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Home My WebLink AboutTR-6494 . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction Y, constructed ~roject complete, compliance inspection. . . TERMS AND CONDITIONS The Permittee Matthew Kar. residing at 750 Little Peconic Bav Rd.. Cutchogue, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: I. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of South old. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of South old require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Ir. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 15, 2006 Mr. Ian Crowley P.O. Box 618 Greenport, NY 11944 RE: MATTHEW KAR 750 LITTLE PECONIC BAY RD., CUTCHOGUE SCTM#111-14-14 Dear Mr. Crowley: The Board of Town Trustees took the following action during its regular meeting held on Wed., November 15, 2006 regarding the above matter: WHEREAS, Ian Crowley on behalf of MATTHEW KAR applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated October 10, 2006, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, in accordance with Chapter 268, said application was found to be Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on November 15, 2006, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 . . WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of MATTHEW KAR to remove a 6'X 33' floating dock, 3'X 12' ramp, and 4'X 7' platform and replace with a 6'X 20' floating dock, 3'X 12' ramp, and 4'X 7' cantilevered platform, and as depicted on the plan prepared by Ian Crowley dated September 12, 2006. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $602.00 Very truly yours, D...~ C7 ~L... Jameff~Ki~~ ~7 President, Board of Trustees JFK/lms . Town Hall 53095 Route 25 P,O, Box 1179 Southold, New York 11971-0959 James F. King, President Jill M, Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~(l#-hn..J. J Mf1 Please be advised that your application dated 1()IIO~OI., reviewed by this Board at the regular meeting of 1111:7(")(,. following action was taken: has been and the ~PPlication Approved (see below) ~) Application Denied (see below) ~) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due, Make check or money order payable to the Southold Town Trustees, The fee is computed below according to the schedule of rates as set forth in Chapter 97 of the Southold Town Code, The following fee must be paid within 90 days or re-application fees will be necessary, COMPUTATION OF PERMIT FEES: '4r ndJ I fl4J-!CU1Y) J-u- - <If S/), 00 .t '-I'(J' -fJ/a.tiJrYlIYl -= d, LI' .!3,ls~_-Pt_ = 8'1,OD 3'{1~'J)otv\f -= J0') -s3.1!f.ff,: "'/08,00. .:y &'(r).o' 61OO1.U19 dO( /z ~ 18.0' A .!3. lS4--rt, - 3ftJO,OD TOTAL FEES DUE: $ foOd, 00 BY: James F, King, President BoorD of Trustees-- ---- . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/W orksession Report Date/Time: Name of Applicant: Name of Agent: Property Location: SCTM# & Street Brief Description of proposed action: Type of area to be impacted: Saltwater Wetland Freshwater Wetland _Sound Front _Bay Front Distance of proposed work to edge of above: Part of Town Code proposed work falls under: .~Chapt.97 _Chapt. 37 _other Type of Application: _ Wetland _Coastal Erosion _Amendment _Administrative _Emergency Info needed: Modifications: Conditions: Present Were: _J.King _J.Doherty _P.Dickerson _D. Bergen Other: MailedlFaxed to: Date: Comments of Environmental Technician: . . Telephone (631)765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., November 8, 2006, the following recommendation was made: Moved by James Eckert, seconded by Don Wilder, it was RESOLVED to SUPPORT the Wetland Permit application of MATTHEW KAR to remove existing 6'X 33' floating dock, 3'X 12' ramp, and 4'X 7' platform and replace with 6'X 20' floating dock, 3'X 12' ramp, and 4'X 7' cantilevered platform. Located: 750 Little Peconic Bay Rd., Cutchogue. SCTM#111-14-14 Inspected by: James Eckert Vote of Council: Ayes: All Motion Carried . .. l ~~- I ,,, . . M C M . M I , 1:- - --- I rECOtltC or'"' ,1:1 Eli ",,-~ ii'~;l ~'" Sl,. " o , ~;;j !<~; ~"'" 8~] o i, ! I: ii! i ~ I:, I: f ! I ~ , ~;';i ~~. :~ ~ ~~:,: '1m! !!~i I/! i~HW i;IIIJI :'11h i~hjfi iiil! i Ii l! ~ l ! -, HIli I'"'' ;!!!!!i iiiiili' ~ ; ~ !l I, iI i IdHI ~,: ~3f;fl/, 'i l ~1 ",y <fJ'C c.s.c'f. ill! 18,,:, I Iii ,l, "~ '<;j;;"'!ll ~'" ~ !:'# I; ~$ -~ /' "'''i -t"~ " !ll j j ill - , ;5''' I . , . :Ill" !" 