HomeMy WebLinkAboutGallagher, John 11/14/2012 02:50 6314778Q43 ALBERTSON REALTY PAGE 03/03
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CARDIINERS SAY ESTATES HO IE OWNER ASSCCIATIQN, INC.
P.O. Box 4, East Marion New York 11939-0004 _
To: Southold Board of Trustees U �; NOV 15 2012 : "1'i
From: Gardiners Bay Estates Homeowners Asso,.iiation I a
George Peter, President seut�n'd Tn,.,a T"
z_ Board 01 Irus,-es .
Re: John Gallagher permit to instal[+/- 100' F EX tubing underground sl
November 14, 2012
Please be ad�dsed this tubing will cross ov;!r an 8' ROW owned by the Homeowners
Association. The request is being considered by 1 he Homeowners Association Board of
Directors and has not yet been decided_ At this t me he cannot move forward with the request
to through our property.
George Pe4r -
President
Gardiners Bay Estates,Homeowners Association li ic,
Mrs _ C�, �1� e�" -
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,. NOV 14 2012
BQ2iG e*iristees
SURVEY OF
LOTS 112 & 113
MAP OF
GARDINER' S BAY ESTATES
SECTION TWO
FILE No. 275 FILED SEPTEMBER 23, 1927
SITUATED AT
-" EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-37-05-04
S.C. TAX No. 1000-37-05-05
SCALE 1 "=20'
MAY 31 , 2002
SEPTEMBER 18, 2008 UPDATE HIGH WATER MARK
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AREA DATA
S�� x'o.e S.C. TAX No. 5,869.49 sq. ft.
1000-37-05-04 0.135 ac.
S.C. TAX No. 8,592.27 sq. ft.
° G \ 1000-37-05-05 0.197 ac.
: °•. + G° �FmS� 0� TOTAL (TO TIE LINE) 14,461 .76 sq. ft.
w a . rode 0.332 ac.
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1Zo E x o NOTES:
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N 0'03 5 N /
8 309 UTILITY�O#4. E NE 13 s
� Q.. FOUNO A 12.9 cE `' i �'`� y`��' '� �'� EXISTING ELEVATIONS ARE SHOWN THUS:
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5 32 A, 36.1 8 SO TO THIS SURVEY IS A VIOLATION OF
5 0 EDGE OF M �` m� JJJ✓✓✓ SECTION 72LA OF THE NEW YORK STATE Nathan
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1 DOC WO 0 maw COPIES OF THIS SURVEY MAP NOT BEARING
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SI Land Surveyor
5 11�0�$ EMBOSSED TO BE A VALDLTRUE LCOPY.
BE CONSIDERED i� ��!!
SCERTIFICATIONS INDICATED HEREON SHALL RUN
333 ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE Title Surve s — Subdivisions — Site Plans — Construction Layout
TITLE COMPANY, GOVERNMENTAL AGENCY AND Y Y
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. )
THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 322 Roanoke Avenue P.O. Box 1931
ANY, NOT SHOWN ARE NOT GUARANTEED. Riverhead, New York 11901 Riverhead, New York 11901-0965
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OCT Z 4 1 LLw-. '
BGs11µ,C?• `Tv F.ES _.,..-------._ "
1
James F.King,President p�suFFoc*
CO P.O.Box 1179
Bob Ghosio,Jr.,Vice-President �j� Gy Southold,NY 11971
Dave Bergen y Telephone(631 765-1892
John Bredemeyer Fax(631)765-6641
Michael J. Domino �
Southold Town Board of Trustees-
Field Ins pection/Worksession Report
Date/Time:
JOHN GALLAGHER requests an Administrative Permit to install +/-100' of
PEX tubing underground from the house to the dock. Located: 700 &
730 Bayview Drive, East Marion. SCTM# 37-5-4 & 5
Tygelo"If area to be impacted:
_Saltwater Wetland Freshwater Wetland Sound Bay
Dista a of proposed work to edge of wetland 0
P of Town Code proposed work falls under:
_Chapt.275 Chapt. 111 other
Type of Application: _/Wetland _Coastal Erosion Amendment
y Administrative_Emergency Pre-Submission Violation
Info needed:
Modifications:
Conditions: �/Z—
Present Were: J. King B. Ghosio D. Bergen,
J. Bredemeyer Michael Domino D. Dzenkowski other
Form filled out in the field by
Mailed/Faxed to:
Date: ,
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OFFICE LOCATION: ��OF SG!/T�o MAILING ADDRESS:
Town Hall Annex ,`O l0 P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor. Main Rd. &Youngs Ave.)
