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Home My WebLink AboutTR-6678 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 CERTIFICATE OF COMPLIANCE # 0256C Date September 27,2007 THIS CERTIFIES that the rock wall with 10' non-turf buffer along the wall, stairs, in-ground swimming pool with drvwell, and surrounding patio At 1555 Bayview Ave., Southold, Suffolk County Tax Map # 52-5-11.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/25/07 pursuant to which Trustees Permit #6678Dated 7/24/07 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 rock wall with a 10' non-turf buffer along the wall. stairs, in-ground swimming pool with drywell, and surrounding patio. The certificate is issued to ELANA GOODMAN owner of the aforesaid property. ;.- 57 ~ Authorized Signature I Q'hc: - I f8 - l t J ~r\Q~ ~QC0 w ,- CJ ~zz :J......a.... Zt::l~ w~ f- CJ~V) -J~~ "~ BAYVIEJr A VENUE S 3r30"00' E: 150.00' ~~ ;1 I "- If) l- I 0 f- -J I CJ I -J I I l I ~ I~ '<~~' ,...... ~ 'r1 . ..,-.- .- ......0 ~ (?'> ~ ~ ~. ~ "CONcRE:,f'--s. ~'fv E:4V4 CL., ~~. I. N 23-.,. .,.(Al.ONG ;/. . ____/j. ;' '001 I / E: I. IlVl' IV ..> N.1t w.N. 59.08/ ./ ....-..... .. '"t ""'1 ...0 Q) ""'1 / ..~;. I- CJ' .. -J .. .. ., .. W .. 0 ~ . 0 l"'l ~ l"'l . <\J If) VI ::2: Ij ". l.. '" Plr:K[ r rfNei' r .. T1 rLJ" ""ODD TR[L tAC! I I J JfJ.( v.Jf, APPROVED BY .BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE . 8. /z ()? ,. ::JOO~ooo ..., /" . "'t'i~ :"~'QlJf. ~~~. I ~. "Z.' t f.'~~~:~:,.:. . " l ,";. " ~ I/O:.' -'T -J.' -.J ~ to,..JG I I I I I I I I I I ~ ~ :: Cl. '"t If) , ~el~) ,A~ I I- o -J \ . 51.8' FI. [1.=12.5' 1 STY, FR, HS[, & ,:"':.'1' '" ,..I/~.~,: .. ---:':::=i;~~::;;;~~:._ iu iii CONCR[ rf PA no SLA.-r PATIO C:. '" 35.9' 12.5' POOL 35.9' CONCRE:TC PATIO <'I . I I -.:-::::-1-.... _ --'-"'"':l~",::.-~ --- ~ . ,4L ONC S['4W/.lL I. N 29-30"00' W C.L,F. --!!.f L INr ~ ~ .....#,HA' '.. :0CbD M.f\! "-J -"d 'l'\~ )'!\ PONn <t ~ <'~ b \' . Res lOeQ"Ce .93.51" IDJ IE CE I lfl1 . AUG 1 3 2007 RSHAlttOAlAQUE '\ ~ .':j\,J >=5 :>Cl.. ~ lr) :? c: ...... ..... <J: E .... "- ~. > CJ <J: v ....' ~ L.. )> 9: v .. v " ,.- ""'1 :r. M f-~ _. C\J c: ..... :2 c:: ..... ..... .... C::: c: <J: 0:: c: Z c:. .... ..... <:l 0: L... .~. m <1 ... >- t:J :2 ;.-J <l. \ I- o -J ~ e:, ~ .. g .. o ('t) . . ~ v, ~,H. \I.H. c:i ~ <.0 ~ E o ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ G:l. "-'.l ,. .. ... fIIIIIAIII I Qhe - I fB - l ~ ') ~rV:)_~ ~QCL L..J'-L:J CQ:<:< ~.... :) Q :<~~ L..J~ f- a.::!",> -.JL...~ ,,~~ ' -~ , BAYVIEW A VENUE S 3r30'00' E ;'<;,' ... ~ .... \6 co .... ~ .... o -' .;9); . .... - CJ- -J .. .. lu 10 <::) S> <::) C") . <\.J It) ...., :2: f.J (-.t ... '" _ Plf.'.![ r r [Nel" I TlrlJ" '-'ODD TI?[ L I.ACe I I I ~ I~ ~l ~ ~ ~ :;::- ;.;; ~ ~ NJ.(,v,,lf. APPROVED BY BO~RD OF TRU,STEES TOWN OF SOUTHOLD DATE' 150.00' .. :JOOcx=t:::c:Jooo '\ ~ ':J~ ~~ C") It) ".2 c: '- f- q E: '- ): .q v '- >- L.... :> ~ v ... v '" ...- .... :r M \.- .... C\J C. f- :2 c: .... f- '- r::: c: .q Q: c: 2 c: .... f- <J: Q: L... .f- ~ <J: .... >- 0 2 -J <J: ...., /" ",lilt ., ~ " 'gJJt. ./,.-- I \> if .z. f!>"" . ~..' .,. . . , ~~.: ... -J..' .... o -J -.J totJ~ t. PICI<n Ft. 'H. r -- r~~-- ~~l I ",q: asS' ~ .. <::) <::) ... <::) . ~" ~ v, I dI ~,._L I --- . I .1 I I I I I I I I I I ~ ~I -I I I I I I I I ! I I I I I <r :x: Q. <t ... ,.., ,.., fot.H.V.H. c:i ::; l:) <: E ~ ~ ffi t5 ~ ~ 'l:( ~ i=:: ~ lu iti ~ It) . ~el~) pJ I .... o -.J '" It) .... o -.J sl.e' tF [L =12.5' ... vi - 1 STY. FR. HS[, & \::2./' -~::~:~;~;":~~;~~'.