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HomeMy WebLinkAboutTR-10616A say Town Hall Annex Glenn Goldsmith, President 54375 Route 25 A. Nicholas Krupski, Vice President P.O.P.O. Box 1179 Eric Sepenoski �3 Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples QF- �' y� 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 OFF 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHE BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 s' day of construction '/2 constructed When project complete, call for compliance inspection; Glenn Goldsmith, President ®f Out Town Hall Annex A. Nicholas Krupski,Vice President ,�®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoskiii Southold,New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples ® a® Fax(631) 765-6641 c®UNT°`�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10616A Date of Receipt of Application: July 15, 2024 Applicant: Jeffrey L. & Mark G.Wade SCTM#: 1000-122-4-17 Project Location: 2980 Ole Jule Lane, Mattituck Date of Resolution/Issuance: August 14, 2024 Date of Expiration: August 14, 2034 Reviewed by: Board of Trustees Project Description: Ten-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed. 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 Jeffrey & Mark Wade, received on July 15, 2024, and stamped approved on August 14, 2024. § 275-5 Permit procedures: (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: No other vegetation is permitted to be cut on the property without further review. Do not disturb any native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder (Iva frutescens), and Groundsel Bush (Baccharis halimfolia). Inspections: The approved operations must be commenced within three (3) years from the date of the resolution. The permittee is required to request a Trustee inspection upon completion of the initial cutting. i 2 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 SOUTHOL'.o TRUSTEES Issued To se��„�� M��K WGat Date Address. Mrio 01e &%le lAne , NIa�:TKcK THIS NOTICE 'MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 SURVEY OF: PROPERTY LOCATED AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY. NEW YORK S.C.T.M. u 1000-122-4-17 SCALE: 1"=30' NOTE: THE EXISTENCE OF RIGHT OF WAYS. WETLANDS AND/OR EASEMENTS OF RECORD ! IF ANY. NOT SHOWN ARE NOT GUARANTEED. •�Sp . Cr BOARD OF i RUSTE S TOWN OF SOUTH LD DATEQcti .^�'`�'• is, • a CAT WALK/ <�u2 DOCK e e 9��0 \ C•Y q3 P STOOP \ �� / WOOD-, BULKHEAD O SOH,peHCS eQT. s $s � HQ•. cam.ry 0� C ST O ryp /yF�C,•f 22q NOF?RHO F,I, M so Fc COOS RES. SC'1 B(OR/` POLE IB.O'/N �'QReY 6' BRICK 6 COLUMN O �• ® GRATE O S FJ F N s p Q� s. 1 LAND N/F /s2/9 2 CHAD MELLO 0'� C� yQp SHARON A MELLOE -E Fv-E c� NO •�� 1Laa NJr: � Y JUL 1 5 202410 6(AM)NDy" I Souttrold Town UNAUTHMUZED ALTERATION OR ADDITION TO THIS SURVEY 15 A VIOLATION Beard of Trustees OF SECTION 7289 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED OR EMBOSSED SEAL SMALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. ' GUARANTEES OR CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY 15 PREPARED.AND ON HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION SURVEYED B Y: LISTED HEREON.AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. P A U L B A R Y L S K I LAND SURVEYING CERTIFIED TO: PATCHOGUE NY 11772 JEFFREY L. WADE PHONE 631-294-6985 MARK G. WADE FAX 631-627-3166 FIRST AMERICAN TITLE INSURANCE COMPANY PAULBARYLSKIaYAH00.COM COR,,TITLE SERVICES. LLC 5632 APRIL 26. 2024 Glenn Goldsmith,President t��p�o COG Town Hall Annex A.Nicholas Krupski,Vice President {�� y<k 54375 Route 25 Eric Sepenoski y P.O.Box 1179 Liz Gillooly �y • old Southold,NY 11971 Elizabeth Peeples �� c '1r Telephone(631)765-1892 � x4 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed in field by: -, 6,51 � JEFFREY L. WADE & MARK G. WADE request a 10-Year Maintenance Permit for hand- trimming of Phragmites. Located: 2980 Ole Jule Lane, Mattituck. SCTM# 1000-122-4-17 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/Modifications/Conditions/Etc.: S�ca�ol„� �rrc.,�os�l N Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples J ��' ,°` ��^ r ►"'` 'P "1N� 1��,4 I Y/ r. A Y`$I'rp'"� to # { '� ,t � a:,,, < � • -�,'`fir rd,►,i�ft ,sy �� I k, „ �.� �'"- 14 11 riff a A..1 3n•\�1. 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'�siY1kR•Y`l��'�' M,� ,.tli\9!