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HomeMy WebLinkAboutTR-7209A Jill M.Doherty,President ��0f SjyO Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O l0 54375 Main Road James F.King J [ P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen G cr John Bredemeyer a� Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 20, 2011 Mr.•Michael Wilson 590 Tarpon Dr. P.O. Box-870 Southold, NY 11971 RE: 590 TARPON DR., SOUTHOI�D SCTM#57-1-6 Dear Mr. Wilson: In response to your request dated December 16, 2011, the proposed burial of a proposed tank within an existing established yard area is an Exempt action in accordance with Chapter 275-4 (9) Wetlands and Shoreline of the Southold Town Code. Therefore, no further action is required by this Board. Very truly yours, Jill . Doherty, Presid t Board of Trustees JMD:Ims ivtICHAEL R. WILSON 590 Tarpon Drive PO Box 870 Southold,NY 11971-0870 Home: (631)477-4174 Cell: (214)213 0296 December 16, 2011 Jill Doherty,President Board of Town Trustees Town Hall Annex Building DEC 1 9 2011 54375 Route 25 P.O. Box 1179 Southold NY 11971 Dear Ms Doherty: Re: Town code 274-4, Section A,paragraph 9,burial of a propane tank within 100 feet of wetlands I would like you to confirm that I do not need a Town of Southold permit for installing a 500 gallon propane tank for my home. We want to add a built-in electric generator to make sure we have electricity during future storms. Attached is a statement from C. F. Van Duzer Gas Service Inc. that the only suitable location for a buried tank is behind the house. The tank will be in the area more than 50 feet from the canal,but less than 100 feet. I have attached a copy of our lot layout. Currently we have a 50 gallon tank above ground behind our house(also within the 100 feet line) for cooking,but it would be much safer if we buried a 500 gallon tank: The installation would be done in accordance with all other Town and State requirements. Thanks in advance. If it is OK to install the tank, feel free to sign and return this letter. Sincerely, 1hoposal Page No. Of Pages C. F® VAN DOZER GAS SERVICE, INC. 46155 Route 48 Box 1497 SOUTHOLD, NEW YORK 11971 (631) 65-3882 FAX (631) 765.8 5-3452 04 PRqWSAL SUBMITTED PHONE DATE/,/� � � 7T�6 .b8 NAME Z7Z/A122i:2- zy. CRY,STATE and ZIP CODE5P7/ JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for. Of Cd G Of VM110511! ,hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars($ ). Payment to be made as follows: All materiel is guaranteed to be as specified.All work to be completed In a workmanlike r manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature cliarge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary Insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptart of proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acxeptance: Signature 1 J ' PSI - -Cao /VA 4-- 11 ON"el --1e - -- .kl NY - 0 SITE PLAN T,d / Ov DA 'V45 49=1'" 0 r Ifo -socvrHocP sAbRks- -s17"- rGO 4 TARJ;4iAA40,14d 4/4E DAM T - ILS _ -1- .�.�..� TAR'' POWORIVE -TQWN .S THOLD F-0 F , ouNT,, ,Y. e y C14OFM9UOCIATES o6ciesiv James F.King,President V S0 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 Q Bob Ghosio,Jr. Telephone(631) 765-1592 ZIP co urm Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7209A Date of Receipt of Application: October 29, 2009 Applicant: Michael Wilson SCTM#: 57-1-6 Project Location: 590 Tarpon Drive, Southold Date of Resolution/Issuance: November 18, 2009 Date of Expiration: November 18, 2011 Reviewed by: Board of Trustees Project Description: To transplant selected taller plants to both north and south of areas and replace with native lower growing plants. 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 site plan prepared by Creative Environmental Design, received on October 29, 2009. Special Conditions: None. Inspections: Final inspection. 