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HomeMy WebLinkAboutTR-10769A ��� ����� 54375 Route 25 Town Hall Annex ® Glenn Goldsmith, Presider -� 4v® P,.O, Box 1179 A. Nicholas Krupski, Vice President Southold, New York 11971 Eric Sepenoski Telephone (631) 765 1892 Liz Gillooly • �® Fax (631) 765-6641 Elizabeth Peeples NT i BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE ES RD OF TRUST OFFEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVI 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 Of S0 Town Hall Annex 54375 Route A. Nicholas Krupski,Vice President ,�®� ®�® P.O. Box 1179 Eric Sepenoski [ Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 Cum BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10769A Date of Receipt of Application: April 7, 2025 Applicant: 1280 Corey Creek LLC SCTM#: 1000-78-4-17 Project Location: 1280 Corey Creek Lane, Southold Date of Resolution/Issuance: May 14, 2025 Date of Expiration: May 14, 2035 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 Richard Corazzini, received on April 7, 2025, and stamped approved on May 14, 2025. § 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. 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 REMOVE 96 SF SHED EXISTING SANITARY \ �'41; - SYSTEM TO REMOVED \ W LOT 14 ELEV 5.25 a © PROPOSED 10'HX5'EFF. PROPOSED U.G.ELECTRIC AND AIR 6.8' DEPTH ROOF DRAIN cy 1 DRYWELL(TYP-5) HOSE FOR HYDRO-ACTION SEPTIC T \ PRIVATE WELL WATER cn m -4 I -` �� REMOVE EXISTING WALL PROPOSED TREATMENT NIT APPROVED BY •P �, AREA OF ,-.•,.•:.::•':•�•'••::•• __ AN500 TREATMENT UNIT �+PNON-DISTURBANCE y y ;'':I:0.8 i� - DW2 j. p PROPOSED ORENCO PUMP o �y y 1 y ::.::. :' w BOARD OF i i�USTEE _f0» w\ y y y [.yr::6}} w HED 1'r" �= q6 O y 1 1 , PROPOSED WATERPROOFED LbUy (: .:::: / ko ' c5` W2 I y ......I .P 1 \ _� > D7 O 9 \ I y y y ABANDON y- ••-•••-•• �s % 6' �� RETAINING WALL(TW=7.5) z =q 1 '•'``�:::: ' '•:i;: ;.:60.0` / _ rn in f 1 1 1 y y TIDA rSVETLANDS BOUNDARY y WELL ::( 1 �1 0 ,o d ,TOWN OF- SOUTHOL -L, w Ul f 1 1 I y AS DELINEATED BY, �� �i o -y i Y r 1 I 1 y yy y y' y •S :.26.4° :.:.: .:.: �.-. 1 -° PROPOSED CONTOURS` DATES MG,' ,� EN-COtJtl„TANTS y y y 1 ::t: ';I"..i.. :' 77.18 5'MIN r ELEV 5.40 � CS Q T I fi,I I y12-1971 y _ : :i>.: :•;: co. - N ,�- m I 11 I y y y y `y OUTLINE OF y :9-.'• 0' PROPOSED z 1W 4 :::.i:.` C PROPOSED O v! r 1 v y _c.EXISTING RESIDENCE' y ;{ ;}..:_.- z ELECTRIC SERVICE\ �/T TO BE DEMOLISHED y 1: ;::1 J . • SANITARY ALARM = TEST OF y y .... is CONTROL PANEL F LJ 1 p Ul N I 1 y y y y :.•a;;:'y` v HOLE m $ !0 ;I;F' 1 v \ y y 1:•::•:•:: '''' oo v 1 O 4 PROPOSED QUICK4 PLUS LOW lip 00 -- O it O I 1 1 I y y y y y •" o ! ' '" '' 1 -nvvzin`z�o \ I r� PROFILE TRENCH WITHPSD 361 Z0 - z I y y o y I i:•..-'.'.'I 1\ ? ?'Oap�mzv v 'S1 IN I I \03C A �lJ v 11 y y y m y I,.. 1 `cfmz� rOo o V (� 0 F "m I O I 1 y y Sy y y y ..••:I.:.:.r.yl l �3r00�1,"-•�r[n v I 36.8 11 \ TO-T 1-5 I �x rry IITT77 zmm c� f'aaaa W 1 I y O y ,.--...:1':':�.':''1 <=c" I�G7mm 1' `� Q Nrvxw I 1 I m y y y y I . PROPOSED y ::1:;•: <�' C; a"' 1 IN �I or CONC ELEV 5.15'► O ,� \ MAP OF SILTFENCE y b o cn �m Qq ate. y 'y' \ t zl s' COREY CREEK ESTATES I 1 y y y y ..1•.:• :•j• mU] r-/ < o C J i I o O TTTTO ~� H OG7 Ib Z m Oo 'oom`m mm f ro I v. I y y Yy1ii y {}} :1: :. 11 j 11y t PROPOSED m m z I. oT y y y k y y y lu'SI Z z « a SITUATE a Z , I o 1 y yj y ::; : 1;.:•:-. :.•Il 1 �� 'IcI mm 1490 SF �. m m LLzo I y y y PROPOSED SPLIT RAIL FENCE 4 'oo O O ' INI N (V r GRAVEL I AT BAYVIE�P w $ z w g v y �lty y L30.4: '-: o \ o 10'MIN DRIVEWAY m3m ` Wri. y O)•'' 1 W n Q m LJ I Q Of ,N s I y y y s �x „a . , 8' �', TOWN OF SOUTHOLD � .