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HomeMy WebLinkAboutTR-6743 Michael J.Domino,President 0� soy0 Town Hall Annex John M.Bredemeyer III,Vice-President h0 l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski • Telephone(631) 765-1892 Greg Williams O! Fax(631) 765-6641 COU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1446C Date: February 6, 2018 THIS CERTIFIES that the existing 3'x22' beach stairs with a 4'x4' platform and gate, and existingdocking ockin ffaacilily consisting of a 4'x44' fixerd dock 3'x12' ramp and 6'x20' floating dock; At 1615 Fleetwood Road,Cutchogue Suffolk County Tax Map#1000-137-4-35 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 5,2007 pursuant to which Trustees Wetland Permit#6743 Dated October 17,2007,and Transferred on October 17,2007 ,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 existing 3'x22' beach stairs with a 4'x4' platform and gate and existing dockingfanility consisting of a 4'x44' fixerd dock 3'x12' ramp and 6'x20' floating dock. The certificate is issued to Vincent Illuzzi owner of the aforesaid property. Authorized Signature Michael J.Domino,President _`��F SU(/jTown Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q � � Telephone(631) 765-1892 Greg WilliamsO Fax(631) 765-6641 '��DUNT`1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: I�• �(n�1D�, COMMENTS: loe4 01C 40 isyc. CERTIFICATE OF COMPLIANCE: 0 0 James F. King,President ��oF soUryo Town Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G Q Bob Ghosio,Jr. i2` �O Telephone(631) 765-1892 � OOUNTV, Fax(631) 765-6641 N`� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 17, 2007 Patricia C. Moore, Esq. 51020 Main Rd. Southold, NY 11971 RE: FRANK SCAVONE/VINCENT ILLUZZI 1615 FLEETWOOD RD., CUTCHOGUE SCTM#137-4-35 Dear Ms. Moore: The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed., October 17, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit #6743 from Frank Scavone to Vincent Illuzzi, as issued on October 17, 2007. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Jame)o King President, Boa rd of Trs JFK:Ims BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6743 DATE: OCTOBER 17, 2007 ISSUED TO: FRANK SCAVONE PROPERTY ADDRESS: 1615 FLEETWOOD RD., CUTCHOGUE SCTM#137-4-35 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 October 17, 2007,and in consideration of application fee in the sum of$25000 paid by Frank Scavone and subj 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 3'X 22' beach stairs with a 4'X 4' platform and gate, and existing docking facility consisting of a 4'X 44' fixed dock, 31X 12' ramp and 6'X 20' floating dock, and as depicted on the plans prepared by Frank Scavone received on 9/5/07 and survey prepared by John Metzger last revised March 21, 2006. 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. gt1FF4(t y TilSo rty 0 0 TERMS AND CONDITIONS The Permittee,Frank Scavone,residing at 1615 Fleetwood Rd.,Cutchogue,NY as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. 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. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of 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. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 0 0 James F. King,President ��0f soyoTown Hall Jill M. Doherty,Vice-President ,�O �� 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold, New York 11971-0959 Dave Bergen G C Bob Ghosio,Jr. Telephone(631) 765-1592 �yCow, Fax(631)765-6641' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 17, 2007 Mr. Frank Scavone 207 Carpenter Ave. Sea Cliff, NY 11579 RE: 1615 FLEETWOOD RD., CUTCHOGUE SCTM#137-4-35 Dear Mr. Scavone: The Board of Town Trustees took the following action during its regular meeting held on Wed., October 17, 2007 regarding the above matter: WHEREAS, FRANK SCAVONE 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 5, 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, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirement: the use of untreated lumber when the docking facility is reconstructed, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 17, 2007, at which time all interested persons were given an opportunity to be heard, and, 2 0 9 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of FRANK SCAVONE for the existing TX 22' beach stairs with a 4'X 4' platform and gate, and existing docking facility consisting of a 4'X 44' fixed dock, TX 12' ramp and 6'X 20' floating dock, and as depicted on the plans prepared by Frank Scavone received on 9/5/07 and survey prepared by John Metzger last revised March 21, 2006. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: None Very truly yours, Jam F. King,czresid Board of Trustees JFK:lms James F. King, President so�jy Town Hall Jill M. Doherty,Vice-President ,�0� Ql� P.O. Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen Telephone(631) 765-1892 Bob Ghosio,Jr. 