Loading...
HomeMy WebLinkAboutTR-10839A Town Hall Annex ���� �e�0® Glenn Goldsmith, President S® 54375 Route 25� p O. Box 1179 �® A. Nicholas Eric Sepenoski i, Vice President Southold, New York 11971 Eric e 765-1392 Liz Gillooly � Telephone (631) • a® Fax (631) 765-6641 Elizabeth Peeples �� gCDUNI`�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUST OFFEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/2 constructed When project complete, call for compliance inspection; Town Hall Annex Glenn Goldsmith, President ®F S®�r� ®� ®� 54375 Route 25 A. Nicholas Krupski,Vice President h ® P.O. Box 1179 Eric Sepenoski J 1 Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 CQUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10839A Date of Receipt of Application: August 15, 2025 Applicant: 70 Deep Hole Drive LLC c/o Roger Leifer SCTM#: 1000-115-12-2 Project Location: 70 Deep Hole Drive, Mattituck Date of Resolution/Issuance: September 17, 2025 Date of Expiration: September 17, 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 Roger Leifer, received on August 15, 2025, and stamped approved on September 17, 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. 2 If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees 9 NOr��71•ll )23 f6006+,00'p N� I)ICKERSON 1060 2y'E�,,,r�8 9£ •�.� H D{✓,II/, 1.70.00• ?� (To 0,M y, M. ULKH EA 7,3'N C ' p • 1wwQ M LAWN&RIM& 3 8 STY v o , �.. %.— . FRAME AR,A44,02e,34 sgF* $moo GAR, O i N 0,7812 Acres �•• 22+�' 34,6' t S , R C` rvw ivaw5uw. ASPHALT DRIVEWAY 0 & 1;REES LAWN C b 1 :" DECK vW . - 3 ® ,�, ,i,., MN � Eva � - ,•� �'{, i cw-C7 i 's. aP. a 41.6' Ir C/) j —Q �+ •� :� �„1 LAWN'` ' Imo" o =-O y,rw• 'Yreq iWw N�''. �1� ..TRE£S 4� 1•_Z ,ygNa szn 'r CMC �o. 'E: ,,,,• UG 1 5 2025 ASPHALT ENE S02°40'40"W 126.68 SouthuldTovrn I i� ' DEEP HOLE DRIVE Board of Trustees ►+ 1. 1HE OFFSETS OR OIMENSiONS SHOWN HEREON, WEST BRANCH) FROM THE PROMTY UN ES TO THE SMUG1URER ARE TAluN PER c FROM A SPEdRc POIN79 ANO iHFAFFONE SSI gVE'Y OF PRDPL'R_7'Y L y��C dT AT.• THEY MM HOTINTENOEM TD MONUMENT PROM � r M Os TO MME THE ERECTION OF FENCr'.H, #70 DEEP HOLE DRIVE. HATTITUCK ADDITIONAL MUCTURES OR ANY O1NER IMPROVEldENiS. TOWN OAT SOOTHOLD. COUNTY OF SUFFOLK SURVEY z TNIS IN FOR WILE PURFGSE O&Y, NOT STATE OF MY YORX DIST. 1000 a FOR ANY MM Use � 3. EASEMENM NOT SHOWN ARE NOr GUARANTEED. SEC. M.00. BLOCK 12.00. LOTS 002.000 REVISIONS FILE DATE I 2 V.S 15-1461 07-02-22 CERTIFY TO 1. 15-1461 7-01-15 �k Thomas Randon and AcAl.Alice uae 1 t'I�. 06109 3 � cmwmY PC i Sou�THOLD ..TR. sIT_ ,, EES No � o83q a Issued To � Pleer : 40k, Lit Dade Address �o deep Nole br ;ve, Ma`1r�TucK . THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES aFFICE.�OWN OF SOUTHOLD SOUTHOLMi N.Y. 11971 TE L.: 765-1892 Glenn Goldsmith,1" ent 0W0 COG Town Hall Annex A.Nicholas Krupski,Vice President a y�4 54375 Route 25 Eric Sepenoski ti ,? P.O.Box 1179 Liz Gillooly �y • 0���¢� Southold,NY 11971 Elizabeth Peeples col �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 9/i Completed infield by: G- Ch US M I II'� 70 DEEP HOLE DRIVE LLC c/o ROGER LEIFER requests a 10-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed. Located: 70 Deep Hole Drive, Mattituck. SCTM# 1000-115-12-2 Typ of area to be impacted: Saltwater Wetland Freshwater Wetland Sound /Bay Part of Town Code proposed work falls under: JChapt. 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.: l'v'a m 4ds only 1G0'V&_ LC'CGV�cXc o 1 O nd Present Were: ✓ G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeples o .4��'��3q,.��� R sEESE x-oa'•. � � � : ���''\ �.... _.`"' _ "'° ..-� �\ � \ To zm \�',£ rwrcx _ :F to sA/ Av°St' t roz ) �� �x > •1f_ E § �t>� +� �° � '- ENPORT -r-y; f sr ` � \ \ eA 1 H„s. a 3 sl ra s a.2 t tsalt, st ac \� ', !