The URL can be used to link to this page

Home My WebLink AboutWinter, John (2) Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 16, 2011 Mr. John Winter 590 North View Dr. P.O. Box 550 Orient, NY 11957 RE: 590 NORTH VIEW DR., ORIENT SCTM#13-1-5.1 Dear Mr. Winter: The Board of Trustees reviewed your Administrative Permit application dated April 14, 2011 to prune dead branches and summer's growth of shrubbery along the landward side of the bluff to no lower than 3' in height, and determined this activity to be ordinary maintenance, in accordance with Chapter 275 of the Town Code, therefore, no permit is necessary. Enclosed is a check in the amount of $50.00, which represents a full refund of your application fee. Very truly yours, Jill M{'/Ooherty, Presider~ Boar~ of Trustees JMD:lms Enc. TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES P.O. BOX 1179 $OUTHOLD, NY 11971 1051 ~ $$~h_j o soo~ a ~'?o,,,,' Jill M. Dohe~ly, President Bob Ghosio, Jr., Vice-President James F King Dave Belgen John Bredemeyer P.O. Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: JOHN WINTER requests an Administrative Permit to prune dead branches and summer's growth of shrubbery located along the landward side of the bluff, to no lower than 3' in height. Located: 590 North View Dr., Orient. SCTM#13-1-5.1 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: J. Doherty __B. Ghosio J. King __ J. Bredemeyer___ D. Dzenkowski __other Form filled out in the field by D. Bergen, Mailed/Faxed to: Date: John Winter 590 North View Drive PO Box 550 Orient, NY 11957 home: 631-323-3733 cell: 631-987-7371 e: JohnandNina@earthlink.net April 04, 2011 Board of Trustees Town of Southold Jill M. Doherty, President Bob Ghosio Jr., Vice President P. O. Box 1179 Southold, NY 11971 Administrative Permit Application 590 North View Drive, Orient, NY 11957 13-1-5.1 purpose: back yard pruning and gardening Dear President Doherty, Vice President Ghosio and Trustees of Southold Town, Attached please find our application for an Administrative Permit to formally conduct backyard pruning and horticulture on our residential property ocated 85 feet above Long Island So.un.d an.d with n 100 feet of the ,w_ ater. The objective is to conduct annual autumn pruning o~ aead branches and summer s growth of shrubbery ocated at the level portion of the backyard and not beyond the survey top-of-bluff line. This identical action was granted to us last year by the Trust,,_e~_ under Permit Number 7294A, dated May 19, 2010. The granted action allowed pruning of dead branches and summer's growth of shrubbery located along the landward side of the bluff to no lower than 3' in height. ~ I obtained a certificate of compliance following inspection of the pruning dated November 10, 2010. Please find attached both documents. The action was positive and successful. I am resDecffullv aDpMn_a for the same privilege under the same Additionally attached please find a signed letter from our Ioca New York State certified arborist Mr. Joseph P. Shipman of Shamrock Tree Experts Company attesting to his knowledge of our property and the beneficial results which occur from the proposed action. No negative results shall result. Photos of the backyard show how the shrubs will look after prun ng Nothing more than pruning. Please note how thick the growth is. The arbodst feels that following pruning the shrub's root structure ~.row stronger and wider increasing the strength of the soil and ground. More so, the pruning wdl increase ground resistance to erosion and rain storms. Winter to Board of Trustees Town of Southold Administrative Permit April 04, 2011 page 2 No root removal will occur. No ground or soil disturbance of any kind will occur. No live tree removal. No poison ivy removal. No ground cover removal. All of the trimming debris will be carted off site and disposed of to code. All work shall be done by our professional landscaper. The backyard is within 100 feet of the water. All the work shall be done in front of the top- of-bluff line and no work shall be done beyond the line on the sloping bluff. Survey attached and denotes area of beckyard pruning. The bluff is well veg. etated and healthy. To my knowledge the bluff around our home does not suffer from erosion problems. The pruning shall be done in the autumn as by then all the nesting birds have had their young and no wildlife shall be disturbed. We would greatly appreciate the granting of an Administrative Permit for pruning in the backyard area as depicted on the attached