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. rr James F. Kingg,iPresident Board of Trustees JFK:eac 0 • James F. King,President ��OF soojyo Town Hall Jill M.Doherty,Vice-President 53095 Route 25 Peggy A.Dickerson P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen Bob Ghosio, Jr. Telephone(631)765-1892 Oly� 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 151 day of construction % constructed V/ Project complete, compliance inspection. & • James F. King,President -``��F SDU)yO Town Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen .0 Q Bob Ghosio,Jr. Telephone(631)765-1892 �yCOUNT'1, Fax(631)765-6641�� BOARD OF TOWN TRUSTEES //��//�� I ' TOWN OF SOUTHOLD TO: Il /ie_k WiASUn Please be advised that your application dated OC-66er f9% oxo has been reviewed by this Board at the regular meeting of,4k7Va1yJoPr f% CR--Vg and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) % Constructed ($50.00) V Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: �01 TOTAL FEES DUE: $ _<0 �I' BY: James F. King, President Board of Trustees �gUf FO( James F.King,President � CDG P.O.Box 1179 Jill M. Doherty.Vice-President 'i Southold,NY 11971 Peggy A. Dickerson y ? Telephone(631)765-1892 Dave Bergen y. T Fax(631)765-6641 Bob Ghosio,Jr. Z' Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: Creative Environmental Design on behalf of MICHAEL WILSON requests an Administrative Permit to transplant selected taller plants to both north and south of areas and replace with native lower growing plants. Located: 590 Tarpon Dr., Southold. SCTM#57-1-6 Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 _Chapt. 111 _other Type of Application: Wetland _Coastal Erosion _Amendment —Administrative—Emergency_Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: _).King _).Doherty_P.Dickerson D. Bergen_ B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: ` r 1�9ry 10 07/Jim jj09 � 8 ; 5`:5''- i II 1 l i f� n „ 1 4 34 j — F O I OSI i` U uls ;Gt :L�-� . h moi' •�... i 0 OgUFF1$ James F.King,President G P.O.Box 1179 Jill A Doherty,Vice-President h� y2 Southold,NY 11971 Peggy A.Dickerson Telephone(631)765-1892 Dave Bergen ,y Fax(631)765-6641 Bob Ghosio,Jr. EP Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: 1o�7 09 Creative Environmental Design on behalf of MICHAEL WILSON requests a pre-submission inspection to discuss the possible options of re- arrangement of the existing plant material in the non-turf buffer. Located: 590 Tarpon Dr., Southold. SCTM#57-1-6 Typg,of area to be impacted: altwater Wetland _Freshwater Wetland _Sound _Bay C � Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ,/�Chapt.275 _Chapt. 111 _other Type of Application: _Wetland _Coastal Erosion _Amendment ZAdministrative_Emergency_Pre-Submission Violation Info needed: Modifications: Conditions: X r/l N7/9/ Present Were: '/J.King Doherty I/P Dickerson t,,6/ Bergen_ B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Board Of Southold Town Trustees SOUTHOLD. NEW YORK 5 7 O DATE: .. October 26. 2001 PERMIT NO. ...._.... ._ ........._. ISSUED TO .......... .GILLIAN & ........................ xr ` � - ,�uthnri�ttftan Pursuant to the provisions of Chapter 615 of the Lave of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titd ."REGUTING AND THEIN�AND ONLTOWN WATERS AND OFPLAC INOBSTRUCTIONSNG PUBLICand the r REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LDS UNDER TOWN WATERSr' and in accordance wifh theLANDS Resolution of The Board adopted at a meeting held on .October•24. 2001 200..--00-... . ............ and in consideration of the sum of 5.... . - paid y En-Consultants,..,Inc._..for,Giiling._k..Michael...Wilson.................. e soutNnp.t n ... . N. Y. and, subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits 46 following: v.tl+na Permit u rmore repl.c. GnPlrnr ,pprod. llS Ilnnr It. e1 edit. limber • pulkhud rfah G-lua PUN]cM b=.W mtl dredge w N'Rmg PP le IP'P[(bulkhod F? la a mr.wum dryth N J' ALM tP S-X W cT tPoll d brck411. C u t rff tier bulkheatl .lMber dacR. mntletlnP e(lld•� db.ntelr,PlN(. pinMrm: ]'Cid' hinged r,mpt and d'% ig' IINt b be,.cured b1 1 Conrtrvct a •ur-,ro da,lling nth aaluMd daek:drfv.ry .rid udtrn' *^d ere M PuENe•rrtn rerrlce.ma Zh aM randltbn e(,5P' nen'dUlurndace bufGr: .MYbuc-NIUM darn rt tl.e 3P- non-dW.bmc.Nne and drYreN to.10. wld bulhr the Prupeseed In all in at reN.etl n loud 4,10,01.through u d dxR. .N r d.Ptcttd o .the originating appncation. a IN WITNESS WHEREOF, The said Board of Trustees hare- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of thits data. c�FFOLj- Trains k n SURVEY OF LOT 40 MAP OF OQQ25� SOUTHOLD SHORES =e fME Me. MS, FILED 10 Qe. lee] 1� SITUATED AT ARSHAMOMAQUE T^ TOWN OF SOUTHOLD ,P(5 ryRpo SUFFOLK COUNTY, NEW YORK A7 S.C. TAX No. 1000-57-01-06 "Ay,. Y �•.:,:fs T SCALE 1-=M' JANUARY 5. IM a. ° -6��• �CI� 1wRCM . ,M 2 ses.wEo canaw urs k,;& y� 2001 ACOFO NOTES N �Sp. All, � 's4 L% \ amem 2+. 4aol nEwsm slE wM NVl1fl1 A. 2002 FP1r11M.110M LCGiYJN ,ua.R le. amt nxv.sua cY /` �t'1- E � / wr s. ama.noLu r�EUNNMc°�" 4� u�l:. / •, ""l MFA = leAeeQe2 .9. N. (ro OUNv(AD)0..51 �,y; �, 4Eq=il��yy', \ ¢y 00� �•.. '�o�[u�s«�liu�_ o .. COO C "RA @'•E" ry 3�Y �p mm nwn e���� .y� �gya m6A • �,ye«IRa�MA Y •�.�ia:eOO'a.Ta'm.m Doc CO�O,i / / feDpIiRTfEJC0 To AWMACT. Inc. MTNIMAL n7d IMSMMMCE COMPANY M M rant 'fin H v A/ N O MKMEL MLS NLAi«v.i �'D•NI'A 2 •''' 8 M1/ GN WRSOM Or,, .V-z uJg . N� a LGvS ;. 53.E 'I'^W ♦ ,� . .• « IT`lAwti aeph A. kV69n0 ry° ss�sNNNsfa«r�s:a-N Land Surveyor Rf.W NINA ��® IAO � L � =0.00 4 ��. - c«IUUm-nn dim wNIN(ol)m-Lwo Ma �. NWeW.«. W1e5 uNNNn.r NNi.plea �s llm n.w ICO .Mer s�wl.i rr �b"O,'NPaM m� m.ra.Iw m,io,-um • F04�0 Town Hall Albert J.Krupski,President 53095 Route 25 James King,Vice-President P.O.Box 1179 Artie Foster : Southold,Newyork 11971-0959 Ken Poliwoda Peggy A.Dickerson a. Telephone(631) -1366 92 'y'ripl � �a Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 27, 2003 Patricia C. Moore, Esq, 51020 Main Road Southold,NY 11971 Re: Gillian&Michael Wilson 590 Tarpon Drive,Southold,NY SCTM#57-1-6 Dear Ms. Moore: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held May 21,2003. RESOLVED,that the Southold Town Board of Trustees Approve an Amendment to Permit# 5438 to construct 115' of 4' high retaining wall 6' landward of the existing bulkhead. Plant 6' area between bulkhead and retaining wall with beach grass on 18"centers revegetate 50 foot buffer as per approved plans dated May 19`h,2003 "Phis is not a determination from any other agency. If you have any questions,please call our office at 765-1892. Albert J. Krupski,Jr. President,Board of Trustees AJK:cjc FT fl: Fn' Ti.a v:L i. Feu.._;: l -: -4• 'E: {•_. - Girl New York State Department of Environmental Conservation _ Division of Fish, Wildlife & Marine Resources, Region One Marine Habitat Protection Building 40- SUNY, Stony Brook, New York 11790-2356 Imbue— Phone: 16311444-0295 FAX: 16311444-0297 Um M.C,ouy commissaner Amendment to Permit August 1,2002 Michael&Gillian Wilson Dallas, Rainsong Drive "EO Dallas,T7C 75287-6645Re:IIPA# 1-4738-02161100003Project location: 590 Tarpon DriveSouthold,NY D1ear Permittee: W& Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR-Part 621, The expiration date is extended to: 1L Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR,Part 621. It has determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions.Therefore,the permit is amended to authorize: Construct 115 feet of 4 foot high retaining wall 6 feet landward of the existing bulkhead. Plant 6 foot area between bulkhead and retaining wall with beach grass on 18 inch centers. All work shall be done in accordance to plans prepared by James H.Rambo,Inc.dated 7/12/02 and stamped NYSDEC approved 8/1/02. This letter is an amendment to the original permit and as such,shall be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. Very Truly Yours, ��///''�' tip Deputy RegionaPermit Administrator CC: MHP New York State Depart nt of Environmental Conservation Division of Fish, Wildlife & arine Resources, Region One Am Marine Habitat Protection Building 40 - SUNY, Stony Brook, New York 11790-2356 NNW (631) 444-0295 FAX: (631) 