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HomeMy WebLinkAboutTR-7194AJohn M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee # 1128C BOARD OF TOWN TRUSTEES TOWN`OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 CERTIFICATE OF COMPLIANCE Telephone (631) 765-1892 Fax (631) 765-6641 Date: June 23, 2015 THIS CERTIFIES that the installation of a 20' non -turf buffer with perennials and shrubs along the creek. At 960 Willis Creek Drive, Mattituck Suffolk County Tax Map #123-10-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 17, 2009 pursuant to which Trustees Administrative Permit #7194A Dated October 21, 2009, 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 installation of a 20' non -turf buffer with perennials and shrubs along the creek. The certificate is issued to BETH LESTRANGE owner of the aforesaid property. 'P`'' f_f 17 Authorized Signature John M. Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders -BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: J 11 A) 9L /�' %O Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1St day of construction constructed Project complete, compliance inspection. M INSPECTED BY: t om' 1 COMMENTS: CERTIFICATE OF COMPLIANCE: (/ /, Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 11 James F. King, President Jill M. Doherty, Vice -President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. BOARD OF TOWN TRUSTEES E Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631)765-1892 Fax(631)765-6641 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 15t day of construction '/ constructed V Project complete, compliance inspection. E James F. King, President Jill M. Doherty, Vice -President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. E BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7194A Date of Receipt of Application: September 17, 2009 Applicant: Beth Lestrange SCTM#: 123-10-1 Project Location: 96Q Willis Creek Drive, Mattituck Date of Resolution/Issuance: October 21, 2009 Date of Expiration: October 21, 2011 Reviewed by: Board of Trustees Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1592 Fax(631)765-6641 Project Description: To install a 20' non -turf buffer with perennials and shrubs along the creek. 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 project plan received on September 17, 2009, and stamped approved on October 23, 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. r Ja4es F. King, Pr ' Ident Board of Trustees JFK:eac 0 James F. King, President Jill M. Doherty, Vice -President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. TO: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631)765-1592 Fax (631) 765-6641 - v Please be advised that your application dated, P� I7_�has been reviewed by this Board at the regular meeting of i- ?I qnny 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) 1 st Day of Construction ($50.00) / '% Constructed ($50.00) 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: Ov TOTAL FEES DUE: $ BY: James F. King, President Board of Trustees itread� fro r%ENeJ _ � ,, - # for & ly ot!l aed a�w6ye dkvf R F# 919f) 1 a , Y" C> YRtM4 ANE' R 7gVr�o. to Ms sErvEC S,9EK#�vo mryib afar a f ' "enEEsp{ wRBaP•+1/ryy... ++ler ombb rfampolp'. uLlgrva�t Mow or fr�baYtef Awf*d rera3 nrhara APPROVED gUSOMO ZONE Dia7mr A-O 4 `O x � FMA{ FLOOD IONS MML O) _ -{, R z47.00` z K–b—OVEY OF r� E .O T 15 9 a :IN j6' 41.00".e �� MAP OF ') HARBOR VIEW AT MATT/TUCK 1 AM AM 44 087 FELE Aro. 49V ^ AT MATTITUCK u Em�owlD - �� v • „ . C % TO WN OF $00THOL AUG 181992 COUNTY, N : SUFFOLK COU 1000 — 133 10 — O1 TOWN OF SOUTHOLD scafe ' May 9r1988 , $� 3epk 1f 19,9T (Apundarion) a �. d $ Die, 28,)991(W ) a. f� _ Apr. 15, 1992 (Anal) �. Y d =I b_ 4 .yq3' s' yea t9 p rEsr 00 06S 1V.y v y� 4E i y sa+or c.w s.snw 6uvUxOa0°eze r., MY& Snug \' ��ea«array l d I d 8 •. :. ....� •• ,-� In �� �., I(oV pWE� rsn2ev - 02 MSM E� 0 9. �' - G h F--- W <onase cswwa Ynea e a Eft%k'1EQ(� TO.,y�. r rem- 1p l� > >✓1/92 _ a AN ` • ." . u LICAQO rl 4t INSURANCE v"r s.a� S r b..../ s I•�v✓ h.