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Home My WebLink AboutTR-7313Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ½ constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7313 DATE: MAY 19~ 2010 ISSUED TO: ROB & CLAIRE RICCIO PROPERTY ADDRESS: 6512 INDIAN NECK LANE~ PECONIC SCTM#98-6-1 AUTHORIZATION Pursuant to the provisions of~Zhapter 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 the meeting held on May 19, 2010 in consideration of application fee in the sum of $250.00 paid by Rob & Claire Riccio and subject the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and the following: Wetland Permit to remove the temporary staked wall, excavate bluff for construction, install a new 6X6 timber wall and backfill, install erosion jute plants; (2) 12" catch basins piped to a drywell; and remove wild bamboo from bluff area, all as depicted on the plan prepared by Creative Environmental Design received on April 28, 2010 and stamped approved on May 19, 2010. 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 the said Board as of this date. TERMS AND CONDITIONS The Permittee, Rob & Claire Riccio, residing at 6512 Indian Neck Lane, Peconic, 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 6ircumstances 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 Southold. That the said Board will be notified 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. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 May 19, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. David Cichanowicz Creative Environmental Design P.O. Box 160 Peconic, NY 11958 RE: ROB & CLAIRE RICCIO 6512 INDIAN NECK LANE, PECONIC SCTM#98-6-1 Dear Mr. Cichanowicz: The Board of Town Trustees took the following action during its regular meeting held on Wed., May 19, 2010 regarding the above matter: WHEREAS, Creative Environmental Design on behalf of ROB & CLAIRE RICCIO applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, application dated Apdl 28, 2010, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 19, 2010, 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, and, 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, and, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees has found the application to be Consistent with the Local Waterfront Revitalization Program, and, BE IT FUTHER RESOLVED, that the Board of Trustees APPROVES the application of ROB & CLAIRE RICClO to remove the temporary staked wall, excavate bluff for construction, install a new 6X6 timber wall and backfill, install erosion jute plants; install (2) 12" catch basins piped to a drywell; and remove wild bamboo from bluff area, all as depicted on the plan prepared by Creative Environmental Design received on April 28, 2010 and stamped approved on May 19, 2010. 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, Jilt I~ Doherty, President Board of Trustees JMD/Ims Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Mo. in 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 Storm Water Runoff Trustee Matters Spring/Summer 2010 With the recent heavy rainfalls, we are reminded once again of the problems Southold Town has with storm water runoff. With over 100 road ends terminating at creeks, bays, inlets, or Long Island Sound, as well as all of the lawns and homes lining our miles of shoreline, 100's of thousands of gallons of storm water runoff enters our wetlands every year. Carrying sediment that prevents sunlight from reaching aquatic plants, nutrients from animal waste and lawn fertilizers that promote algae blooms detrimental to shellfish, and bacteria and other biologicals that in high doses can be harmful to swimmers, storm water runoffis one of the Trustees main public safety concerns. So important, in fact, that Southold has a Storm Water Management Code. Southold Town's Chapter 236 provides an outline for how people need to deal with storm water runoff from their properties. For example, new construction or renovation is required to contain any potential runoff to the