'I JI]1 :/ill ' , ,", I' II d, ~ J q IJ!J i I' , :~ Albert J. Krupski, Presia I:'"') James King, Vice-Presid"- c.....3Y Artie Foster Ken Poliwoda Peggy A. Dickerson . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~"'1o'l1 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD Office Use Only Coastal Erosion Permit Application -;;Wetland Permit Application .~ Administrative Permit Amendment/Transfer/Extension ~eceived Application: l ~ \ bliJk, --Received Fee:$ ~/ _ -f;ompleted Application l0l I It\{ 00 _Incomplete _SEQRA Classification: Type ]~Type II~Unlisted_ _Coordination:(date sent) C:.~ ~ 1 0 ~5 ~AC Referral Sent:---illUol!:io _-1T.lte oflnspection:--1LII~/OIo _Receipt ofCAC Report: _Lead Agency Determination:~ Technical Review: ~ublic Hearing Held: II IlK'll.,,,, Resolution: ~ ......... Name of Applicant I!lrmJkW t~_ Address 1st! i- ;7i!t> Jh'''ilr /~1 120M Phone Number:(t:3/ ) /" .nzdo6U ;Jrj 1;<1:3) 1"'3<1 2Q-z I Suffolk County Tax Map Number: 1000 - III - N - ," Property Location: I~ ('rr/( ~"WI( kl !o>'tfJ flrrdMlJ> ;\),I I!<;:r:s- (provide LILCO Pole #, distance to cross streets, and location) AGENT: ::7/il1 (If applicable) CitMlej , C~()(p '3- ~{~o...\ Address: A r:5{h [It (fl/<-()"f'''; IJiI 11<;/1 Phone:Jl?6 ~~-(7y'O I . Board of Trustees APPltirtion GENERAL DATA Land Area (in square feet): ~. 5~1. '>600i\Y..... -- iL-"'--' Area Zoning: ~~ i(b'\JT1I:W- Previous use of property: i2C'S I b-o^JTlli.....-L Intended use of property: fl .' t:S, i}c:wn tt1-- Prior permits/approvals for site improvements: Agency /J<I(;/ocz ~w r: i~~ate ~/ tff No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend~ by a governmental agency? ~No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): ~W6 &XS'l n)w Ll:WFo.l.,1/ "", Frof-r 4>11) Jl"fJ/ltzc f""^"",, V//TI{ t;nc RiJlmtVtJ . l1n.t CoIl til 4plt2c ~~1 (Mrrl t"~I,u"'J"'" pd~ '''''W'>tT5 v~iitL ,&XVTS r etw1oJ~ ~ l,"1 plfrrFMi+! Ptplm:.. sxt2- ~ ~~"{)I~i:-,..J'<I. . Board of Trustees APPwation WETLAND/TRUSTEE LANDS APPLICA nON DATA Purpose of the proposed operations: -r" (7-,~ '.'.((1 Srn' vii.i" (Cj"" ~ lIi\l\t-<( fli\"\J,w &,"\)WClWL<f IJt1'/,w\ l-rrrn I Area of wetlands on lot: .~ square feet Percent coverage of lot: ./ % Closest distance between nearest existing structure and upland edge of wetlands: I cro feet Closest distance between nearest proposed structure and upland edge of wetlands: ftr() 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: --- Statement of the effect, ifany, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): (ij/.?W IS -Iv ~ iN> /l<(/i/J?:r 7"/) l.VVi/A1>1d<;; JJI~ n<>1T wJI hr: , CC>\ST'LU.c'<l\. lf~'Il" J\.1/.\ ~...ft11 M.il~ ,~I S"'lp'r pop/ftu Il!/? oft, FiGI'll hiltv/l7h (w15Tr1vtT/'''; ~ oil) 11~ WI/I he -MtbiJ ..;0 ~ f/tw., kf<<>$ '$. . Boar~:__~~~stees APp~ation ------ i ~ASTAL EROSION APP ~'-- Purposes of proposed activitY:~i",,-:;--sm"- f;> ICATION DATA {q'W 'jJ &'1lt1V:S Are wetlands present within 100 feet of the proposed activity? No V Yes 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) Manner in which material will be removed or deposited: ./ Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation ofthe project as proposed. (Use attachments if necessary) JkIJW JI,w Iv 6" M' (JI/iL...Alen/11I 1")'*1S !I/ ,k(II:4J WIIfr -It, /MJ/fvtJt(4- / 7 ,/p/~fJ 1M /P!S!tJ!h , Oi'/k .ft.ait-r '1I-k. ;A~ Wi II b~ ('()I/!fL(/cTlf) 10kw YftL tMy/ttliW Jf' '-41: )v/fJ/I:1JA_ , I . . . .' o<rSI . . . .,'", " ....%}. .' .._........ f. \\"'-1 a{lJ"""':" .0.1.1 $ pos\S.ge l.^ .z.... ~.\'lO $O.\'lO '2.1'/ ;#.ti . ( 0\ 9"1l!fi ~ . \:~ ./ .........."..-..:I<i"O/.. ~;j&~ .'~ CJ '" IT' f'- U S postal Service", C'-:"'"..lCIED MAIL" RECEIP Cn I I' (Domesl">; Mail Only; No Insurance Coverage ~. '" '" ..!I ru rn CJ CJ f'- Total Postage & Fees postage $ rn it . '5 ---".......~ rn CJ CJ Return RtlClept Fee CJ (EndorSement RequIred) D RestT\ct8d Delivery Fee ...., (Endorsement Required) CJ .-'l Certified Fee STATE OF NEW YORK COUNTY OF SUFFOLK -:Ji,r CwIC/ , residing at !?/) f!t(fc~r &.. (It..J- q I , being duly sworn, deposes and says that on the ~ day qf ;Ui,;b+!IlJAL , 2~ deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of he To of Southold; that said Notices were mailed at the United States Post that said Notices were mailed to each of said persons by c.._. . Sworn to before me this /~ Dayof N~ , 20...Q..J..e '1;ff:./'1;fJ ~)qf . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD - --- ---.. - -- ------ - - - - --- - - - - ------ - --- - - - -- - --- - ---------- -- --- In the Matter of the Application of -----~-1tJr:l~__11_~________________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,:-Jt1 Ctowty , residing at /!({'" ;(;!c~tsT Ic.\e.. Dt(LVIf tW Ifrs1 being duly sworn, depose and say: That ou the I day 0 ~ k by placing the Board of Trustees fficial poster where It easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wa1- t..r)e1J, I~. &OC\b- 0,,' <<V\. a ()lD... (P ;30 pm, Dated: o(1UTJf' -==---=--~ (signature) ~ Sworn to before me this ~. . . 1~<I1dayo~200~ ..., M ~2~~ .' fr_ Notary Public ~ NillIIy ,=, TAGGA No. " Qualifi . , . """"'-I . . .Iy 'M'nm SSlO pli l:;> i~ ...." ...J, ~ ..'11 1'~"'"'rtl'tilrt''JIj~~ · Board of Trustees ApPli!ion County of Suffolk State of New York -:Li.r C'~ BEING DULY SWORN DEPOSES AND AFF THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. - Signature J1'I/ SWORN TO BEFORE ME THIS 7 DAY OF tJe.1iJ46t ,200(. . JOSEPH W. IRWIN Notary Public, Stale of New York No. 4921106, Sullolk County Term ExpIres May 16, 2otL. ~ I nOJECT JD NUMBER -/ 617.. APPEN STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME SEQR PART 1. PROJECT INFORMATION 1. APfLlCANT I SPONSOR WII\11'k",v \(.1lL- 3.PROJECT LOCATION: Municipality .~.~ ~"'''viiv btt County C i. (Jlr!4" It 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ate ~ or provide map 1st ~,11J< ~\\{ [ST, 5. IS PROPOSED ACTION: 0 rJ If I/~ Modification I alteration 6. DESCRIBE PROJECT BRIEFLY: V"''1 (k1VlWi' &r')e, h-trr ftnD iC9!/rlze vrlt, L.<7.C Mufti ^ ~Iv "~p; ro: h' ~\I~.nl\i.' 1 4tr f~v><" Ir<n ft'11."" i,V~ II ".!\'It , ~tJ> ^)1i1 ~11Il" ",)<\2- iiM\r . V;'l~1'rr.'" \:v,zt'"V-j ("rimb}t'(t<il .!In ,'I'; 7. AMOUNT OF LAND AFFECTED: Initially ,-- acres Ultimately ______ acres 6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? pes 0 No If no, describe briefly: 9. WJ;JA'T'IS PRESENT LAND USE IN VICINITY .0 Residential 0 Industrial 0 Commercial OF PROJECT? (Choose as many as apply.) DAgricu,ture 0 Park I Forest I Open Space Dother (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federaystate or Local) o Yes.0-No If yes, list agency name and permit I approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? .1LI-'fes 0 No If yes, list agency name and permit I approval: E:uil~ 'Cl ~I>J1iI~ htwol flJk:i:lQ !f-rCrc: PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Applicant -Sponsor Name THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE -.... ~ Signatur -'- o te: If the action s ostaf-Area, d you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . PART II - IMPACT ASSESSMENT (To be comoleted bv Lead Agency) A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. DYes DNo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. DYes DNo C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCJA TED WITH THE FOLLOWING: (Answers may be handwritten, jf legible) C1. Existing air quality, surface or groundwater quality or quantity, noise Jevels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I rl C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain brieffy: I I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I I C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly: I I C7. Other impacts (includina chan es in use of either Quantitv or tvpe of enerQv? Explain brieflv: r I O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: l DYes 0 No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: DYes 0 No I I PART 11I- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (Le. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination af significance must evaluate the potential impactafthe proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or I ype Name of ResponsIble Officer In Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If dlfferent from responsible officer) . . APPLICANT/AGENTIREPRESENT ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Dfohibits conflicts of interest on the Dart of town officers and emoJovees. The Duroose of this form is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is necessary to avoid same. ((l" , ~A YOUR NAME: 'i:!i: _ -..Y11'1 (Last oa e, first name, -I}1iddle 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 Variance Change of Zone Approval of plat Exemption ti"om plat or official map Other (If"Other", name the activity,) Building Trustee Coastal Erosion Mooring Planning -- // 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~es. YES NO Y If you answered "YES", complete the balance of this fonn 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 applic~nt (when the applicant is a corporation); _B) the legal or 'beneficial own~r 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 Su 's 7--- da Si nat rint Name oo~ Form TS I > Town of Southold .6> . 