• ce¢oaarF n 23:3A(cl ra~ "*s•.,x „�? ! , z.an t six SLtl OS T a2 \ �\ \ xwx'"s°i,W r t b t• Npi;R�UCK i e zEkk _ ^t teye t m� >,� \ 3,��q � \ .ac-. -'2l •t@ t 3 i y s � 7 t. } au —W. A(=t t `.�$ vb �� i S r s 3<j t a &s i a-xxmerzcawu.xzo a oszaas M", a .�:'\ q _«.:,, \ ., .s& ~' .h jt s pE., teKf B` ✓ •fl- s t i z\ �''v,`' ry : i T.. ° a 1 l t .•a ' } �'Vier-t ° nt 7 ma, �' \`\ <,�^'<'. t _ Iry •o "•P I-0) St9 A e i j o:o l ostzrot ✓vt 6 t'' o �tS.`� w u v `asa ;a s ` Asa N n_ S wt z \�i •� MW.,, ,, e ty ax ts-ts �'"' ton t 4 i, ,fie 2 3'kt• _ P� #, iy.9p = "S L.i a' tO,Th(cl y `._ r s la t.vn(m4 ,•t i": v i 1ef t r \ 1 O n o ww i em 4.41. X � �yy ��.ram- �� -+r r S 18 S:e--.-�'.S e.s z4"t fi_x s5 a •, � �1 i a t y.j '. �4�s�� ��. r \�i'..� �.R,r> ' s: s - -tw•r) ,�et.3 a u.0 1 ! o l 2 , 'i� 25 -. tat o.,l r i•'''` \. E8 T_ Ala 2. h 1 0Al) n AS \\`�'yn` ` ._;.tZ \r 21 2l. ; t �.•} 1 t0' ,8 $;S$ xs �st E i ,,, _. .._" ;�s_� R qi<�� �\ larcEc i sn { sss 1 1 � 5 $ t tr fU i3 3a 'i i t K L j2y '4T2G 1T1T � c1� 23A 'a 1 t,w+lc) $ >? i 31& ° y't 11 l� _ ,% t- ty v_<-< t t 2 2. 5 tTs gt�F ,. ti Zl.rna) -raft v1" ! txt' i zs E i 15 1 zs i i 4 3 tata' p' a m ? \ d 2 1 �4 _i W M 7 K ) 1 � TOnN Of 60UTMOLp i �& _y4{ , \ x 2 E 2 _ {1 t c l pm 2 2 - r ]a t 3 t 2T 23 i } 3& 23 x :- -t •L, c r 9 'O €„ ,y _i 2asi s t _ �..- OI.Y toixNAk�SotFttlo z t � zs- � t `� 1R.. SUzFF-� a'•.s�..<" .. _ o` 1Al).r ws ;: 9eT tt xz EK ,� K� -,. t i `.> r`. .� n c° E a Yaz22 E a J trAl) r 1 '� a=v r. " u \�>t, a �° ••'b 9 ss •t?3nlq 'ta tsA ; �. - s 1s:,,,s s fi-�1zo r a:16\ _ SsT '�`'., �. 4a cxx t i7'm xis --'ia' »z t _ g ''r 'at �.la _f \— ..\. �� zt• ' ) rc;' r�'';'^n,� �t ':�vb iA x t n n �„; •:�x x, .3 .�-.t F�°�t �� ` 's � � ��\�����.v*,- ^� {{^• b 'tz r s a'� 1..1 °'�,� s'aS _ {� c z .z ` S F k'�'- x �~•z IS '• �,j t "` 1 *.P t >h "'` Y4 •,fir. _ •-+' 'x_�m��"'$-,z,A `,a a Ya a E 3 t OF :. ke �'� i� G}En Yz,�'. � "�c.. _-1nat. Fl � a � §-,� r':m"• txt 1 ma4�`as. z,'.-e'&; m �. s z S. - °E``T t �nib,ni.•.«tt° s Scz �`. 1w, �4,* v �,,, �rrt �"X.. � 10 t �•a ffib 1 .V.°..- � �1 - F._..u_ { •,::a '.S �s �, �:,, �y s,,;.. S _i zap ter, Mato rC t Wit` .,:.. e ,sy. t ; ,,y• Yav ,$w, '�` n. I� "°tns h r \ as axkZ a ,v s ,r ...�. 1 11; 4• a > z„m` S t� N r ,'' �$ z°Tte•ii r` `�`• is E E�, a, " ''\�\ ,snw e°-v..•.-• ♦�yti�,,g• It a... a ''A\ x, �$ •° s s M1aw t p: ¢ µ'a a is 4� �� -\`roNvnacEU p �a,Hn?5?' \ d A� E. e e.�i r ��• E'� ..+�$ 1 'c'`s �t z s.rarei '�R ''',. '�, i ortDp„No tSEtsEaxo\. \, ems12 ._ � :. ti :; �,.�., �� '' bR— ,3,. �- a�''• f$�, ., �za �S1a�a;"�..a ,:'1 �Da<4-..ymv'4T,,"..•^�i_<ns'.'i$'�t��.�,y,.,�.r t s,11`°€e�i�t.'r,',y°v.i'' '90s-`E_€�i kz is 8�l1,tu• t l� ', tl 4 xi .�.T�a .��....... a\,� '�'','`�' � .. � �•. �:� ���,� ,,.,� y .� ,, "��....;.� `�. � ? '.,'`.` t,"�,,•; �,.,�fir,, AA�� - 7 i - - n.t t ..+,S_ , .'. v`,. ,,b. '�T <f -r1- 17 ^:\'' - �' w o s=� s n. tz 1t'°,wToa ' fi ,.: ''r..:. t ?,.' S. �, ,\ � '" .. •=lM�.E.a.,t. oa4>e�gnc° ,z, `�a'>' .,�.,Y�tu''�... �`; ,. .�`�'iv. :,z, �z�+'sa,t•u^�FSv?� s^, ay:�� .v�, v,�. .cea2.a.., wo_E <. �-� '�a>;pxm .. L� wn:w.`i:¢°iawnwws.rc:z nnma„m• w — vx.u. u. xt N ...K :aa rw. taaa� SECTION NO e x�Ir,xt, awaya COUNTY OF SUFFOLK© NOTICE E e __ __ -- _ __ �ry O v.:u..l Real Prope ty Th.S rviec Agency Osm�aino�ixv xoFrxe M xa a. SOu Oro i00(en,rrbnq 2:arh.waf At'x9a/ W 51FFOLN Cg4tlY iAx FV➢6FPNBIED aw (21) ew.... as LNRgUf YixxFlBx xem65xN 6TIE p ' .... ___ $ PfnLNOFxIV TAx 31ME XtFtLY. ir.i' Town Hall Annex Glenn Goldsmith,.President 54375 Ronte.25 A:Nicholas Krupski,Mce-President. 