<�x H�1 1 = y 1y y V :1::•::•:•.:.::::•C'1 ` rc) O ELEV5.11' . ammo _e `'♦ I00 I I y y y y 11) y y ' t ✓ /\� rm p I / SUFFOLK COUNTY NY y x \► A mm �A _ m R7 I; \ <II 34.3' o h y y z y y O „N ^ h FILED: AUGUST 15, 1967 Z I 40 4 y {-: ::? '9 5m„ 1.47 I ` " v I 1 RAISED WOOD WOK y y x [ oT / jl CD PROPOSED MAP No: 4923 •v y y .v x y y --• TRENCH �, i SCTM• 1000-078-04-017 a z(n 21' 1 9 v DRAIN I Q-j F-Z ;rSyl 1 1.1 x 1 x I w w y y y y 4-WIDE %J6L.::' �' �� _ 1 DW4 I� `J �a=�O IX W I v y y y j y y PATH TO ;:__ o o m nr SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES W F t x W w 1 y �v y y RAISED : i / zi I o Q Z y d c 14h !� Io I I I i y y {y*'y y y WALKWAY'I ;Y.:;:.::' `••. - �� -!1�m z PERMIT FOR APPROVAL OF CONSTRUCTION FOR A O W a y[)1/(�f JJ •v y :....-.y.....' D�V3 --. �v - ,�I yll `'\.11�'•'.. ..•; - ....�.: I -' ' f \ c ' V I " SINGLE FAMILY RESIDENCE ONLY Q O a O a I y" 1 .27 08 DW5 W I I LOT AREA-29,709 SF=0.682 AC y _ O Z �" , 1 Da _ PROPOSED I ` � O Z Z 6"PVGPIF `�I I U)F •' .\� O 1 y y /frY, y y y 4:.'.•.•.•:-'. TODRYWELL \ a . :8'::. &' y 0' IN_ h� DATE 11/15/23 H.S. REF. NO. R-z2-1971 ohs m 'y y EXISTING CONTOURS yl ........ :'::7•,:•.•. =__ _ ___-__- -= �P 6) I I� g� W s�O 1 - - I I y - y y - : 5 •6' ..... 5'MINI' \ 1 J76, w�-wuAPPROVED �twI y y y yl ly :.. I FOR MAXIMUM OF 4 BEDROOMS 3 - \\ \ o I ! \ EXPIRES THREE YEARS FROM DATE OF APPROVAL r h. T T 236.72 PROPOSED W MAIN I "a z ,,,J Y 8 55 2 W W 38'TRENCH ELEV 5.0' - z W f� LOT 27 u EXISTING PIER LINE 1 PROPOSED PROPOSED v I a s WATER BELGIUM PROPOSED 3/29/24 PRIVATE WELL WATER 1 �2 Revised Plan Approved SERVICE G � CURB 123 SF GRAVEL WALKWAY ` Expires 11/15/26 z g rc g PROPOSED NON-TURF BUFFER TO O " N Z BE PLANTED.WIDTH VARIES FROM 16-30'.SEE MITIGATION PLAN, THIS SHEET. y g W= g o ENGINEER S CERTIFICATION REQ LQ RE 0. ¢Y w SITE & STORMWATER PLAN EE q a > W /•Rr� ^ C SU6M FT P-E- OR FZ.A- GCRTIY IC/1T 10N o om oZ 0 15 3O COl'Ny FOR INSTALLATION AND CONSTRUCTION ^= v� OF I/A,PSD,Retaining Wall Q NOTES: FOR FIIHALAPPROJAL, Zj MITIGATION PLAN 25-RV 1. ELEVATION DATA BASED ON NAVD 1988 235-PV 2. NO NEIGHBORING WELL WITHIN 150'OF PROPOSED Abandonment of adding mituy 6ystem mua be in PROPOSED 2 STORY COVERED SANITARY SYSTEM. Cmif with d tra ueatent Submit ►0-+ SINGLE FAMILY PATIO DWELLING(4 BED) 3. EXISTING SANITARY SYSTEM TO BE REMOVED. , (`V('yJ C �Pig��q/9{1jyj.aeD as proof � PATIO 4. PROPOSED FILL FOR SITE=60 CUBIC YARDS. rn PROPOSED NON-TURF W BUFFER FENCE ~z 200-OB �s mcs Q � ° APR 7 2025 y Y �VVcc EXIST.GRD=8.0(2022 WICKS SURVEY) Y K Z 0.0'-0.3' TOP SOIL PT W U p /� 0.3'-1.5' BROWN .Southold TOWD WQ,W= a a al W SILTY SAND SM Board of Trustees V 0 - ¢ 1.Sd.5' PALE BROWN }m 0 12 g�2018j 4'WIDEPATHTO a oo SAND&GRAVEL SP PERCENT LOT COVERAGE w a TIDAL W��pNDS'gOUI�DA�RY � a RAISED WALKWAY a 0 4.5'-7.0' I BROWN DESCRIPTION OF LOT AREA 1 (%)OF LOT COVERAGE L) SAND&GRAVEL SP HIGHEST EXPECTED WATER GROUND WATER EL 2.0 TOTAL LOT AREA 29,709 SF li EDGE OF. ADJACENT AREA(UPLAND) 13,570SF 100% e, � GROUND WATER EL 1.0 9 q a 7.0'-12.0' WET BROWN SP o I a q j * a a q I SAND N1AX'ALLOWABLE COVERAGE 2,714 SF 20% j BORINGAKON:FE RU REISSIG,PE Y17,2022 PROPOSED LOT COVERAGE ADJACENT r' TAKEN ON:FEBRUARY�17,2022 25ANTITY RV BOTANICAL NAME ROSAVIRGINIANA BEACHRO ROSE 4EISHT WIDTH8' , TEST HOLE DATA HOUSE&GARAGE 1,982SF 14.5% 235 PV PANICUMVIRGATUM SWITCHGRASS 4'-6' 2'-2.5' 7 N.T.S PATIO&PORCH 433SF` 3.2% H 200 09 OENOTHERABIENNIS EVENING PRIMROSE T-5' 2'-3' TOTAL LOT COVERAGE 2.415SF 17.8% SOIU- T D TR .. ST HOL - u EES No. Issued T 12'90 - Core%4-Creeg ti'-c Date. 5/14 AS Address,., to COre efg00< AAty SOtA�0�1� THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE.,TOWN OF SOUTHOLD 50UTHOLD,: N.Y. 11471, TEL.: 765.1892 Glenn Goldsmith,Preside,, �0�0 COOy Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 o Eric Sepenoski to P.O.Box'1179 Liz Gillooly �y • ��� Southold,NY 11971 Elizabeth Peeples �Cl Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:MN11,2_� Completed in field by: f1% ewa -aj' 1280 COREY CREEK LLC requests a Ten (10) Year Administrative Maintenance Permit to hand-cut Phragsmites. Located: 1280 Corey Creek Lane, Southold. SCTM# 1000- 78-4-17 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 Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Sh-Mgkk6rw" • OkAN +n issue peryrmjk Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly ✓ E. Peeples Oil -! r- 1 . PK 00, a T A _ / �` �t •c.,y .fir ! , rK ,`��r� � M1y �j 7 _ ` "" i ` 1�1 , �' ' ,tip :,Id � ,�� .