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HomeMy WebLinkAboutTR-6236BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6236 DATE: November 1~, 2005 ISSUED TO: JACK CIPRIANO PROPERTY ADDRESS: 8150 MAIN BAY~ IEW RD., SOUTHOLD ~'"~'~' --,,x SCTM # 87-5-23.6 N~..~ ~--~) AUTHORIZATIO Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on November 16, 2005, and in consideration of application fee in the sum of $250.00 paid by Jack Cipriano and subject to the Terms and Conditions as stated in the Resolution, the and permits the following: Wetland Permit to construct a two-story single-family dwelling, sanitary system, with the conditions of a 60' non-disturbance buffer from the edge of the creek, drywells to contain roof runoff, pervious driveway, and all as depicted on the plan surveyed by Kenneth Woychuk revised November 28, 2005. 1N WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 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 complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6236 DATE: November 1~ 2005 ISSUED TO: JACK CIPRIANO PROPERTY ADDRESS: 8150 MAIN BAYVIEW RD., SOUTHOLD SCTM # 87-5-23.6 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on November 16, 2005, and in consideration of application fee in the sum of $250.00 paid by Jack Cipriano and subject to the Terms and Conditions as stated in the Resolution, the Southold Town B{ and pem~its the following: Wetland Permit to construct a two-stow single-family dwelling, sanitary system, and with the conditions of a 60' non-disturbance buffer from the edge of the creek, drywells to contain roof runoff, pervious driveway, and all as depicted on the plan surveyed by Kenneth I Woychuk revised November 28, 2005. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee, Jack Cipriano, 8150 Main Bayview Rd., Southold, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 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 Southold. 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. That this Permit should be retained indefinitely, or as long as the said Pennittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization xvas originally obtained. 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. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 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. That if future operations of the Town of Southold 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. 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. 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, 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 November 16, 2005 Ms. Vicki Toth 425 Jacobs Lane Southold, N.Y. 11971 RE: JACK CIPRIANO 8150 MAIN BAYVIEW RD., SOUTHOLD SCTM# 87-5-23.6 Dear Ms. Toth: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, November 16, 2005 regarding the above matter: WHEREAS, Vicki Toth on behalf of JACK CIPRIANO 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 September 8, 2005, 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, a Public Hearing was held by the Town Trustees with respect to said application on November 16, 2005 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, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the proposal complies with the standards set fodh in Chapter 275 of the Southold Town Code, and, WHEREAS, the LWRP Coordinator recommends that the proposal be found consistent with the policies of the LWRP, and, WHEREAS, the Board has found the proposal to be Consistent with the policies of the LWRP, and, 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, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application JACK ClPRIANO to construct a two-story single-family dwelling, sanitary system, and driveway, with the conditions of a 60' non-disturbance buffer from the edge of the creek, drywells to contain roof runoff, pervious driveway, and all as depicted on the plan surveyed by Kenneth M. Woychuk revised November 28, 2005. 