1;,► P.O:Box"1:179 Eric Sepenoski Southold,New York 11971 Liz:Gillooly .', Telephone(631)765.1892 Elizabeth Peeples• F.ax:(631)s765 6641 BOARD OF TOWN TRUSTEES; :. TOWN OF SOUTH OLD This.Section Far::Uffice.Use On1y' � ( E �' . � Coastal:Erosion:P,ermit Application Wetlan&Permlt•.Application LLJ)." �Admmistrative Kermit : . .` AUG ,1 ,5 :2025. Amendment/Iransfei/Extension :. ,:Receiued Application I Received Fee $ SobftldTown. Completed Appiicatibm, -Board of Trustees { Incomplete SEQRA.CIass}fcat�on Type I Type II: Unlisted Negative Dec: ' . Positive Dec: Lead Agency Determ nation Date - : Eoordmation(date sent)' ' LWRP Consistency Assessment'Form.Sent: _ CAC°Referral Sent, l :Date of Inspection " ' • Receipt-of CAG:Report -__Technical Review Public Hearing Heid - ..Resolution • :,Ownec(s)Legal Name of Pro a as shovim on Deed 1� �`���•�P' ��'�� , �� C •' P rh' Mailing Address Phone:Nurnber Suffolk County Tax Map Nunnbe>: •1000 " � dB0 Property Location " �',�d',��/' off' ��c`'� N�j� a'r °� /1!�r,�t ��1���/.�(e° /4 ..✓� -; (If necessary;.provide LIL,CO Pole C distance to cross streets,and locatron) ` '"•':''.AGENT'(If applicabir le),;. -. .. i • "..: ' Mailing Address, Phohe•Number::: OL Board of Trustees Application GENERAL.DATA.. Land.Area(in square feet):.. .. Area Zoning.- ... Previous use.of property: �5 �Ch Intended.use-of property: -- . Covenani&and Restrictions:on property?' Yes ��Nq i 'If"C Yes';,please provide a copy: Will thiiproject require:a•Building-Permit as:per Town Code:.. If"Yes'.be:advrse-'Ahis:application VviIl be reviewed by-the Bu lding;Dept prior to.a Board ofTrustee review.. and Elevation.Plans:will:be required... Does thisprojectrequire a'variance:from the Zoning;Board ofAppeal's.. �Y'es. -. If"Yes' please.provide copy:of decision. is project:re any demolition:as,.per.Towne Code or.as:determined�by:the Building Dept.?. Yes N:o = ma ahe=structure: s. on ro.P et 'have.avalid:Certi£icate-of Occupancy.. Yes N Does (.).. :..P .r t, ,. f rior permitsLa royals for srteam rovements: - pp P.;.. . -.. Aglen' c. : ...... ••:: Date:.:. 'Cud' �l�:.C��.�.� 'O�for� � �• �_lPJl23 . . -.. .. .. _ .:..:..:.. ❑;No prior permits/approvals forsitearnprouements, Has any,peinut/approval ever been revoked or suspended by a governmental agency?No�Tles If:yes;;provideexplanation .` t.' . 77 ents if necess Project Description(use attachm . azY) :. Board .of Trustees. Application WETLAND/TRUSTEE LANDS:APPLICATION.DATA ; sed operations: rurpbse of the p ro o p. . p Area of wetlands:on lot::. : . square:feet Percent.eoverage of lot::::.. .: i Closest distaiice between nearest existing•structure and-upland edge of`wetlands:: feet Closest distarice:betuveeri nearest proposed.structure and upland;edge of wetlands: feet Does the p;oject uiyolve excavation or filling?:: No Yes If yes;.how much materral will be excavated cubic Xards �" cubic yards How:much:material will be filled.,, Depth:of which material=will:lie removed.or.deposited: :.. Proposed slope throughout the:area.of operations: Manner iIi which materral Will be removed or deposited �� �t��/�'s ::... .• Statemerit of the.effect,if aiiy,on the wetlands and tidal.waters•of the fown that may.result by : .reaSQn ofsuch"proposed°operations(use.attachments If appropriatO — . , 6l•7.20 : Appendix B Short Environmental'A'ssessment Farm Itistkiktions.for: Comnt'etinR Part I-.'Pro Jeci in The:applicant'or project sponsor is,responsible for the completion,of Part-L.Responses become part ofthe application for•-approval or funding,are subjec-to public review,and may be'subject to furtherverification:. Complete Pa based op information currently available. 