+.4, •AY ,;.� ' •. ti4.�- ._ "'EYE" ... .. �.ylbh �• � 4a _ ��y � �` �1. t• _ yy f1"� a_�y.\� 'r' er"�� I�.c:. �yy��.! 40v'�'��L' Y 4��c! _,fplf�` 1 ��V•FI 1.��7y�{{ /T T.�. • ♦. +I ✓ '�• 'a ZJ'r�, �E"`.�'�'°{.r� �1��`�'��!�� '.°�r,,t-� •.-,�.a�• ✓ 4s,_•x,�'.'� ..`� #'. r �R•�.""�'a;` 1., k_t- •f,�+= ,'_- ,i� v nas-s, i TCH �ME �_xaa u. is oa SLEEPY (�HOLLOW +�'A xR� �t 5�f us.. qi • ! 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' �O MAILING ADDRESS: Town Hall Annex �' �!x. ; P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd..&Youngs Ave.) Southold,NY 11971 Q ` 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: May 8, 2025 Re: LWRP Coastal Consistency Review for 1280 COREY CREEK LLC SCTM# 1000-78-4-17 1280 COREY CREEK LLC requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut cut the Common Reed (Phragmites australis) to 12" in height by hand, as needed. Located: 1280 Corey Creek Lane, Southold. SCTM# 1000-78- 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 LWRP Policy 6 and, therefore, CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney Glenn Goldsmith,President �OF S®�/� Town Hall Annex ® 54375 Route 25 A. Nicholas Krupski,Vice President �� �® P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only 22 - Coastal Erosion Permit Application RDj NPL Wetland Permit Application Administrative Permit APR 7 2025 Amendment/Transfer/Extens ion k Received Application: 141 V15 k Received Fee: $ aS0 '00 5o,rthtT stn Completed Application: Board of Trustees Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): fa�as -LWRP Consistency Assessment Form Sent: CAC Referral Sent: — C�Date of Inspection: 5A,1 25 Receipt of CAC Report: Technical Review: X Public Hearing Held: 1`l Resolution: t i ITo Cr b�t2u� LAC , Owner(s) Legal Name of Property (as shown on Deed): ) Lln Mailing Address: 7- Phone Number: '7 s C Suffolk County Tax Map Number: 1000 - D —D 7 o f Property Location: TZffb (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: -'Board of Trustees Applicaa, >n GENERAL DATA Land Area(in square feet): Area Zoning: !/L e � T7 Previous use of property: We_S1'4Li2_4,� Intended use of property: 4.5", f �`I a��'i , Covenants and Restrictions on property? Yes ___A__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 ,X No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes �No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency � I � � Date I is,,/Z3 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: � o Project Description(use attachments if necessary): XT__ - 'Board of Trustees Applice ,,,n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: �!✓:� / dVl Area of wetlands on lot: 74000 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: / feet Closest distance between nearest proposed structure and upland edge of wetlands: L/ 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 " 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 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 Name of tion or Project: le�� I Project ocation(describe,and attach a location map): )7194P ale�41 Id Brief Description of Propose Action: P Name of A plica t or ponsor: Telephct 4, Y6' h i E-Mail: h✓e, Address: City/PC)j State: , Zip Code: . ly 1.Does the prop d action only i volve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulati n? 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. 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? 