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.) This is not a determination from any other agency. Fees: $100.00 Very Truly Yours, James F. K'~g President, Board of Trustees JFK/hkc Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Tow~ 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 Opr',', o Please be advised that your application dated reviewed by this Board at the regular meeting of / I/ following action was taken: ( W0Application Approved (see below) has been and the (__)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 the instruction sheet. The following fe.e must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: ~-5~,J~ ~-~ ~,ech~ ~ ~O TOTAL FEES DUE: $ lbo & SIGNED: PRESIDENT, BOARD OF TRUSTEES 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., October 12, 2005, the following recommendation was made: Moved by Don Wilder, seconded by Jennifer Mannino, to TABLE the Wetland Permit application of JACK ClPRIANO to construct a two-story single-family dwelling, sanitary system, and driveway. Located: 8150 Main Bayview Rd., Southold. SCTM#87-5-23.6 The CAC Tables the application because the project was not staked. Vote of Council: Ayes: All Motion Carried Board of Trustees 37 November 16, 2005 the face of the building and it says 75 feet. TRUSTEE KING: This is the building envelope; it's not necessarily going to be in front of the house. TRUSTEE KRUPSKI: I think in this case we thought it was appropriate because of the size of the lot, The previous development of the lot. TRUSTEE DICKERSON: We want new plans on this though, no? TRUSTEE KRUPSKI: They can just adjust those to reflect hay bale lines and dry wells and gutters. TRUSTEE DICKERSON: Right. So otherwise it's okay. And do I have a second? TRUSTEE KING: Second. TRUSTEE DICKERSON: All in favor? ALL AYES 6. Michael Liegey on behalf of CURTIS & ANGELA DWYER requests a Wetland Permit to convert the existing sun porch into a kitchen. Located: 720 Mechanic Street, Southold. SCTM#61-4-11 TRUSTEE POLIWODA: Is there anyone who would like to comment on this application? MR. LIEGEY: I'll be here to answer any questions on that. TRUSTEE POLIWODA: Any other questions? I looked at it as far as the Board is concerned, very straightforward application, existing sun room into a kitchen, same footprint. CAC recommended approval with the addition of a dry well to catch the roof runoff, so make that part of the stipulation for the permit. TRUSTEE KRUPSKI: How about hay bales? TRUSTEE POLIWODA: I don't know. MR. LIEGEY: I was going to do that anyway. TRUSTEE POLIWODA: I was thinking you weren't going to trash the whole lawn. Okay, put a row of hay bales in too dudng construction. If there's no other comments, I'll make a motion to close the public headng. TRUSTEE DICKERSON: Second. TRUSTEE POLIWODA: All in favor? ALL AYES TRUSTEE POLIWODA: And I'll make a motion to approve the Wetland Permit on behalf of Curtis and Angela Dwyer to convert the existing sun porch into a kitchen with the stipulation that a dry well to catch the roof runoff be added as well as a row of hay bales during construction. TRUSTEE KING: Second. TRUSTEE POLIWODA: All in favor?. ALL AYES 7. Vicki Toth on behalf of JACK CIPRIANO requests a Wetland Permit to construct a two-story single-family 37 Board of Trustees 38 November 16, 2005 dwelling, sanitary system, and driveway. Located: 8150 main Bayview Road, Southold. SCTM#87-5-23.6 TRUSTEE POLIWODA: Would you like to comment on this application? MS. TOTH: Good evening, I'm Vicki Toth. The project was before your Board a month ago, but it wasn't staked out because it was too wet and rainy at that time of year. But now it is staked out and I'm sure you were able to see the corners that were there. TRUSTEE POLIWODA: Now construction creek side I believe we have a 50 foot nondisturbance buffer on the books, so leave 50 feet from that berm top landward. We'll leave as a 50 foot nondisturbance buffer. Any other comment from the public? MR. MAXWELL: My name is Doug Maxwell, and I live adjacent to that parcel. I have lived there for eight years and I thank you for your care and concern about the environment, TRUSTEE POLIWODA: In the condos or across? MR. MAXVVELL: In the Cove condominiums, yes. I'm in the unit that's next to it. I'm a music composer, and I've been hired for the last three years by Pfizer Pharmaceuticals to produce recordings of nature for their blood pressure medicines, and so I've become intimately acquainted with the creek at all hours of the day and at all seasons. So I feel in a way that I'm here to speak for the two families of swans and all the swans that live behind that parcel and the deer that access and egress through the parcel and the fact that that parcel is part of one of the last remaining untouched perimeters of Corey Creek where there is no development. And I would like to just say that I know when we purchased our home, one of the few taxes we enjoyed paying was the one for the land preservation fund, and I don't know what special provisions are available to us, but I would like to ask that that parcel be considered as especially valued to the wildlife, either to purchase it or if that wasn't acceptable to the owner, I would like to see if there could be special provisions made to extend the buffer zone to protect this very special part of the creek. And in