Southold, NY 11971 G Q Telephone: 631 765-1938
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUME WE
LI; NOV 14 2012 C
To: Jim King, President
Town of Southold Board of Trustees =
So,,-Iwl
Board of Trosiees
From: Mark Terry, Principal Planner " "
LWRP Coordinator
Date: November 14, 2012
Re: Proposed Wetland Permit for JOHN GALLAGHER
SCTM# 1000-37-5-4 & 5
JOHN GALLAGHER requests an Administrative Permit to install +/-100' of'h" PEX tubing underground
from the house to the dock. Located: 700 &730 Bayview Drive, East Marion. SCTM# 37-5-4 & 5
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 proposed action is
EXEMPT from LWRP review pursuant to:
§ 268-3. Definitions. MINOR ACTIONS item "G" which states:
G. Minor temporary uses of land having negligible or no permanent impact on coastal resources or the
environment;
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: Lori Hulse, Assistant Town Attorney
7
James F.King,President Qf SOUry Town Hall Annex
Bob Ghosio,Jr.,Vice-President ,`O� �l0 54 Main Road
P.O..Box 1179
Dave Bergen l Southold,New York 11971-0959
John Bredemeyer
Telephone(631) 765-1892
Michael J.Domino 'O Fax(631) 765-6641
�yCOUNTY,�
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Applicati n �uf
_Wetland Permit Application Administrative Permit . �I
Amendment/Transfer/Extension { OCT 2 4 2
Received Application: 012 1
Received Fee:$ 6D�
Completed Application seuthl2 o!dl Tova.1
_Incomplete BOUd of Trustees
_SEQRA Classification:
Type I Type II Unlisted
Coordination:(date sent)
LWRP Consistency Assessment Form D 6 /
CAC Referral Sent:
TTp�-- Date.of Inspection: ( /
n1/Q-Receipt of CAC Report:
"/�' Lead Agency Determination:
_Technical Review:
Public Hearing Held:APW
Resolution: �� ��
Name of Applicant �` L I P ✓
Mailing Address p�a`L`� S�- �ir�0� �� • 1� 3
Phone Number:(63i) �f �3 6 q
Suffolk County Tax Map Number: 1000 -3 — G —0`f - 3 7 --U D
Property Location:
-A4 dC V
(provide LILCO Pole#, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Lrd of Trustees Applicatic
GENERAL DATA
Land Area(in square feet): S q Z 17
Area Zoning:
Previous use of property: es�c
Intended use of property: �5► �'►a
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 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 __ZNo
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?_ No Yes
If yes,provide explanation:
Project Description (use attachments if necessary): % to C,V
UNA dgr -
Ba 11 of Trustees Application
i
WETLAND/TRUSTEE LANDS APPLICATION DATA
I
Purpose of the proposed operations: %� f,0 4- put
Z IF
CJU Ski
,M G�cry( C��rA�„�- r�v �D u a- 1+ 0V1 c2v\'- ri d
v
Area of wetlands on lot: square feet
Percent coverage of lot: %
Closest distance between nearest existing structure and upland
edge of wetlands: ./o o feet
Closest distance between nearest proposed structure and upland
edge of wetlands: p 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: Y wt,� — S J ve ►Q�
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):
617.20 SEQR
PROJECT ID NUMBER APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor)
1.APPLICANT/SPONSOR 2.PROJECT NAME
3.PROJECT LOCATION:
Municipality SOU k_�U I) County
S�F�I k
4.PRECISE LOCATION: Street Add ss and Road Intersections, Prominent landmarks etc -or provide map
73 o a"I v1e") r
C 5-�- (" I m- JU.- • R 3
5.IS PROPOSED ACTION: F,--rN ew ❑Expansion ❑Modification/alteration
6.DESCRIBE PROJECT BRIEFLY:
�O ►M X C&ref w a,%,%4- -}v v 1 f UV1 d-fly S'y�v ►mac°
7.AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8..W ILPROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
Yes ❑ No If no,describe briefly:
9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
❑Residential ❑Industrial ❑Commercial ❑n_Agriculture ❑Park/Forest/Open Space 'E Other (describe)
V_A Cati r l0-t"d W
10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
❑Yes pr�o If yes, list agency name and permit / approval:
CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes If yes, list agency name and permit / approval:
12. AS A RES OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
Dyes allo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant ! Sponsor Wme / Date:
