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HomeMy WebLinkAboutTR-7148A James F.King,President �OF S�UryO Town Hall Annex Jill M. Doherty,Vice-President h0 4j 54375 Main Road P.O.Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen �O Telephone(631) 765-1892 Bob Ghosio,Jr. l�C�U Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 16, 2009 Ms. Donna Wexler 1775 Indian Neck Lane Peconic, NY 11958 RE: 1775 INDIAN NECK LANE, PECONIC SCTM#86-5-9.1 Dear Ms. Wexler: The Board of Trustees inspected your property on October 7, 2009 and found that the special conditions of your Notice of Disapproval-Administrative Permit have been met, and the bog will be left undisturbed. Please be advised that the piles of indigenous beach stones can either be completely removed or spread out along the landward side of the bank, as a non- turf buffer area, as discussed. Thank you very much for your cooperation. Very truly yours, )James F. King, esident Board of Trustees JFK:Ims cc: Lori Hulse, Esq. James F.King,President �aof soUjyo Town Hall Annex Jill M. Doherty,Vice-President hO 54375 Main Road P.O.Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen v' Bob Ghosio,Jr. Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7148A Date of Receipt of Application: June 8, 2009 Applicant: Donna Wexler SCTM#: 86-5-9.1 Project Location: 1775 Indian Neck Lane, Peconic Date of Resolution/Issuance: July 22, 2009 Date of Expiration: July 22, 2011 Reviewed by: Board of Trustees Project Description: To trim dead and/or diseased limbs and branches landward of the top of the bank. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the application received on June 8, 2009, Inspections: None If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James . King, President' Board of Trustees 9 0 James F.King, President ��OF su�ryo Town Hall Annex Jill M. Doherty,Vice-President 54375 Main Road P.O. Box 1179 Peggy A.Dickerson Southold, New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NOTICE OF DISAPPROVAL - ADMINISTRATIVE PERMIT Applicant: Donna Wexler Date of Receipt of Application: June 8, 2009 SCTM#: 86-5-9.1 Project Location: 1775 Indian Neck Lane, Peconic Date of Resolution: July 22, 2009 Reviewed by: Board of Trustees Project Description: Placement of indigenous beach stone and sand on top of bog and on either side of the dock. Findings: The project does not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, and the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP. Special Conditions: All beach stones must be completely removed from the area and allow the natural vegetation to grow back. Inspections: Final compliance inspection in September 2009. This is not a determination from any other agency. o'er ',��'' Jame . King, Presid4e Board of Trustees J• It air 46 d' 07/08/2009 13 : 28 + � w! + e 40 � ' e ,_ .. +fk• 'fix' - T �� -s 07/08/2009 13 : 28 Am FA 4 r _4� W. r f 1 a L. James F.King,President �sOPPot�.�4 P.O.Box 1179 Jill M.Doherty,Vice-President TT Southold,NY 11971 Peggy A.Dickerson y Telephone(63 1)765-1892 Dave Bergen y, Fax(63 1)765-6641 Bob Ghosio,Jr. Southold Town Board of Trustees Field InspectionfWorksession Report Date/Time: -7 q- DONNA WEXLER requests an Administrative Permit for the trimming of dead and/or diseased limbs and branches landward of the top of the bank, and for the placement of indigenous beach stone and sand on top of bog and on either side of the dock. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 yTyp of area to be impacted: altwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: �pt.275 _Chapt. 