closing, I would just like to give you all a copy of the last CD of the wildlife that has been recorded on the creek, and I would give you listening to the voices that we claim to be protecting on this disk. TRUSTEE KRUPSKh Thank you. TRUSTEE POLIWODA: Any other Board comments? TRUSTEE KRUPSKh What about the buffer? TRUSTEE POLIWODA: 50 foot nondisturbance buffer as 38 Board of Trustees 39 November 16, 2005 declared, that's on the books. They are going 90 to the house that leaves 40 and 50. TRUSTEE KRUPSKI: Artie, you wouldn't think they would clear next to the cove next to the tennis courts. I think one thing we'd specify on our permit too, there's a lot of garbage that's been dumped there. TRUSTEE POLIWODA: Have you seen it? MS. TOTH: Yes. TRUSTEE KRUPSKI: Even though the permit will contain a nondisturbanoe area, we'll allow a provision for them to clean up the garbage that has been dumped because it would fall within the nondisturbance area, so the nondisturbance area would be a place they couldn't tdm anything, they couldn't mow anything, they couldn't clear anything at all, and that would be back from the creek, but in that area there's a pile of plastic bags, and there's a substantial amount of yard waste that's been placed there. So we would allow them to clean that up. TRUSTEE DICKERSON: Vicki, would you be willing to do any more than of a buffer; would you consider another 10 feet? MS. TOTH: They have to be 50 feet from the road, right, the house? TRUSTEE DICKERSON: 35. MS. TOTH: My only thing is I don't know what the setbacks are for other houses. (Discussion) TRUSTEE POLIWODA: If there's no other comment, I'll make a motion to close the public hearing. TRUSTEE DICKERSON: Second. TRUSTEE POLIWODA: All in favor? ALL AYES TRUSTEE POLIWODA: I'll make a motion to approve the Wetland Permit on behalf of Jack Cipdano for a two-story, single-family dwelling, with sanitary system and driveway with the stipulation that there be a 60 foot nondisturbance buffer from the edge of the creek. TRUSTEE KRUPSKh Don't forget the debds clean up. TRUSTEE POLIWODA: As well as the debris cleaned up after construction, as well as the hay bales line at that 60 foot nondisturbance buffer. TRUSTEE DICKERSON: Second. TRUSTEE POLIWODA: All in favor?. ALL AYES 8. Environmental Survey, Inc. on behalf of JAMES BROWN requests a Wetland Permit to remove the existing 3' by 64' dock and replace with a 3' by 70' open pile dock in a 39 PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON To~ From: Date: PLANNING BOARD OFFICE Town of Southold Boar(T6~[I~a~OUTHOLD Mark Terry, Senior Environmental Planner LWRP Coordinator ~ November 15, 2005 ~ MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 Re~ Request for Wetland Permit for Jack Cipriano SCTM# 87-5-23.6 JACK CIPRIANO requests a Wetland Permit to construct a two-story single-family dwelling, sanitary system, and driveway. Located: 8150 Main Bayview Rd., Southold. SCTM#87-5-23.6 The proposed action has been reviewed to Chapter 95, 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 proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Please contact me at (631) 765-1938 if you have any questions regarding the above. Albert J. Krupski, President James King, Vice-President 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-i,,~ql BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~Wetland Permit Application __ Administrative Permit Amendment/Transfer/Extension _..R'ece~vved Application: qlgloa' · ..l(eceived Fee:$ ~ -~)" ~ompleted Application __Incomplete __SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~-~5~AC Referral Sent:~. ~)~_ --/~ate of Inspection:/O_ __Receipt of CAC Report:_ __Lead Agency Determination:__ Technical Review: ~-'Public Hearing Held: Resolution: SEP - 8 2005 Name of Applicant Address_ Iq luV 117gD- Phone Number:(~D*'] ~ 14' /_..Dlto ~ Suffolk County Tax Map Number: 1000 - ?r/_ ~_ ~ Pr°perry L°cati°p~' tQ 5/-[ Mc ~/q'709') S/s fh n (provide LIt, CO Pole #, (fistance to cross streets, and location) AGENT: (If applicable) Address: ~ I q7/ Board of Trustees Application Land Area (in square feet): Area Zoning: GENERAL DATA Previous use of property: Intended use of property: Prior permits/approvals for site improvements: Agency Date ~/No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspendej~by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): d~or~ ~4¥u,~c_~4q o'n 04: Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~o ((~O,\E -~Ct ~ ,'l ~ ~0.3 ~c~ o~nC-°~ Area of wetlands on lot: [ I ~ [00 square feet Percent coverage of lot: cQ c> % Closest distance between nearest existing structure and upland edge of wetlands: ~' feet Closest distance between nearest proposed structure and upland of wetlands: ¢<- feet edge Does the project involve excavation or filling? ~/~ No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: f%~ c~\~ ff~cT~c~_~ ~Cf~ (~x~ ~) Are wetlands present within 100 feet of the proposed activity? No ~ 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 of the project as proposed. (Use attachments if necessary) ! Albert J. Krupski, President James King, Vice-President 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-~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at ~,~.5 ,~it.t Ob'5 being duly sworn, depose and say: That on the I~ day of 0o~, ,2005', I personally posted the prop, erty known as t~ __ by ~lacing the ~o~d of Trustees official poster where it c~ easily ~e seen,rand that I have checked to be sure the poster has remained in place for eight days prior to the date of the public he~ing. Date of he~ing noted thereon to be held /~. ~,/~, ~ - Dated: Sworn to before me this (q day of ©cx'-200~¢ o~ry Public (_~ BONNIEJ. ~OROSK] Notary Public, State O~ New Yo,~ No. 01006095328, Suffolk Co~unty Term Expires July 7, 20 ~/ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS NaiTIe: Address: STATE OF NEW YORK COUNTY OF SUFFOLK To+la , residing at q3~ ~-'&c-O~O"5 ja /d , being duly sworn, deposes and says that on the day of OE.4'~[QLV' ,20 0¢, deponent mailed a tree 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 the Town of Southold; that said Notices were mailed at the United States Post Office a_t ~o cc-~O [ ~ , that said Notices were mailed to each of said persons by ~ (registered) mail. ~x,,A~ k%(.D~4~. ~ Sworn to before me this Day of ~c~'tO~3~C--, 20_0__~ Not~__~ublic BONNI~J.T)0R0ffi Notary Public, State Of New'Y~ll No. 01D06695328, Suffolk Ceunly Term Expires,hdy 7, 20 Oq, PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1.APPLICANT/SPONSOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUAUTY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NA~ME Oounty tX SEQR 3.PROJECT LOCATION: t 4. PRECISE LOCATION: Street Adders and Road Intersections. Prominent landmarks etc -or provide map 5. IS PROPOSED ACTION: ~ New ~ Expansion ~ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 7 AMOUNT OF LAND AFFECTED: Initially , ~ acres Ultimately O~ acres WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: 9. W~T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 117]Residential r~ Industrial r-~ Commercial ~]Agriculture ~-I Park / Forest / Open Space ~her (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AE~yCY (Federal, State or Local) es r'~ No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A C~RRENTL~' VALID PERMIT OR APPROVAL? E~Ye$ If yes, list agency name and permit / approval: 12. AS ARES~ES~L"T OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor Signature X If the 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~lenc¥) A. DOES ACTION EXCEED ANY TYPE THRESHOLD IN 6 NYCRR, PART 617.4'~ If yes, coordinate the review process and use the FULL FAF, r-~ Yes r~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 handwritten, 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 cultural resources; or community er neighborhood character? Explain briefly: I- C3 Vegetation or fauna fish shellfish or wildlife spec es, s gn ficant hab tats, or hrea ened or endangered species? Explain briefly' C4. co unity's existing plans or goals as officially adopted, or a change in use or in ens' y o use of and or other natural resources? Explain briefly: C5. Growth, subsequen dove opmen, or re ated act v ties likely to be induced by the proposed action? Explain briefly: I , C6~ Long term, short term, cum~i~tiv~i o'~ ether effects hot identified in C1-C57 ExPlain b~iefly; C7 Other ~mpacts 0nclud~ng changes ~n use of e her uant i¥ or e of ener ¥? Ex lain briefl · D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: · I E. IS THERE, OR IS THERE LIKELY TO BE, CiNTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex~lain: 1 PART III - 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 (i.e. 