444-0297 Erin M. Crotty Commissioner Amendment to Permit June 6,2002 Gillian& Michael Wilson 4107 Rainsong Drive Dallas,TX 75287-6645 Re: UPA # 1-4738-02161/00003 Project Location; 590 Tarpon Drive, Southold Dear Permittee: N/A Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621, The expiration date is extended to: X Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is amended to authorize: Increase area of disturbance to 30' maximum for the purpose of storing excavated material resulting from the bulkhead replacement. Restoration of buffer area shall be done in accordance to plans prepared by Plantings by The Sea, Inc. dated 6/5/02 and stamped NYSDEC approved 6/6/02. This letter is an amendment to the original permit and as such,shall be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. Very Truly Yours, Deputy Regional Permit Administrator CC: MHP 1 U L -'dF1 FF:M: r,.. -o: V, 1. F;1,1,- TC.: 7,r% E: REPurHr(f4b F—MrsN& IBvPfrQ / klzrR t�Q.1.STIG ohr�l+.r�tq d +M6 °—/ a6 S2inrf�ys NYS DEC Ly, ry Ul��4Bnp� APPRON D�Vod PEA TERLE J AND CONDi1 PlItMTNOfio3 �I2-` 16Z DATE pECE � vE ►anv 2 0 cuus D Southold Town ., ___ P—d of Trustm %AR6/N L�f.� :ov�'�fccD , N✓- EXs_ SrR.}w S4tE� NYS DEC APPROVED AS PER TERMS AND CONDITIONS Og PERMIT NQ I-Y73S-osis//oegg a - DATE Y/ ,.� / y �z eT— q: 'si/84fR Y' o 0 uLy r � • - .J.—�.. S�yE ES/ST/./4 O/�✓F 7b RCw..W.✓ �� . �� Ti BE Pw dNE� i r \tL� SEAR/ VW�G4u.vOSE� - .s•I.rua —\J\I ��1 j o+T nPA.vsp4l,y sEo _ � TR�W3'^coyYFo Gf'155 i LI4T ., Dust/yon/Ft'Jt/e,�yE 6T.9 BvsyNow/Ersuet<F, TlE 9 3 44.rrs /A _ �. �.� a�.s..p�e'er ��f •,cl�� +� �� �CiP.T�C klq'GI—bpG fT 11 1 t Sc4tE; �io /O"( ^^ Nr Y• 4y e" x n mo n n SOUND ISL�D SHELLER TY OF E © ( �a• Sg1TN0LD 3C1KK11q im ke km ^ m �• _ mmm,mam•.. mm.,., m mm. 057 OFFICE LOCATION: o��OF so�j�ol MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 * # Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Q Telephone: 631 765-1938 �� Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM '--- G! nuL&0-1dT,0Wjjj-- To: Bo Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: November 13, 2009 Re: Proposed Wetland Permit for MICHAEL WILSON SCTM#1000-57.-1-6 Creative Environmental Design on behalf of MICHAEL WILSON requests an Administrative Permit to transplant selected taller plants to both north and south of areas and replace with native lower growing plants. Located: 590 Tarpon Dr., Southold. SCTM#57-1-6 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 CONSISTENT with the LWRP Program. 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 ��fiF SOU , Town Hall .Jill M. Doherty, Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson # Southold, New York 11971-0959 Dave Bergen CA Bob unosio, Jr. Telephone(631) 76.5-1892 �A Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only D __Coastal Erosion Permit Applicauoo _Wetland Permit Application V Administrative Permit 1 vv 2 9 _Amendment/Transf r/Ext ncsyion eceived Application: 0 / eceived Fee:S Southhold Town -----_- Board of Tru Completed Application_ 1Or Oq stees ---Incomplete___------Incomplete _ _ __SEQRA Classification: Type 1__Type II _Unlisted Coordination:(date sent)__ r� i-WRP Consistency Assessment Form I0 14QIO3_ CAC Referral Sent Date of Inspection: 1 fl-(N- _ Receipt of CAC Report:___ Lead Agency Determination: Technical Review: _ �_ ubhc Hearing Held:. Resolution. Name of Applicant 1 `'1CN-1ex 2-\ W A:ss J�--) _ Address Phone Number:( Suffolk County Tax Map Number: 1000 Property Location: 1 (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: -c) Phone: B9W of Trustees Application* GENERAL DATA Land Area (in square feet): qLTX) , SQ ElT - Area Zoning: Previous use of property: t�2S ,d e Intended use of property: A Q,1K P, Covenants and Restrictions: Yes _ C 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): O-=— SY �v7 Ta�t,E� Ra>1Ts A-b gt, t{ >JGa-i K f ;t),Jff, or, �,(11.iTl �lL� 1�¢rTIJ� LUWC(L GIZt7W�rJC� ��).l-05 `!