1•f additional'research or rovesfigation:would'be needed=to fully respond'to any item;.please answeras.thoroughlyas-possible based:on current iriformatron Complete.all itenis in.Part L.You may also,provide-any ad'ditionaCinformation-which you:believemill`be.needed'by or - - to-tt e_lead agency;attach additional pages as necessary.to supplemenvany item: ` " .;Part 1=I'ro�eet•andrSponsor lnformatiori� • • - • Name of Action or Pro�ect:Location;(,O s rik;and attach a location map): -.lez e/` Brief•Description•ofProposed Action I Name of Applicant or Sponsor. ®� ;, .'; Telephone:a®3 : 'S� Elvlail:.; �. • Address: City/PCQ State: Zip Code I..Lloes.the•propose d''actlon only•mvolvethe legislative adoption ofa plan local`law;,ordinance, NO YES- idmipistrative;ruie or regulation? : I If Yes,attach a narrative description of the ii►ten rofthe proposed ac..on the environmental resources that " maybe affected in'the miinici alt `and; rgceed to Part>2:-if no,.continue to uestion 2 P tY p _ q 2 Does the proposed action re uire a ermi roval or fundm from an other overnmental A enc ? "' N4 : YES 4 P aPP g Y g g Y If Yes;list agenoy(s)name and peRnit orapproval f `1 a Total acreage of the site of the proposed acdon� acres J eage to be physically disturbed? b T6ta1a6r acres c Total acreage(project.site and'any contiguous properties):owned; or.confroUed by the..appLcant or project sponsors acres }, :. 4 Che.` I land us at occur on,adjoining an ar the propq action UFlian Rural(norr-agriculture): Industrial L_J,Commercial �esidential'(subur6an) Forest ❑Agriculture Aquatic' Q0 her(specify)t Parkland Page l of 4' 5,_ Is the propose&action, NO " YES! .•NIA•. a.A;permitted'use under the zoning regulations?' b.Consistent with:the adopted:comprehensive plan?` 6::Is.the proposed action•consistent with:the predominant character of the existing built or natural NO. YE/S.: landscape?. 7 ls;the site of the pr posed action located'irU',.ordoes-tadjoin;a stateaisted Critical Environmental Area? NO . YES fy. �riy `��' worer &J m If Yes,.Hen -; 8. a.Will•the proposed action,result.-in a'substantial increase in'traffie•above present:fevels7 NO- YES, b:.Are public.transportation.service(s).available at:or nearthe.site of the. r re`any:pedestrian-accommodations:or bicycle routes available on•or-near:ti:oftfie proposed:actior►? ./ 9 Doesahe proposed action"meet or.exceed the:state energy code requirements? NO: : YES- [f the:proposed:actwn wtll exceed_.requ►remerits,describe design features.and technologies: t ]O WilCthepmposedactionconnectto,an-ex►stmg,p'pbhe�privatewater;supply?:' NO '' YES j .If No,describemethod:forproviding.potable)water: j L1.W►Ilahe proposed action connect to existing_wastewater util►t►es?:; NO YES' If No,describe methodfor•providing wastewater treatment ' h. a.hoes the"site contain a stri►cfi►re that is listed on either"'the State or National Registerof H►sfohc NO ; YES' F. -° : ._ • Places?: ',•:. .�. . .: :.• .. ,: ' PT b.1's the proposed.action located m an H►cheological sens►tt area?: t • 13.a..Does any portion afihe sitepfthe proposedaction or lands adjoimng the:proposed:aetion,:contain•': NO wetlands or other waterbod►es regulated by a federal stafe or local agency? ;. : .. b;-Would;thd iroposed;acttori.phys►cally%alter,or encroach into,:any existing wetland or waterbody7 i Ff Yes,:ident►fy the wetland or waierbody`and extent of alterations m square feet or acres .�, .•h - - l4. nnfy the.typ re ic bdattypes thatare likely to be found on t y rojecis►te Check all that apply.. ?Shorehneosl Agricultural/grasslands EarlY`mid successional :Wetland Urban Subui.ban IS I?oes the site:ofthe:Proposed action contain any species of animal;or associated habitats,fisted. NO YES' by the State_or Federal'government as threafened•,or endangered i •. l6 IS the projectsrte located m the'1 OO year,flood pfain? • N0 .' 