'Q Fax(631) 765-6641 COO, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: 16 7 3 ' FRANK SCAVONE requests a wetland Permit for the existing TX 22' beach stairs with a 4'X 4' platform and gate, and existing docking facility consisting of a 4'X 44' fixed dock, TX 12' ramp and 6'X 20' floating dock. Located: 1615 Fleetwood Rd., Cutchogue. SCTM#137-4-35 Type of area to be impacted: V Saltwater Wetland Freshwater Wetland _Sound _Bay Distance of proposed work to edge of above: Payt of Town Code proposed work falls under: _Chapt.275 _Chapt. 111 _other Type of Application: _✓Wetland_Coastal Erosion_Amendment_Administrative _Emergency Pre-Submission Violation Planning 4n€o needed: �a.nhooks /r 9 �. o . K . Modifications: -'�' �. � ,- � � ✓`� � `=� � Conditions: Present Were: _LKing _J.Doherty�, P ickerson D. Bergen_ B. Ghosio, Jr _H. Cusack_D. Dzenkowski_Mark Terry_other Form filled out in the field by Mailed/Faxed to: Date: Environmental Technician Review • ��gUfFQ��.cO • Donald Wilder,Chairman y Town Hall,53095 Main Rd. Lauren Standish,Secretary p P.O.Box 1179 • '' ' 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 10, 2007, the following recommendation was made: Moved by Don Wilder, seconded by James Eckert, it was RESOLVED to SUPPORT the Wetland Permit application of FRANK SCAVONE for the existing 3'X 22' beach stairs with a 4'X 4' platform and gate, and existing docking facility consisting of a 4'X 44' fixed dock, 3'X 12' ramp and 6'X 20' floating dock. Located: 1615 Fleetwood Rd., Cutchogue. SCTM#137-4-35 Inspected by: Don Wilder, Chris Kempner Vote of Council: Ayes: All Motion Carried rmA T � w Ak i Y y j;yr T r *41 000 1 pyyo s` '.. 4 /4 �n F " F ' *rt. .F r� i' e ��' _.. .,;:�. . i it ,I . .B — � ya r �� a . . S _ — 1 ���� S �"� _. ��.� _ a ��Y i., t�;, '��., .�...F I. i iT�r i ka .�� t x.. c 1 .. `s s i � I / � .°" i�_ ��i �� _ �'�� '_; .� a. _ LA D . - .�� I r a� " .� �— �� — ---� :+.:� e_ , �.` STAIRS • 1 tw-•- �Y 1 r e� i }W`r 1 . •F SI vF`i� F 1 P.. 1vS, y� ii Sf / R Y CR I r— ti a s Q 6 \�\ 1 \ acci�om ¢� 5 k • ys `fq m1� •. lance COUNTY OF WVICe ©UE SOUTHOLD 'J'TPfWertytaxUFFOL. "�" 37 `_ -- -- -- 29/08 '07 WED 11 42 Aa 831 785 8145 SOUTHOLD TO LERR +4+ Trustees 0001 AUG. 29 20tl7 ;:1tl 1A1fl' . . ":.Business loan Express, LLC N0. 1200 P. 1 �^� ���� maWa f�au.6s9es n�Casa F.0'Bmt 1149 8EQ1✓ 8( tq.'FAT.6'1ri'14S'1S fioL4tho13,New York 11971 >itA11 SORFfC®R "FF Fax(6S1)U"145 AECOltD6MANA[�181GTt1FFR'pJ�t � e FREHy M OF DUORIIATION OFL'[Cm � D O"ICE GF THE li m AU 2 9 2001 TOWN OF�r Tom APDL -rjOH MR p4jgW ACCCSS Seutiof Trustees�1= �!$rd of Trustees INSTRUCTIONS: Please Complete Section I of thi8 form and give to Town ClerkL$ i3 La�gency Fropedit of InfnrMation Officer), Ope dopy will be returned to yypq In re00M;e to your request, or as an interim r9sporflM, SECTION t_ M �b111) (Department or Officer, if known, that has the informationyou are raqulssting.] keWRD YOU WISH TO INSPECT. (Describe the record sought, If possible, stl�xply date, Idle kitle, tax map number, and any other pertinent information.) 1� ` ��JCtJJx I, iY�c Ae.T OrtAn 1 'O(AtJ 4nort�$S . Signature of Applicant, Prikted Names �RlresaoiJ l� IS i lee.�u�oov 2.p C.,.r� a-2.. N ll�t3� eliallinrtj Address of different frog above) Telephone Numbers (o3 t - - `F 4 pate• o O t 1 APPROVED 6 1 APPROVED WITH DELAY* l ) DENIED3 %444a4zlw� Eliretreth A. Nevil a Date Freedom of inrnrras$ion 61.fFir r - V MUD �LZ7 If Belayed or dented see reverse side for explanation_ AUG- 29- 2007 3:dgvM Business Loan Express, LLC . N0. 1204 P. 1 — ODE 'DTo: Jim DingFrom:Frank Scavone Date:Aug 28",2007 RE: 1615 Fleetwood Road VIA FACSIMILE: 631-765-6641 Dear Jim— Sorry to trouble you but I need your help. I am in the process of selling my house on Fleetwood and Pat Moore is representing the buyer. We were scheduled to close the 76'and in the process of producing documents (Certificates of Occupancy,Permits...)when we learned correspondence relating to the dock had not be loaded onto the microfiche system. The dock was a pre existing structure when I purchased the house in 1995, probably built some time pre 1980 and, as I recall,"grandfathered"by the Trustees. The original dock structure was in bad shape and I traded correspondence and drawings with Al Krupski to confirm that I could repair it.He requested at that time,as part of the repair,that the structure be relocated approximately 10 feet south of the northern property boundary. I complied(as most of the pilings were rotted anyway),Henry Tuthill constructed it and the Trustees were satisfied. This all occurred around the time that we were addressing the bigger issue of installing the boulders and replanting the buff(the permits for which are fortunately in the system). It would be greatly appreciated if you could accelerate some sort of confirmation that the