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Home My WebLink AboutPiscotta, Madeline Irrev. Trust Glenn Goldsmith, President � So��° Town Hall Annex A. Nicholas Krupski,Vice President ®§ ® ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples • �® Fax (631) 765-6641 C®U05 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NOTICE OF DISAPPROVAL—ADMINISTRATIVE PERMIT Applicant: The Madeline Piscotta Irrevocable Trust Date of Receipt of Application: October 2, 2024 SCTM#: 1000-87-5-23.8 Project Location: 8554 Main Bayview Road, Southold Date of Resolution: October 16, 2024 Reviewed by: Board of Trustees Project Description: To create a 2' walking path for certified environmental engineer/surveyor to mark wetlands boundary; saplings and trees will not be removed in creation of path. Findings: The Board of Trustees DENIES the application as submitted. It is not necessary to create a path to conduct a survey and the clearing will have an adverse environmental impact. The project does not meet the requirements for issuance of an Administrative Permit as set forth in Southold Town Code Chapter 275-12A. —Adversely affects the wetlands of the Town. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. j d L v Glenn Goldsmith, President Board of Trustees 1 1 Glenn Goldsmith,President 0�� COG Town Hall Annex A.Nicholas Krupski,Vice President �� y< 54375 Route 25 Eric Sepenoski ,? P.O.Box 1179 Liz Elizabeth Peeples Telephone oy�o� honSouthoe 631 765-1892 P P ( ) Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:OnWo e!'101 ?jj Completed infield by: U%ZAa to Ven te.5 Krista Jones on behalf of THE MADELINE PISCOTTA IRREVOCABLE TRUST requests an Administrative Permit to create a 2' walking path for certified environmental engineer/surveyor to mark wetlands boundary; saplings and trees will not be removed in creation of path. Located: 8554 Main Bayview Road, Southold. SCTM# 1000-87-5-23.8 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'p 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.: A oe.fm*t11 a(Away i5 DIA heCCe &iXnj C,MDk4r, q surVty . Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly t/ E. Peeples -- - ---- - .mow - I GRIN SURVEY OF PROPERTY SYTUATED AT LU - BAYVIEW o - O`gD z� � o TOWN OF SOUTHOLD C11 - r p �P-- ------ n-1+ ti.t� �.` SUFFOLK COUNTY, NEW YORK '� N S.C. TAX No. 1000-87-05-23.8 Uj 1000-87-05-23.7 ey°r C4 pQ}� 1 �4--1 SCALE = � r � � -, � MARCH 4. 199998 �✓ AREA = 61.925.14 sq. $(� 1.422 cc. I1 �''•" 0 yar ! -. PROPOSED ROPOSED SEP71 C SY STEM DETA IL InoSUEI0 HOUSE V. = nrr ENOT R o �• OF ' r •. i 3 4/YPROTe �r DrL +toA a+a �;• i S.C.TAX No. 1090-a7-OS-23.7 I Nc V ,ypR�T� •- SmrC o.,- �� IunoHD yJ sw0� i. I 1C S 7T0p ma �,.E. HT 3 rAr.99. .k,POc1N�a tAl� nia gfCN 1/S/t• ruo-t. POOL COLLAR ` 6 ON.EL i a I LOT a.x A.. I I O r-•`_ J� 8 ,� �' t /~ Lsvr a 7 r D 0O0irrsTD°i Lrol.n.Ta' ��,."i IfA1FR .$ 1 L1 l•. ] '�_ ��Ic�r' /• .� �,� 9re eFPTIC TANK 11) {y. _ FL.ACHINt; POOLS (5) -r D YMom 1, iMr��,�p1�foll a,To.emlo�NWf[a I,Ot D rAua1N1 iM•C fY LGR Y-Y.•IDE. cup 1 1.kMIW IGIOwG A311r rR M EQ. 1a041 NulII b]00.0 n]mat IIfA -�� 7• �xyL I WE A WdddAN�Sg16a1 n 5010 Al AT N9 ona 7 P00.k T Dm.I M. D faNONR(W LDU111 I 1 .TJY ,obi sAN1 /• 3.WAL n.uN=9ru E A.wr 6 X.A NIF aoum OF s.o A•D�IDr MWcss n :.u/uawa rop.s ws to�c rnenRlcim a w61sr rFsroAa v 1 uAv.e s+.leneal sa+v ma ro/al sus - _i {yl£/ /, 'q a ♦ AICIa•L7..oT>oN AND >m 9M1 LLIINN m.CICw7 m a['3F M A/RAD i41ft o<]eD Aa a Ala":,mrNa IDbK.P0011 Ala.rDN UPI[9ML R INNRArfD. Y 6rJ..Ni JDrR 9Ml E SNm 7D TNT tK lY.b Mauro" .1/.l m+oa.at H n A[Cas<Im/GRfn CGMOAIi NI EWKf ` 7.M EPIC 9W1 00. AaT.1D 1T UbLL i ALL G A=Xa"A W1.T0UEF*IFE Or a+/el h' N w 1 -��-/.