4YE, ; 17 Willtheproposed action create storm water.discharge;either from point ocnon pomt.sourees? ' NA [f Yes;.". - ° .. ., .. •, .: . a Will storm`water discharges-floWto ad jacent:properties9.. JO :❑YES ❑ ; b Will storm water discharges be'd►rectedao:established conveyonce systems v i"ff an 'diams)? 1 • L�J" If Yes,'briefly describe'•.' . . . 0 ES ; I Page 2 of 4 i 1.8.Does the proposed.action include construction,or other activities that result in the impoundment of y I NO Y.ES water or other liquids(e.g.retention pond,waste lagoon,dam)? t If Yes,explain purpose and.size; 19.Has•the site ofthe"proposed-action.or an adjoining property been-the location of an.active or•closed ' NO, .YES t solid"waste management facility? If Yes,describe: . - -" - 21 .20..Has.the.site.of the proposed:action:or.an adjoin ing property been:the.subjectof'remediation(ongoingor NO . -YES completed),for hazardous•waste? IfYes;describe: ❑ ❑` i I AFFIRM.'T:HATTHE INFORMATION:PRO.VIDED.ABOVEIS TRUE AND'ACCURATT,TO T.HifBEST"OF MY I KNOWLEDGE''.. APPlicandsponsor`nam . 7 0 ,pe /`�rJ�t? Date: " Signature:_. . . Part 2'-Impact Assessment..The Lead Agency is responsible:ftirttie"•completion,of:.P.art:2:'Answer all of the;fglloviing. •:questions ih Part2.using-the informauon'contained-in:Part f and other,ir aitertalssubmitted`:by the project sponsor or. f otherwise.availableto•ihe,revidwer-- When answering the?quest ions•the rewewershould:be gWded by.,the concept"Have:my responses been.reasonable considering the sca16 and context.of:'the proposed'action: " No;or .Moderate- i small: ;toaar-ge ,.. :. impact:.. :: impact 1 'may. : � may. " tic-::" �..� occur ;'I'. Vi!ilf the piopo§ed;action create a matbfial con fliatwrtfi arr:adopted land use plan:or'zoning ' �_ :.: :.. •regulations?• :. r- j ;`• . :. .< 2:;.will ahe proposed action result;in:a change m:tlie use'or intensity of'use of lands i ❑ Wtll the proposed action impair the character or:quality"of the existing commumty? ❑ ❑ 4 Will the proposed action have an Impact on the enwronr iental characteristics,that caused the establisFiroent of a:Critical Environmental Area.("CEA)? 5 V✓ill the.proposed`action result inan adverse chanm ge the.6xistiniglevel of trafficor affect existifig infrastructure,-for mass tranMr biking•orwalkway?.: _ r - : ❑ .. - 6- W"ill.the;poposed aetion:cause'an.increase m tfie"use,ofenergy and ttfails to:incorporate: cea§onelily'available:energy conservation:or,cenewalile ener o ottunities? = 7.- W ilf the"proposed action:'impact dx(sting:. .a.public%private water upplles?. ❑' - :_ b.'public/private wastewater treatment..utilities. . 8.' Will the proposed action•impair the character or qualtry'of-important historic,,arcliaeological,: " architectural'or:aesthetic:resources?', _. " Will the proposed action:cesultin an adverse-change to:natural:resources.(e;g.,wetlands, ❑ ❑ ivatetBodie's;groundwater,air quality,:flora•and fauna)? I fr No,.or Moderate' small to large impact: impact may may loccur occur 10. Will:the proposed action resultin an:increase.in-the potential,forerosionjlooding.ordrainage problems? i 1:..Will;the proposed action create a kiazard to environmental resources or.human health? ' . Part.3-Determination of significance::The,Lead Agency is responsible for the compietion.of Part.3. For eveiy question in Part 2 that was.answered"moderate to large impact.may occur",.or.if there is a need to explain why-a.particular' ' elementof.the proposed action may or will not result in a significant adverse enviionmental impact;please complete Part3. Part3shouldJhi sufficient.detail;identify the.impact,.includingany measures:or