^IJ OF 1 � F i�Lril.I i� t i o FEES Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: {� LCJC -n-ON T-tA +JJ 1 WI 1V/'VV1k , 1'b Y<I,I WI i ti'YYI� �VTJ f rn A'%�J�N/4-NU 0 Area of wetlands on lot: O square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 9t2 feet Closest distance between ynefrest proposed structure and upland edge of wetlands:--N JA' —feet Does the project involve excavation or filling? _X _ No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? 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): [PROJECT ID NUMBER 0 617'20 ! 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. Municipality ����I, o-zi County �- 4 PRECISE LOCATION. Street Addess and Road Intersections, Prominent landmarks etc -or provide map 5 IS PROPOSED ACTION New Expansion Modification/alteration 6 DESCRIBE PROJECT BRIEFLY. lel .,.-,[-�D 1 X15 r� lL t Nit �Gwelt-- V/pst�t C--FJ D N�T—Il)C 7 AMOUNT OF LAND AFFECTED Initially acres Ultimately acres e 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? LJ Yes ❑ No If no,describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 1�1"Re F-1 Industnal D CommercialAgriculture 1:1 Park/Forest/Open Space FlOther (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes I ro If yes, list agency name and permit / approval: _ 11 DOES t ANY ASPECT-OF THE-ACTION—TfAVE"A CURRENTLY—WER PSAMTT-3R" APPROVAL? - - -- - - -- ❑ --- Yes PNo If yes, list agency name and permit / approval: 122 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Des IN No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applica nsor Name C9E T7VE E.Vv1j00,V&7C—A/T14i /�E-Sr�j/� Date Signatur , If he acti n is a Costal Area, and you are a state agency, complete the oastal 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. ❑ Yes No 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. ❑ Yes N 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: No C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly. ili 0 C3 Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: NL) 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. Nv C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly 40 C7 Other impacts(including changes in use of either quantity or type of energy? Explain briefly No D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA)? If yes,explain briefly Yes No E. ISTHERE,O,,R II,,S((THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es explain E Yes Iryl No 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 of of part It was checked —yes thedetefirni hon efsignifloansemusF evaluate the potential impact of the propesed-set ionontheerwirenmentateharactenstics of the CEA: Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on-the information and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supposing thi determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature o Responsible Officer in Lead Agency Signature of Preparer(if different from responsible officer) &oard of Trustees Applicafan County of Suffolk State of New York {kt)f✓IVIG( h+�1�1 O w 1 C Z 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. 7:�: Signa e SWORN TO BEFORE ME THIS C29'- DAY OF —J CCtobv\ 2009 ll Notary P blit,Stent Aof�eew York 1 n 1 No.OIST6164008 ny Notary Public Commissions Expires April 9,20jL *d of Trustees Applicatiole AUTHORIZATION \ ('where the applicant is not the owner) residing atOx 8� (print owner of property) (mailing address) do hereby authorize C (Agent) �t�Ca to�t- G(1� tR JJ to apply for permit(s) from the Southold Board of Town Trustees on my behalf. MW Ji (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 pnccible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Cyec Je (Last name, first name,griddle 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 (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 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 V If you anscered'YES complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Tide or position of that person Describe the relationship between yourself(the ipplicant/agent/representativeI 