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Home My WebLink AboutTR-6482A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Ha~ 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 CERTIFICATE OF COMPLIANCE # 0385C Date: November 25, 2008 THIS CERTIFIES that the construction of a one-car garage addition to the existing dwelling At 2905 Westphalia Road~ Mattituck, New York Suffolk County Tax Map # 114-10-1 Conforms to the application for a Trustees Permit heretofore f'ded in this office Dated 10/26/06 pursuant to which Trustees Permit # 6482A Dated 11/15/06 and was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of a one-car garage addition to the existing dwelling The certificate is issued to CLIFFORD D. POLACEK owner of the aforesaid property. Authorized Signature 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) 765-664! 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 __ 1st day of construction ½ constructed Project com :)lete, compliance inspection. James F. King, President Jill M. Doher~y, 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 Januaw 24,2007 Clifford Polacek 2905 Westphalia Road Mattituck, N.Y. 11952 RE: CLIFFORD POLACEK 2905 WESTPHALIA RD., MATTITUCK SCTM# 114-10-1 Dear Mr. Polacek: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 24, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the amendment to Permit #6482A to an additional 18" to the width of the garage to accommodate a 10' door, and all as depicted on the plan surveyed by Young and Young approved January 24, 2007 by the Board of Trustees. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. James F. King President, Board of Trustees JFK/hkc Cliftbrd D. Polacek 2905 Westphalia Road Mattitut:k, N.Y. 11952 January l6,2007 Dear Board of Trustees, That k you for issuing my garage extension permit #6482A on November 15, 2006. Due to a miscommunication, my builder planned the garage with a nine foot wide door. I required a ten foot wide door, so on occasion my car trailer will fit inside. Therefore, | respectfully request an amendment to my previous application, to add an additional eighteen inches to the width of the garage to accommodate the ten foot door. Thank you for youl time and consideration. Sincerely yours, ~Polacek NOTE= 9UFFOLK COUNTY TAX MAP DIS~ 1000 9ECT. ll4 9LK l0 LOT I ~' ' ' SOU?HOlD "' gO0~ ~ ~ L~ APPROVED ' BOARD OF TEU' TOWN OF SOU'[HOLD --j OCT. 22~ 1990 AUG. 6j 1991 YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. yOUNG SURVEY FOR: 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 ½ constructed __ Project complete, compliance inspection. James F. K~ng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Town Hall 53095Route 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 Permit No.: 6482A Date of Receipt of Application: October 26, 2006 Applicant: Clifford D. Polacek SCTM#: 114-10-1 Project Location: 2905 Westphalia Rd., Mattituck Date of Resolution/Issuance: November 15, 2006 Date of Expiration: November 15, 2008 Reviewed by: Board of Trustees Project Description: To construct a one-car garage addition on the northwest side of the existing dwelling. 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 plan received on October 27, 2006 and survey prepared by Howard W. Young received on October 27, 2006. Special Conditions: The installation of gutters and drywells to contain the roof run-off. 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. _ J a m ~¢F~. 'King,-Pres~d~t Board of Trustees 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 Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: /i11~'~0~, has been and the (c.