�n p�(� AM • (n (� ��� o �'A LEAS Pr6 qr d In gecgre nce rfls Iqe -/'n '1q 4 F< )O/•(�K r3 A9 Mils /a5 rfYp qa as/pblisgsa z 1 N.Y.S. Lf®.. NO. 498f \aa �y f e L Ip. L.S.tpnd ]!y rdvod qqd odoplr4 p Y^�� - . Eb ooa h usa.rip OHt $tufa 6urtd p roc(alloo. EO OIis P.G. K.ss '.,;✓,a$sx X/.oea, bre) iTR f g o, FL"' •- .` ,. REVI ION"9-YV-90 a 09 FLA006'O WETLAND 10 ' /0/$f�j,'.0:^ y RFVlSIQN'b-17-90 Y. Ug 71 s • ,. -'-. .:is 87 — 8$4 d Board Of Southold Town Trustees', SOUTHOLD, NEW YORK i PERMIT NO.. 3890 DATE: February 15, 194 ISSUED TO . Panagiotis ..Gazouleas ...... ,�uthnrt�tt�inn Pursuant to the provisions of Chapter 615 of the Laws 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- i titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the ! Resolution of The Board adopted at a meeting held on February 14 19 91, and in consideration of the sum of $ 150.00 paid by Land .Use Go. on behalf of Penagiotis Gazouleas 1' of N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: To construct a single family dwelling, attached decking d I; associated sanitary system a minimum of 75' from the land- ward limits of TWL. House construction will require approx. 300 c.y. of clean fill to meet flood plain regulations and SCD r all in acc rdance with the detailed specifications as presented in the origin tin ap0lica %cant a o 0 oses to construct a 4'X30' r uir.. �U �p s1 fixed Dock, N' 1 & 6' Z � foat IN WIT E S HEREOF, T e said hoard of Trustees here- by causes its Corporate Seal to be affixed, and these Presents to be subscribed by a majority o4the'd, Boardasass of this date. 0 James F. King, President �%'��� lip P.O. Box 1179 Jill M. Doherty, Vice -President Southold, NY 11971 Peggy A. Dickerson y ? Telephone (63 1) 765-1892 Dave Bogen ,y Fax(631)765-6641 Bob Ghosio, Jr. G Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: �l F Trimble's Nursery on behalf of BETH LESTRANGE requests an Administrative Permit to install a 20' non -turf buffer with perennials and shrubs along the creek. Located: 960 Willis Creek Dr., Mattituck. SCTM#123-10-01 Typ,,-of area to be impacted: vSaltwater Wetland _Freshwater Wetland _Sound /ay Distance of proposed work to edge of wetland Part Town Code proposed work falls under: hapt.275 Chapt. 111 _other Type of Application: Wetland _Coastal Erosion _Amendment ✓Administrative_Emergency _Pre -Submission Violation Info needed: Cond Present Were: King Doherty P.Dickerson D. Bergen_ B.Ghosio, D. Dzenkowski other Form filled out in the field by014, �° /� / -Ci �----- Mailed/Faxed to: 0 9 TRIMBLE'S OF CORCHAUG NURSERY Plant List for Buffer Installation Lestrange Property, 960 Willis Creek Drive, Marxituck, New York Prepared by: Anne E.Trimble,Trimble s of Corchaug Nursery, Cutchogue, NewYork Trees: 3 Eastern Red Cedar Guniperus virginiana) Shrubs: 18 Bayberry (Myrica pennsylvanica) 18 Winterberry (Ilex verticillaa) 12 Carolina Rose (Rosa carolina) Perennials/Grasses: 18 Seaside Goldenrod (Solidago sempervirens) 18 Butterfly Weed (Asclepias tuberosa) 18 Blue Lyme Grass (Elymus arenarius) 12 Switch Grass (Panicum virgatum) �� Jw, yyea� WIMMEgal PELpNIL Bo GPEpt �„�A cPllW aF sUFFaK © fld i}ppAA}y Imt $Bf'IICB X97 Cen1A C F•1YILY l m p w�mmo nLL Y ens n-- wmm_ P mamnml w 0 OFFICE LOCATION:Or3F Town Hall Annex SO�Tyol O MAILING ADDRESS: P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 Q �� ��y00UNTV ,�� Telephone: 631 765-1935 Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: October 15, 2009 Re: Proposed Wetland Permit for BETH LESTRANGE SCTM#1000-123-10-01 Trimble's Nursery on behalf of BETH LESTRANGE requests an Administrative Permit to install a 20' non -turf buffer with perennials and shrubs along the creek. Located: 960 Willis Creek Dr., Mattituck. SCTM#123-10-01 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. King, President Jill M. Doherty, Vice -President Peggy A. Dickerson Dave Bergen Bob unusio, Jr. F --I L BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit —Amendment/Transfer/Extension V eceived Application: / 7 d (/ Received Fee:$ _/Completed Application 0 _Incomplete SEQRA Classification: _ Type I_Type II_Unlisted Coordi Consistenc(datey sent) � M - ✓1;WRP Consistency Assessment Form -,zCAC Referral Sent Hate of Inspection:' 10 N _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: ;Tublic Hearing Held: Resolution: Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1592 Pax(631)765-6641 Name of Applicant rV�N Ll ��/ Address 1 (( f�� poop ffzT tT t(5 AT 0-707K Phone Number:(q()� Suffolk County Tax Map Number: 1000 - i 23 - /O - Of Property Location: ) W:UO �eb K Mb (provide LILCO Pole #, distance to cross streets, and location) AGENT:_ (If applicable) Am e - MAE I -Tz1 M13tU 6 Address: .210 19'5 MAW �OR) CATCH o aU E N/ Phone: 631 75q b _i v I 1 Wrd of Trustees Applicati• GENERAL DATA Land Area (in square feet): Area Zoning: /LES 1 PE M -PA L Previous use of property: (L E-25 1 0 e: I v -(—(A-c, Intended use of property: IZC— S (er,3 ((A ( i Covenants and Restrictions: Yes �4- No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. C To ley kIlea&76E /0 Has any permit/approval ever been revoked or suspended by a governmental agency? Y No Yes If yes, provide Project Description (use attachments if necessary): ZOAUATiod of 10' &SMR. AL-oik caeK u k Or NATIVe PEeC IWA 112 SEC- A STA t,0 PE9�rk/ F"orz 5W,5S �ard of Trustees Applicat WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /l%ti //I L 0ax Ar l( Al Area of wetlands on lot: D -6 square feet Percent coverage of lot: '� t r 5 % Closest distance between nearest existing structure and upland edge of wetlands: CV feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? 7` No Yes If yes, how much material will be excavated?cubic yards How much material will be filled? ,Acubic 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: yJ 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): I b iMD�cf rive tJ��(��tds 6r-(�tdw� �a�eis� PROJECT ID NUMBER 61720 • 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 44lie E. I7111e 2. PROJECT NAME SETH [c�re14vFE 3.PROJECT LOCATION: IGwlo'54065& V 5�`F1111717/\ Municipality j 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map q6d 9i/l//5 GVeek D1z1dC 1-441-nl_�16A� 5. IS PROPOSED ACTION: ❑ New ❑ Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: T u4rAUAW at ZD l FM4Z 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ® Residential ❑ Industrial E] 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, Stateor Local) �W.V TT�USTE�'S ©Yes E-1 No If yes, list agency name and permit / approval: �f'O/llf/D�h PERMITAPPROVAL? ❑Yes No If yes, list agency name and permit / approval: 12. AS AORESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor N me Date p �f G Signature O t/' U / If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 0 0 PART II • IMPACT ASSESSMENT (To be completed by Lead Anencv) 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 ACTION S. 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. Yes N7No 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, h O potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 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 Cl -059 Explain briefly: C7. Other impacts (includin2 chan es in use of either quantity or type of ener ? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA ? jif yes, ex Iain briefl : Yes 3'No IT, ORISTHERE No LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: 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 it was checked yes, the determination olisignifiGanGe must ten€ . Check this box If you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the F EAF and/or prepare a positive declaration. Check this box iTyou have delemiined, based on the information and analysis above and any supporting documentation, that that-oposed a WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting determination. Name of Lead Agency Print orType Name of Responsible Officer in ea gency Signature of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer (If different from responsible o cer) *Board of Trustees Applicaton 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 THIS �I w DAY OF '20_0f Notary Public