survey and shown in the photographs. In order to save resources and the Trustee's time in the future, we would further appreciate the permit's language to extend automatically from year to year or to such time the Trustees wish to have a new application put forth. In order to support such a request, I am most willing to write the Trustee's an annual assessment of the backyard's pruning results. Please let me know if there is anything further I can present the Trustees in order to have this application approved. Thank you very much for your kind assistance in this matter. Very truly yours, John Winter Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town H~lAnnex 54375M~nRoad P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7294A Date of Receipt of Application: April 14, 2010 Applicant: John Winter SCTM#: 13-1-5.1 Project Location: 590 North View Drive, Orient Date of Resolution/Issuance: May 19, 2010 Date of Expiration: May 19, 2012 Reviewed by: Trustee John Bredemeyer Project Description: To prune dead branches and summeCs growth of shrubbery located along the landward side of the bluff with the condition that there be no trimming below 3 feet in height. 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 survey prepared by Hillebrand Land Surveying, P.C., received on April 14, 2010, and stamped approved on May 19, 2010. Special Conditions: No trimming below the height of 3 feet. 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. Board of Trustees JMD:eac 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 Southaid, New York 11971-0959 Telephone ~ 631 ~ 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0604C Date November 10, 2010 THIS CERTIFIES that the pruning of dead branches and summer's growth of shrubbery located along the landward side of the bluff to no lower than 3' in height At 590 North View Dr., Orient Suffolk County Tax Map #13-1-5.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/14/10 pursuant to which Trustees Wetland Permit #7294A dated 5/19/10 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 pruning of dead branches and summer's growth of shrubbery located along the landward side of the bluffto no lower than 3' in height. The certificate is issued to JOHN WINTER owner of the aforesaid property. Dear Mr. John Winter, I am very familiar with your property at .590 North View Drive, Orient. As a New York State Cerlified Arbo~st it is my opinion fha! annual pruning in the fall of dead branches and the summer"s gro~h, of the shrubbery at the northern wall portion of your sound front property will be beneficial In all respects for the shrubs, ground structure and environment resullJng in: a) the shrub's root structure to grow s~unger and wider increasing the strength and stability of the soil and ground. b) the shrubs produci .nc~ stronger, thickened and wider canopy growth furlher increasing the integrity of the supporting ground. c) the shrub's increased ability to withstand disease, die back and aiiriiion by deer paths and grazing. d) increased ground resistance to erosion from rain storms. In addition, removal of dead tree branches and conservative pruning is recommended to stimulate new growth, prevent tree disease and provide more light in order for ground cover and shrubs to grow beallhier and stronger. I recommend that the pruning be done with both power and hand tools resulting in dean cuts and that all debris be removed from the site and disposed of properly. Sincerely, · --.,Joseph P. Shipman Shamrock Tree Expert Company us~44 John Winter 590 North View Drive Orient, NY 11957 13-1-5.1 EXTENT TO WHICH THE BACK YARD TRIMMING WILL B~. NO WORK PAST TOP OF BLUFF LINE WILL BE DONE. FROM JOHN WINTER - COHSULTI4 FAX NO. : 9419248301 13 2011 01:37PM P1 John Winter 590 North View Drive PO Box 550 Orient, NY 11957 home: 631-323-3733 cell: co31-987-7371 e: JohnandNina @earthlink. net APR 1 4 2011 BY FAX April 13, 2011 Board of Trustees Town of Soulhold Jill M. Doherty, President Bob Ghosio Jr., Vice President P. O. Box 1179 SOuthold, NY 1'1971 Adminislrative Permit Application 590 North View Drive, Odent, NY 11957 13-1-5.1 purpose: back yard pruning and gardening Dear President Ooherty, Vice President Ghosio and Trustees of Southold Town, Elizabeth mentioned to me that the hearing for this, admin' _~a'a~_. permit .r.eq ...u~,_st Wednesday May 18 2011_ Last year the Board grantecl ,me me perm~ wm~,.ut ..my presence at the heari..ng, a~:l...o..nce again, I a,tt?m, pted ~ maKe,~? as complete as pcesible, a'TOll.O~, ng .your$!..