-'''~) Application 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: TOTAL FEES DUE: James F. King, President Board of Trustees BY: New York Slate q~enenlrtment ol Envtronmenlsl Conl etlon Uulldiflg ~--~UNY; y ~o~k, N~ Ym~ L~uued on tt~e lnEormation you have aubmlcted, the New York State Department og ~nvironmental Conservation ha, determ&n.d C~aC the parcel 3 Greater th~n 300' ~rom Inventoried tidal wetlands. Landward o~ d Subitdl%tid~ man-mdde struct,ure greater thdn ~00' in length wl~lch wa, con~tru~ted prior to 9/20/77. ~ ~ ~ndward o~ th~ 10' above maen ~wa level elevation contour on a There:ore, no permit ia required under the Tidal Hetlands Act (Article 25 oK the Mnvironmen~dl Conservation Law). Please be advised, however, that no construction, sedimentation or disturbance og any kind may take place seaward o~ the 10' contour or topograpn%c crest without a permit. It is your responsibility to ensure that al~ necessary precautions are taken to prevent any uedimentation or other alteration or diatugbance to the ground SUrCdCU Or vegetation in this area da a result og your pro~ect. Such prucautions may include providing adequate work ·rea between the 10' contour or topographic c~eat and the ~ro~ect (i.e. a 15' to 20' wide construction aria) Or erection et · temporary genre, barrier, or hay bale ba~m. Please note that any additional worK, or modiglcation tO ~he pro~#ct aa described, may requite authOrllation by this Department. p~saae aonta~t this of:ice ig ~uch are contemplated. ~luase be :urther advised that thil letter does not relieve you og the responsibility oK obtaining any necessary permits or approvals ~rom other agencies. Very truly yours, DeputF ~egiona~Permit A~ministrator TAX MAP '~ BLK tO LOT I / / / / / / / / / / / / / / / / I I .£V~S,ONS YOUNG & YOUNG'I.~. OCT. 22, 1990 400 OSTRANDER AVENUE, RIVERHEAD, NEW AUG. 6, 199I ALDEN W. YOUNG HOW SURVEY ,FOR: CLIFF POLACEK LOT NO. 19 "DEER PA TOWNOF } SOUTHOLD /"= 4~ ~T~: MAR 27,1990 * ~Pre Albert J. sident John Holzapfel, Vice President William G. Albertson Martin H. Gan'ell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 August 26, 1994 Mr. Roy Stakey Tuthill's Lane Aquebogue, NY 11931 RE: Clifford Polacek SCTM %114-10-1 Dear Mr. Stakey: The following action was taken by the Southold Town Board of Trustees on August 25, 1994: RESOLVED that the Southold Town Board of Trustees grants Roy Stakey on behalf of CLIFFORD POLCEK a waiver to extend deck 6' X 6' towards creek. Located 90 Deer Drive, Mattituck. If you have any questions, please do not hesitate to contact this office. Sincerely, lbert J. Krupski, Jr. President, Board of Trustees AJK:jmd cc: Bldg. Dept. ~ BLK IOLOT I 'C '..9 ~ >~ ~ // /// / · =MONUMENT. !: :': !~il !: ;.. $/./BDIV/$/ON '/I~ F//.EZ/ /N I'HE OF'~"/CE" ~i ~ '''? .//J/Y aS,/9$O .4$ ~'//,E /VO.$~O,I. ,~ '~ ~ · . · ..::!, .?!, ~,,:, [.AW . REVISION5 YOUNG & YOUNG I~:':,'; OCT. 22~ t990 400'OSTRANDER AVENUE, RIVERHEADi NEW AUG. 6~ 1991 . ALDEN W. YOUNG , HOWAI SURVEY .FOR: ; 'i :' CL/FF POLACE/¢ ..... LOT NO. 19, */DEER · , t,. f_,,o-.-,,,.j;::: TOW, o~ J' SO~ITHOID ' SUFFOLk. ... CO., N.Y. sc^~: / "= 4~" J'o^T~: ,,,,,,,:, o~ ,,~,... ,-,¢.~,_ · 27, 1990 PLANNING BOARD MEMBERS~ JERILYN B. WOODHOUSE Chair KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON JOSEPH L~ TOWNSEND PLANNING BOARD OFFICE TOWN OF SOUTHOLD MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 To: Town of Southold Board of Trustees From: Mark Terry, Senior Environmental Planner LWRP Coordinator Date: November 15, 2006 Re: Proposed Wetland Permit for CLIFFORD D. POLACEK SCTM#1000-114-10-1 CLIFFORD D. POLACEK requests an Administrative Permit to construct an addition of a one-car garage to the northwest side of the existing dwelling. Located: 2905 Westphalia Rd., Mattituck. SCTM#114-10-1 The proposed action has been reviewed to Chapter 268, Waterfi'ont Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. I Policy 6 Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction Comply with Trustee regulations and recommendations as set forth in Trustee perrmt condihons. The proposed distance to the garage is less than 53 feet from a marine wetlandl a rninlmnm setback distan** of 100 feet is required pursuant to Chapter § 275-3. Findings; purpose; iurisdictionl setbacks. Please requir* that the applicant amend the application to meet the above policy to the greatest extent possible. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. James F. tGng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Admin/strafive Permit ~ Amendment/Trans~r/Extension Rece~vved Applicafion:~)Ja~JO_~ ~eceived Fee:$ ~ ~ ~ompleted Application Itq! _h~ ! ~1o Incomplete SEQRA Classification: Type I Type II Unlisted Coord/nation:(date sent) ~ Consistency Assessment Form 10blo J Qb __CAC Referral Sent:~ ~---Date of Inspection: ] I [ I0! ~ff~ __Receipt of CAC Report: __Lead Agency Determination: __Technical Review: ~el~blic Hearing Held: I l} I~.