Signature
If the action is a Costal Area,and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
r �
PART II- IMPACT ASSESSMENT To be completed by Lead Agency)
A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAR
Yes a No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative
declaration may be superseded by another involved agency.
Yes 0 No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible)
C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal,
potential for erosion,drainage or flooding problems? Explain briefly:
C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly:
C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly:
.
C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly:
C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly:
C6. Longterm,short term,cumulative,or other effects not identified in CI-05? Explain briefly:
C7.-Other impacts(including than es in use of either quantitX or!Xpe of every? Explain briefl
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA CEA? If es,ex lain briefl :
Yes a No
E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If xes ex lain:
❑ Yes 0 No
PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each
effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e)
geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain " -
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes,the determination of significance mustevaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur.Then proceed directly to the FULL
EAF and/or prepare a positive declaration.
Check this box If you have determined,based on the Information and analysis above and any supporting documentation,that the proposed actin
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary,the reasons supporting thi
determination.
Board of Trustees 1/ .7 Z O/Z—
Name of Lead Agency K-1A)
Date
0—JR��jf,0- , President p
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
94:�4� cop" v "
Si nature of Responsible Office in Lead r
cy Signature of Preparer(If different from responsible officer)
I
Town of Southold
U Erosion, Sedimentation .&. Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
0(�j /O fJ(J ?j UtS D� STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
sfi tT—nct ect on �— —�Ot� CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION PTEM# / WORK ASSESSMENT Yes No
a. What is the Total Area of the Project Parcels?
(Include Total Area of all Parcels located within / Will this Project Retain All Stone-Water Run-Off
the Scope of Work for Proposed Construction) G 61.76 Generated by a Two(2")Inch Rainfall on Site?
(S.F./Acres) (This item will include all run-off created by site
b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed x_ /D Site Improvements and the permanent creation of
construction activity/ (S.F.I Aces) impervious surfaces.)
2 Does the Site Plan and/or Survey Show All Proposed PROVEDE BRIEF PROJECT DFSCRIP'I'ION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This
/f El
(� Item shall include all Proposed Grade Changes and
WA to f, '�,I 9 U l o D ( o t—y Slopes Controlling Surface Water Flow.
�" C 3 Does the Site Plan and/or Survey describe the erosion
U7 f V lM Y �1 G U and sediment control practices that will be.used to
control site erosion and storm water discharges. This
LAA t&fib _ (rGW l (.n item must be maintained throughout the Entire
Construction Period.
Irk u ovk(i�✓ri �yy�// 4 Will this Project Require any Land Filling,Grading or
Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards
of Material within any Parcel?
j Will this Application Require Land Disturbing Activities F
Z
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.)Square Feet of Ground Surface?
6 Is there a Natural Water Course Running through the —
Site? Is this Project within the Trustees jurisdiction
General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or
Submission of a SWPPP is required for all Construction activities involving soil Beach?
disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes
are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to
including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance?
