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Home My WebLink AboutTR-6642 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fe~ (631) 765-6641 June 22,2011 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Mr. John McNamara 79 Village Lane Hauppauge, NY 11788 RE: MARGARET McNAMARA 640 TAKAPOSHA ROAD, SOUTHOLD SCTM# 87-6-10 Dear Mr. McNamara: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, June 22, 2011: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Wetland Permit #6642 to install ¼" high density polyethylene sheathing to the front face of existing 120' bulkhead section and 20' east return; and as depicted on the revised site plan prepared by Costello Marine Contracting Corp., last dated May 23, 2011, and stamped approved on June 22,2011. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, J;lrlesideDn°t?eB~cYa rl of T~stees JMD:eac i~ 1//~/¥/.. Jill M Doherty, President Bob Ghosio. Jr., Vice-President James F King Dave Bergen John Bredemeyer PO Box 1179 Southold, NY 11971 Telephone(631 765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ~;~ ~' ('-J('~ q John McNamara on behalf of MARGARET MCNAMARA requests an Amendment to Wetland Permit #6642 to install ¼" high density polyethylene sheathing to the front face of existing 120' bulkhead section and 20' east return. Located: 640 Takaposha Rd., Southold. SCTM#87-6-10 Type~Carea to be impacted: ~_.8'altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part./ef Town Code proposed work falls under: ~.~/Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: .rese. C Were: t//J. Doherty ~"~ Ghosio__ ~/J. Bredemeyer. D. Dzenkowski Form filled out in the field by ~J~. King /~. Bergen, other Mailed/Faxed to: Date: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Jolm 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 APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT ADDRESS PROPERTY LOCATION ~ TAX ~We ~tt~an Amendment to Permit # _.~_~ 6 4~.''~ Signed Board of Trustees Application Ab'ruORI ZATION (where the applicant is not the owner) ~~ ~ ~~/~-~ residing at ~ ~ ~/~ (prdnt owner of property) (mailing address) do hereby authorize Agent ) ~C~/~6~ to apply for permit(s) from the ~i~ ne~r,s, i~gn/~ld Board of Tow~ Trustees o~ my behalf. ( ture ) II ~11 07/21/2010 08:35 PAE~ 0~ Te~n I*I~! 580~ ltoute 28 P.O. B~ 11'/9 5outhold, New Yerk 11~71-0989 Telephono (~1) V~-1~99 Fax (681) 76~64,1 BOARD OF ~OWN TItUar,'~sF, S TOWN OF SOUTHOI.D APPLICATION FOR AN AMEN'DM~NT TO A W~TLAND PERISflT . Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeycr Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 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 MARGARET MCNAMARA COUNTY OF SUFFOLK) STATE OF NEW YORK) I, ~4~f"d('J~ residing at/dba AFFIDAVIT OF POSTING being duly sworn, depose and say: That on the [q day ,2010, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that 1 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 Wed. October 20~ 2010 on or about 6:00 PM. Dated: Sworn to before me this 14 day of S764t-20gg7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Nanle: Address: STATE OF NEW YORK COUNTY OF SUFFOLK //~.,~j~]t/]~('~/~'q ,residingat'7~ (-][[ ( (~ ~-~ ~" /'~]~/ .t~ /(~, ~ , being duly sworn, deposes and says that on the ! c} daY of c?)C~gz~/2/~ ,20 , deponent mailed a true copy of the Notice ~t 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 at , that said Notices were mailed to each of said persons by Sworn to before me this my of , 20_/O Notary Public Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 October 20, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Margaret McNamara 79 Village Lane Hauppauge, NY 11788 RE: 640 TAKAPOSHA RD., SOUTHOLD SCTM#87-6-10 Dear Ms. McNamara: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., October 20, 2010: WHEREAS, MARGARET MCNAMARA applied to the Southold Town Trustees for an Amendment to Wetland Permit #6642 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated September 16, 2010, 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 Exempt from the Local Waterfront Revitalization Program policy standards, 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 Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #6642 to construct an extension to the existing easterly bulkhead return and install new support pilings adjacent to all existing face pilings along 120' of existing bulkhead and 20' east return, and as depicted on the plan prepared by Costello Marine Contracting Corp. dated August 24, 2010 and stamped approved on October 20, 2010. This is not a determination from any other agency. Sin~;erely, Jil[/M. Doherty, Presi(~bnt Board of Trustees JMD:lms Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765 - 1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 13, 2010, the following recommendation was made: Moved by Doug