existing dock structure is in compliance with that specified in 1995 and can be transferred Post closing of the sale to the new buyer. I realize this is a tall order and I am doing all possible on my end to locate applicable documentation. I will be in Cutchogue Friday morning and would welcome the opportunity to meet you either in the office or at the property if it helps out. As always,th PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold, New York 11971-4616 Tel: (631) 765-4330 Fax: (631) 765-4643 October 3, 2007 Town of Southold 2007 Board of Town Trustees - P.O. Box 1179 Southold, NY 11971 - soa o d Tawn RE: Frank Scavone ......... Fo�rd of Trustees Premises: 1615 Fleetwood Drive, Cutchogue, NY SCTM # 1000-137-4-35 Hearing: October 17, 2007 Dear Trustees: Your hearing regarding the dock permit for the above referenced premises is scheduled for October 17,2007. Mr. Scavone applied for the Permit. He has since sold the premises to my client Vincent Illuzzi. Please transfer the Permit to Vincent Illuzzi. Enclosed please find my check #1686 in the sum of $50.00 payable to "Town of Southold" for payment of your transfer fee. Please send the Permit to my office. Thank you. Very truly yours, tcia C. Moore PCM/mr Enc. OFFICE LOCATION: ��� SO MAILING ADDRESS: Town Hall Annex O P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold, NY G Telephone: 631765-1938 � Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD MEMORANDUM To: James King,President ' �h Town of Southold Board of Trustees �1 l From: Mark Terry, Principal Planner LWRP Coordinator Date: October 17, 2007 Re: Request for Wetland Permit for existing docking facility for FRANK SCAVONE SCTM#137-4-35 FRANK SCAVONE requests a Wetland Permit for the existing 3'X 22' beach stairs with a 4'X 4' platform and gate, and existing docking facility consisting of a 4'X 44' fixed dock, 3'X 12' ramp and 6'X 20' floating dock. Located: 1615 Fleetwood Rd., Cutchogue. SCTM#137-4-35 THE PROPOSED DOCK IS LOCATED IN A NEW YORK STATE SIGNIFICANT COASTAL FISH AND WILDLIFE HABITAT AND A NYSDEC CRITICAL ENVIRONMENTAL AREA. 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 INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. 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 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The applicant must demonstrate that the following dock standards pursuant to S 275-11. Construction and operation standards have been met. (d) Review and approval of dock applications. Before issuing a permit for a dock structure, the Trustees shall consider whether the dock will have any of the following harmful effects: [1] Whether the dock will impair navigation or be located in areas of high vessel traffic or vessel congestion; [2] Whether the dock will unduly interfere with the public use of waterways for swimming, boating, fishing, shell fishing, waterskiing and other water-dependant activities; [3] Whether the dock will unduly interfere with transit by the public along the public beaches or foreshore; [4] Whether the dock will significantly impair the use or value of waterfront property adjacent to or near the dock; [5] Whether the dock will cause degradation of surface water quality and natural resources; The construction materials (type of timber) of the dock, catwalk, and ramp have not been identified. [6] Whether the dock will cause habitat fragmentation and loss of significant coastal fish and wildlife habitats; [7] Whether the dock will result in the destruction of or prevent the growth of vegetated wetlands, sea grasses including eelgrass (Zostera marina) and widgeon grass (Ruppia maritima) or shellfish; [8] Whether the dock will unduly restrict tidal flow or water circulation; [9] Whether the dock will be safe when constructed; [10] Whether the dock will adversely affect views, viewsheds and vistas important to the community; [11] Whether the cumulative impacts of a residential and commercial dock will change the waterway or the environment and whether alternate design, construction, and location of the dock will minimize cumulative impacts; and [12] Whether adequate facilities are available to boat owners and/or operators for fueling, discharge of waste and rubbish, electrical service and water service. It is recommended that the proposed action be amended to further the above listed policies to the extent practical. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. MT/hkc 0 • James F. King,President ,zf so 4, Town Hall Jill M. Doherty,Vice-President 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold,New York 11971-0959 Dave Bergen John Holzapfel C;1_5 e%. i� Telephone(631) 765-1892 1 COUNTY Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application /R etland Permit Application _Administrative Permit Amendment/Transfer/Extension /ReceivedApplication: 0� ,eom ledFee:$_�—rwL�L RompletedApplication _Incomplete SEQRA Classification: _ PDType IType IIUnlisted Coordination:(datewnt) �LWRP Consistency Assessment Form ICAC Referral Sent: 1 O q Hate of Inspection: Q p � irus ees _Receipt of CAC Report: _ Lead Agency Determination: Technical Review: !Public Hearing Held:_ Resolution: Name of Applicant �t ^nJ`L S CJD wJ' ( Ct, Address r l\ \ S5 Phone Number:( Suffolk County Tax Map Number: 1000 - '1 Property Location: (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: N P, Phone: Woard of Trustees Applicn GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: A� Intended use of property: Covenants and Restrictions: Yes No If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency \\ ( Date 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: N k 1 Project Description (use attachments if necessary): �d � � �o° a� �n�VN-\ �oard of Trustees Applic*n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: T Area of wetlands on lot: Z,Y Imo square feet Percent coverage of lot: ti _S�* % Closest distance between nearest existing structure and upland edge of wetlands: 2,S feet Closest distance between nearest proposed structure and upland edge of wetlands: / 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? C:cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: N Manner in which material will be removed or deposited: N P�_ - 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): PROJECT ID NUMBER 617'20 Is SEOR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME 6 , S^ 1 S rP 2TWtX . 3.PROJECT LOCATION: r Municipality County V� C 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc OF provide map 5. IS PROPOSED ACTION : ❑ New ❑Expansion ❑Modification/alteration ^\ n 6. DESCRIBE PROJECT BRIEFLY: V V" 1 +\ fl5� �UL vv"+'^R,'•'•'�'-k'1G„`� dam'` �OL.�,�- :.fii0.......:�.,,. ---. I' CCJJ 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILD PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? TY as ❑ No If no,describe briefly: AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential El Industrial 1:1 Commercial DAgriculture F Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) F-1 Yes No If yes, list agency name and permit / approval: 116ES /ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes F-1 No If yes, list agency name and permit / approval: 1I-2.. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [--]yes es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature ')— L1 0 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 Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes,coordinate the review process and use the FULL EAF. D Yes LZNo e. WILL ACTIOA RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may a superseded by another involved agency. ❑ Yes No C. COULD AC ION 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 or neighborhood character?Explain briefly: -N A C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly C4. A community's existing plane or goals as officially adapted,or a change in use or intensity of use of land or other natural resourcesvExplain briefly: n �— 05. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly - NA , C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quanti or pe of energy? Explain briefl : —/u ,* — D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If Xes,ex Iain brief : E Yes LA (No rR� E,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex IainI-7�No __. _._. _. L. I 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 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 orsignifcant 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 innn"aion and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse envirpnmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Age Date Print or Type Name of esp ible Officer in Lead Agency Title of Responsible Officer Signature of sponsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) • Board of Trustees Applition County of Suffolk State of New York :tw�fi�Ic SCA-vo/\)� 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 HISMER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. igna re SWORN TO BEFORE ME THIS DAY OF 120 No ry P c � WEN GAVIRIA NOTARYPUBLIC,STATE OF NEW Y N0. 01GA6115249 0101 !RED IN KINGS COUNTY MY COMN', :;SION EXPIRI-S SI PT 7, 200f1 ,q � �3 0 James F. King, President ��OF SnuTyo Town Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen Bob Ghosio,Jr. Telephone(631)765-1892 l COU '� Fax(631) 765-6641 i BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of --- _L_--!'