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 the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP SubmitteZ of T 2009 Signature Print Name Form TS I Town of Southold • 0 LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold 's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# I C)Ck:) - ,5 1 - I — U J PROJECT NAME H I � W l The Application has been submitted to (check appropriate response): 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: Nature and extent of action: A L -To 2c—Lcx 4-Fc- (f 1 N 5—, A'u— PZQ i Ti V hf.'ti-L. OAityt; rJa JI ILA Location of action: 590 %/37e-PO jU /DiZI v Site acreage: I S Present land use: ae'u 7--/✓-1 C 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: l (a) Name of applicant: COC-A-%1V /6&VI A?0-9//YICiAITAt )( C-514p (b) Mailing address: Pa &x lbo PCL)V/C, AA- �j9s r / � (c) Telephone number: Area Code&3/ 7 ?J q - 2�2- (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No� If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. 0 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 0 No V 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 �K 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—PoliciesPages8 through 16 for evaluation criteria ❑ Yes ❑ No 1Z2!1 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 �Z 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. Yes No Not Apable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No LL,j 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 �0 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III-Policies; Pages 38 through 46 for evaluation criteria. ❑ Yeo No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIEA 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 ®, 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. ❑ Yes ❑ N4Z 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 ❑ Nop 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 ❑ NoM Not Applicable CELEr-I-�rut1; Com/ �ES�GN PREPARED BY CrC �V��iLZ TITLEES. DATE iOa D • CREATIVE Po1ute 25 6°R° amaa � �w Post Office Boxx 160 ENVIRONMENTAL ''"° "Y "958 4y. DESIGN 631-734-7923 '. 631-734-7924 fax Iliriaor..I L:aien Nnu(mpoeihnr September 29, 2009 Southold Town Trustees Pre Application site visit Request Creative Environmental Design has been authorized to Represent Mike Wilson of 590 Tarpon Drive, Southold, NY. The purpose of the visit is to discuss the possible options Of re arrangement of existing plant material in the non turf buffer approved by the trustees permit in 2002. Enclosed is a $ 50.00 c k for th visi David Cichano Pr Creative Environmental Design Int �J LIi SEP 3 0 2009 rd of Trustees Applicati0 AUTHORIZATION \ ('where the applicant is not the owner) I, M'�cheQ� �111Sd � residing at ?0—i�ox $n (print owner of property) (mailing address) •So -C> do hereby authorize (Agent) �s�Caco �L- �Z(1� cR� to apply for permit(s) from the Southold Board of Town Trustees on my behalf. y J� . (Owner' s signature) 8 �oard of Trustees Applica4n County of Suffolk State of New York N)) A 66 - Q ) yJ LSo/U BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISMER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.j Signature SWORN TO BEFORE METHIS gT� DAY OF SEPT. 120 O� NotaPublic MARGARET C. RUTKOWSKI Notary Public,State of New York No. 4982528 Qualified in Suffolk County Commission Expires June 3, f/ TA-tiz Pa r�L '1J�vr✓ - • -PLANTS I o 'gE T2.ws�La rNT�1� "T-o I�elw,ET� as SNoviN . i I Glzau�DS El_ 6 - ---- - CLETFAy d oVe ;3'12.' 14leA- _ - I KE4IT�EAICE Lf-1, I�LdrITI ioT �� INiC1o2 �eEx~� : _ - - VACCINUM AvrUbTIFoI..tUt� CL-F-TH2A At-N tti o�ta - �C HHiZ.Aci1a=Yiui� .SCopP�2tvr•� �oL�Z�AC,o 5r<rQ PSK v/reegt) - � t - - - LATNyi?v5 MA2tT1MUS Zl £� GL�T32 y TttilCi DE SCNargps1& FLF-xvof>d. AzEAS TO F Loc,iTE ` ; t l;�tsT. PL.+1HTs MORE �l-IAN 'r RF— VCTe1T"1bN LL �90- TAK' oc)M 'D'2i\/E 6ouTFfoLlyr)'�.7. 5CALE : V'= �.- TgeP,-1 tc , >Jy -7 34 - 79 z 3 d O APPROVED BY CT z s zoos COARD OF TRUSTEES Southhold Town Board a(Tmsteee _ TOWN OF SOUTHOLD F ' TE