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HomeMy WebLinkAboutTR-6935 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road 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 # 0457C Date:~ THIS CERTIFIES that the as-built log gazebo and the re-planting of the area that was cleared At 4660 Vanston Road, Cutchogue, New York Suffolk County Tax Map # 111-10-15 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 5/7/08 pursuant to which Trustees Wetland Permit # 6935 Dated 7/23/08 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 as-built log gazebo and the re-planting of the area that was cleared The certificate is issued to ARNOLD BLAIR owner of the aforesaid property. Authorized Signature James F. King. President Jill M. Doherty. Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report ARNOLD BLAIR requests a Wetland Permit for the as-built Icg gazebo and to re-vegetate a cleared area. Located: 4660 Vanston Rd., Cutchogue. SCTM#111- 10-15 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound I,/B~ay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _L_.Gh'~pt.275 Chapt. 111 __other Type of Application: ~etland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __J.King __J. Doherty ~L--P:Dickerson __ D. Dzenkowski Mark Terry__other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: Environmental Technician Review- BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6935 DATE: JULY 23~ 2008 ISSUED TO: ARNOLD BLAIR PROPERTY ADDRESS: 4660 VANSTON ROAD~ CUTCHOGUE SCTM# 111-10-15. 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 She meeting held on July 23, 2008, and in consideration of application fee in the sum of $250.00 paid by Arnold Blair and subject to the Terms and Conditions as stated in the Resolution ~he Southold Town Board o:f T~ustees authorizes and permik~ the following: Wetland Permit for the as-built log gazebo and to re-vegetate the cleared area doubling the vegetation that currently exists, and as depicted on the site plan prepared by Arnold Blair received on May 7, 2008. 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 thc said Board as of this date. TERMS AND CONDITIONS The Permittee, Arnold Blair, residing at 4650 Vanston Rd., Cutchoeue. NY. as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if; in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Sonthold. That the said Board will be rtotified by the Permittee of the completion of the work authorized. That the Permittee will obtain all'other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 July 23, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Arnold Blair 4560 Vanston Rd. Cutchogue, NY 11935 RE: 4660 VANSTON RD., CUTCHOGUE SCTM#111-10-15 Dear Mr. Blair: The Board of Town Trustees took the following action during its regular meeting held on Wed., JU!Y 23, 2008 regarding the above matter: WHEREAS, ARNOLD BLAIR applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated May 7, 2008, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 23, 2008, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of ARNOLD BLAIR for the as-built log gazebo and to re-vegetate the cleared area doubling the vegetation that currently exists and as depicted on the site plan prepared by Arnold Blair received on May 7, 2008. 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, j me~s F. KinC~~ President, Board of Trustees JFK/eac C) ....j SZ 331 S ~7° 20' 40"E ~ ao sz l~epared /n accordance with the n~-fenum atend~'de fo~ rifle s~veys M es~d  e LDi. L~ ~ ~ov~ ~ adopted · ~ u~ by ~ ~w York State ~ 332 AMENDED MAP "A " NASSAU POINT CLUB PROPERTIES INC FfLED AUG ~6. t92ZFILE NO !56 ¼ T NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, N 1000 111- ~0 15 Scale 1'" = 40' Apr// 27, 1988 t:OA ?,O OF TOV¥'N OF ~'"' ..... 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 TO: /]c old Please be advised that your application dated /'~F ~Z-2~::~°°'' has been reviewed by this Board at the regular meeting of' -,.~,.~/v ~ ,2o~,,~ and your application has been approved pending the completion ~f the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of,Construction ($50.00) ~ Constructed ($50.00) /Final InsPection Fee ($50.00) ~'o-f~ · Dock Fees ($3.00 per sq. ft.) Permit fees are.now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$ ~)~ BY: James F. King, President Board of Trustees Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (63 I) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., June 11, 2008, the following recommendation was made: Moved by Glen McNab, seconded by James Eckert, it was RESOLVED to NOT SUPPORT the Wetland Permit application of ARNOLD BLAIR for the as-built log gazebo and to re-vegetate a cleared area. Located: 4660 Vanston Rd., Cutchogue. SCTM#111-10-15 Inspected by: Glen McNab The CAC does Not Support the application because there has been extensive excavation and clearing of the vegetation and there is a potential for erosion. The CAC recommends the area be restored. Vote of Council: Ayes: All Motion Carried Agency S. Case NO. 14. Oate 6. ;ncident NO. 18. Weapon(s) 21 LOcation Code 38. Add r e-.