BABETTE CORNINE Notary Public, State Of New York No. 01C05792800 Qualified In Suffolk County Commission Expires 3a, C"/o Ward of Trustees Applicaap AUTHORIZATION A (where thel applicant is not the owner) I, L�Il��xx(ny nz � Lt9-Vbf\,xxesidi:ng at 6UL�I(it SCFrle(LI/V.VC, +h���� (print owner of property) (mailing address) v T / 1i4s� do hereby authorize I n W^ (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 APPLI CANT/AGENT/REPRESENTATI VE TRANSACTIONAL DISCLOSURE FORM necessary to avoid same. ' / ✓ �f YOUR NAME:N (Last name, first name, {piddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate theother person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (if`Other', name the activity.) Building Trustee Coastal Erosion Mooring Planning 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 h 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 Aw C. %'-/A1Ie Title or position of that person dAI UAPGA.% i MM/T6 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-corpomte 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 thisdam_ ay of 200 _ Signature Print Name A Form TS 1 Town 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. 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 sigmficant 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#( 'V) -// /0 - 01 PROJECT NAME tOT944 NPEKr/ The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ 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: 1-07 /Pl *- PEk4FNNIa / 15f#Od3 bd``2Fi� 0 Location of Site Present land use: Present zoning classification: 1, %0 bVI 1,5 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 (b) Mailing address: / r Ae,4 -/ ROAD (c) Telephone number: Area Code ( ) 973 - / q-- `%S5g (d) Application number, if any:, Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ Nom If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III — Policies; Page 2 for evaluation criteria. ® Yes ❑ No ❑ 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 K 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 0 Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III — Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ 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 0 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. Yes No Not Appable 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. X Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy S. 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 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. ❑ YesD No 19 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE00 L] 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 ❑ 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 ® Not Applicable PREPARED BY Annt e.l(h A TITLE TW3AL7= DATE 45,605 sq. ft (to tie Jm) HS REF# 91 SO 13 CONTOUR LASS & ELEVATIONS ARE REFERENCED -r, TO N. G. V. D. 0 ZONE DISTRICT A -C FLOOD ZOAE A4(EL.B) ® R IN 7a. 4y 0a" E C E / .1 s .b Ol e 6 F E / 3_s O U t � � \W Fat 1 J Sco 3 s. 1 Esc �� 1 t i i �. � S Is•� Is.d� r r ` m E \W 0 ' N O �m� \ boCK 'LANDWARD EDGE OF TIDAL WETI p = WETLANDS FLAG F/ush AS DELINEATED BY SUFFOLK ENVIRONMEN7AL CONSULTING INC. ON SEPTEMBER 22,2004' 0 17 SURVEY OF LOT 15 MAP OF IARBOR VIEW A T MA TTI TUCK FLED ALIO. 2% x887 FXE NO. 8977 A T MA TTI TUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 123 - 10 --01 Scale 1" = 40' May 9, 1988 OCTOBER 7, 2004 OCTOBER 28, 2004 No,1 EL -%'t TEST BORINGS 4-4-9Y ilo.2 ti EI.=4.Ss GRCY SANO �I IOhM ' B¢ewN le.w _ $iMlo GRouN� wATG�` W eR. Ehs 2.0 � WATAI[ N DROWN FINE TO COARSE SAND 3.5 WATER IN GREyWI 66 SANDY Ct AY 6 WATER IN -V l& BR. F.Ne Te CeAR6E 5AMD 12' ioo - wzv ti BOX 909 TRAVELER STREET HOLD, N.Y. 11971 87 - 834 4961 nlo.3 9Al! BR. Kw -r0 Glo SAND GQouND W ATE�- 2L 4 PARK VIA. 6w v t:o�Y a¢t". TA. $.g MYEY'IANO GRpy', WATt4 IN WATE A- r� - GEEYUN BR. CLAYEY SAND 9 -WATER. IN Se. FINE TOCOARSE SAND ioo - wzv ti BOX 909 TRAVELER STREET HOLD, N.Y. 11971 87 - 834 4961 EXISTINC-4 ©AV -5 c. I \ PRovUS>;!) BUFFER PLAtQTlefC POOP PEC- KS k wA L Kw�Ys a�0 I"IIILL15P-IvF-�- �fATTITUCKYO9K 2o'6UEr-Ef INSTALLLATIC) N