�:♦ 'CF_ , " 77 u P , Fes. ,,f• x.S �T.A.'1 5!^?, .^R '\:w {� .` }' ,,k�{ `� :'y'��rs a {p"'* ,.�eNy �lt t �;�•'9R?n � _� 1 •y .- .a wee•-w rN w,•� • '1_r� � .. � l.IY1N na. �tr I t M Nlrt wn� •r' - 40 - •/` .M • . 7 / , ••a -a is• IAA, !�1�, �'. • I- a:.w t s_ ■R. t ., E •sn■ 1 ra \`!•■~\t �i • + % I� - _---r�-y j"au `. _�M '� a• iE1 1 g 0. c`•, ♦ ., `� �1 .,\ as \ .,� •.! � +� 11 - .-- R , T `- t ) :' '• ;� vi♦ '�'�, t w- u: r r1 .` �• s a M a Ai i w44�ri* �� 1 aln N eLi.A w ww �. • .1 t{ \a ���� ' r M' • /' .— �_.0. lac � � ■ � jai .- . - •• N�'> �� �y: ♦ % `� i ♦ ` \tea\! �s ! r �-'i aJ• 1 T • � a i• w1�,9 y �`N!\L\ �\ % tt • w .� �}. .00 rw \va'•,.s J /r -01 It •MAII OpY•r: � a�i ` O .....� a O„' .p C• •`•v. —�Mws �a "'�"_\_.1�.1,' w SOM c 1 P So Y :;,,r as 40 R 'a♦ T .a.agw fI� ornwwwaors ar MeY r x-vrabat,^ •»_•• » _ _ - �w courrrr of SUFFour kE r r e „w owl"w-- .,r-_i_ —— —— .r ��_—_• _ "�' �� •pY1NrD Kc-�I`r..I is 7' Rr.c.rr.wc� 122 rrM •.Y Y. r� IIIIIII llll 1lIII IIIII IIIII IIIII IIIII IIIII IIIII II{IIIII I IIIIII IIIII IIIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 6/25/2024 Number of Pages: 4 At: 9:12:40 PM Receipt Number: 24-0079667 *ELECTRONICALLY RECORDED* Transfer Tax Number: 23-34475 LIBER: D00013253 PAGE: 639 District: Section: Block: Lot: 1000 122.00 04.00 017.000 EXAMINED AND CHARGED AS FOLLOWS Deed Amount $1,595,000.00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20.00 NO Handling $20.00 NO COE $5.00 NO NYS SRCHG $15.00 NO Notation $0.00 NO Cert.Copies . $0.00 NO RPT $200.00 NO Mansion Tax $0.00 NO EA-CTY $5.00 NO EA-STATE $125.00 NO _ TP-584 $5.00 NO Comm.Pres $34,875.00 NO Comm.Pres Fund $27,900.00 NO Comm.Housing Fund $6,975.00 NO Transfer Tax $0.00 NO Transfer Tax Number: 23-34475 Fees Paid $35,270.00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL Vincent Puleo County Clerk, Suffolk County BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S ACTS (INDIVIDUAL OR CORPORATION) STANDARD NYBTU FORM 8007 CAUTION:THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND 8; PURCHASER BEFORE SIGNING. L:o1 qA ® THIS INDENTURE,made the t5"A day of 1-k 2024 between MATTHEW CUNNINGHAM and ERIN CUNNINGHAM c►� residing at 2980 Ole Jule Lane,Mattituck,NY 11952 (� party of the first part,and JEFFREY L.WADE and MARK G.WADE, � residing at 1835 Park Avenue,Mattituck,NY 11952 party of the second part, WITNESSETH,that the party of the first part,in consideration of Ten Dollars and other lawful consideration,lawful money of the United States,paid by the party of the second part,does hereby grant and release unto the party of the second part,the heirs or successors and assigns of the party of the second part forever, ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected, situate,lying and being in the Town of Southold,County of Suffolk and State of New York. SEE SCHEDULE`A'ATTACHED HERETO AND MADE A PART HEREOF Said premises being and intended to be the same premises described in a certain deed recorded on February 4, 2011 in Liber 12650,page 402. TOGETHER with all right,title and interest,if any,of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof, TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises, TO HA PW AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part,covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part,in compliance with Section 13 of the Lien Law,covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly.executed-this-deed the- day-and-year-first-above written. MA W CUNNINGHAW- ERIN CUNNINGHAM NYSBA Residential Real Estate Forms on HotDocs1°(9100) Copyright Capsoft"Development • -1- First American Title Insurance Company Title Number: CORE28636 Page 1 SCHEDULE A DESCRIPTION ALL that certain plot piece or parcel of land,situate, lying and being at Mattituck, Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a monument placed at the comer formed by the intersection of the Northwesterly side of Ole Jule Lane and the Southwesterly side of Channel Lane (unimproved); RUNNING THENCE Southwesterly along said Northwesterly side of Ole Jule Lane,the following two(2)courses and distances: 1. South 52 degrees 35 minutes 40 seconds West, 15.00 feet;and 2. South 46 degrees 35 minutes 40 seconds West, 50:00 feet to a monument and lands now or formerly of Mello; THENCE North 55 degrees 19 minutes 20 seconds West along last mentioned land, 152.39 