design.elements.that:have:beenincluded'by the:project sponsorto•avoid or.reduce:impacts- Part3 should also explain.how the lead agency determined that the impact ingy;or-will not.be significant:;Each potential impact should`.be assessed considering its.setting;.piob9biUty•of occurring, duration;irreversibility,.geographic.scope:and.magnitude.. Also conside'rthe potential:for short-term,long-term and cumulative impacts. . p Check this bdx if yop:have;deterrnined;:based'oa the information anii�arialysis•above,and.any supporting documentation,.: .that the proposed°agfion:;may resulYin one or more;potentially'large arsignificantad'versis impacts and:an env troninenial'impact.statement is re:uired`. Check.this•lioz..'ifgou:have:determiined basedon.:theinforination:andanalysis•aboye;and:anjrsapporting.documentation, t6tthe•proposed'actionwilFnot:resultiwanysignificantadverseenviromtiental impacts.. ToiNnof`Southold• BoardiofThmslees. Name'ofLead gA enc y . : . � . ..-Date. Prestdenl ._ Print orTypeName•of Responsible.Officer in Lead Agency . Title.of Responsible Officer Signature af'Responsible Officer in Lead:Agency Signatimre!of P*arer(if different:from Responsible.Officer) PR1-iVT. Page 4 of 4 API'LICANT/AGENTmPRESENTATIV}E: TRANSACTIONAL DI9CLOSUREF.ORI4 The Town of Souihold'si6ode of Ethics arotiitiits conflicft.of tnteiesl on dhe:oartofiown ttffieers and emtfiovees.Ttie nuroose of•._. this:foani,tsbo. roviae:inforinationwfiichcan:slErtthet wn:o nssibieeonfticts,ofmterestand<allawitfo take whateveractionas gecesser Phi avoid'same. YOIJR.NAME .. . (L:ast:niunefi stmame;lpiddle initial;.uniessyou are applymginthe name of someone else.orotherentity;.such as a company..If so,.indicata theottier. Ors on's or:company's name.) NAIv1E'OF APPLICATION:.(Check all that :.Tax gngvance. Building: Yanence Trustee . Change of Zone,", CoastalErosion: Adoorin Approval of peat,.':, g Exemption from plat or•official map Planning `(If"Other•;.nameAe activity) •�®• tfY►q'i . Do youipersonaily,:'(or through your xeampany,spouse!sihlung,parent or ctiildj have a ielationsfip with any Pro. employee of the`Town ofSouthold�."Reiafidnship inclhdes}ay bloody marriage,or buemessttteresl "Business rnterest"means a business; including a partnership in which!fie town.ot iceror entployce heS'even.a pariidl owileiship of(i5[emploxment by)aicorporahoi► { ., .. "' in whichahe town giaer oI employee owns more than 5"/0 of tlteshares:. YES n NO , If yoir snswefed YES';complete the balance of this f6nn and date and sign•where indioated Name of person employedby the Town of Southold: Title oipositiomdf thatperson Describe the.relationship.betweenyoursetf(the.:applicant.agenViepreseritative)and the.town otficer or employee Eitt ercheck.,: the appiopnaie lrtie A)6thiough D)and/or dgscr;6e in thespace provided. The town officer or employee or hE. isoi her spouse,sibhng,parent;or child isi(check ail that apply) A)the owner of greater than 5%u oflfic shares of the coriso(dtc stt,ek of the gpplic�wt •• • •- "' :. when the a leant is a'co ration, '' • f PPl � )`• ` B)the legal orbeneficial owner of anylnterest in a non-corporate entity jWheni 4 applicant is rota corporation) , C)an pfticer,duector partney:or employee of the apphcant;.or D)the actual DESCRIPTION OF RELA MONShIIP',,; f .a� $.:•. .'20 S.ignaWt Form TS�I;. Board of Trustees Application AFFIDAVIT : . Le s " . BEnvG DULY"swouv. DEPOSES".AND �'AFFIRMS'T HE/SHE IS;THKAPPLICk.vrllOR'TI ABOVE' DESCRIBI<D:.PERNIIT(S)ANRTHAT ALL'STATENMNT-S'CONTAINED HEREIN ARE:TRUE:TO THE BEST OF: At KN HISk OWLEDGE AND:BELIEF;AND'THAT ALL;WORK WILI�BE DONE IN THE MA.NER.