wetlands from the construction by installing hay bales and silt fencing. This acts as a banier and keeps our wetlands clean. Another example in Chapter 236 is that every building must have provisions to collect and disperse, ON-SITE, at least a 2 inch rainfall. This is usually handled by installing gutters, leaders and drywells to the home. The Trustees also have a standing policy of requiring pervious non-turf buffers along bulkheads and at tops of bluffs that help k~ep run off from entering the wetlands and prevents erosion to bluffs. These are important measures to keep our wetlands safe and clean! Before deciding to renovate or build, the Town Trustees urge you to check our website and the other department's websites to make sure what you are planning to do meet the Town's Codes. These codes have been developed for the good of all citizens. And the wildlife all around us too! Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-664t BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~0~_ (:~-Cf o~c.c~ A!'PPt'~ Please be advised that your application dated ~l/ol ?IlO has been reviewed by this Board at the regular meeting of ,_'~lq !th 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) __ ½ Constructed ($50.00) ~/Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$ BY: Jill M. Doherty, President Board of Trustees Na~ 17 10 09:13a Daniel Gammerman (516)92~-5666 p.! SU~ ODELL PHONE: (713) 942-9395 Date: MESSAGE TO: Name: Board of Trustees Facsimile: (631) 765-6641 Telephone: (631) 765-1892 Total number of pages sent May 17, 2010 MESSAGE FROM: Sue Odell (713) 942-9395 (516) 921-5600 (including this cover sheet): IF YOU DID NOT RECEIVE THE NNMBER OF PAGES SHOWN ABOVE, OR IF ANY COPIES ARE ILLEGIBLE, PLEASE CALL (516) 921-5600. RE: RICCIO WETLAND APPLICATION (HEARING Maw 19r 2010) TO THE BOARD OF TRUSTEES: My property and the Riccios' are contiguous. The Riccios do not have my permission to do anything on my property or, anything on their property that will adversely affect my property. The problems they may be experiencing on their property appear to be self-created as trees and vegetation on the bluff in question have been removed over the last few years. If you have any questions, please feel free to contact me at (713) 942-9395. Thank you for your attention. Sue Odell Peter Young, Chairperson Lauren Standish, Secretary Town Hail, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 12, 2010, the following recommendation was made: Moved by Jack McGreevy, seconded by Doug Hardy, it was RESOLVED to SUPPORT the Wetland Permit application of ROB & CLAIRE RICCIO to remove the temporary staked wall, excavate bluff for construction, install a new 6X 6 timber wall and backfill, install erosion jute plants, and install (2) 12" catch basins piped to a drywell. Located: 6512 Indian Neck Lane, Peconic. SCTM#98-6-1 Inspected by: Doug Hardy The CAC Supports the application with the following Conditions: · the requirement of an engineered drainage plan for the property; and · additional hay bales are installed and/or replaced, Vote of Council: Ayes: All Motion Carried ✓-�r`BEV, • .r ,.r 1�A , .". I ,' , * � �` ` i , � � �• , - � Int^'— � `� 1* r ' + ,¢a�`'',v ^ y pkv "Ei IM1x� d '• . _ e � ` , ,R I 1 `';"i^' � "",�-....:R_ / �� `"t`�"`'";.rte.,,;",�"":.;».,ftp,}"K'•»,'„a:+»'�F„<r�.a,�..,»^..,m'w,xw �� t � ,, � ,�' ' � !' � �'" F+<I�1.�!7 3 _ s %S,` r � + �� ,_,. - .,,+• _,.,, < ` <i^7+Y1'iR4vYRNx•PMiKbAi�l4r{„q,�k,y,a.* � , � J l , , " `(i(+ , , ��'*' ..``�` `` y�i'I�',I�j�Ij1II ifI'�iII i1I'I�t''tr�nk�a„9Yi..,5'"r•+_`'a,z�-ry,,aS"ts(8,•`r,i'�t`.„Y�tt��45S-',b✓1b.Ri�r1rt3)sr.`r4v',4L`'.'a'xSt,/l'-j-c'`{+"`-lYi.4}":-#ry�''»l'i.?r#'.".'A a4�ry'Y-,°r'.,Y rfI>Kf�}r.-R3Fr,-,�•,i_r�"�'kY'wiJI�4 •, +�'..�.-�,��. 