feet to the mean high water mark of the"Dredged Canal"a/k/a James Creek; THENCE Northeasterly along the said mean high water mark of the"Dredged Canal"a/k/a James Creek on a tie line bearing North 31 degrees 27 minutes 20 seconds East, a distance of 119.66 feet to the Southwesterly side of Channel Lane (unimproved); THENCE South 37 degrees 24 minutes 20 seconds East along said Southwesterly side of Channell Lane(unimproved)and passing through a monument, 182.93 feefto the comer at the point or place of BEGINNING. TOGETHER with all the right,title and interest of the Seller, if any, in and to Ole Jule Lane and Channel Lane in front of and adjacent to the above described premises to the center line thereof; TOGETHER with a right-of-way, if any, over a certain 25 foot private road leading from the Southerly line of New Suffolk Avenue Southerly to Peconic Bay; TOGETHER with a free and unobstructed use of the channel lying in front and adjacent to the said premises. For information only: Premises is known as 2980 Ole Jule Lane, Mattituck, NY 1 STATE OF NEW YORK ) ss.: COUNTY OF SUFFOLK ) On the 09' day of AY ,in the year 2024,before me,the undersigned personally appeared Matthew Cunningham,personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity,that by his signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the instrument. RY PIj LI LORRAINEKLOPFER Notary Public,State of Newyork t No.4828373 OuelHledinSufklkCo�mty J e/ 4'ommtesion Expires Nov.30, �i O^9 STATE OF NEW YORK) ss: COUNTY OF SUFFOLK) On the F day of /n4/ ,in the year 2024,before me,the undersigned personally appeared Erin Cunningham,personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity,that by her signature on the instrument,the individual,or the person upon behalf of which the individual acted,ex uted the instrument. I J I LORRAINEiLOPFER � GGG Notary Public,Stava of Newyork RY PUBL No.4828373 cualiRed to Suffolk County t i commission alms Nov.30, f&A DEED District 1000 1JILgNa—CORE28636 Section 122.00 Block 04.00 CUNNINGHAM Lot 017.000 County or Town SUFFOLK To WADE Return By Mail To: Nicole M.Cardiello,Esq.,P.C. 70 Medford Avenue Patchogue,NY 11772 Reserve This Space,For Use Of Recording Office NYSBA Residential Real Estate Forms on HotDocs°(9/00) Copyright Capsoa°Development -2- OFFICE LOCATION: Adla MAILING ADDRESS: Town Hall Annex' P.O.Sox 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) •,'' rjt h ;� a''1 ► �O:' Telephone: 631 765-1938 Southold,NY 11971 -4111I�'i'lt;N� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: August 8, 2024 Re: LWRP Coastal Consistency Review for JEFFREY L. WADE & MARK G. WADE SCTM# 1000-122-4-17 JEFFREY L. WADE & MARK G. WADE request a 10-Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to not less than 12" in height by hand, as needed. Located: 2980 Ole Jule Lane, Mattituck. SCTM# 1000-122-4-17 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 r L Glenn Goldsmith,President of SO Town Hall Annex A. Nicholas Krupski,Vice President ,�®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples �® Fax(631) 765 6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only � ' Coastal Erosion Permit Application D i' Wetland Permit Application Administrative Permit JUL 1 5 2024 Amendment/Transfer/Extension Received Application: Southo�d7own Received Fee: $ BwdofTrustm Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): 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): JE j G. �✓�DE Mailing Address: o2!Jp0 QLE. —SVLE I.A(Vf- '1" to s-i`Y+j o< Phone Number: t�;Lf/,-a 1-4 —1'14 oL Q Suffolk County Tax Map Number: 1000 - 1 '�'a-— 4 Property Location: 2530 OLE auiE (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): I^ A Mailing Address: Phone Number: Email: and of Trustees Applicati,r GENERAL DATA Land Area(in square feet): 1 , ITT 5C— Area Zoning: ID, _ 1-1 O r Previous use of property: �E 5��EN\►l�L Intended use of property: \<f—S 11>15/lITIAL. 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 x No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes _ No If"Yes", please provide copy of decision. Will this project require 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? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): fy) e_ �bZ l�M�ty and of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Tco 'A LLsw ��or-�c�®w aJZ3 - -TO Area of wetlands on lot: G) square feet Percent coverage of lot: © % 0 Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? /1 No Yes If yes, how much material will be excavated? N cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: (VA—feet Proposed slope throughout the area of operations: a l/ 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): 61 Z20 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 I -Project and Sponsor Information Name of Action or Project: 1R47fL'4a0r-,, T6 kit lrndh.rJ& Project Location(describe,and attach a location map): Brief Description of Proposed Action: /' 1 n�7 � * �6)J"-.)IA IA.-' 1(VV A-&I v cm /V V?rita Name of Applicant or Sp) `onsor 4: _ ' Telephone: ti -�_ 0 am J Ec-cz e`I' L. t/ >6- E-Mail: f VV S> 1 Qrh 1 Cbw/ Address: al �O Uc_C z LA/ City/PO: Sta_te:, Zip Codes 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 n may be affected in the municipality and proceed to Part 2. If no,continue to question 2. f� ' 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: ❑ TO"-PS-T9SS "'?e ®� (DF 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? Q acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ,❑..,Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture LYAquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ Lr--N—1 ❑ b. Consistent with the adopted comprehensive plan? ❑ ❑ fl 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? ❑ 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: n El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Y ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � ❑ b.Is the proposed action located in an archeological sensitive area? ❑ Ln 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 typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional S'Wetiand ❑Urban ❑Suburban If 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 YES If Yes, a. Will storm water discharges flow to adjacent properties? EKrNO DYES ❑ b. Will storm water discharges be directed to established conveyance systems(ru f and storm drains)? le If Yes,briefly describe: nNO ❑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: Vn I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam : -J N6tFke Date: Signature: Part 2-Imp-- 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 ❑ 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: ❑ 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, ❑ 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. ❑ 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 ;ard of Trustees Applicati� ` AFFIDAVIT ,alVING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ur roperty Owner Signature of Property Owner SWORN TO BEFORE ME THIS �a DAY OF lLf 20 T NICHOLAS A.MRACOSTAS Notary Public NOTARY PUBLIC-State of NY No.01 KA4851906 Qualified in Queens County My Comm. Exp. March 3, 2c-5 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, 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# )Ooo _ J :2 A _ 1-1 " -- ) '- � 1© YE Utz PROJECT NA tv�Z.ry+ r �T ME 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: I to ©L� Tv zr Lr r��-+ N �' ►��s'�� Location of action: 1 ►'Cu CIti., Site acreage: s `F Present land use: 1?t•7C I D167�I L Present zoning classification:y 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: V (b) Mailing address: g 0 0 L[> 5U C-E Cf V (c) Telephone number: Area Code( ) �o y�i^ T'1 7�— (d) Application number, if any: /J 1A Will the action be dir 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. ❑Yes ❑ No Not Applicable 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 0 No eNot Applicable 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 X Not Applicable 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 ElYes ❑ No LNot 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 ❑ Yes ❑ No ANot 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. Yes No of Apt a 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 kj"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 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.❑ Yet—n] No E6 Not Applicable Attach additional sheets if necessary WORKING COAST POLICII -,� r -` 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 I 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 FLN 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 rK Not Applicable PREPARED BY Sfic—ea `f • C.. ,W0XXZ TITLE_�.omdrc26veol DATE 9)?