- C\J vi COII/eR[ rf PA no SL 4 t[ PA fIll <:, vi \ 4.0' \ ~ POOL <:. \. ,.~~ CW:R<TC3>~ WID ~ ~"+.) /.; T"--- COM: " .,,;> /' STEP'S ~ ~"1'":" y' /Q ~-?f: ~ P'~ ." ql ~ STON[ & CONCRET[ SEAWALL 35.9' 12.5' =- C.LF. -!!E LINe =-- . 'G" " '.. . . "--^ '.' 111":"'\" {Yl", '-I' .' . .,'~ ... -"d *~ \ POND t t ~r"\ b \' . Res lDeQCe 93.51' \.Y AR8H.AltiOJI~ ~WUjQUE . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK,TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction -7:2 constructed ~K _ Project complete, compliance inspection. ~,\\. Oq \01 . . TERMS AND CONDITIONS The Permittee Elana Goodman, residing at 1555 Bavview Avenue, Southold, New York, 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 TownofSouthold. 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 ofthis Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of South old require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provid(;:dwithinninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, 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 July 24, 2007 Mr. Robert Bohn Robert Bohn Contracting P.O. Box 876 Southold, NY 11971 RE: ELANA GOODMAN 1555 BAYVIEW AVENUE, SOUTHOLD SCTM# 52-5-11.1 Dear Mr. Bohn: The Board of Town Trustees took the following action during its regular meeting held on Tuesday, July 24, 2007 regarding the above matter: WHEREAS, Robert Bohn Contracting on behalf of ELANA GOODMAN 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 June 25, 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 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: removal of pipe from rock wall, installation of drywells for in-ground pool, a 10 foot non-turf buffer, and 2 . . WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 24, 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 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 ELANA GOODMAN for the existing rock wall and stairs, the existing in-ground swimming pool, and surrounding patio with the condition of the removal of pipe from the rock wall, installation of drywells for in-ground pool, a 10' non-turf buffer along the rock wall, and as depicted on the plans prepared by Robert Bohn Contracting, last revised on August 13,2007. 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 inspection. (See attached schedule.) Fees: $ 50.00 Very truly yours, Jat-:inO: ~ President, Board of Trustees JFKleac . 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 EIa/7a. G~ TO: Please be advised that your application dated -0 v..ne. d5; f).OO 7 has been reviewed by this Board at the regular meeting of \.1Z\,~ df.{/ ~? and your application has been approved pending the compl on of the follow~ items checked off below. vi Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) _ ~tructed ($50.00) ~inallnspection 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: $ -50~ +re\ltser:1 p~ BY: James F. King, 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 Mon., July 16, 2007, the following recommendation was made: ELANA GOODMAN for the existing rock wall and stairs, existing in-ground swimming pool, and surrounding patio. Located: 1555 Bayview Ave., Southold. SCTM#52-5-11.1 The CAC did not make an inspection, therefore no recommendation was made. ~\ . . ,.', .(. ~." , '<fro-,.",,;," . "c.o ~.;a..... . 4 . ... '"'" :,> i,' ~ . ~ . J..: )t.~..~ - ..... .. '. , . ..... #. ~(A~ . . \ / ., . ~~ar1 . 