111 _other Type of Application: —Wetland _Coastal Erosion _Amendment _Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: YJ.King �d.Doherty _P.Dickerson l.D. Bergen V B.Ghosio, D. Dzenkowski _Scott Hilaryother Form filled out in the field by Mailed/Faxed to: Date: KHJUNu �r � Town of Southold A 386155 SuffolkCoumY, NY g �,, ,i �, The People of the State of New York vs. T E)DEFENDAFM FIRST NAME 'MIDDLEINITIALd Town we�a �N NTrustees STRE r�A}DORE45 //f.7� {N17f ATE / Cm g4lf)alf� - N v I f -gTd ZIP STATE p UCENSE OR REGISTRATION NUMBER 12J 2A O 'STATE TYPEDFMCENSE. DATEEKRREB MV DATEOFBMM OPEMIOR /u E`1 G MCY YEAR OwKs4[MDIE T ❑YEs ❑FIp 1HEOMEMTOR-0R'REGI6TESEDpMYEROF VEHICIE,DEBCRIB@ QIBJ W FATE NO. MTEEATYRES :STATE - PATETYPE ❑N.Y. ❑U.J. ❑N.Y. (3 N.J. ❑ ❑PASS ❑COMM ❑ VEHICLE MAKE ❑. OODGE ❑ SUIOK O CHEV ❑ CAOUAC ❑ PONDIAC -0 FOPD ❑ OlDS ❑ Km ❑ TOYOTA ❑ . VIXl(S ❑ - BOGY ❑ 2DR ❑ ADR ❑ BUS - ❑ MCY ❑ S.W. TYPE ❑ TRUCK ❑ TIUIIER ❑ vAN ❑ MN NUMBER - THE PERSON DESCRIBED ABOVE M CNA mAS FOLLOWS KAM OF OCCURRENCE 4 )72Y i,iu/oil i JNCG 044 30 DATEOF OFFENSE AM TIME FMatt.TOWT NUAOE OP H\MlE! SUFFOLKWLNTYM 04-0 IfN�MO4TONOFSECTION SUED.' OF TIE C7 VEHICLEAND TRAFFlC AW OFMESYATE OFNEw YDRN fd�fFIER 7CIFY) DO S. ❑OOF ❑SUS ❑HAZ ?G 2 - DEF VEH 75 MT ❑ SPEEDINO OTHER CFFQ MPNINA MPIi ZONE NO ft�e••nit MISDEMEANOR fA N-PART NOT FOR TVS) WEABWENAMEDDEFENDAMDIDIX WESTATED M,TMEMDPIACE Ao,/an 'IAS -c-TN* 5 l�AAn ,?S £J<-t- L.} -�rcwT i r2vSrEr 5 ri2c,,. T T1M fenpdry•`wwam(pPmnlhrowweBx) of ftw c)(-a,- 04 PARKING SCHEDULED FINE$ OONTACTCOURT❑ WE PERSON MOCRIBED ABOVE W SUMMONED TO APPEAR AT- -•6 exa K SOUWOW TOWN JUSTICE COURT,33006 ROUTE 2E,SOUTHOF),NY 110)111 'LL t t '74 MTE F 11lOL FORIYHI /. ON . o"f LZ / LOO AT ' FNSESTATEMENISHERE MEFUMSIN MAa AMISDEMEMN.'NRRY4 MSE M2100CP P1NY.S. COMFNVNMT DATE i [t6•ob a , _ BADGE Y COURT APPEARANCE • • James F. King, President Town Hall Jill M. Doherty, Vice-President 53095 Route 25 Pe A. Dickerson P.O. Box 1179 Peggy Southold, New York 11971-0959 Dave Bergen John Holzapfel Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6331A Date of Receipt of Application: April 14, 2006 Applicant: Karen & Roland Grant SCTM#: 86-5-9.1 Project Location: 1775 Indian Neck Lane, Peconic Date of Resolution/Issuance: April 19, 2006 Date of Expiration: April 19, 2008 Reviewed by: Trustee Dave Bergen Project Description: . - , e d and/or diseased limbs and branches landward of the p-0M ;v . Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated in the application received on April 14, 2006 Special Conditions: None If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Ja es F. King, Presient Board of Trustees e '}e aad E a p "a o/p ay 6d nJrP aW° xWn \ O 2. REEK J. J` m W ne �. JV 4 1 • t� _—_— _ -^-- _ COUNTY OF SUFFOLK © E 6' WUiHULO sccr,8 NO E•�• ,z1, -- — Red Property T.Service Igaxy �i W O - - - - .r 086 low orwry N OFFICE LOCATION: o�aq so MAILING MAILING ADDRESS: Town Hall Annex ` Q P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) GO Southold, NY 11971 Telephone: 631 765-1938 i Fax: 631 765-3136 �1y00UN N,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 13, 2009 Re: Proposed Wetland Permit for DONNA WEXLER SCTM#86-5-9.1 DONNA WEXLER requests an Administrative Permit for the trimming of dead and/or diseased limbs and branches landward of the top of the bank, and for the placement of indigenous beach stone and sand on top of bog and on either side of the dock. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 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 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. E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided: 1. Maintain buffers to achieve a high filtration efficiency of surface runoff. 2. Avoid permanent or unnecessary disturbance within buffer areas. 3. Maintain existing indigenous vegetation within buffer areas. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. King,President ��OF SOpj�o Town Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson # 4 Southold,New York 11971-0959 Dave Bergen Bob unosio,. Jr. �I Telephone(631) 765-1592 �yeft% Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal ErosionPermit Applicatiao _Wetland Permit Application Administrative Permit _Amendment/Trans f r/E tension eceived Application: (Q 8 U q (� Received Fee:$ d� 5 - i 4 Fe e-� D C (� Completed Application _(. _Incomplete Type Classification: JUN Type IType IlUnlisted Coordination:(date sent) ✓LWRP Consistency Assessment Form Southhold sown _CAC Referral Sent Board of Trustees �iDate of Inspection: n _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: ./Public Hearing Held: 4 Resolution: Name of Applicant �G�1v. ,\e �e\( \ Address Phone Number:( Suffolk County Tax Map Number: 1000 - � Pro ertyLocation: \\(�c.,,.,� �o�� 1�`Q,;r\ � _ (\�4 td yz \�, ls� �X :r-.A•=�k' . ,'�o�����ti. (provide LILCO Pole#, dist ce to cro s streets, location AGENT: (If applicable) Address: Phone: *rd of Trustees Applicatice GENERAL DATA 7 Land Area(in square feet): Area Zoning: -7_ Previous use of propert 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: Project Description (use attachments if necessary): \ 'Vt (S-)&A 'lU "n )c �C'n o '� u U-40 "C�.2V p�90 �ard of Trustees Applicatil WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 1 53 > feet Closest distance between nearest proposed structure and upland edge of wetlands: VL feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? —�ubic yards How much material will be filled? -N%,L� cubic yards Depth of which material will be removed or deposited: feet 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): FROIECT ID NUMBER • 617'20 • SEQR 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 3.PROJECT LOCATION: ,/��x �'\_\� (kct Municipality '} County 1�• `\ -1 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmark etc -orrovide map- ' `l- .,� �. 5.IS PROPOSED ACTION: El 4aw Expansion Modification/alteration 6.DESCRIBE PROJECT BRIEFLY—To.", n ^ �1 -� ck--0O-e� � �wAR boa- 'F' `�Y�`°'v.�y'w4�1� Cin•�oc-moi- �n� t-t�... �`�..._ '�+.cQa.o . Ru" `� 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTION 'MYes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 0 Residential ❑Industrial El Commercial ❑Agriculture ❑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) Yes I�No If yes, list agency name and permit / approval: �' y APPROVAL? ❑Yes o If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPO ED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E]res ❑No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature �, (7 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. E]Yes XNo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declarationma b superseded by another involved agency. Yes 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 pattem,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: �b 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: 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 C1-05? Explain briefly: r�> CT Other im acts(including changes in use of either 2uantior type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONME T L AREA(CEA)? If yes,explain brieFl : Yes No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? It es explain: ❑ Yes A 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 potential4mpact of the proposed action on the environmental eharactep!sties of the eEA. 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'rf you have determined,Eased onthe-riformationand 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 Print cr Type Name of Responsible Offlosr in ea Agency Title of Responsible Officer Signature of Responsible Officer to Lead Agency Signature of Preparer(If di erent om responsible officer) Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1, n residing at �c + (print owner of property) (mailing address) do hereby authorize �A o{C�b�h� R3LJ1 G?/ l (Agent) CN9T�✓� K � bt�o�/ to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) 4toard of Trustees Applicata County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE 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. Signature SWORN TO BEFORE ME THISDAY OF�{J y� 20 O Not ry Pubrit' L M11 P.PANDOUw WrAW FURM,lYbdNMV&% Na("RABUM �yMbd h 8xIN3Mc @er ConnHMbh ExpMp Jdy 2010 _ and of Trustees Applicat* AUTHORIZATION (where the applicant is not the owner) I, residing at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf . (Owner' s signature) 8 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 name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate theother person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Buildin¢ , Variance mstee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.