~'~. 0 O __Resolution: Name of Applicant Address Suffolk County Tax Map Number: 1000- l / q'- /0 Property Location: 2 ? ~.}'"' [.AJe,J-[~]/]IA~[Lq (provide ~LCO Pole ~, dist~ce to cross streets, ~d location) AGENT: (If applicable) Address: Phone: o Board of Trustees ApplicOon GENERAL DATA Land Area (in square feet): ~Je ~5[ ~& .~k 6 ~r xO. Previous use of property: f6[ ~ ~ Intended use of property: _~ Fx V~ Q Prior permits/approvals for site improvements: Agenc __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspxen~ded by a governmental agency? /~, No Yes If yes, provide explanation: Project Description (use attacll[n, ents if necessary): o Board of Trustees ApplicOon WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeoftheproposedoperations: C(~ A/JTf t~.c-~' CJ M ~ ('fa( y ~l VO~t/ ~ Area of wetlands on lot: 3 l~lJ square feet eercentcoverageoflot: , ~)[~0 % Closest distance between.nearest existing edge of wetlands: [/"7 feet structure and upland Closest distance between ne.al:est proposed structure and upland edge of wetlands: '~,~ feet Does lhe project invol e~avatio~or fi~g? No 3)~ Yes If yes, how much material will be excavated? 7 cubic yards How much material will be filled? ~(~'- cubic yards Depth of which material will be removed or deposited: ~ Proposed slope throughout the area of operations: --O -- Manner in which material will be removed or deposited: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of SUdl prop~)S~d opeiati~n~ (us~ ~itt~eriiS ii' app~:opi:i~t~Si IPROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only SEQR PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 3 PROJECT LOOATION: 4 PRECISE LOCATION: Street Addess a~d Road I sections, Prominent landmarks etc -or provide map 5 IS PROPOSED ACTION: [] New [] Expansion [] Modification / alteration 6 DESCRIBE PROJECT BRIEFLY: 7 AMOU OF LAND F ED: Initiallyr~l~ ~'?~F~ Ultimately3(~ ~' F?~-~T ,,LL PROPOSED *CT,ON COMPLY V,T. E×,ST, NG ZON,NG OR CT. ER RESTR,OT,ONS? --' Yes [] Ne , no, de.ori 9. WHAT IS PRESENT LAND USE iN VICINITY OF PROJECT? (Choose as many as apply.) ~Residentlal E]lndustria, ~'~Commercial E~Agriculture E~Park/Forest/OpenSpace [~] Other (descdbe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) F~Yes F'~NO If yes, list agency name and permit / approval: ll. UUb~ ANY A6PbOl OI- [HE AE;IION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E]Yes ~No if yes, list agency name and permit / approval: 12. AS A E ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MOD F CATION? [~Yes ~o I CERTIFY THAT THE INFORMATION P/~OVIDED /~OVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Na,~/ D [)~ Date: Signature t ~(~he action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~enc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 6f 7.4? if yes, coordinate the review process and use the FULL E~F. E~] Yes r--j No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANy ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: {Answers may be handwrffien, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cuflu? resources; or community or neighborho_od character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: · A community's e~isting pJ~S or g0al; a~ o~ficially ad~pted, or ~ ch~ in use or intensi? of use of land or other natural resource;? Ex¢iain C5. Growth, subsequent development, or relat~d._activ!ties likely to be induced by he proposed action? Exp ain briefly: C6~ Long e m, short term, cumulative, or other e~leets no dentified i'n Dt~CS? Explain briefly: D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRIT~C~ ENVIRONMENTAL AREA ICEAI? Ill yes explain bdefl~,: E3Yes r-iN°] I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPAcTs? If yes exnlain' I PART III - DE ~t=~MINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~r eachadversee~ectidenti~edab~ve~determineWhetheritissubstantia~~~arge~imp~rtant~r~therwises~gni~cant~ Each effect should be assessed in connection with its (a) setting (La. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessa~, 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 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 FAF and/or prepare a positive declaration, chec"~ this ~f y~a-v~ ~J~:4ned'i b~ed'~n ~ information and analysis ~bove and' any ~upporting docurne~t~fi0nl that'~prop~d ~i~ determination.WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessmy, the reasons suppoding thi Name of Lead Agency Date Tifie of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (It different from responsible officer) Board of Trustees ~p ication County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS 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 1N 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), 1~ GRANTED. 1N COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PPG~MISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION ~Signature?~ SWORN TO BEFORE ME THIS c~ff DAY OF KATH' EE!! DREXLER Notary P~;:, , ,: olNewYork No (', ' )39770 __ Qua!if let ir .JlolkCounty APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the uart of toTM officem and emulovees. The oumose of this form is to nrovide information which can alert the town of~ossible conflicts of interest and allow it to take whatever action is (Last name, first name, rgiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"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, nlarringe, or buiiness interest. "Business interest'* means a business, thcluding 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% oftbe shares. YES NO X If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title Or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate Iine 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 applic0nt (when the applicant is a corporation); B) the legal or beneficial own~'r of any interest in a non-corporate entit~ (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 Form TS 1 Submiited this Signature Print Name Town of Southoid LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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. 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). 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 suooorfiw, 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 / t The Application has been submitted to (check appropriate response): Town Board [-~ Planning Board [] Building Dept. ~ Board of Trustees [] 1. Category of Town of Southold agency action (check appropriate response): (a) Action undeFtaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) ~ approval, license, certification: ~;~. Nature and extent of action: /t~/~ T{ Location of action: Site acreage: Present land use: Present zoning classification: ! ,.vL)//lq, r 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: C,l(~6tI~rd O. (b) Mailing address: 2~ /)~--- /d[Jt~JTt~J4-6t {(t'l (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ No .~ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [-~ No ~ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes [] No ~ Not Applicable 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 No ~ Not Applicable Yes 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 Pages 16 through 21 for evaluation criteria [] Yes [] No ~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southoid ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No No plicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. Yes ~-~ No ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [] Yes ~-] No [~ 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. [] YeJ~ No [~ Not Applicable Attach additional sheets if necessary ' WORKING COAST POL~I~Es Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~-~ Yes [] No ~-~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~-] Yes n~ 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 ~fi~ Not Applicable TITLE 0[~/f,/~t~~- 900Z /~ APPROV~P I~OARD OF TRU Sou'r io D / NOTE= 1. SUFFOLK COUNTY TAX MAP DIST. I000 SECT. 114 BLK lO LOT I ~O,qD .Ev,s,o.s YOUNG & YOUNG OCT. 2:2, 1990 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK AUG. 6, 1991 ALD£N W. YOUNG HOWARD W. YOUNG SURVEY FOR: CLIFF POLA CEK "' ............. LOT NO. 19, "DEE/? ~ L -' · ow~o~ ~ SOUTHO~D SUFFOLK CO.,.N' Y. SCAL[: / ~ ~0'I~AT[: MAR. 27, 1990 90-0188 UNAUTHORIZED ALTERATION OR AOOITION ~0 THIS SURVEY IS A VIOLATION OF SECTION I,'J L evct~ OCT APPROVED BY TOWN OF DATE C,LI, FF oLA