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 Southold Town Board of Trustees Field Inspection/W ork session Report Date/Time: 71 \ \ \.0' ~ Robert Bohn Contracting on behalf of ELANA GOODMAN requests a Wetland Permit for the existing rock wall and stairs, the existing in-ground swimming pool, and surrounding patio. Located: 1555 Bayview Ave., Southold. SCTM#52-5-11.1 , ' TWe of area to be impacted: II Saltwater vi etland Freshwater Wetland Sound _Bay Distance of proposed work to edge of above: Part of Town Code proposed work falls under: /Chapt.275 _Chapt. 111 _other Type of Application: -:!W etland _Coastal Erosion _Amendment _Administrative _Emergency _Pre-Submission _Violation Info needed: j~3 ;:ltx>;'~~rf' be ~J~~tJl Modifications:~~ ~r ~ UkR" ~ <9 ( -\- s,-\ep .' ~ f'to"~ b'~ (: L r f'p<- Conditions:j) ~ W{ \ \ -Fv. fbo\ d- kvs-e ". , Pres91t Were: \/('King ~Doherty ~-Dickerson ~Bergen ~. Ghosio, Jr ~H. Cusack_D. Dzenkowski ~ Mark Terry_other Form filled out in the field by Mailed/Faxed to: Date: Environmental Techniyian Review' Wher. vJa. S ro \ b<.tll+? wlt IJ f uryo" ,ii!, "~ ",.1/1 ~~LA'~ po., ~f- lo( f{PL .I f ()O ( O'{ ry ~ ... "- PVI /fWi.L (,..../~rr ();J PDJ,rTv~;C 6vr/~/2.. Pt pi yewWJ;I'f-~ !J/lCfC(;A/pff'lr ~IL /,Oe> L ej d~ ~i V> " ~~ ~i I cd: ~ ull. ~ ~ = /'// I; ..Q // I / .: he.,/' ..' .~~ / ~H /" I !.1" . /q\)' :O~. .~ z ". :/?/' I Ii ~ s ~9ic:,'! I I" Q-?;'" I R;i9' IC? ii I I ~~I'N / Ui/ / I ~/ I , ~// I at I ~ I - I . "~I r.;::.. ~ !; I ~ . I 0:,;<. II "yl / I,. ~/qS'l' ~{.~ ~.'\.t:l{V .:,CJ+"~' /Vg,"- // /,./ r . I -<::>- Z I ~ ~~ I~ 51 1/- I ,;" + a::~t n~ I I lil~~1 . > 1/ i " .. ~. e I 'I ~:~ ni I ~I ~ L II III .i t i f~i!l i;i~ Mr!l j j jj i i i i I ~ I J nJl II II I" , ! III t'" -.., Iii i, i ~ i I ! J ',II ., .1 1@ll I Ii ! . J! I I i j - a Iii- 'k . ! · f ~ fflfi. ill if 'III " A I: i ~ I ~ I q'i ufli . ~. OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAIUNG ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD MEMORANDUM To: James King, President Town of South old Board of Trustees Mark Terry, Principal Planner fl\1, L WRP Coordinator ~lliL~ ~ tij -~rm UI J U L 1 0 2Iv"u'j J J'~/ Southold Town Board of Trustees From: Date: July 10,2007 Re: Request for Wetland Permit for Elana Goodman SCTM# 52-5-11.1 ELANA GOODMAN requests a Wetland Permit for the existing rock wall and stairs, the existing in-ground swimming pool, and surrounding patio. Located: 1555 Bayview Ave., Southold. SCTM#52-5-11.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of South old Town Code and the Local Waterfront Revitalization Program (L WRP) Policy Standards. Based upon the information provided on the L WRP 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. Policy 6 Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. . . The distance to the pool and patio from the seawall is 20 feet: a minimum setback distance of 50 feet from the wetland line is reauired pursuant to Chapter 275-3.Findine:s: purpose: iurisdiction: setbacks. Please reauire that the applicant amend the application to meet the above policy to the e:reatest extent practical. Additionally. if the action is approved and to further Policy 5: Protect and Improve Water auality in the Town of Southold: 1. Establish a non-turf buffer landward of the rock wall to protect Mill Creek, a New York State Department of Environmental Conservation designated Critical environmental Area. 2. Require a drywell to contain pool backwash. The in kind replacement of the existing rock wall and stairs is an exempt Minor Action and not subject to LWRP review pursuant to Chapter 268-3; Items A and B ofthe Town of Southold Town Code. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review ofthe Town of South old Town Code and the Local Waterfront Revitalization Program (L WRP) Policy Standards. Based upon the information provided on the L WRP 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 review pursuant to Chapter 268-3, Exempt Minor Actions, item B 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". Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency ofthe proposed action. MTlhkc . . 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, N ew York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application /Wetland Permit Application _ Administrative Permit Amendment/Transfer/Extension .L:Received Application: ~ceived Fee:$ ~ompleted Application _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ _ Coordination:( date sent) ~LWRP Consistency ~Pffl ent Form b ~ O'J ~C Referral Sent: Q) _ ~ of Inspection: 07 _Receipt ofCAC Report: _Lead Agency Determination:_ Technical Review: P1115Ilc Hearing Held: rJ I Mt If:> 1 Resolution: - (+- \O)1~ ((: ~ fi 'W ~ l~ 1\fU\ JUN 2 5 ?"OI 1'-..1 L __:::------1 SouthDld 10NI: B03~d 01 1ru~';'.~''"!s Name of Applicant Address \~~~ 5o~l {) ElI/Nil ~dJ7V\A~ T5p,-y cJ tc-~ A-v(,~ V e Phone Number:( ) -J ~ S- -- '-/1 S-3 Suffolk County Tax Map Number: 1000 - 5" do -- 5 -/ (~ I Property Location: '5S-S- ~A-1VI~ ~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) ROBERT BOHN CONTRACTING P.O. BOX 876 SOUTHOLD,NY 11971 sur COJ'O' lD (~~1 Address: Phone: 7~S-- 1//9 4ItBoard of Trustees APPlic4lton GENERAL DATA Land Area (in square feet): Area Zoning: 1< e S l' U e..,..l..\1A:.L Previous use of property: ~ ~S I' Q 'GAl + \ A-L Intended use of property: $ AN\\.<... ~o Covenants and Restrictions: Yes - 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 suspenr14y a governmental agency? 7N~' Yes If yes, provide explanation: DtJ~ ~c...~ . Board of Trustees APPliCeon WETLANDITRUSTEE LANDS APPLICATION DATA (O~. EtJ~uJU , (y\A-ke 1(0(,."-. ~l IAJA-l\ - lE~ (., (f:) S () (l.~ Purpose of the proposed operations: l"n-t'...~+- oF' , \5 ~T Area of wetlands on lot: plJtJe.. square feet IS % Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: l/) S- feet Closest distance between nearest proposed structure and upland edge ofwet7 feet Elf"" 5 +l ''d f,tJA-t( Does thTJ:,ct involve excavation or filling? ~o )Tes If yes, how much material will be excavated? D cubic yards is ~.,. W(.+ If\/Ji) E:J~ ~ How much material will be filled? o cubic yards Depth of which material will be removed or deposited: () feet Proposed slope throughout the area of operations: 0 Manner in which material will be removed or deposited: Jt/~ , 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): W ffFc Cr PROJECT ID NUMBER . 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME SEQR rj- PART 1 - PROJECT INFORMATION 1. APPLICANT I SPONSOR $/lJ-tVh ~M1AN 3.PROJECT LOCATION: SOli/kID County ~ (/ {~ I /( Municipality 4}56 5C60;{~trvt I ~d~nd ~ov;t;rsea:;~;;~ or P~d~dl 5~1L:.+hoLcJ. J 1V."1 · ' 5. is PROPOSED ACTION: D New D Expansion 6. DESCRIBE PROJECT BRIEFLY: /fbj) o tJ r.. ~crf -10 EX-51 's-t-~" WJ+/l 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WlL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? D No If no, describe briefly: (l/pl'l c AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) o Industrial D Commercial DA9riculture 0 Park I Forest I Open Space o Other (describe) 10. DOES ACTION AGENCY (Federal. DYes OLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL Ie or Local) If yes, list agency name and