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Box 1179 Southold, NY 11971 Telephone(631)765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ROB & CLAIRE RICCIO request a Wetland Permit to remove the temporary staked wall, excavate bluff for construction, install a new 6X 6 timber wall and backfill, install erosion jute plants, and install (2) 12" catch basins piped to a drywell. Located: 6512 Indian Neck Lane, Peconic. SCTM#98-6-1 alalof area to be impacted: twaterWetland Freshwater Wetland __Sound Bay Distance of proposed work to edge of wetland ~chOf Town Code proposed work falls under: apt.275 Chapt. 111 other Type of Application: /-.~Wetland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: B.Ghosio, __ D. Dzenkowski __other Form filled out in the field by Mailed/Faxed to: Date: OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Truste~,s,- From: Mark Terry, Principal Planner N~ LWRP Coordinator Date: May 17, 2010 Re: Proposed Wetland Permit for ROB & CLAIRE RICCIO SCTM#1000-98-6-1 Creative Environmental Design on behalf of ROB & CLAIRE RICCIO requests a Wetland Permit to remove the temporary staked wall, excavate bluff for construction, install a new 6X 6 timber wall and backfill, install erosion jute plants; install (2) 12" catch basins piped to a drywell; and remove wild bamboo from bluff area. Located: 6512 Indian Neck Lane, Peconic. SCTM#98-6-1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the below Policy Standards and therefore is CONSISTENT with the LWRP. Note that the type of lumber (treated or untreated) has not been identified. It is recommended that the Board have the applicant identify the type of lumber and require materials that would minimize the introduction of chemicals in the environment capable of entering surface and subsurface waters. 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 CREATIVE ENVIRONMENTAL DESIGN Divisi~t! ¢~f l,di¢~, N~:t~ Corpolutio, M-y 7, 20t0 8OUthold Town Trueteee PO BOX 1179 8outhold, NY 1te71 Re; Cl. im mhd Rob RI~cio ApplIMM SCTM~ t000: MI4~1. Thank you for y~m, $1nc~rMy, Dlve.CiclmnM~ i' DJC:dmg 39160 Route 25. Po~t Office Box 160 · Peconlc, New York 11958 Phone: 631-734.7923 · Fax: 631-734-7924 e-marl: cteatlveen~designCi~yahoo.com, www. oceativeenvdesiSn. COm Jill M Daherty, Pmsidunl h,ncx [: KinB, Vicc-Prexklcnl [)a;c Bclgcn I'own Hall, 53095 Mnin Rd. P.O. Box [ 179 Southold, NY 1197~ Telephone (631 ) 765- 1892 [:ax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Usc Only ~astal Erosion Permit Application Wetland Pemm Application Administrative Permit A mend men ffl'ra ns fer/Extension ~ecc,ved Apptication:'"qf~A~Jl_o /Received Fee:$ ~5~~ ~'ompleted Appl~aii;; ~ Incomplele SEQ~ Classification: lype I I'ype I1 ...... Unlisted ~ Coordmation:(date sent) ~I.WRP Consistency Assessment Form Rcl~a[ Scm: ..~ CAC ~ate of Inspection: -~~ Receipt of CAC Report: Lead Agency Determination: Technical Review: Resolution: Phone Number:( Suffolk County Tax Map Number: 1000- Pr,,>pcrly Location: · 1 o - Z 70¢ (provide LILCO Pole #, distance to cross streets, and location) (it'applicable) erd of Trus=ees Applicatioe GENERAL DATA Land Area (in square £eet): Area Zoning: ~ ~'~ Previous use of property: r'~. Intended use of property: e~.%. Covenants and Restrictions: If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Yes ~ No Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental age~acy? r~ No__ Yes If yes, provide explanation: Project Description (use attachments if necessary):. o 'Fev D, WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: A~ea of wetlands on lot: ~ ~ h~--O square feet Percent coverage of lot: · [ c~ ""] % Closest distance between nearest existing structure and upland edge of wetlands: ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~-0 feet Does the project involve excavation or filling? No ~/ Yes If yes, how much material will be excavated? How much material will be filled? I ~ cubic yards cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: ] Manner in which material will be removed or deposited: feet 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): ~d of Trustees Applioatio~ COASTAL EROSION APPLICATION DATA Purposes ofproposed activity: 5~-~Z4'~(~ Uib[:)E~:L ?c~t-e~r~ , Are wetlands present within 100 feet of the proposed activity? No e'/Yes Does the project involve excavation or filling? No /""Yes If Yes, how much material will be excavated? I._~ (cubic yards) How much material will be filled? 