-' `ct�_ll '7PS� "9\� a i'le lli'.,mrN1a DD Ins mAE sw hVE MddVp 1. a.N•..� nSre1:s+sml.0 vAcwc Fmu uo ssmc rr.9au er rvrr..co I 1 �t V cl 1, 21.00' ,/- k� 3��6 1.REYATONHS ARE REFtA'OICED to II.GV.D. 1919 DATUM I S M ASS 2 S.Ior DISTINo EILVATIONS ARE SHOWN 7>I115:JIIQ .- 2 _ ®S42'QO' .Fano �r 6, PI�P'OSED EEEVAiIOMS ARE SibNM THUS:® t -� 1 �� t07•.;Ys. �2.59• A ►Or vrl•M E.r aid- 1°emlm�as -_. . `r I r10 ` f �() w 1 "rENCE r,05- 1.FLOOD MSURANC[NOT AVAlu9u FOR NEW comet UCTION OR SUBSTANnmv IMPROVED STRUCTURES ON AND AF,ER NotIENBER la. 1990 3 ,\ y` 7T DI oe IN UIIA COASTAL Ry1RIERS AS SHOWN OW.FLOOD INSURANCE RATE YAP COMMUNITY=PANEL Ne. 360a13 0079 D H p •1;1 S.G.TAR Isa. 1000-87-05-I 1- Ip tf f- THIS PROPERTY IS NH FLOOD ZONE M(EL S) 1 •�N� !MON Pb6 3 0� Vf•*•" ' ZONE A.(EL a): AREAS aF too-YbR nooD:rusE nDoo nlatoc Nw nOOD IINARa rACT0A3 6E�NaNrlm. en a ~ PoDEE FENCE 1 4� \ JAllE4�NSSB��/pO� A.LOTLFW TNUMBERS SHOWN THUS:LO OntSCIMPTION ASEREFERDTO 9115 PAGE SSt. I 1,\ �11i►?H �� MINOR SU6D7YISION MADE FOR JA4ES W. DAWSON i e 0�00'0fl W 7 �•oo' �' S.W CLA TW AM D 1%THE EOLEACHIHING POOL AANRDA IS FOUND. IT MUST 0E e e q ?y �= �� A ADELINE PISC OTTA �a OI' i6 • Qh PROPOSED EXPANSON POOL y ;� R._ � '"©i. PROPOSED IfAC1ONG POOL ti H �Q ryrb PROPOSED CONC._RElAININO WALL DETAIL p PROPOSED SEPTIC TANK Urn to sra 6.THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD a f I Epp __ - Wok, OBSERVADONS AND/OR DATA OBTAINED FROM OTHERS. ` vgEPMEO a1 1MFN 7NE MRIWW �Q Ort AItIANR ensue STANDWDS AS STEDO 1\^ \l B"THE MANa:Aaa•-. OR TOTE IANO _..-�._.- O.'iF�` PAL►N �`. r N. e •Mat I�.J1�..�. 71 1 ` \•- Malff�s rr� AY01/rn i AL V aSA!rrw JONi .a..�-'1'OOStPO�bWf \� e tt\\\ nlwft OaN'-• V— ••••••N- � Aa � i antr eeau��. a..bvYw wiu w wr..r.nAoi..M•w m TEST HOLE DATA au./r 1•a T_Ir M'r pu.•+Y Oc � � C _fQP Dv+FEeRUARY?7. 1996) `\- , a"� NG�~ AIpLE Off,gVnnAu1TI RFASdENCE yQ N Y 5 LiC. No. 19668 1•'+• "�9 } } I F w0 rk[t7/.w4aw�0 ri�l M Cow. -'�— fYlaAN qNE m CO.UISE SAND SR � e A• i ; i I` . WATEII IY N�IDr1 Rl[W GaAAu sMo e •_°- L r - I - Joseph Ingegno ': �� 07r�_ U NTNNUgZEv ALrtRAnw on ADortuN ';-• WLTFR N rAEY ORQMG C"T of tL f - I r0 1NIS SURVEY IS w Vg1ATgN OF or e ..• \ • ,,. 7 _ _ - SEC[xIc" N MR of 'WE NEW TORA STATE Survey _ • �' rOHRII N BROAN EOC n ' ___-_____•.._- -- _-_ 1 Land _ •a. �y ___+_---------.� ' DOPES ar TARS SURYET NAP WTT OWING ElErATPN 71NDrIINNG fJIRIM FACE KWi UTaU, THE 11Vo SURt2Y0R'S TVKZO SEAL OR • 1 1 1 1) - 1I-.' daossm SW SWui NOT ff caNsmEREo 1 1:1 rOLR N DAL~ a r-g-d-'-.�-ice_ TD BE A VAUD TINE COPY raw r�,.A ..SuDAt+stiM! - Sle PwsOMAW - CorslnNttiOn LOybUI 1 I ) CLAY ! u vl-r 1 Ot Y TKO THISPE Fgt W1OY MEE SUM PHONE (516)727-2090 Far (516)722-5093 "•_ K PREPARED. ND A ON NNS BEW U SD THE THE rJUSTANCE OF RIONT OF WAYS TRLE Cok". GOyE)a.NEN1AL.AOEMY AND M ADDRESS •WLiu N PALE B7LTAM AND/OR EASEMENTS OF RECORD. IF �10�•N5IfiU110k IbRD HEREON,AND OFFR:CS LOCAF£D At TII[y LOAIai SND ANY.NOT SHOWN ARE NOT GUARANTEED. TO TIE AS41UIFES OF THE LENDING NSTI- oft P.O.Boa 1931 Mom'CENI6CAT+ONIS ARE NOT TRAHSIDU.BtL gyV�ar ua New YS oM 119J1 Riverneaa. N■,Yak 1190 oza, - oa.z,o, osniw OR M-0a N� SNq - TOMM OF , � K,.y2 ••::+- ., 1, J. � '`�� ap J 6 i a � X .. t ., a.soa S " y.': t aourHDLD a� ny08 a°m 1 9 ,� 1y('��\'�'�'..' a�� 0 p-°' �r.'