`Business interest"means a business, including 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 _X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate 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 owner of any interest in a noncorporate 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 Submitted this $ day of200 Signature —V— Print Name Form TS I , 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 detaillisting 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 SPPE AND PROPOSED ACTION loo O SCTM# _ PROJECT NAME The Application has been submitted to(check appropriate respor ): Town Board ❑ Planning Board❑ Building Dept. ❑ 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) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval, license,certification: I� Nature and extent of action: m c - a w.l cse w -A � \0055 V4 DT£ Location of action: S `���.o 4 `i. t Site acreage: Present land use: 9 Present zoning classification: >� ,o 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 lt[AlIfA 2�LZS9Af 11+F,GGf.� 1775�J!a(7�ECl�fl� (b) Mailing address: SOW,NEW 2M11958 (c) Telephone number: Area Code( -;,c D A3i — �r3 l�-- /o60 (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No)rn" 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. J4Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III —Policies Pages 6 through 7 for evaluation criteria 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 AYes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No ❑Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ ❑ es No Not Apple 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. F] Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes ❑ No ❑ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide forte 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 1:1 Not Applicable Attach additional sheets if necessary •WORKING COAST POLICIES0 40 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 Z 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. XYes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. Yes ❑ No❑ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No a Not Applicable PREPARED BY TITLEC -A:r n DATE . 2 zz.os' d Soot hhoid sown v Board of Tr8stees5 At(ef o 3 ° •£�s� �° E � 169 _ w LU 0 ` 8 • N 4 + I dv2oue �i- - -'O T p O. i1 ioa it n. 0 L 6 I 4 � c Zo,lrE,X a It` a I 1 .T 1 ICI 1 2 I_ i SI P J b yi y CL lel • 1)166' N. 24'00'00" w. 150,00' INDIAN NECK `LANE r a. 1 a SiiP� A l W J w ffi„ .�. b`'o r 8 R E ^� •�6 r � s r r er 7 'Y ALI aL B T^•a I4} r `9 uW F 1 r 16, \ RJ% t � _ S • :.t. e j 1 � \ \ \e A�::: r LL r r ne \ :e •- � q] a gg ml .� +f i+��y (}, 4, a a i� � \ � 1 tirA r r� ,��y n } • fele Jr.'� r �yt � ;!� • Q1 aeSa oy i" nrvr 5�4 � 3 a swgvga to iSS T A S 99 � S {{t {{ F d hse � S• >,p,� 9(911,Sg:'F�'2a SCDHS. Ref. # RIO-95-0068 f ��r. e/ 15.5ry S # RIO-01-0159 el 13 r oa e el 13 o .5 C P RIO - Of - 0159 1'm'e. / ie,iz.o -�� r SB• I xe Tin 452 - l/ L.P. s ST V 569, P' la: iSil \ SANITARY SYSTEMS- + 68- . 5 5�' F POOL HSE. (1000 gal. SEPTIC TANK 8vow r 9� min. 4 deep 8'0 leaching pool) a• 05• NN BARN f1000gal. SEPTIC TANK 8 min. CROSSECTIO14 12' deep 8'0 leaching pooU SEPTIC SYS TE vd ` d /BLDG \� ( P I= J I °mor � w w1 0c P NO SCALE jrn ° 't 3z.�• . r� O �i1 1\I, f c� A / m 'ry1lJ� n q 1I9 3:< a.z ^ V PAVEns ` \ y 1 1 (� Vz ' P o e I I 5��/ o ' �i i�;:c ; o L �\ \ 13D I I Ilkd ✓P O( , � _.� P� R!. \\ h \ �/^moi / y O D d%Ile ,;�� , � � �•� � ,� 761. 2 L^ y. 36 v m 69.24 DO E•vl'ole wood Isa 8 ° r�I t n1l 1 T 0 �ENLACONSULTANTSNDS FLAG 49Y R tNC.R, ON MARY 7A 999 N / P \° E R U Es B!a( d 0 A .STK FOR DOCK N 2 51'/•. 6 i t� xt !P�. 01 G CZ 0 � ;�}� r6. •; SURVEY FOR .