2~' (cubic yards) Manner in which material will be removed or deposited: t Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SI. YFFOLK ~'-~C(.w~.I0~c'z , residing at /~h~ ~$Pc~"~..on~t~et~g , being duly sworn, deposes and says that on L-~°~o, ~rl~ ~,x.~ 20 ( ~, deponent mailed a true copy of the No!ice set forth, in the Board of Trus}ees Application, directed to each of the aoove named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at .~.,_- t_~ ~ (- ~ ., that said Notices were mailed to each of said persons by (certified) (registered) mail. ~ Sworn to before me this /c/q- Day of Q'D,'~t ,20 l0 C.~// - Notary Public Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 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 ROB & CLAIRE RICCIO COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING 1, ~-~Ck ~{(~,+~-~oc~leL., residing at /dba ~ Z~' 0z~d-¢t~MCk~( being duly sworn, d~ose ~d say: That on t.Z,he '? day of P/]/~ ,2010, I personally posted the property known as by placing the Bo~d of Trustees official post~ where it cm easily be seen, md that [ have checked to be sure the poster has remained in place for ei~t days prior to the date of the public he~ng. Date of heating noted thereon to be held Wed. May 19~ 2010 on or about 6:00 PM. Dated: ~-/7/1 o Swom to before me this / ~Qlay of 711o~7200;0 Public - ' LAUREN M. STANDISH Notary Public, State of New York No. 01ST6164008 Qualif ed n Suffo k County Cornm ss on Expires Apfi 9l 20~[ of Trustees Applicatio~ County of Suffolk State of New York ~'"'~¢,o ~ ~ c ~o~ig~ 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 THIq~..~PPLICATION Signat~ SWORN TO BEFORE ME THIS DAY OF /gA:M,c/" ,2010 ~aYy Public - LAUREN M. STANDISH Notary Public, State of I~ew York No. 01ST6164008 Qua!ified in Suffo!!* APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thc TOwn of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officers and emolovees. The ouroose of this form is to orovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is pecessarv to avoid same. YOUR NAME: tC-L~t~ ~CZ Ny I (Last name, first name, ~iddle 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 Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning (I f"Other", name the activity.) Do you personally (or through your company, spouse, sibling, pa~nh or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business int~rasL "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 / If you aasx~ered "YES", complete the balance of this form and date anti sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicanlIagent/represcntative) and the town officer or employee. Either check the appropriate linc 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. " DESCR[PTION OF RELATIONSHIP Form TS I Submitte~ Signature Print NameX>'~, ~ AUTHOR/ZATION (where the appliaant is not the owner) .... (print owner of property) /(/y, //6~ o (mailing address) do hereby authorize C~%~.~ ( Agent ) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. Owner' s signature) 617.20 PR'OJECT ID NUMBER 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-~APPLLC.~NT~ SPONSOR , ] 2. NAME ~,~ ,c~ (,.~c ~A-w,g~,.-~ ,(.-"?.., ~ 'I PROJECT . TPI~OJECT LOCATION: .-- . ~1' County SEQR 4 PRECISE LOCATION: Street Addess and Road InterseclJons. Prominent landmarks etc -or provide map IS PROPOSED ACTION [] New [] Expansion ~odiflcation / alleraflon 6 DESCRIBE PROJECT BRIEFLY: I 7 AMOUNT ,OF LAN(~AFFECTED: ~ Initially /~(..)