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_FR01VI ANY AND ALL DAIGIAGES AND OLAIMS ARISING UNDER OR BY VIRTUE OF SAID Pg,M, .T(S),IF ' GRANTED: IN'COMPLETING.THI,8f.APPLICATION,I,HERE- AUTHORIZE THE: '. TRUSTEES,THEIRAGENT(S)ORREPRESENTATIVES INCLUDING THE;. CONSERVATION'ADVISOR'S COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT'THE MI PRESES IN:CONJUNCTION W-1-TH THIS APPLICATION, INCLUDING A FINALI INSPECT. I FURTHER AUTHORIZE THE BOARD:OT TRUSTEES.TO ENTER ONTO'MY PROPERTY AN AS REQUIRED TO.INSURE: ; COMPLIANCE Wr ANY CONDITION OF ANY WETLAND OR COASTAL:: EROSION PERMIT ISSUED BY THE:BOARD OF TRUSTEES DURING THE`TERNT t OF THE:PERIYTIT; Signature:oProperty caner Signature.of Property Owner: " SWORN T&BEFORE ME:THIS _DAYC)AM, Y r;f • i��U�!iiil+Z�SSiON LYa3. .. ` .s.�..x :� ..- . . '`sir;; •r�;' Hoard of Trustees Application AUTHORIZATION . (Where the applicant is not the owner): I/We,.. owners of the property identified:as SCTM#`1'00.0- �"� _ in theao n of -;New York,hereby authorizes: . to.act as niy agent and handle all: .necessary work'involved with the application'.process for.permit(s):from the:Southold.Towri s Board.of:Trustees:for.fiiis:proper:.ty.: ..-.... Property Owner's Signature Property Owner's Signature SWORN TO:BEEORE'IVIE:THIS . DAY'OF .,20. :. Notary:Public. 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 in ormation:used by a.Town: of Southold:agency m.. making;a• determnation of consistency.:.*'Except minor. exempt actions including Butldin Permits: y .and:other ministerial permits:not located'within the Coastal-Ergsion Hazard�Ared: 2. -Before•answering.the questions:hi.Section C,.the preparer of this:form-should review. ,the exeinpf :minor action.list,policies and explanations•of each policy contained nn the Town.of Southold Local :Wb aterfront Revitalizahon..Prograni.. A nrovosed action. M lie evaluated.�.a§ to its sienificarit.•neficial'and adverse effects•uyon the"coasfal area(which includes all of Soiitliold Town):. :. ' 31:.., If any, question in:.Section Q on-thiss.: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:reaih';'—swei< must.be e"laiited ia�detail..listiik-both supportui9 and:non - suvportinit fads. If`an action cannotbd certified as:consistent:with the LWRP pohcy.standards:and ' conditioiis;.rtAah;.nofbe undertaken:. • i I !.; A copy of the'LVCIRP is available,in jhe followmg,:places:online at the Town of Southold's:.: website(southoldtown northfork.net),the Boaid:of Trustees Office,the.Planning Department all local libraries and tfie Town:Clerk's B:.. DESCRIPTION.OF-SITE•.AND'PROPOSED:ACTION 1 :0�2:.®6 SCTM#. rl • z -. ..� PRo�cT rtAME; •.����w' s�ral�i•r�r: ��,��a/.:�r�..e�..�U>��ar:Ma�'�, eta _ _ • .. . : - 17 es TheApplicatioaaas.been.submitted to.(checkappropriateresponse) ; Town.Board:.. ❑ Planning Board❑ Building Dept: ❑ Board'ofTidstees 1 Category-of Town.of'Southold agency action(check'appropriate (a)• Action undertatcen directl b Town a enc. a ca ntal < YY g Y( g P a onu tY•-agencye atio land.iransaction Financial assistance:(e g;.grant,loan,subsidy)' (c) Permit;;approval,.license;,certfication:. Nature'and extentof action:T:. T .. rPn Location of action: Peep Aa/e; PrIye1 144 ,IBA '+ MY, — Site acreage, Present land use:: Are.: Present zoning:classificationc - 2'. If ant application for the proposed action ha&been.filed with.the Town of'Southold agency,the followings information shall-lie prov'aded:. a) P: Name of a plicanE D:: ' Irvu. . (b):-Mailing.address: . c) Tele h6ne number. actiontie'directl.undertake" "re uire:funding,or'.appro"al bya:stat&orfederal,agency7. Will the y,.: :. . . n; q. i �.... i Yes �.No If yes,which state or federal agency? . C. Evaluate the ro ect fo the followin olicies b "anal yin how the ro ect:will furfher su ort .r " p.. J g P y 3'Z. g P .J PP not support.the policies; Provide all•proposed Best 1Vlanagemenf Prachces:that-w.