>F� To, 3f' '� ROLAND & KAREN GRANT F(0, -`Z° C'RANT KAhEt4 GRANT o - SOUTH BAY ABSTRACT INC: Q Q00. w• d AT PECONIC WASrdNGTON MUTUAL BANK, F.A. 0 5 69 2 � riny al 7 ��Boring TOWN OF SOUTHOLD 26' 0 a Pic 0 2 P.U. SUFFOLK COUNTY, N. Y. v>' {'"t I• TOPSOIL of 1000 - 86 - 05 - 9.1 r 2 LQAMr O LOAMY Scale: I"= 60' 0 6;5 SAA1D 2 ND Mar. 16, 1995 p C E V D Zs W 8 coARSE SAND APRLL 4, 1995 (revisions) m GRAVEL WITH April 6,1995 (revisions) MPI _ g !0' SAM d May 1, .(995 (revisions) LOT NOS ARE REFERENCED TO ' MINOR SUBDIVISION FOR QRAVEL GR. RATER - MAY 4, 1995 (revisions) Southhold sown PECON/C BAY GARDENS, /NC.'FKED N/ THE OFFICE OF 11.5 11,5 JAN. l6, 1996 l sfk hse 8 barn 1 Beard of Trustees THE SOUTHOLD TOWN CLERK. WHITE —-" - - Mar. ll, 1996 (foundation location) ELEVATIONS ARE REFERENCED TO /$G.V Dcjwn. 1P• SAND April 3, 1996 ( Additions) AREA = 2.6069 Acres to tie lines I6.5 PALE _- M WATER GRAVEL Dec. 20,1996 (final) ORANGE MAY /4, 1999 (STK FOR DOM) OF NEj.V SAND June 23,M9(revilioi) CO ME O I am familiar with the STANDARDS FOR APPROVAL JUNE 7, 2001 (prop. addhions) Ota 2G� AND CONSTRUCTION OF SUBSURFACE SEWAGE July 24, 2001 (addlllons) F� P DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCES NOV. 4, 2002 ! Flnal 1 d k and will abide by the conditions set forth therein and on the ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION _ N 96/B permit to construct. OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF PECONIC U. •4�6'Cb FLOOD ZONE LINES FIRM 36103r_nIF9 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR (6311 765 - 502 1797 wwncF .ar:NA TURF APPEARS HEREON. � SCDHS. Ref. # RIO-95-0068 r n `r el 15.5 ,e t a \� se Oss�"''6a'9 # RIO-01-0159 el 13 rte. rooLe eii3s 0_ S RIO - Of - 0/59 I'm,� fE-12.° \ r.� Se S� Ow ?'M rxx t.6 I I G \ "Y/O L.Y.. \ I;:s s T V 603 5g S F tO; k( \_�a�---� Za g?/y3•4.- SANITARY SYSTEMS- v ,E- jr Io.4 �t /. r�'�Qr ��� POOL HSE. (1000 gal. SEPTIC TANK d —__9�w �r el t� V` I \ �n min. 4 deep 8'0 leaching pool! °A� y' \ ��" wiz W CROSSECTIOI. 011 °5 ( o r -� g s N N BARN (IOOOgal. SEPTIC TANK B min. W ; 12' deep 8'� leaching pooU SEPTIC SYS wEOr a I y'i ` E NO SCALE 25 wi'°oer J / �� 92a• . rue \ Q 71, ' Q r'y Q.2mv PAVERS n351 ` \ \\ a PRN elf ' Sri ' Poot \\ _ \ /I A) ( Sp! / = iz' yy a 9ry. � � "a Pool 115/ \\ � \ mfn�'O S � 1t.2' X411 lJ,ri' y, If ZA'�Or E ,I WQ°d t.n e\ \ i / l Ir9 o WETLANDS FLAG BY ROBERT E. HERRMAN / 69• Pavl' \ r• 0� I EN - CONSULTANTS, INC. 1 ON MAY 7, 1999 ' N / oaARoE o 1 w o u • •smFoRD°G! N 2 511•. 6,rr 0 ifs' t. 0'G . mcg tff tfi.. SURVEY FOR _EpirrlZ-u TO, Ir 391, Q ° AROLAND & KAREN GRANT KARENGRANT 4 O" w AT PECONIC SOUTH BAY ABSTRACT IN.-`. 'ti o S. 69 Test TiiBaring al Test d` TOWN OF SOUTHOLD wASrdn1GTON MUTUAL BANK, F.A. p .9 4 P.AL 2 P.AL NT Y N. Y. 2 D D SUFFOLK COU lip Tsa mE I• SANDY 1000 - 86 , 05 - 9.1 2 LQA_W SAND 65 aAR Y SCale: Y' = 60" 2 Mar. 16, 1995 p 'z SAAV SAND APRIL 4, 1995 (revisions ) m /0. 6MvQ GRAVEL April 6,1995 (revisions) �V SHAD d May 1,..1995 (revisions) `n HEAVY MAY 4, 1995 (revisions) LOT NOS ARE REFERENCED TO ' MINOR SUBDIVISION FOR 6RAVEL GR. IrATER JAN. l61996 ( sfk hse 8 barn ) South old Town P£CONIC BAY GARDENS, INC.-FILED IN THE OFFICE OF 11.5 Il. guard of Trustees tees , THE SOUTHOLD TOWN CLERK. WHITE hear. ll, 1996 (foundation /OColion) ELEVATIONS ARE REFERENCED TO N.G.V. Dalian. 12• PSAApril 3, 1996 ( Additions) ALE AREA = 2.6069 Acres to tie lines Is5 ORA -- G2 warER Dec. 1420,19 96 (fain Ul DocK ��oF NEiN� ORANGE SANJvoe 23,M9 (revisio•,) yAP a.(, MEp� OQF I am familiar with the STANDARDS FOR APPROVAL JUNE 7, 2001 1 prop. addlllons) AND CONSTRUCTION OF-SUBSURFACE SEWAGE July 24, 2001 (addit/ons) DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES NOV. 4, 2002 1 Final F and will abide by the conditions set forth therein and on the ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION _ N 9618 permit to construct. OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF PECONIC U, •4A FLOOD ZONE LINES FIRM 36103rnIR9 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ws. 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