permit I approval: ECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? No If yes, list agency name and permit I approval: 12. AS A R []yes PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUiRE MODIFICATION? THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment Signature . . If yes, coordinate the review process and use the FULL EAF. DYes B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. DYes D No 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: ll/l2 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. t1) ......~ . .- 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: tV; . - Explain briefly: NO C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: J E. 'DH~:. OR 'S ~r U~LY T:B~~O:ROVERSY RE~m TO PO~~~ A~RSE ENV'::MENTAL IMPA=? If ~ .'1"'" 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 ofthe proposed action on the environmental characteristics ofthe 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 Pnnt or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) PROOFOF~ffiGOFNOTICE ATTACH CERTIFIED ~ RECEIYfS Name: ~\~ ~~ Address: \555 BA-tV"("~ (0. · Comp~e ~ 1, 2, ancI3. Also complete Item 4'1T RestrIcted ~Ivefy Is ,desired. · PrInt your name and address on the reverse so that we can return the card to you. · Attach tI1ls card to the back of the mallpiece or on the front If spaCe permits. ' . \ 1. AdclrII888d ~: · R ,hard 7<~m4n(j ~~'a~-6oU.+h~"en rJV~ rn~rd, NLf , JI7~~ ClAgent Cl AddI'8llSee by (PrlfltedA*me) c. Date, ',of DeI'~ 'VI VLt ((j)~7-:1 - 0 I o. Is delivery acIdr8ss dlfferenttrom 1tem1? Cl Yes If YES, enter delivery addr8ss beIow:Cl No B. 3. ServIce 1YPe ;!! Cl CertIfted Mall ClExpresa Mall I, Cl RegIater8d . 0 Return ReceIpt for Merchandise ;I Cllnsured Mall o C.O.D. .1 , 2, _~'!' ! 4! ---"'" 0 "" . ~bor" I<..J , ,(7hInsttJrfromseMd, 7005 llbll 0002 8647 5334 i: " ys that on the / j PS Form 3811, February 2004, Domestic Return ReceIpt , " 1Q2595.a!-M-1540~.' " py of the Notice l:it;L LVI. LU ill. u..... .LO~_ _ __ _ . , , . > 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 e Town of Southold; that said Notices were mailed at the United States Post Office at U-t: d t said otices were mailed to each of said persons by (certified) (registered) mai . Sworn to befO[e'le this 6"f/1 Dayof:r~ l ,20~ -ffoiuf~ . Notary Public ROBERT CURTIN NOTARY PUBLIC. State of New Vork 01CU4604511 Qualified in Suffolk County i~ Commission Expires March 30 ~ f V . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES. TOWN OF SOUTHOLD In the matter of applicant: E\AtJ~ ~~ f'fI\AN . SCT~# 6~ - S-- ({. " YOU ARE HEREBY GWEN NOTICE: 1. That it is the intention ~e undersigned to request a Permit from the Board of Trustees . to: EK-f~,.J() 76f lJF tV"" II ()}/-l, !;;or IP/() ;:$1h-1fl-S -h ~I'I-.,v.. ~t:k5;5n~ ~61 ft7J.o p~~_ /d ~~ 16 l:v,l-r Sr 2. That the property which is the subject of Environmental Review is located adjacent to t51l.~, your property and is described as fol~ows: ~h~ 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: 0 u...l~ ~'f j 0600 7 . You may contact the Trustees Office at 765-1892 or in writing. ' The above-referenced proposal is under review of the Board of Trustees of the Town of South old and does not reference any other agency that might have to review same proposal. OWNERS NAME: &JA,JA ~ o~~ :M.J\TI..-ING ADDRESS: I Ss~ 'B/4.=fiUi'aJ ~IT'^ b \..Q I'J'( ( l"t r PHONE#: 7&S- --. 1/5"3 A-II./L Ene: Copy of sketch or plan showing proposal for your convenience. ~'d 9~G9 99L ~€9 ~NI E)Nll~~lNO~ NH08 eo€: ~ ~ LO 9G unr James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, II. . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter ofthe Application of ___~lJt~__~~_~()_______________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) I, Ro~-t~ .5ou +"" D l t AFFIDAVIT OF POSTING ~D e7(P , residing at tJy box being duly sworn, depose and say: 't\" \ . That on th~l day o~ , 200ry, I personally posted the property known-as '(J Ga?bN\AN ~1'PerJ c~ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place:6 r eight days prior to the date of the public hearing. Date of hearing noted thereon to be held 1 ~ 01- 01 a ~ (signature) Dated: Sworn to before me this ~ 1'fV\.day of~200 '}- ..~Q~ Notary Public R8ARA ANN RUDDER NO\:~ PubliC, State of New York No 4855805 Qualified in sutto~ ~~~ty~ 1 U Commllllon Exp're. "P I 4It Board of Trustees APPli~tion County of Suffolk State of New York -R19~ e.rI ~C> H tV 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 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 REPRESENTATlVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREWSEsmCONnmCTIOv~\;S Signature SWORN TO BEFORE ME THIS eX 5 DAY OF -f)/L/J ~~ ,20 07 ~~~ vU ~ otary Pu ic 9f1 LINDA J COOPER NOTARY PUBLIC, State of New York NO. 01 C04822563. Suffolk CounJ~ Term Expires December 31, 20-/-0 ',...- . e Board of Trustees APPlieion AUTHORIZATION (where the applican.t is not the owner) .~;. I, ~/E,JII- b~blW1,4t1 (print owner of property) residing at }-r5"S- ~II/l-U JUI-.e- (mailing ad ess) 9ov~\D 60HtJ do hereby authorize~~O t3 (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ~s s~~ 8 . . APPLICANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM T~e To~ of~uth~ld:S Code ~fEthi~s prohibits conflicts ofintere~t on the ~art of~own officers and ~mplovees. The oumo~ or this form IS to rovlde mformatlon which can alert the town of possIble conflicts of mterest and allow it to take whatever actIon IS necessarv to avoid same. ' ~6 1?oN~ (Last name, first name, .!piddle 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.)' YOUR NAME: NAME OF APPLICATION: (Check all that apply.) Building Trustee Coastal Erosion Mooring Planning Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map 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 partnershi m which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town 0 Icer 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 L ~ ~ 1) ft <3 l> ~ Title or position of that person ~.~ V+, ~ C l<" ~ Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): _A) the owner of greater than 5% of the shares of the corporate stock of the applicllnt (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 , vJ'~~ '2'- Submitted this ~y of ~U ~ 2002 Signature ?_~ Print Name "\<.obe..'\ 'Eo~ 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 South old Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. * Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of South old Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the L WRP policy standards and conditions contained in the consistency review law. Thus. each answer must be explained in detail. listine: both supportine: and non- sUPllortine: facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. SCTM# .5 ~ -s- 1/, I JUN 2. 5 ?N\l A copy of the LWRP is available in the following places: on!' website (southoldtown.northfork.net), the Board of e\f9{Gc~th~ local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION soutllo\d 10wn Board of 1rustees PROJECTNAME [\f1m GDO('i~ The Application has been submitted to (check appropriate response): Town Board D Planning Board D Building Dept. D Board of Trustees 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) 1 D D (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: D Nature and extent of action: It!)