- further each.poliry.. 1 Incomplete answers will:require-thatthe form be returned for completion: : DEVELOPED' Policy 1. Eoster;a pattern of deyelopnient m t6e Town of Southold that enhances community charactea', preserves open space; makes efficient use of W 'istr1.ucture,.makes.beneficial use.of a coastal location,and mmim�zes>adverse effe¢ts.ofdev.•elopment;•See"L•VW. , Section III-PoLcies; Eage2 for;:evalnahon . criteria: • Yes Na;, •Not Apphcable.". • Attach additionaC sheets if'necessary : Policy 2. Protect and .preserve'historic and archaeological. resources- of`the' Town of.Southold..`See " L�VRP"SectignIII=.Policies Pages 3 through b for evaluation criteria : :❑ Yes❑No L-1.Not Applicable: Attach if additionalaheets necessary Policy 1 . Enhance visual quality and -protect scenic. resources throughout the Town of Southold. See LWRP Section:HI—Policies;Pages.6 through 7 for evaluation criteria .Yes ❑°No❑ Not Applicable :Attach Ott talsheets if necessary ; NATURAL.COAST POLICIES: Policy 4.. Nlininuze loss'of life,structures;:and-,natural.resources:from"flooding:and erosion..See LWRP` Section.IlI=Policies Pages&throw h,16:for-,evaluation criteria. Yes No Not A':. licable: _ pP . --y_...._......-.. ..`-, - _ Attach additional�sheets-tfnecessary Policy 5 Protect and improve:water quahty and:supply in.the Town of.;;outhtild..see LWRP 5ection;III ='Policies:Pages 16 through 21 for'evaluation.cnteria Yes Not.A;p 'R.—cable. ttac a ittona's ie- ts.ifnecess . Policy.6. Protect and restore tfie..:quality`'and•.function oUthe Town_of Southold.ecosystems including. Significant Coastal Fish"and Wildlife Habitats and.wetlands.• See N. 5ection.IlI=Policies;.Pages.22 through 32 for'evaluationcriteria:. Not A � licable Yes No' PP 4 f Attach additional sheets ifnecessary, `. Policy 7. Protect and.improve air quality in the Town of Southold. See LWRP.Section III—Policies - Pages 1-2 through.34 for evaluation criteria. No Not Applicable Yes o S . a: Attach additionai�sheets:=cessary Polley'8,. Minimize. environmental•:degradation. in..T6w.n•of Southold from-solid.waste and`:hazardous:: . :. substances and wastes: _See LW1tP'.Section III-Policies;.Pages 34 through-38 for.evaluation°criteria.. Y.es:a `No Not:Applicabie - . :.PUBLIC COAST POLICIES' `c 9: Provide for: 'ublic access.to;:and`recreational:fuse.of,:coastal:Witers;;publ ie-lands,.`and public Poi.y .. pub resources of:the:TovYa of Southold'. See LWRP Section 111 Poliiies;Tag6s.38thr010.46 for evaluation :.: Criteria.: . . • ❑ .:Ye�..No:L� .Not Applicabie. .. - i Attach additional sheets.if necessary WORKING COAST POLICIES Policy 1U: Protect Southold's water-dependent uses and promote siting of new wateV dependent uses in: 'suitable locations. See.LWRP Section.III—Policies; Pages 47through 56 for evaluation criteria: ;Yes '❑ :No. Tot Applicable e Attach additional sheets if iieaessary Policy.11. Promote: sustalna4le'use :of living: marine resources. in. Long Island. Sound,. the Pecorric Estuary and.Town waters. See LW-RP Section.III=Policies;.Pages 57 through 62 for. evaluation criteria. : . Yes. No Not Applicable Attach:a�ditionat sfieets:if-iiepessary. Policy 12. Protect agrieultural lands.in_the Town of Southold: See LR�RP Section.III=Policies;;Pages 62 through 65 forevaluation criteria;.. /. . D Yes O .No;LJ'N.ot'Applicable Atiach.additional sheets.if neoessary Policy. 11. Promote..appropr:iate use-and: deveiopment of.energyr .and;mineral resources:. See.LWRP.. Section III—Policies,Pages 65.through 68 for evaluation criteria:.. n Yes :No ; Not:Applica . e. DATE. PREPARED BY . TITLE