Hardy, seconded by Audrey Horton, it was RESOLVED to NOT SUPPORT the application of MARGARET MCNAMARA to Amend Wetland Permit #6642 to construct an extension to the existing easterly bulkhead return and install new support pilings adjacent to all existing face pilings along 120' of existing bulkhead and 20' east return. Located: 640 Takaposha Rd., Southold. SCTM#87-6-10 Inspected by: Audrey Horton, Peter Young, Doug Hardy The CAC does Not Support the application because the project does not provide for public access, there is currently no buffer, and the perpendicular bulkhead is increasing erosion of Suffolk County and Town of Southold properties. Vote of Council: Ayes: All Motion Carried Jill M. Doheny, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer P.O. Box 1179 Southol& NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: MARGARET MCNAMARA requests an Amendment to Wetland Permit #6642 to construct an extension to the existing easterly bulkhead return and install new support pilings adjacent to all existing face pilings along 120' of existing bulkhead and 20' east return. Located: 640 Takaposha Rd., Southold. SCTM#87-6-10 Type of area to be impacted: y-S~ltwater Wetland Freshwater Wetland __Sound f,~ay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: P//Wetland __Coastal Erosion __Administrative__Emergency Pta-Submission __ __Amend ment Violation Info needed: Modifications: Conditions: Present Were: "&King ,,,.Doherty __J. Bredemeyer Bergen__ B.Ghosio. __ D. Dzenkowski other Form filled out in the field by(~ Mailed/Faxed to: Date: 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 1st day of construction ¼ constructed V' Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6642 DATE: JUNE 20~ 2007 ISSUED TO: MARGARET MCNAMARA PROPERTY ADDRESS: 640 TAKAPOSA ROAD~ SOUTHOLD SCTM# 87-6-10 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 June 20, 2007, and in consideration of application fee in the sum of $250.00 paid by John & Margaret McNamara and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit for the existing bulkhead and to install porous pavers along the bulkhead to minimize erosion of soil behind the bulkhead, and as depicted on the plans prepared by John McNamara received on May 18, 2007, and survey prepared by Roderick Van Tuyl, P.C. last dated May 18, 1982, and received on May 18, 2007. 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 Margaret McNamara, residing at 640 Takaposa Road, Southold, New York, 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 at a later date. 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. 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. 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 June 20,2007 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Margaret McNamara 79 Village Lane Hauppauge, NY 11788 RE: 640 TAKOPOSA ROAD, SOUTHOLD SCTM# 87-6-10 Dear Ms. McNamara: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, June 20, 2007 regarding the above matter: WHEREAS, MARGARET MCNAMARA 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 May 18, 2007, 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 Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 20, 2007, 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 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 MARGARET MCNAMARA for a Wetland Permit for the existing bulkhead and to install porous pavers along the bulkhead to minimize erosion of soil behind the bulkhead, and as depicted on the plans prepared by John McNamara received on May 18, 2007, and survey prepared by Roderick Van Tuyl, P.C. last dated May 18, 1982, and received on May 18, 2007. 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 ~nspection. (See attached schedule.) Fees: $50.00 Very truly yours, King President, Board of Trustees JFK/eac ' ~;~'N OF souTHOLD MAY 18 ~007 Southhold Town Board of Trustees -'1 MAY 18 2007 Soutldiold Tow~ Board of Trustees James F. I~ng, 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 /'~a.c~ I ~/~ 7 has been reviewed by this Board at the regular me,eting of" D'7~_ne_ o~1(2cJ7 and your application has been approved pending the completion of'the following items checked off below. __ Revised Plans for proposed project __. Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) ~Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. · The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees James F. IGng, 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 Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: MARGARET MCNAMARA requests a Wetland Permit for the existing bulkhead and to install pavers along the bulkhead to minimize erosion of soil behind the bulkhead. Located: 640 Takaposa Rd., Southold. SCTM#87-6-10 ~Se of area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of above: P.ar~ of Town Code proposed work falls under: ~'Chapt.275 Chapt, 111 other Type of Application: ~/' Wetland __Coastal Erosion __Amendment __Administrative __Emergency Pre-Submission Violation Info needed: Modifications: Conditions: P. re~nt.L/H Were: __ . ing erty ickerson D. Bergen__ B. Ghosio, Jr · Cusack D. Dzenkowski Mark Terry~other Form filled out in the field by ~ct',~r C~,o~.