~. ~nspeot~o~on ,Ma.y. ~?_,_...~,_H rsepeclfully request that you ac not aeny mr laCK Ot my pceao~ absence, ou~ g ~ment to the ~ heari _rig in J, une. I hope that this is not the case and my applica~on is accepta~e to the ~oara. Thankyouve~Jmuch. Sincerely, John Wlnt~' Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application --Wetland Permit Application ~ Administrative Permit Amendment/Frans fcr/ExSension ~_Received Application: /Tt/} ~[~_Received Fee:$ ~)OJ.~ t ~"~Completed Application t_[ I~q Incomplete SEQRA Classification: Type I Type 11 Unlisted Coordination:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: ~te oflnspection: ~..~ Receipt of CAC Report: Lead AgencY Determination: Technical Review: ~P4~blic Hearing Held: ~?~,aB] tt Resolution: Name of Applicant Address f0 6o~ Suffolk County Tax Map Number: 1000- 15-/- ~" Propertynocation:~r~O NO~,T~-/ ~/,L~f ~O. aV~/ ~0; ffclO IV~T~ Vle~U Mt,z~, O~,~r, NY PhoneNumber:~6 >23-3733; cci(: 631 - ~g 7-737 { I o~l~,~T, N y I(qg7 (provide LILCO Pole #, distance to cross streets, and location) AGENT: t~//J~ (If applicable) Address: Phone: B~rd of Trustees Applicatio~ GENERAL DATA Land Area (in square feet):Iq i~ Area Zoning: Previous use of property: ~ e ~4e,4~ ~- {,.. Intended use of property: ~e 5~de,,s~ ~v(,_ Covenants and Restrictions: If "Yes", please provide copy. Yes W/ No Does this project require a variance from the Zoning Board of Appeals __ If "Yes", please provide copy of decision. Yes w/' No Prior permits/approvals for site improvements: Agency, Date ~o prior pe~ltstapprovms ~or sit= ~mprov~ts. 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): Applying for an Administrative Permit. Action requested is the identical granted by the Board of Trustees by Permit 7294A, Issued May 19, 2010, for "pruning of dead branches and summer's growth of shrubbery_ located along_ the landward side of the bluff to no lower than 3' in height" Please see attached Permit document and Certificate of Compliance. Our residential back yard is 85 feet above Long Island Sound and within 100 feet of the water. I am requesting an administrative permit in order to do some simple annual pruning of dead branches and summer's growth of shrubbery located at the level portion of the back yard and not beyond the survey's top of bluff line. Attached please find Shamrock Tree Expert Company's certification, photos, survey and my letter to support the action. Thank you. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Applying for an Administrative Permit. Action requested is the identical granted by the Board of Trustees by Permit 7294A, Issued May 19, 2010, for "pruning of dead branches and summer's growth of shrubbe _n/located along_ the landward side of the bluff to no lower than 3' in height" Please see attached Permit document and Certificate of Compliance. Area ofw. aflan~on lot: I (% fro O square feet Percent coverageoflot: '~-~'O % Closest distance between nearest existing structure and upland edge of wetlands: _¢'-.5"-. t/ feet Closest distance between nearest proposed structure and upland edge of wetlands: feet A~//:]- Does the project involve excavation or filling? t,/ No Yes If yes, how much material will be excavated? How much material will be filled? ~' t~/ cubic yards cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: feet Manner in which material will be removed or deposited: Statemen~.0f._the. ?_f.f_e~_tt !f any, on the wetlapds and tidal w~_ters- 9f [h_q .town~_that may result b_y ..... reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER 'ART '1 - PROJECT INFORMATION 1 APPLICANT / SPONSOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME County SEQR 3.PROJECT LOCATION: Municipality 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or orovide mad 5. IS PROPOSED ACTION: [~New [] Expansion [] Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: Annual autum, n bac.kya~im.mingand pruning of dead branches and summer's shrubbery growth to no ~ower man ;~ in neight. No soil or ground disturbance. No root removal. No live tree removal. All work done professionally and debris disposed off site according to code. 7. AMOUNT OF LAND AFFECTED: initially ~; 0~o acres Ultimately O, O.(O acres 8. WILL PROPOSED ACTION COMPLY With EXISTING ZONING OR OTHER RESTRICTIONS? {~es [] No If no, descdbe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~esidential [~]lndustrial [---]Commercial E~]Agriculture E~] Park / Forest / Open Space []Other(describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) E~Yes ~o If list name and permit / approval: yes, agency .... T~UObS ANY ASPECI OF THE AClION-~F,l~[~E-- MIT~OR APPROVAL? [~Yes ~-~d~lo If yes, iisi agency name and permit / approval: 12. AS A RESLLI~' OF PROPOSED ACTION WILL EXiSTiNG PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applic.