~f'a/c'res ,~ O/ Ullimalely ~ ~a~res · O/ 8 ~OSED ACTION COMPLY ~TH EXISTING ZONING OR OTHER RESTRICTIONS? ~ Yes ~ No If no. describe briefly: 9 WH iS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~enlial l'~lnduslrial l-~Icommercial r--]Agriculture l---I Park / Forest l Open Space l'~Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal/Slate or LOCal) [~Yes ~"'No I, yes. list agency name and p.e, rmJt / approval: 11 DOE ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~No II yes. list agency name and permit / approval: 12[~}YesAS A RESU~F PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY T~T ~H[E INFORMATION PRO~YIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If th,~ ¢o*tal Ar~a, and you are a ~tat* ag*ney, complete tho Coastal Aese*~ment Form b,[ore proceeding with this a~*$~m~nt PART Il -~ iMPACT ASSESSMENT (To be completed by Lead Agency) * B. ~MLLACTION RECENECOORDINATEDREVIEWASPROVIDEDFORUNUSTEOACtlONSiN6 NYCRR, PART617.67 IfNo, a nega6ve I, CS. Growth, subsequent dev~,~ ~,,~ ~x related ac~;~?s flke~y to be Hduoed by ~ ~ action? F~?:~ Ixteey: I D. WII.I THE PROJECT HAVE AN IMPACT ON ~'IE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABUSHMENT OF A CRITICAL ENVIRONMENTAL AREA (CE.A)? (If yes, expiain t~tel~: E. I$ T'r;F-~_.. OR 18 THERE UKELy TO BEt CONTEOVERSy RELATED TO*POTENTIAL ADVERSE F-.NVl Re f.'U ?-%'TAL IMPACTS? If ~es PA~T m - u=, =""eNA'noN ~ S~I~a~c~ (To be (.~np~ted by Agency) INS'I~JOTIOflS: ~m~eachac~versee~ectk~nU~edab~ve~`dehm~hew~tissu~thii~arge~n`tp~i`tanL~s~n~ Each eflbcL 8houkl be a _ss,~'~,~__~ _ in ,ooflnectkm wflh its (e) setang (i.e. Urban or rural); (b) pmbebil~ c~ ~: (~) ~ (~ ~; (e) geograp~ _=-:c-,:-e; and (f) magnitude. If ne~essmy, add alta~ or ref~ence ~ppmtlng materials. E~sum Ihat e~/danalfens ~aln euflk~nt detMto show Ihat all relsvant adverse Impacts have been iden~fled ;~d ~ ~. If ques~n d of prat il was dmcked EAF and/re' Fepam a posltlve.dedamtio~. Board of Trustees Name of Lead Agency ,Jill M. Doherty Prhlt ~r Type Name of Responsible Officer In Lead Agency Date President 'rifle of Responsible Officer agna~,~re of Preparer (~f d~ from re~x~mt~e off. er) 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 cor~istency. *E~cept 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 om~osed action will l~e evaluated as to its significant beneficial and adverse effects uPOn thc coastal area (which includes alt of Southold Town). 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 mu~t be explained in detail~ listing both supporting and non- suooorfiw, 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# t/OQ c-) PROJECT NAME The Application has been submitled to (check appropriate response): TownBoara Planning Boara [] BualdingDep . oar ofT ustees 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: r~ If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Co) Mailing address: (c) Telephone number: Area Code ( ) (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 thc 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 ~NotApplicahle Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Polices Pages 3 through 6 for evaluation criteria --[---J Yes [~ NoI.'1/'1_~ 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 - Pol~lies Pages 6 through 7 for evaluation criteria [] Yes F-~ 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 Pa~gos 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 throuf~h 21 for evaluation criteria F~ Yes [-~ NoF-~[_2 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 evaluatio/d criteria. Yes ~///App~ble No Not 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 forfyaluation criteria. ~ Yes ~-] Nor~ '[ ~ Not Apphcable 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 [] NoI~1 ¥ 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 Southoid. SeeLWRP Section III criteria. / - Policies; Pages 38 through 46 for evaluation ~] Yes~ NoF~/~ Not 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/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 w~ers. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~Yes [] No l' INot~ Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Souihold. See LWRP Section III - Policies; Pages 62 through 65 for~tion crlteria. [] Yes /-'-] No ~ Not Apphcable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies;/P/ages 65 through 6gfor evaluation criteria. ~ Yes [] Nor~t/I gl Not Applicable DATE