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 exp[anafions 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 of significance must evaluate the potential impact of the 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 FULl 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 Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Board of Trustees Application County of Suffolk State of New York ~)! L~q- '-~ -O~['h 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), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature sWORN TO BEFORE ME THIS DAY OF ~)~L ,20 O~ BONNI£J. DOROSKI Notary Public, State Of New York No. 01D06095328, Suffolk, ~unty Term E,xpiresJuly 7,20 k)-I of Trustees Applica~n AUTHORIZATION (where the applicant is net the owner) (print owne~ of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ( Ow~r' s signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics omhibits conflicts of interest on the oart of town officers and emnlovees. The oumose of this form is to orovide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. ~Last namte, flint name, r~iddle initial, unless you arelapplying in the hame of someone else or other entity, such ar a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply0 Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooting 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 ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southoid 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 ctf 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 Form TS I Submitted ,th~ ~_.~__da.a.a~ of S~ 200 ~ Signature x( ~,L~' ~.~N~..~ Print Name 'q icA/.. ~ -~'-o'~fh~'~ Town of Southold INSTRUCTIONS 1. LWRP CONSISTENCY ASSESSMENT~ All applicants for permits* including Town of Southold age ciesl shall co!l~tl~te--tt~CCA~ for proposed actions that are subject to the Town of Southold Wate,~-onttC~t~ n~iaw ~t.x~n s~ ~t~., ,~r~ Th/s assessment is intended to supplement other information usec ~outhold 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 pr~arer 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 (xvhich includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 scm# I0o0 - gq- ¥- The Application has been submitted to (check appropriate response): Town Board [] Planning Board [~] Building Dept. [--] Board of Trustees 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: Site acreage: ~0. COO q~ Present land use: \_] Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (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. 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 prteserve historic and archaeological resources of the Town of Southold. See LWRP Section III -Policies P~/ges 3 through 6 for evaluation criteria [] Yes ~ No~l'Vl Not Apphcable- Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section !II - 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 Scion III ~olicie~Ns 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 throug/h 21 for evaluation criteria ~ Yes ~ No[~l~l 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 evaluatio~criteria. ~-] Yes ~ No I ~( 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 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. ["-] Yes[] NoV~Notapplicabie Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~-~ Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town *vaters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~-~ Yes ~ 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 even criteria. [~ Yes ~-~ No I "I 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 Created on 5/25/05 l l.'20 AM DWELLINGS S.C.T.M,// DIST:IO00 SEC:87 BLK:5 LOT:25.6 W/PUBLIC WATER //R10-05-0198 CL 18.60 16 861.00' CONDOMINIUM COMMON AREA OF "THE COVE AT SOUTHOLD" MAIN BA YVIEW ROAD S64o07'00"E 185.00' EL 16.6 SET 10 'MIN 5' WIDE WOOD STEPS 60.0' 2,50' EDBE OF PAVEMENT 14 ,~,ROPOSED 2~. 8 04-02-06 PROPOSED LIMITS OF CLEARING DECK 16.5' DWELLINGS W/PUBLIC WATER 150' LAND N/F OF JAN/CE HILLMAN SHYLES EL 2.2 ELRV 16,6 BROWN ~ANDY LOAM BROWN _OAMY SAND DWELLINGS W/PUBLIC WATEI Subject Proper~y: Jack Cipriano Main Bayview Read Southold, NY 11971 60' NON BUFFER / AS DELINEATED __ --HH~ ,,, ~ ~ ~o~°o~,'oo"y N64°OT'OO'ff 70.00' ~ CONDOMINIUMX ~COMMON AREA ~ LAND OF "THE COVE AT SOUTHOLD" TOTAL LOT AREA: 40,500 SQ.FT. OR 0.93 ACRES UPLAND LOT AREA: 38,610 SQ.FT. OR 0.89 ACRES ALLOWABLE IMPERVIOUS SURFACE 5,791 S F OR 1B~ LOT COVERAGE: PROPOSED HOUSE 2,¢00 $.F OR 6.2% PROPOSED DECK & STEPS 210 S,F. OR 0.5~ TOTAL PROPOSED LOT COVERAGE = 2,610 S.F OR 6.7~ DRAINAGE CALCULATIONS: PROVIDED BLDG. FOOTPRINT = 2,400 BQ.FT. 2,400 x 0.166=398.4 < 599cf REQUIRED (2) 8'DIA x 5' DEEP DRYWELL=441cf REVtDED 11-28-05 NOTIz: CBABTAL BARRIER B~UNBAR¥ IDENTIFIED I1-16-90 N, IBEN IFIED li-16-90 "' ~ ~ ~PPkO~TED BY "~ Bt~ARD~OF T,I~USTE ES ., m~WNxO~.~.oumo~ PATE' -- 115. O0'(ACTUAL)' d ,COREY CREEK EL(15.0) FINISH 6RA~E 1000 PRECAST S.T. GROUND IdlA]fZR EL 2.2 GROUND WATER EL 2.2 SILT SCREENING WITH HAY SALES ARE REQUIRED ALONG APPROVED UMTIS OF CLEARING NVGD 1929 ~IRVEY OF. DESCRIBED PROPERTY MAI: Of' FILED: SBUA~D AT: BAY VIEW *o'~ or: SOUTNOLB SUFFOLK COUNTY. NEW YORK FiLE 1125--92 SCALE: 1"=20' DATE:AUG, 12, 2005 CERTIFIED TO: JACK CIPRIANO;