10 acres ,d tsj$ b.Total acreage to be physically disturbed? ,p L 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 El Residential(suburban) ❑I~orest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? D IN ❑ b.Consistent with the adopted comprehensive plan? ❑ [A ❑ 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? N ❑ 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: EA ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: n ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? EN ❑ 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 I 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: 9 Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional m 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? n ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ® ❑ a.Will storm water discharges flow to adjacent properties? ❑NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO DYES 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 I YES completed)for hazardous waste? If Yes,describe: T ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 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 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 is 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. EICheck 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 plI lame o Lead Agency Date V',0' /!1 Z President Pri me of Responsible Officer in Lead Agency Title of Responsible Officer Sign tire of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Applica',_ )n AFFIDAVIT V ' V ✓Q 'ly1 BEING 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. Signature of Prop rty Owner Signature of Property Owner SWORN TO BEFORE ME THIS l DAY OF r r ( 20 4a Not ul 1i y 61ic,5tgeQf 4f r:tom► {�o.ODS750T� cmiu ssiall Board of Trustees Applic-- 4on AUTHORIZATION (Where the applicant is not the owner) I/We, ilill Z owners of the property identified as SCTM# 1000- 7 `d / ©(� in the town of Z All New York, hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. . --xa Property Owner's Signat e Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF r7L 20a Not P WENDY A.STAPON jany 01ST�0�9)9 HIM Yy q Jan.6.Z��` APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Town of Southold's Code of Ethics rohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to nrovide information which can alert the town of ssible conflicts of interest and allow it to take whatever action is neceg=to avoid same. i YOUR NAME: Z ' l 8Al - (Last name,first name,Middle initial,unless you are applying'n 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 Ifyou 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 / ay of I 200 Z S Signature p Print Name Form TS l 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 icant 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# n b - o 29 - n 4 —o -7 r PROJECT NAME P ✓4 6ivo? e— N` The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees l. 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: �, Location of action: Z' e- v✓ �` Site acreage: G 67, Present land use: 4 ,li-ou 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) 1' g dress: e— � 0 (c) Telephone number: Area Code( ) , V-r 7 O —7 9 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No[A 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 a 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 1:4 No ❑ Not 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 ❑ 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 ❑ 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 Pageess116 through 21 for evaluation criteria ❑ Yes 1 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 Applicable 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 an:E1 astes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.❑ Yes 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. El Ye ❑ Not Applicable Attach additional sheets if necessary r , WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locatio s. 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 yTown waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. nd ❑ Yes �L1 No ❑ 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❑ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes No ❑ Not Applicable PREPARED BY TITLE DATE