~ant / Sponsor Name Signature Date; If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Le~_~_ A~e-"-_~/). IA. ~ ACll~__..I~ ANY TYPE I THRESHOLD IN 6 Nyc~ PART 617.47 B. WILLA~--~'i~:a~tm'~TED REVIEWA8 PROV~ED FO~UNUST~. ACtlONSiN6 NYCRR, pART617.67 KNo, aneg~ . . .[ D. ONMENTAL CHN~,~ rc.~l'=C~ THaT ,C,~U,SED 11-1F EgT'.RBUSH~ENT O~: A ~ . Impam have been kleaehd.aad adequae~ ~_ If aor Board of Trustees Name of Lead/~eaW ..Jill M; Doherty - ~ O~ Tyl~e~ Name of R/~poris~e Officer In Lead.~Agency __ ~i,a;.ure of e~ Of~ce/.J.l~ad/~gency President Title o[ Reapo~sibte Officer 81gna(ure of P,~pm~' (1~ diffef'ent from responsible officer) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM ~ ~ PROPERTY LOCATION: S.C.T.M, #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~)C'O 13 'I ~'" I STORM-WATER~ GRADINGs DRAINAGE AHE EROSION CONTROL PLAN Dtst~ S.cUon BLOCK Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. $COPEOFWO~ - ?ReiSsUeD CON$~[1RUCrI~[ON l'r,'~/#/Vv'OP,-~$,~$U~-,~T~'- I Y~ No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within ~); O ~:~ 1 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2') inch Rainfall on S~te? the Scape of Work for Propesed Construction) (S.F. / Acres) (This itam will include all run-off created by site b. What is the Total Area of Land Cleadng/ cleadng and/or construction activities as well as all and/or Ground Disturbance for the proposed ~ Site Improvements and the permanent creation of construction activity? (s~l Acr~) impervious surfaces.) 2 Does the Site Plan and/or Survey Show Ail Proposed PRO~V'~)F~ ]B]EI~F P~.O. IEC~ D,CSC'Ktt'YtON (~o,~d. ~,~ P~. ~ Drainage Structures Indicating Size & Location? This V~ I I Item shall include all Proposed Grade Changes and / ,zec-f / IaT S opesCon cl, ,gS rfaceWsterF,ow. /~/,//~' £0//- 4/~'ro~/=,,oC.*- 3 DoestheSitoPlanand/orSurveydescribetheerosion ~ and sediment control practices that will be used to control site erosion and storm water discharges. This -- item must be maintained throughout the Entire Construction Period. P G,ffc? "/'.; 4 Will this Project Require any Land Filling. Grading or Excavation where there is a change to the Natural ~/~/~fV~' /j[*l/'~ ~'~J~l~'~-/~ ?V'¢.~,,~ ~ Existing Grade lnvolving more than 200 Cubic YardsI~1 Sh~[a~t/'/~ (e~l~,,~4(o~ I"~'J~l'~/~~ S/~ of Matadal within any Parcel? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5.000 S.F.) Square Feet of Ground Surface? 1~(3~.f. '.' 6 Is there a Natural Water Course Running through the Site? Is this Preject within the Trustees jurisdiction~ General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1) o~ more acres; ir~uding dbturbances of less than one acre that7 Will there be Site preparation on Existir~J Grade Slopes r~ am part of a lan2er common Pisn Ihnt will ultshate~y dbturb °r~e °r re°re acres of land; which Exceed Fifteen (15) feet of Vertical Rise to i Ir tdedi~g Construction activities involving scsi disturbances of less than one (1) acre where One Hundred (100') of Horizontal Distance? I~1 the DEC has determined that a SPDES permit is required for storm water discharges. SWPPP's Shall rneeil the Minimum Rsqulrements of the SPDE$ General Permit 8 W~II Driveways, Parking Areas or other Impervious or Storm Water Discharges fi'om Construction eclJvity - Pen'nit No. GP-0-t 0-001,) Surfaces be Sloped to Direct Storm-Water RunOff~L.~J 1. The SWPPP shall be pmpered prior to the subralltal of the NOI. Tne NOI shall be into and/or in the direction of a Tovm right-of-way? subrniited to the Department pder to the commencement of constmcben ac~. 2. The SWPPP shall desedbe the erosion and sediment control practice~ and where 9 Will this Project Require the Placement of Material, required, post-conatmcfion sfom~ water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ~ i constmcthd to reduce the pollutants in sfom~ water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder ~l~at l ....... ...?...0..~........~..~...~.....~...~...~.. .......................... being duty sworn, deposes and say~ that he/she is the applicant for Permit, And that he/she is the ............. .~..~ .~...~..