�" ---------------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING residing at being duly swom, depose and say: That on the 2L day of sets m-, 2001, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that Iat I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held (g p, OC-1 J?,, JM) — _ On toy a6txet�%� Dated: (signature) Sworn to before me this aq day of 1 200 7 of ublic N4tTl�,�)ti ��f�iW,MP Mv�4?f ;£v145�8� , Qyl,ryiIIF96�q{n:r:(!IEINTI`+ f41A4QQ4slM„pk51,41M J,XUl41faS �P,L,7,.20'0'8:i PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Postal Name: m ru CERTIFIED MAILT. RECEIPT M 7 (Domestic Only; m n� Er ru r o o 0 Ir tr Er Off" Postage $ r=I :-R ra Certified Fee O C3 O Retum Receipt Fee Pos"a* pO (Ei O (Endorsement Required) Here M (R P C3 O R Restricted Delivery Fee O (F, O (El p (Endorsement Required) p ruO O Total Postage&Fees $ .r C M1 sr M1 se M1 Fst—toApt, E3 M h C3 - ----------------------------- ------------------- --- ---- or O or O No:orM1 a M1 No.-...-- -C, 2'P'4 STATE OF NEW YORKNPSFori� :r 06 Orr k's, See Reverse for Instructions COUNTY OF SUFFOLK orJ�- , residing at t-'�') �� C ` (� - ska Q-\ N. , being duly sworn, deposes and says 'that on the —day of 4 s, � , 200 T, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at �i L--X that said Notices were mailed to each of said persons by (certified) (registered)mail. Sworn to before m this //Day of g / ' 20_� N �4�ryPubli CARMEN ,,AV,R,A �iKv2� NOTARY PUBLIC, STATE OF NEW K No. O1GA6115249 QUALIFIED IN KINGS COUNTY MY COMMISSION EXPIRES SEPT.7,2008 • 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last time,fust name,rniddle 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 "7 (If S (If"Other'-,name the activity.) C ^— 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 �z 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 applican 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,siblin ,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of a corporate stock of the applicant . (when the applicant is a corporation); B)the legal or beneficial owner of any interest in non-corporate entity(when the, applicant is not a corporation); - _C)an officer,director,partner,or employee of th applicant;or _D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 'A day of _200 Signature f� Print Name Frp) t z fa'D Form TS 1 Town of Southold • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting 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 SCTM# toric PROJECT NAME (0 1 \ A I.RA Ott fl �A The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees l�1 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 and extent of action: TZ aoeN'T— L Location of action: •\ �' ( �� D Site acreage: o1 Present land use: Present zoning classification: - l7 2. 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:_ �� A (b) Mailing address: (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 ❑ Nop 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 [Z 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 0 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section IH—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 Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No W 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 VNot 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 evaluation criteria. ❑ ❑ Yes No NA�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 0 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 1� 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. ❑ Ye�] No�] Not Applicable Attach additional sheets if necessary WORKING COAST PODS 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 0 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. VElYes ElNoNot 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 Lam'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 9 Not Applicable / � I PREPARED BY �2MJ' �, �G�ro TITLE O".J2-i DATE ft �� APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE /o�izl�7 iso CD ji t U 3a V fINY �Eco�37� io a� o F pa c�� �2H,vt ►° F soft T �o/i�/a7 7'D 0T14-/z v,� r2 G✓f v L vw+ d F ly. i r — s - -� OA E_PRC . 77 L1111ARD O; TOWN OF SOJTr-116i D DATE i I STREET ADDRESS 1615 FLEETWOOD ROAD SCOHS Rej 0 ,Q/0-o33072 D�nn N AND CONSTRUCTIOth N OF SUBSURFACE CE RDS FORSEWAGE AL SURVEY OF PROPERTY �4,y DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES P :;,>. . and wltl abide by the conditions set lor/h /herein and on The AT CUTCHOGUE gj� '��r permit to aansJrnal. TOWN OF SOUTHOLD 0 6 _ SUFFOLK COUNTY N. 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SEPTICTANC' `.._ .—..._.. , sP LEAaANG POOL row.I3'DEF.P - -- �� FRLORREMOVEEmsTWG'SEPTICSYSTF_y_ AREA-18,541 S.F. AST j;OAD MOVE EXISTING WATERLAIE.TO TO 77E LINE �qSE OF NEW; STING /O'FROA!NEW SEPT)C SYSTEM 2P d EPI AS REO 80. RELOCATE ELECTRIC A3 REOUIREO � C P•p -9-8 ANY ALTERATION OR ADDITION TO THIS SURVEY/S A WOLA77ON CONIC . '60 OF OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 F 97 ELEVATIONS REFERENCED 70 N.G.V.D. £xcEPr A5 PER sEcnav 7209-SUBDIVISION z. ALL c£RnFrcAnoNs P.O. BOX 909 HEREON ARE VAL7D_FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET 02-352 wH05£ SIGYATIIRE APPEARS HEREOV. SOUTHOLD, N. Y. 11977