•.� t ta' 'm 9z� zaa z �R W i tellde a a_a;�aD e• --"r z yq, a Is na l SEE SEC mT o, a a R] lulu .. x 3's�yv aaCiap'�c cai'h, ,Y' Rd•}�69 �8 a ��'(U� h'!I'� TOKN OF SOU'NOLD 1y5`•zv a'• s ��b ,o. Y q s ~ R�TA(cy H DOVE ATBWTIpD ' 2DAl<t 3m3M<1 � 5 a. wl/ 9 ;i y AlQ •.6 ;k m 'y�"geTq�. M1i 6.. x .l U e5 sin� '•-`,• Ywc__e.-x_r'� 'z„a 'Y/ '°•away sourwLo '. i} � ue I �, ',�,�/m s '.�a a +°yL�•4t ,yR 9 q .�+. �;'� STI�NCT F D 28 L D 43 .� 3ye.� ;. • .. __LL�� \ T' L"'� 19 �''•..�. , '\�' � �� _awunTa—sursae 2• �``�.* \ �: � „ � � `>< �" �x\, =: ,.?: � >*•�' � � � ''fix''*>, �<. �� ti` �� .�: �,\�M..• V., .�..., a"�. F S., ,..M.,.p's.•�•.. ��'*� �. ,..�. \..� ell ��'f:.'k,.,.r;��p �� ,-, . .� .., ..,,.,• , -.� :�� . ; .;, ,L ...r•: � ,-.� , . . .,, ,,. .�,, .k�:. �- max^ � *.,... COUNTY OF SUFFOLK W _ ;_ •••` ':z .. _ ___ w.+.... ,:wo^ Rea r„p-ty li. S 4genOcy ac�w � �_ a-- ;,.•�„« - _.- .w�:.� a u�,u,... ., n(rdrr,?:.r.N:«Awul na'1/W,l W E awx,ElYifF untvA6nt r" O M 80UTIOLO y m tanpta•• . *o O�7 { OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex `.`'F``: ._ "P!+. P.O.Box 1179 54375 State Route 25 ;' Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: October 15, 2024 Re: LWRP Coastal Consistency Review for THE MADELINE PISCOTTA IRREVOCABLE TRUST SCTM# 1000-87-5-23.8 Krista Jones on behalf of THE MADELINE PISCOTTA IRREVOCABLE TRUST requests an Administrative Permit to create a T walking path for certified environmental engineer/surveyor to mark wetlands boundary; saplings and trees will not be removed in creation of path. Located: 8554 Main Bayview Road, Southold. SCTM# 1000-87-5-23.8 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided.on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney Glenn Goldsmith,President �Of so Town Hall Annex y� 54375 Route 25 A.Nicholas Krupski,Vice President P.O.Box 1179 Eric Sepenoski i�l 0�1 Southold,New York 11971 Liz Gillooly es> Q Telephone(631) 765-1892 Elizabeth Peeples ® Fax(631) 765-6641 CQ�•� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This'Sectioa For Office Use Only D G I V Coastal Erosion Permit Application Wetland Permit Application _Administrative Permit FOC2 2024 —Amendment/Transfer/Extension Received Application: sowiolu luwn Received Fee: $ _ Boar101Rustees K Completed Application: 10 Incomplete:y _ SEQRA Classification: Type I 'Type II k Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: 10 N aK CAC Referral Sent: Date of Inspection: Receipt of CAC Report: _Technical Review: ?C Public Hearing Held: . 10 /I(� I�H Resolution: Owner(s)Legal Name of Property (as shown on Deed): Piscotta, M. Irr. Trust Mailing Address: 906 Gardiner Drive, Bayshore, NY 11706 Phone Number: 516-650=5986 Suffolk County Tax Map Number: 1000 --87.-5-23.8 Property Location: 8554 Main Bayview Road, Southold, NY 11971 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Krista Jones Mailing Address:2465 Gabriella Court, Mattituck, NY 11952 Phone Number: 631-335-8175 Email:milistonepropertyservices@gmail.com __ Board of Trustees Application GENERAL DATA Land Area(in square feet): 61,419 Area Zoning:AC Previous use of property:vacant Intended use of property: vacant 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 Jallo 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. his