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 South old 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 L WRP policy standards and conditions contained in the consistency review law. Thus. each answer must be explained in detail. listine: both supportine: and non- supportine: facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. A copy of the L WRP 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# IpDo - 1// - /'1- /-! PROJECT NAME kilt. ft,i "?lIfe",,,.,..,- OCT 1 0 lue5 The Application has been submitted to (check appropriate response): Town Board 0 Planning Board 0 Building Dept. 0 Board of Trustees [B" I. 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) o o (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: [M' Nature and extent of action: &k -Ji; PeIIII", t:;M/~ tJ63 I1I1t/hAllf .~ ~Ik. ~ t,(1O ftill1J,th ~ Wt/Ir ()I~ ~. &".,;- At- ~ ~ fJ/4/M 14 I~ 1M tllJy -I, tVtI!t-.J. .sItJr. t,.",. .4M &ji4rc Z,IJ' J1&~ G""~"tf. . Location of action: 1':>1; I.,({{, ArDII& J Site acreage: '5/1 ~ Present land use: ~pfJ- Present zoning classification: , J I/?"*I . ~"'". }J. r/. ;Iflr 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) NameofapPlicant:~ IIH.. (b) Mailing address: 1~ J,,!IIt ll"tiWK Eyk t!' vltH,f' IfhI ; /9'lS'" (c) Telephone munber: Area Code (){,,~ "'sf, ~'f'J..1 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ NoD Ifyes,whichstateorfederalagency?~ .lJtIE , Co 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 South old 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 L WRP Section III - Policies; Page 2 for evaluation criteria. DYes D No ~otApplicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of South old. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria DYes 0 No ~otAPPlicable . . Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Policies Pages 6 through 7 for evaluation criteria DYes 0 No [E"'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 - Policie~es 8 through 16 for evaluation criteria DYes 0 No L!2J 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 thro,-,h 21 for evaluation criteria DYes 0 No 0Not 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 L WRP Section III - Policies; Pages 22 through 32 for evaluation criteria. o 0 ~ Yes No Not tPlicable . 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. DYes 0 No~otAPPlicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes 0 No ~t 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. _ / DYeD No [j2f Not Applicable Attach additional sheets if necessary WORKING COAST POLI~S . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria. DYes [J No ~t 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 L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes 0 No~otAPPlicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages 62 through 65 for evaluation criteria. DYes 0 No~tAPPlicable 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. DYes 0 No ~ot Applicable PREPARED BY~ ~ TITLE ~ DATE I(r~~ .I L;IJ J HOG NEe! ~ li1lt ~ol\c ~ >.. ~ '~ , I I f ~' f~ I SE ~ i, ~.' " '. .' _'-,J \~~ " ~ ~~. t; ~ ,t., (.\'\; ~ ''<. l~ .'.':1 . > fr~:" ;\' K. ',~~. ef" ~ " l;':.::, ~.. ~ ~ ~ ~ ;;<( " , ~"" --"" ~ 'i~\.\ ,f NO~\~(, '\!lIlY "". :+.'~ "'#,t,~t., (&~ \' .; 1'" (15 \~"~~\:...,V\..4. 'f-i' ..,\",1<"'4,fi"" /~\'/." A.,ti-' . ~o.I.~':l IifXI t~W W.'L I.ll:5 AlbNl( tJ tQl41J~ AHW M ~lk>lli" tJ'l t11'ltJlAiS AlP~ Avti AI/& (0 i}~~H~ I ",,'fl' lil/tI~~^", Af€A D' ' l\M1< l3!. __.,.FJlJ',iJ\til) ':.t<~ ~O (~ "Y' (j) ~ MMrkAt &1/~HEMI ~tI . /<fI.l, f1v~i ~\lIltIIl~~ 'JlPIt ;:~ f~ \.rIJJl~~\f~ ~ il' 0 PllII ro'''' fl' l f 1\1 .,oI\f Cttc"~ N. V, ~rl~.~: MI!f1!W ~At- : -:Jiw ~jt.'1 l?- 1D '" ,- "" ,'~. 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