LWRP Coastal Consistency Review for COUNTRY ESTATES WEST CREEK HOME OWNERS' ASSOCIATION SCTM# 1000-76-1-15.1 COUNTRY ESTATES WEST CREEK HOME OWNERS' ASSOCIATION requests an Administrative Permit to construct a 4'wide gravel path from association park land to the shoreline to launch paddle boards; leave shoreline grass intact. Located: between Bayberry Lane and Smith Drive North, Southold. SCTM# 1000-76- 1-15.1 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 f \ a < � --zz �_ S Town Hall Annex Glenn Goldsmith,President E O!/jy `a <, 54375 Route 25 A.Nicholas Krupski,Vice President r`� �� P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly cn Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765 6641 Pulm BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only E E Coastal Erosion Permit Application D C Wetland Permit Application Administrative Permit JUN 272024 Amendment/Transfer/Extension Received Application: =Received Fee: $ 5 S 6 . 5 o Southold Town Completed Application: ofT Incomplete: SEQRA Classification: Type I__ Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: _Coordination:(date sent): V LWRP Consistency Assessment Form Sent: irsi LA CAC Referral Sent: VDate of Inspection: Receipt of CAC Report: _Technical Review: �C Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): Country Estates West Creek Homeowners Assoc Mailing Address: 285 Ripple Water Lane, Southold NY 11971 Rick Rogg President Phone Number: 401-574-0124 Suffolk County Tax Map Number: 1000 - 076-00-01-00-015-001 Property Location: Located between Bayberry Lane and Smith Dr N (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Rick Rogg Association President_ Mailing Address:285 Ripple Water Ln. Southold NY 11971 Phone Number: 401-574-0124 Email:rickrogg77@gmail.com Board of Trustees Application GENERAL DATA Land Area(in square feet): 30492 Area Zoning: R-40 Previous use of property:Assocation park land Intended use of property: Association park land 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 JJNo 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. Mhis project reowr any demolition as per Town Code or as determined by the Building Dept.? - Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No Prior permits/approvals for site improvements: Agency Date / ❑✓ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?-a No ❑ Yes If yes,provide explanation: Project Description(use attachments if necessary): Construct on the association park land adjoining West Creek a 4 ft wide pea gravel path to the shoreline to launch paddle boards and leave the shoreline grass intact. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Provide a safe path for the 5 household members of the association to use the association park to access West Creek and Goose Creek to place kayaks and paddle boards in the water along the. shoreline and leave the shoreline grass intact. Area of wetlands on lot: 1,500 _ square feet Percent coverage of lot: .01 % Closest distance between nearest existing structure and upland edge of wetlands:0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 25 feet Does the project involve excavation or filling? 0 No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: no change Manner in which material will be removed or deposited: The low growing scrub below 12" tall will be cut to lay the pea gravel and no shoreline. grasses. 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): No effect as this is just open path for kayaks. The path with be permeable pea gravel. 61 Z20 Appendi_r 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 I -Project and Sponsor Information Country Estates On West Creek Homeowners Association Name of Action or Project: Pea gravel path to the shoreline Project Location(describe,and attach a location map): The waters edge end of the association common area. Brief Description of Proposed Action: Construct a clear path for the association members on the association park area along West Creek to access the water to put kayaks in the water and leave the . shoreline grasses in place. Name of Applicant or Sponsor: Telephone:401-574-0124 Rick Rogg E-Mail:rickrogg779gmail.com Address: 285 Ripple Water Lane, PO Box 364 City/PO: State: Zip Code: Southold NY 11971 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. RI 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: Z ❑ 3.a.Total acreage of the site of the proposed action? .7 acres b.Total acreage to be physically disturbed? W acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0 acres 4. Che I land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) VAquatic Industrial CffiCommercial ©Residential(suburban) Forest ❑Agriculture QOther(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? �fi 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 1 IF 7. is the site of the proposed action located in,or does it adjoin,a state Iisted Critical Environmental Area? NO YES If Yes,identify: Z ❑ 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? ✓ 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: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Z ❑ 11.Will the proposed action connect to existing,wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Z ❑ 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. Identify the typic bitat types that oc n,or are likely to be found on tl�groject site. Check all that apply: Shoreline Forest Agricultural/grasslands Early mid-successional YJ 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 YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes, ❑ OYES ❑ ❑ a.Will storm water discharges flow to adjacent properties? NO b.Will storm water discharges be directed to established conveyance systems ff an¢--rm drains)? If Yes,briefly describe: ONO LuVES 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: Z ❑ 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: Z ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE S Applicant/spo o n e: k ROgg Date: —f— �—~ 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 sponsoror 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 ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ E 3. Will the proposed action impair the character or quality of the existing community? ❑ E 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑ establishment of a Critical Environmental Area(CEA)? S. 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 El reasonably available energy conservation or renewable energy opportunities? 7. W ill 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 I j 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 ❑ a 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. 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 Page 4 of 4 J i Board of Trustees Application AFFIDAVIT RC I1�•�� K UAjs-6c i\23 de � BEING DULY SWORN DEPOSES AND AF S 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 WILLBE 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. ignature of Prop Owner Signature of Property Owner SWORN TO BEFORE ME THIS a DAY OF , 4" ,20,gq CONNIE D.BUNCH Notary Public Notary Public,State of New York No..01 BU6185050 Qualified in Suffolk County Commission Expires April 14,2 � r;- APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Prohibits conflicts of interest on the pert 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: Roqq, Rick (Last name,first name,.gniddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or 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 F-1 NO 1 If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): _aA)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 thi r ay of 20V Signature _ Print Name ro d 6etc�,2ti� Form TS 1 Town of Southold J 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 sienificant 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, 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 SCTM#76 _1 _15.1 PROJECT NAME Pea gravel path to the shoreline 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: Install 4ft pea gravel path on association park land by West Creek to access the water to place kayaks in the water. 1 Location of action: West Creek end of Ripple Water Lane, Southold Site acreage: .7 Present land use: Park land 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: Country Estates West Creek Property Owners Rick Rogg Pry (b) Mailing address: 285 Ripple.Water Lane. SoutholdrNY 11971 (c) Telephone number: 401-574-0124 _ Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No❑✓ If yes,which state or federal agency? _ C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST 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. r ❑Yes ❑ No ❑ Not Applicable Simple and clean design to work along the park area for the gravel path to the shoreline to put kayaks in the water and leaving the shore grass in place. 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 0 Yes ❑ No ❑ Not Applicable Not removing any materials or vegetation to impact the area past the low bushes and leaving the. shoreline-grasses in place. 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 Using natural materials to blend in with the character of the land. 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 0 Yes ❑ No ❑ Not Applicable Not removing any materials or installed any major structures. 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 ❑✓ Yes ❑ No ❑Not Applicable Using clean natural materials to not impact water quality. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ Yes ❑No ❑ Not Applicable No impact to the area with light soil disturbance. 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 No impact. 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 Not applicable. I 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 Z Not Applicable Attach additional sheets if necessary 1 I P 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❑ Not Applicable Using pea aravel. 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❑✓ Not Applicable PREPARED BY Rick Rogg TITLE Association President DATE