!) / H 1D WA-I( ~ ,fer e.",\~~ S~ at"()l In.-qYOUf'{)\ ~l oj' ~o.1,O . Site acreage: / f5'S~ ,4-e (U . Rt 5)1'd< N7tA-L ~5. . l3a.o--u I'~ /rPf/lV X 50,./71,0 I () . Location of action: Present land use: Present zoning classification: 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: GOD J IW\~ B A if L/ Jr!.w , f NY llq II (c) Telephone munber: Area Code () I C:? S- - L/ { 5"3 E (EtVA /f):):) }4-t/-L (b) Mailing address: So ulhD lJ) (d) Application number, if any: Will the action be ~y undertaken, require funding, or approval by a state or federal agency? Yes D No E:f" 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 0 development. See L WRP Section III - Policies; Page 2 for evaluation criteria. DYes D No Attach additional sheets if necessary Policy 2. Protect and prese historic and archaeological resources of the Town of Southold. See LWRP Section III - Polic' ages 3 through 6 for evaluation criteria DYes D No Not Applicable . . Attach additional sheets if necessary Policy 3. Enhance visual guality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Po~ Pages 6 through 7 for evaluation criteria DYes D No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of e, structures, and natural resources from flooding and erosion. See L WRP Section III - Policies Pa s 8 through 16 for evaluation criteria DYes D No Not Applicable Attach additional sheets if necessary Policy 5. Protect and impr e water quality and supply in the Town of Southold. See L WRP Section III - Policies Pages 16 throu 21 for evaluation criteria DYes D No 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 W' life Habitats and wetlands. See L WRP Section III - Policies; Pages 22 through 32 for evaluation c . eria. D D - ----.....---_..... --..--- Yes No NoaPlicable . Attach additional sheets if necessary Policy 7. Protect and impro e air quality in the Town of Southold. See L WRP Section III - Policies Pages 32 through 34 for ev uation criteria. DYesDNo Not Applicable Attach additional sheets if necessary Policy 8. Minimize envir mental degradation in Town of Southold from solid waste and hazardous substances and wastes. ee L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes D No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public ess to, and recreational use of, coastal waters, public lands, and public resources of the Town of thold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. DYeD No Not Applicable Attach additional sheets if necessary . 'WO~NG COAST POL.ES . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locatious~L WRP Section ill- Policies; Pages 47 through 56 for evaluation criteria. DYes D No L!J Not Applicable Attach additional sheets if necessary Policy 11. Promote sust .nahle use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat s. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes D No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricul rallands in the Town of Southold. See L WRP Section III - Policies; Pages 62 through 65 for evalu on criteria. DYesDNo Not Applicable Attach additional sheets ifnecessary Policy 13. Promote a~ opriate use and development of energy and mineral resources. See LWRP Section III - Policies; ages 65 through 68 for evaluation criteria. DYesDNo Not Applicable PREPARED BY TITLE DATE