project Many demolition as per Town Code or as determined by the Building Dept.? re Yes ✓= No Does the structure(s) on property have a valid Certificate of Occupancy? Yes FVI_No Prior permits/approvals for site improvements: Agency Date 0 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓�NoE Yes If yes,provide explanation: _ Project Description (use attachments if necessary): 2'walking path for certified environmental engineer/surveyor to mark wetlands boundary. Saplings and trees will not be removed for the path. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: to mark wetlands boundary Area of wetlands on lot: tbd square feet Percent coverage of lot: tbd % 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? No F_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: 2' Push mower 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): i 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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 1-Project and Sponsor Information Krista Jones - 8554 Main Bayview Road Name of Action or Project: 8554 Main Bayview Road Project Location(describe,and attach a location map): 8554 Main Bayview Road, Southold, NY 11971 Brief Description of Proposed Action: 2' walking path for certified environmental engineer/surveyor to mark wetlands boundary. Saplings and trees will not be removed for the path. Name of Applicant or Sponsor: Telephone:631-335-8175 Krista Jones E-Mail:millstonepropertyservices@g Address: 2465 Gabriella Court City/PO: State: Zip Code: Mattituck NY 111952 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: ❑ ❑ 3.a.Total acreage of the site of the proposed action? 1.41 acres b.Total acreage to be physically disturbed? <.1 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1.41 acres 4. Che I land us at occur on,adjoining an ar the prop action. Urban Rural(non-agriculture) Industrial Commercial ❑✓Residential(suburban) Forest RIAgriculture HAquatic QOther(specify): — Parkland Page I of 4 f 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ✓ b.Consistent with the adopted comprehensive plan? ET V IR, 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: ❑ ❑ 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 fbet or acres: 14. ntify the typic bitat types that oc n,or are likely to be found on tf�-groject site. Check all that apply: Shoreline Forest ✓Agricultural/grasslands Early mid-successional a✓ Wetland Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ✓ 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, a. Will storm water discharges flow to adjacent properties? ONO DES �✓ b. Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,briefly describe: [7NO 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: P], ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE 1S TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: KriSta Bolles Datel0/02/24 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 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? ® D 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? El 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 1\ 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? 91 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 f Board of Txustees Application AFFIDAVIT �((r1loCGI?