~'~ Mailed/Faxed to: Environmental Technician Review ~.[.5 b~c ~g Date: 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 Mon., June 11,2007, the following recommendation was made: MARGARET MCNAMARA for the existing bulkhead and to install pavers along the bulkhead to minimize erosion of soil behind the bulkhead. Located: 640 Takaposa Rd., Southold. SCTM#87-6-10 The CAC did not make an inspection, therefore no recommendation was made. OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAIl_lNG ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees/ From: Mark Terry, Principal Planner LWRP Coordinator Date: June 4, 2007 JOb "' '"' "' t L $outhCd Re: Request for Wetland Permit for Margaret McNamara SCTM#87-6-10 MARGARET MCNAMARA requests a Wetland Permit for the existing bulkhead and to install pavers along the bulkhead to minimize erosion of soil behind the bulkhead. Located: 640 Takaposa Rd., Southold. SCTM#87-6-10 The in/like replacement of and/or removal and disposal of existing timber bulkhead and proposed pavers is an exempt Minor Action and not subject to LWRP review pursuant to Chapter 268-3; Items A and B of the Town of Southold Town Code which states: "Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site, including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit". The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application · .-'"CsVetland Permit Application __ Administrative Permit Amendment/Transfer/Extension -'~eceived Application: ,/Received Fee:$ o~'~'~ ---'Completed Application b")l ~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) .,~WRP Consistency Assessment Form ,--CAC Referral Sent: ~-)O%1 { 'U'ate of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ,-Public Hearing Held: ~ l0 ~ 0-'"} Resolution: C E g V"E MAY 18 2007 Southhold Town Beard of Trustees Name of Applicant ]/~ da~~ Address 7~ V, ~ [;7 L.j~C' Phone Number:( Suffolk County Tax Map Number: Property Location: (~4~ "~ / / 7'$? (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Applicati¢ Land Area (in square feet): Area Zoning: t4/~ Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Yes /No Prior permits/approvals for site improvements: A~ency ~ Date /9~_~ ,z- 44 / 072_.4 __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): Vd of Trustees Applicatio0 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: /~,t'x~]/~( 2~ ~---C3~'/CY;'~ Area of wetlands on lot: C~) square feet Percent coverage of lot:~~__% Closest distance betwee~_nearest existing structure and upland edge of wetlands: AJ,V-~ feet Closest distance between/t3earest proposed structure and upland edge of wetlands: /~)///Ot- 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 ~"~.~.2~'~'~{ ~ ~ d~2~..3 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: / 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): ~d of Trustees Applicatio0 COASTAL EROSION APPLICATION DATA Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No V~ Yes If Yes, how much material will be excavated? /2~ (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) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT / SPONSOR 3.PROJBOT LOCAT,O,: County ~----~ ¢~ 4. PRECISE LOCATION: Street Addess and R~'ad Intersection., Prominent landmarks etc -or provide map 5. IS PROPOSED ACTION: [] Expansion [~odification / altera~on 7. AMOUNT OF LAND AFFECTED: Initially, (~ ~-'~ acres Ultimately ; C~..'~ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: eAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.} sidential [~,ndustrial [~Commercial E~Agriculture []ParklForest/OpenSpace [~Other(describe) ~ ~ ~ 7 PERMI~ APPROVAL, O~ FUNDI~G~ NOW O~ ULTIMATEL~ F~OM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) enc---~y ~.~__' [~es []No If yes, list ag name and permit / approval: 11. DOES AN~o ECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes If yes, list agency name and permit / approval: 12.{~]YesAS ARES~No OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantsignature / Sponsor N~.///-- '~~ D te,~7 v 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~lency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. 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. r-~ Yes r-]No i 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 flcoding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I 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 briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 Explain briefly: C7. ither impacts (includin~ chanties in use of either (~uantit,/or t~pe of energy? ~p!