~ (Street No., Street Name, Bldg, NO., Apt. NO., City, State, Zip) 41. Date of Birth 43. Sex C3~ OF Commuter O Military r-I Homeless i--I Urd~ [] impaired Alco [] Inj,' tll [] AppNO~m 57. Mist, 73. 70. Color(s) 63. PlateTypo 64, Value 69. VrN. 71. Towecl By: 72. Vehicle Notes TO: ~]Juv.-NoCustody ~lArrest*Juv I~Offe~clerDeaCl []E~tracLOe~.lin [~UnknOwn I ~ DCJS-3205 (2/97~ *FALSE STATEMENTS ARE PUNISHABLE AS A CRIME. PURSUANT TO THE NEW YORK STATE PENAL LAW. INFORMATION FOR VICTIMS OF CRIMES AS A CRIME VICTIM YOU ARE ENTITLED TO THE FOLLOWING ASSISTANCE: INJURED VICTIMS OF CRIMES, OR THEIR DEPENDENTS, MAY RECOVER COSTS OF MEDICAL TREATMENT AND REIMBURSEMENTS FOR LOSS OF WAGES. IF DEATH RESULTS FROM A CRIMINAL ACT, THE VICT~I'S FUNERAL EXPENSES MAY BE PAID FOR BY THE STATE. YOUR LOCAL LAW ENFORCEMENT AGENCY HAS BROCHURES AND APPLICATIONS AVAILABLE FOR YOU TO APPLY FOR THESE BENEFITS. COMPL~ r.D APPLICATIONS ARE TO BE FORWARDED TO THE NEAREST CR~IE VICTIM'S BOARD, WHICH ARE LISTED BELOW. BELOW ARE THE VARIOUS LOCATIONS FOR THE CRIME VICTIM'S BOARDS THROUGHOUT NEW YORK STATE Crime Victim's Board 845 Central Avenue, Room 107 Albany, New York 12206-1588 (518) 457-8727 Crime Victim's Board 270 Broadway, Room 200, New York, New York 10007-5160 (212) 587-5160 Crime Victim's Board 65 Cmut St., Room 408 Buffalo, New York 14202-3408 (716) 847-7992 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob unosio, 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 Office Use Only ~Coastal Erosion Permit Application V Wetland Permit Application Administrative Permit Amcndmcnt/Trans let/Extension l~/Rece~vved Application:~f~_ ~_Received Fee:$ °~~,O~D -~ -0.ti' Iq ,..,'C'~ompleted Application __Incomplete __SEQRA Classification: Type I__Type II Unlisted Coordination:(date sent) ~----%-'7WRP Consistency Assessment Form ~AC Referral Sent:~-[~/~_ ..Date of Inspection: .~////O~ __Receipt of CAC Report: Lead Agency Determination: Technical Review: .P~fl:rlic Hearing Held: Resolution: NameofApplicant ~--~(.-~ g C~//~ Phone Number:(~t) Suffolk County Tax Map Number: 1000- eropertyLocation: qtlo (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~rd of Trustees Ap~ Land Area (in square feet): Area Zoning: ~ Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: Yes ff No If "Yes", please provide copy. Prior permits/approvals for site improvements: ~kJ0A)~ Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend/ext by a governmental agency? v/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): ard of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: "'T'O ~0~'~'('¢~t ~ Area of wetlands on lot: ~) .square feet Percent coverage of lot: 0 % Closest distance betweg, n nearest existing structure and~upland edge of wetlands: t~) feet pr~fl~)~ttt}'/'~ Closest distance betwee~ nearest proposed structure and upland edge of wetlands: '/D feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material ~vill be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet Statement of~e effect, if any, on the wetlands and tidal wa_ters- _of the town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: Municipality u 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by A[ ,licant or Project Sponsor) 2. PROJECT NAME cou.ty ~o ~c0 t ~< SEQR 4. PRECISE LOCATION: Street Addess and Road intersections. Prominent landmarks etc -or provide map IS PROPOSED ACTION: ~New [] Expansion [] Modification / alteration 7. AMOUNT OF LAND AFFECTED: 'n'"~J~0,01 acre, U,timate,y 0.0 1 acre, 8. WI PROPOSED ACTION COMPLY WiTH EX~STING ZONING OR OTHER RESTRICTIONS? [~Yes [] No I1' no. describe briefly: / 9 AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply ) [~R'esidenfial [~lndustria} ~Commercial [~Agriculture [~Park/Forest/OpenSpace []Other(describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AG CY (Federal. State or Local) ~es ~-~No If yes. list agency name and permit / approval: E'ou~T~-o~ -'?o~,/ T~us~-~ ]~. DOES- ANY ^,~','~CI OF tHE ACTION HAVE A CURRET~ITE? VALID PE~-MIT O~ APPROVAL? ]Yes ~o If yes. list agency name and permit / approval: 12. AS ARE~E~L'LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIF)~THAT THE INFORMATIOi"J PROVIDJ~D ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action Is a Costal Area, and you are a state agency. complete the Coastal Assessment Form before proceeding with this assessment 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) . ~'~ ~ ~-7~ AFFIDAVIT OF POSTING being duly sworn, depose and say: That °n t~;~(~Y~2~f ,200, I personally posted the property known as by placing the Board of Trust~es cliff'itl poste~ ~here it can easily be seen, and that 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 f..Oo,,,t...,~tcrl.~j ~ aq0~' Dated: Sworn to before me this ~l~t dayofS,,~t 200g {s~gnature) John M. Judge NOTARY pUBLIC, State of New York No 01JU6059400 Qualified n Suffolk Count,/ Commission Expires May29, 20 ~ I PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: STATE OF NEW YORK TY OF SUFFOLK .~rY / day o~f tC/]f )/ set forth in the Board of Ti'ustees .residing at ff~6'~ O y/q/qJ.{/P/v' ~'~,~. ~..