��u�� hCFIef PSI Kor-f�s asTruC1r . e h�Cr elme Porn* BEING DULY SWORN DEPOSES AND AFFIRMS THAT H PUSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IBIS/HER]KNOWLEDGE AND BELIEF,AND THAT ALL WORT{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 IIDAMIAGES 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,.INCLU DING 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. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS (_,� DAY OF M�`(_ _ , 20 PATRICK VESEY otary Public NOTARY PUBLIC,STATE OF NEW YORK Registration No.OIVE4969860 Qualified in Suffolk County My Commission Expires: ' 4 Zfo Board of 7Grust:ees Application AUTHORIZATION (Where the applicant is not the owner) IIWe, raQ-%to t — rfe-yoca)vG I—hAt " owners of the property identified as SCTM# 1000— ��J'23 in the town of thy) New York, hereby authorizes Kl i5kQ, -:S6,q1a-S to act as my agent and handle all necessary work involved with the application process for permits)from the Southold Town Board of Trustees for this property. ��?rt Y►�.�s,Taus�� Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS 601 DAY OF A L&)& , 20 2 Gf Notary. Public PATRICK VESEY NOTARY PUBLIC,STATE OF NEW YORK Registration No,OIVE4969860 Qualified in Suffolk Cou ty My Commission Expires: 7 3o r' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Prohibits conflicts of interest on the part of town officers and emylovees The Purpose of this form is to provide information which can alert the town of possible conflicts of ifnterest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Krista Jones (Last name,first name,iriddle 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.) r 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] 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): 12A)the owner of greater than 5%of the shares of the corporate stock of the applicturt L2 (when the applicant is a corporation); 13)the legal or beneficial owner of any interest in a non-corporate entity(when the Papplicant is not a corporation); C)an officer,director,partne,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 02 day of October 20 24 Signature Print Name Krista Jones _ Fonn TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. 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, listinix 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# 87. _5 _23.8 PROJECT NAME 8554 Main Bayview Road 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: 0 Nature and extent of action: Location of action: 8554 Main Bayview Road, Southold, NY 11971 Site acreage: 1.41 Present land use: vacant Present zoning classification:AC 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: Krista Jones (b) Mailing address: 2465 Gabriella Court, Mattituck, NY 11952 (c) Telephone number: 631-335-8175 _ 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. ❑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 ❑ No❑ Not Applicable 1 J / 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 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 Z 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 ONot 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 Fv], Not Applicable L 1, Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑No❑✓ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑Yes ❑ No F 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. ❑ YeLl No 0 Not Applicable Attach additional sheets if necessary � l 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 0 Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑Yes ❑ No❑✓ Not Applicable PREPARED BY T- ,VQA TITLE ��\ '�44ATE14 Z 2