~in briefly: WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA/? {If )'es, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~/es ex~lain: I--lYes I---1 No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadverseeffectidenti~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therWisesignificant~ 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 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 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 Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency ~own of Southold 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 Water~ont 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 detafl~ listing both supporting and non- suooortiw, 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 PROJECT NAME .~/~'7 r~ 7-'~'~ ~4-J ~'~ ~-~- The Application has been submitted to (check appropriate response): TownBo,r~ 7] PI,nn~,gBo,r~ Ruila~gOept. 73 ,o,rdofTru,,~, 1. 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_0~d ex4~nt of action: g-×rsrraJ Site acreage:. · ~ Present l=d use:~r~l ~L Present zoning cl~sificafion: ~/~ If ~ application for ~e proposed action h~ been filed M~ ~e To~ of Sou~old agency, ~e folloMng ~o~afion sh~l be prohded: (a) Nmeofapplic~t: ~~ 1~~~ (b) M~lingad&ess: 7~ ~,~ /~, ~0~~ ~[1~ (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. ~[~..es [] 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 Sonthold. See LWRP Section III - Policies Pages 6 throngh 7 for evaluation criteria ~ Yes [] No [-~ Not Applicable /, .... Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [--~Yes [-~ No ~ No pli ble 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 th~h 21 for evaluation criteria ~ Yes ~ No ~ Not A~licable .-- 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 throu~l~ 32 for evaluation criteria. / Attach additional sheets if necessary Policy 7. Pages 32 through 34 for evaluation criteria. ~ Yes ~ No [~Not Applicable I Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies 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 Anplicable_ 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~ No [-~Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ 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 ~N~ot 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 [] No ~-~Not Applicable/7 / .... At, ach 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 AUach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ~ Yes [] No ~/Not Applicable PREPARED BY PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK , being dul~w~r~e-tP~9.~s/~says that on the /~.z~- day of ~ t0 ~.- ., 20~7, d[~c~fit~~opy 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 at ., that said Notices were mailed to each of said persons by (certified) (registered)mail. ~__.~~ Swor~o~e. m.e this Day ~(~---~, 20 Pu}~c Notary ~i~ Jsmes F. King, Presid~t Jill M- Doh~, Vtoe-Pre~id~t P~ A. Diek~son Daw lkr~n Bob O~io, ~r. Town Hall P.O. Box 1179 Southold, New York 11971-0959 ?elepbone (6~1) 76~-1892 F~x (6~1) 76~41 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In thc ~ of the Application of COUNTY OF SUFFOLK) STATE OF NI~W YORK,) AFFIDAV~ OF POSTING being duly ~wom, dcposc and sa~ by pla~in~ the Board of Trnste~-O~cial poster wh~e it ~n e~ily b~ seen, and that I hnve chee~, ed to be sure the poster has remained in plnce for. eil~t! days prior to thc d~e of the public he. arin~.DaIeofhearingnot~dthereontobeheld j~.f~.~r. ~ ~.~ . of Trustees Application County of Suffolk State of New York 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 IN THE MANNER SET FORTH 1N 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 CONIUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS /- Signature DAY OF Notary Public of Trustees ApE AUTHORIZATION (where the applicant is not the owner) I, ¢~ at V/~ ~ ~~~~ ~ ~4esiding ~ (print owner of property) (mailing address) /~~ ~-~ [[~ do hereby authorize ~ ~ ( Agent ) ~/~~ to apply for pe~it(s)from the Southold Board of Town Trustees on my behalf. 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics t)rohibits conflicts of interest on the hart of town officers and emnlovces. The numose of Wis form is to t~rovide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is e t void same. (Last name, first name, middle 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, marriage, or business interest. "Busines~ 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 Southold Title or position of that person Describe the relationship between yourself(the applicant/agentffrepresentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or Child is (check all that apply): __A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); __B) the legal or beneficial owber 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 Signatur~5;~~ Print Name ~tq~(' t~