~7'~,//'~ {)~- , being duly sworn, deposes and says that on the ,20 0~, deponent mailed a true copy of the Notice Application, directed to each of the abo~amed 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 ot~ Southo~:lc~that said Notices were mailed at the United States Post O~ace4t &i) 7i~//~)£ II)-~/)1~, that said Notices were mailed to each of said persons by ~cert~ (registered)~ail.-' ~~ Sworn to before me this ~(~ Day of [ff'~C~..t ,20 (~ Notary Pub i~ County of Suffolk State of New York ~/kJ 0/~ ~ )~LA- IR BE1NG 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 IllS/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. SWORN TO BEFORE ME THIS ? / DAY OF O C'"Ct~8~ct~. ,20 O 7 Notary Public D~-VID M PANTALL NOTArW PUBLIC. STATE OF NEW ¥ORI( NO. 01 PA,50,33427 QUAUFIED IN QUEENS COUNTY COMMISSION EXPIRES .MAy 9TH. ;~0.~{/.~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics urohibits conflicts of interest on the oar of town officers and emolovees. The ouroose of this form is to un)vide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is ,ecessarv to avoid same. /i~' ~/~ (Last n~'~e, first name, ~alddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name,) NAME OF APPLICATION: (Check all that apply,) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "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% o~/ shares. YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/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 non-corporate entity (when thc applicant is not a corporation); __C) an officer, director, parmer, or employee of the applicant; or __D) the actual applicant, DESCRIPTION OF RELATIONSHIP Form TS I PART II - IMPACT ASSESSMENT (To be completed by Lead A~lenc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. ElTM E~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. E~] Yes [~No C4. C5. C6. C7. 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: C2. Aesthetic, agricultural, archaeological, I~i~'io~ic'i o~'other n~i~ral or cultural resources~ ...... or communtty: or neighborhood: character? Explain' br,efly: · C3. Vegetat on or fauna, fish, shellfish or w~ldhfe species, s~gn~ficant habdats, or threa ened or endangered species?. Explain briefly'. A community's existing pans or goals as officially adopted, or a chan~ ~n use or ~nlensfiy of use et land or olher natu[~l resources? Explain briefly: Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I , i Long term, short term, cumulative, or other effects not identi6ed in C1-C57 Explain briefly: l- D. WiLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA ? Iff es explain bdefl · I--lyes [--'lNol( I ¥. . . I E. IS THERE, OR IS THERE LIKELY TO SE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL MPACTS? If yes ex Jain' 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 signil'icant. 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 (0 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 d eterm!.".et!cn cf c[gnificanc~ m u~e~tu a t~t h epetentia I impaet ortho prcpo3cd action ca thc orrviro~ist[cs of ~ha C,"A. 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. (~heck ~i~ b~if yo~ ~V~ de~4rm~n~d, based on the i~f0rmation and analysis ~bove and a~y ~upporting document~ti~nl that {he ~r0p0S~d ~cti0r WILL NOT result Jn any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi.~ deten~nination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) To(vn of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold 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. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# //I - The Application has been submitted to (check appropriate response): Town Board ~ Planning Dept. ~ Building Dept. ~ Board of Trustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following (a) Name of applicant: (b) Mailing address: information shall be provided: (c) Telephone n~ber: ~ea Code (d) Application nmber, if any:. Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No ~-] If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [] Yes [~ No ~Not Applicable Attach additional sheets if necessary Policy 2. Protect and 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 -~s Pages 6 through 7 for evaluation criteria ~-~ Yes ~ No [M~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 Pagefi~-8 through 16 for evaluation criteria ~ Yes ~-~ No['~t-~ Not Applicable Attach additional sheets if necessary Polie~(~>rotect 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 Polic~)Protect and restore the quality and function of the Town of Southold ecosystems including Signi ~cfi'~nt Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. [~es [] No [] Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. See Section III - Policies Pages; 34 through 38 for evaluation criteria. ['-] Yes ~ No [--'~ot 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 NotApplieuble PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [] Yes~ No ~N~i Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See/I~WRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [] Yes ~ No~1~1 Not Appheable- Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~] Yes ~-~ No [~Not Applicable 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 evaluatio/gcriteria. ~] Yes ~ No~l wl Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Polices 65 through 68 for evaluation criteria. [] Yes ~ No~1 t/I Not Applicable