~ ................................................................................................................................. Owner and/or representative ob the Owner or Owners, and is duly authorized to perform or have peffom~ed the said work and to make and file this application; that all statemenbs contained in this applicatior~ are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicatiot~ filed herewith. of Trustees Applica~n County of Suffolk State of New York ,~'oH d /AJ I ~ T t~ fo~ 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 BELlEF, 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, THEI1R. 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 DAY OF L ,20 Notary Public Dard of Trustees Applicat' AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Tile Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officem and emnlovees. The numose of this form is to orovide information which can alert the town of~ossible conflicts ofimem~t and allow it to take whatever action is necessary to avoid same. (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 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 buginess 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 '~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title Or position of that person Describe the relationship between yourself(the applicant/ngent/repmsentative) 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 shams 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, par~nei', or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this g// day of ~-]4~! ( Print Name ~ ?.off Town of Southold f~u~'~ &~ ~nwd L~ CONSISTENCY ASSESS~NT FO~ 1. ~1 applic~ for pe~* includ~g To~ of Sou~old agangies, shall complete ~s CC~ for proposed aations ~at ~e subject to ~c To~ of Sou~old Wate~ont Consistency Review Law. msessmem is intcnded to supplement o~cr i~o~afion ns~d by a To~ of Sou~old agency m~ng a dete~afion of comistcncy. *~cept minor exempt actio~ including Building Permits a~ other ministerial permits not located ~ithin the Co~tal Erosion H~ard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its sign/ficant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" 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- suDoortin~ 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# PROJECT NAME The Application has been submitted to (check appropriate response): TownBoard ~ 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: Location of action: Site acreage: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) 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 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 ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~-] Yes ~-~ No [] Not Applicable Attach additional sheets if necessary [j' 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 ~ 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 A 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 V~ No [] Not Applicable ./ Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes ~] No [] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational usc of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~-~ Yes[~ No [--] Not Applicable Attach additional sheets if necessary WORKING COAST POLICI4 · Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent ases 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 IIl- Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~-] No [] Not Applicable Attach additional sheets ifnecessmy 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 TITLE DATE ~ AREA ' . MOk -- CONC. BLOCK WALL ~ ' ' EDGE OF A . SEPnC $YSTE~ ?lATER LINE .DRYWELLS AND LEACHING POOLS PER OTHERS SURVEY OF DESCRIBED PROPERTY Ar ORIENF FO~N OF SOUFHOLD. SUFFOLK COUN~K NE~ YORK QUARAN~EED 70~ JP. ~ORQAN CHASE ~ANK ~A~YERS D~LE INSURANCE CORPORA DON JOHN O. ~INTE~ NINA Z S~YED: J~ 26. 2003 NOT GUARANTEED UNLESS PHYSICALLY EVIDENT AT THE TI~E OF SURVE~ SCALE * I'" 30' ~R C~~ ~ Y IZ 2004 F~AL: A~S[ 24. 2004 THE OFFSETS OR OWENSlONS SHO~N HEREON F~O~ THE P~OPE~rY U~ES TO THE STRUCTURES ARE FO~ A SPECIFIC PURPOSE ANOUS¢ THEREFON~ THEY TO DA T~' ~VE~ ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE rD ~ ~, No~ ~ ~7 EREC~/ON OF FENCES. ~DD~T/ONA~ $T~UCTU~E$ OR ~NY OTH~ /~PROVE~EN~ WHO" THE SURVEY I$ PREPAREQ. AND ON THEIR BEHALF TO THE TITLE ~ ~ , SUFFOLK COUNTY TAX MAP CO~PAN~ GOVERN~ENT A~ENCY AN¢ L¢N¢/NO /NST/TU'/ON L/STE¢ HERE¢~ ~5 ~ ~ ~ 0)~ DI STRICT SECTION BLOCK ~OT CERTfF/C/T/ONS ARE NOr TRANSFERABLE rO AOOlTIONAL iNSrlrUUONS OR SUeSEQUENT OFNERS. 1000 I ~ I 5. I ~e~ ~ HILLEBRAND LAND SURVEYING. P. C. / I CHUECH/&~ &ARE. S~I[H~O~N. NEE YORK