El
the DEC has determined that a SPDES permit is required for stone water discharges.
(SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious
for Storm Water Discharges from Construction activity-Permit No.GP-0.10.001.) Surfaces be Sloped to Direct Storm-Water Run-Off El
Z
1.The SWPPP shall be prepared prior to the submittal of the NOT.The Not shall be into and/or in the direction of a Town fight-of-way?
submitted to the Department prior to the commencement of construction activity.
2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material,
required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any EIZ
constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder
compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(This Item will NOT Include the Installation of Driveway Aprons.)
identify potential sources of pollution which may reasonably be expected to affect the
quality of storm water discharges. NOTE: If Any Answer to Questions one through Nine is Answered with a Check Mark
3:All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre In area,
component shall be prepared by a qualified Design Professional Licensed in New York a Stone Water,Grading,Drainage&Erosion Control Plan is Required by the Town of
that is knowledgeable in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit
(NOTE: 'A Check Mark(4)and/or Answer for each Question is Required for a Complete Application)
SPATE OF NEW YORK, ��� l/L
COUNTYOF..........................................SS
That I,��.?...Z\...�. L .. — being duly sworn,deposes and says that he/she is the applicant for Permit,
..... ...................
(Name of individual signing D men/)
Andthat he/she is the ........................................ . ............ ................................................................................................
( ner,Contractor,Agent,Corporate Officer,etc.)
Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to
make and file this application;that all statements contained in this.application are true to the best of his knowledge and belief;and
that the work will be performed in the manner set forth in the application filed herewith.
Sworn to before me this;
..........................o� .....................day of.. ® .-..................,201.a
Notary Public: ..... ......... ...... } _.,... .. .......... .........
Notary Public State of Rew York ( gnature of Applicant)
FORM - 06/10 Qualifiied in Suffolk County
Commission Expires July 28,20te
Bc I of Trustees Application `
County of Suffolk
State of New York
BEING DULY SWORN
DEPOSES AND AFFIRMS T41AT 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 TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF T4APPATION.
Signatu e o Pr
SWORN TO BEFORE ME THIS C-Q DAY OF (�C!� 120__��—
Notary Public
VICKI TOTH
Notary Public State of New York
No.01Y06190696
Qualified in Suffolk County
Commission Expires July 28,20�C2
i
APPLICANUAGENUREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same. I 1 '-
YOUR NAME: `I �l N J 6
(Last name,first Warne,middle initial,unless you are applying in the name of
someone else or other entity,such as a company.If so,indicate.the.other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
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 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 a'`{ d of C1� 200 l 7/
Signature.
Print Name
Form TS I
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 sirup
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# /(Yo U - 3 7 _ G 5 04
PROJECT NAME S— t( Z_X
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:
0c) t c� F v " x '[061
�_Em-NA" IM�J y 1 o v 5 2. '}U I/JA V Pik fib eA J-
Location of action: 7 3 ��-y 1 mow - UL /"� ��� . „IJ-Y
Site acreage: e 3 k ,/R 7 _ ?j 3 Z
Present land use:
Present zoning classification:
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:
(b) Mailing address:
(c) Telephone number: Area Code�a1) 7 7 — 3 c7
(d) Application number,if any:
Will the action be di tly 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 0 No ZlNot 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 ❑ No VfNot Applicable
I i
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
FzKyes ❑ No ❑ Not Applicable
/3 C'Vcrn d' krc. 6j-Pr r+— D,/
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
Yes ❑ No 1 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
❑ 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.
❑ ❑
Yes No Not Apl a `,ble -�
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 ❑ Noj2 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.
❑ YeO No VINot Applicable
Attach additional sheets if necessary
WORKING COAST POLICI6 N
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 ❑ NoZ 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 evalu tion criteria.
❑ Yes ❑ No . Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
❑ Yes ❑ No Pj/Not Applicable
PREPARED BY TITLE DATE I 0