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Home My WebLink AboutTR-7708A Jmes F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 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 James F. King, President Bob Ghosio Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 7654641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7708A Date of Receipt of Application: December 15, 2011 Applicant: Julia & Joseph Vergari SCTM#: 115-5-18 Project Location: 5855 New Suffolk Ave., Mattituck Date of Resolution/Issuance: January 18, 2012 Date of Expiration: January 18, 2014 Reviewed by: Board of Trustees Project Description: To replace the existing 20'X 24' front stoop and retaining wall against the house; add pillars on bottom of stoop; install pervious cobblestone driveway; define entrance with two (2) pillars on each side and add an apron; remove asphalt and re-grade dirt back onto property at same grade. 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 indicated on the survey prepared by John C. Ehlers last dated June 21, 2011 and stamped approved on January 20, 2012. CONDITIONS: THERE SHALL BE NO ACTIVITY SEAWARD OF ZONE AE (EL 6) WITHOUT FIRST OBTAINING TRUSTEE APPROVAL/REVIEW 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. Jam~F.~ing, Presi'~t Board of Trustees James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application dated IoTI 1%1 II has been reviewed by this Board at the regular meeting of ! !1 ~ ! I ~' and your application has been approved p~nding 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: James F. King, President Board of Trustees $ill M Dohelly, President Bob Ghosio, Jr. V/cc President James F. King Dave Bergen 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: ! JULIA & JOSEPH VERGARI request an Administrative Permit to replace the existing 20'X 24' front stoop and retaining wall against the house; add pillars on bottom of stoop; install pervious cobblestone driveway; define entrance with two (2) pillars on each side and add an apron; remove asphalt and re-grade dirt back onto property at same grade. Located: 5855 New Suffolk Ave., Mattituck. SCTM#115-5-18 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 ~Ad ministrative__Emergency __Pre-Submission Violation Info needed: /_,~' / 7" lt ,, /~ ,,~ Modifications: Conditions: / Present Were: // J. King__B. Ghosio _ ~. Bredemeyer___ D. Dzenkowski __ Form filled out in the field by j, t Y I ~? Mailed/Faxed to: Date: ~. Bergen, other I ® 115 OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. 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: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator ,lAN 2012 Date: January 12, 2012 Re; Proposed Wetland Permit for JULIA & JOSEPH VERGARI SCTM#1000-115-5-18 JULIA & JOSEPH VERGARI request an Administrative Permit to replace the existing 20'X 24' front stoop and retaining wall against the house; add pillars on bottom of stoop; install pervious cobblestone driveway; define entrance with two (2) pillars on each side and add an apron; remove asphalt and re- grade dirt back onto property at same grade. Located: 5855 New Suffolk Ave., Mattituck. SCTM#115-5- 18 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 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 Office Use Only ~weastal Erosion Permit Application~- tland Permit Application ,~' Administrative Permit Amendment/Transfer/Extension ~ece~vved Application: __~Received Fee:$ ~ .,.fompleted Application ~ ~L[ I ~] II __Incomplete ' ' __SEQRA Classification: Type I Type Il Unlisted ~.C.~rdination:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: ~-~-"Date of Inspection: ]Jl{] ~Receipt of CAC Report: ! __Lead Agency Determination: Technical Review: ~e'l~blic Hearing Held: I Resolution: Name of Applicant Address t-?0 Phone Number:( ) ~-Ib 't~t ~- 9;t iH Suffolk County Tax Map Number: Property Location: ~'¢ ¢~ Na~ ~c4gT~'ot4c Ao~ AA,&~I-IWCiC (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Boa~rd of Trustees Application GENERAL DATA Land Area (in square feet): } ~ °I '7 -'/{3,0 ~ ( ~. 6, Area Zoning: [~ - q 0 Previous use of property: fadl¥~,~. Intended use ofproperty: ~g~q~q~ Covenants and Restrictions: Yes If "Yes", please provide copy. Agency ,/' No Does this project require a variance fi.om the Zoning Board of Appeals __Yes ~ No If "Yes", please provide copy of decision. Will this project require an3demolition as per Town Code or as determined by the Building Dept. Yes No Prior permits/approvals for site improvements: Date Io/zot __. No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen.51ed by a governmental agency?. ,/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): (4 e~o lac e B~d of Trustees Applicatio~ WETLAND/TRUSTEE LANDS APPLICATION DATA Areaofwetlandsonlot: ~ ~ / OIL squarefeet Percent coverage oflot: ~0, b~ % Closest distance between nearest existing structure and upland edgeofwetlands: .~¥. ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ u(~ ht feet Does the project involve excavation or filling? No v/ Yes -' For ~r,~'e~c,.y o,~ ly If yes, how much material will be excavated? (~ 0 -7,5'cubic yards How much material will be filled? - o '- cubic yards Depth of which material will be removed or deposited: - o Proposed slope throughout the area of operations: I Manner in which material will be removed or deposited: bt J feet I o 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): COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetl~ds present within 1 O0 feet of ~e propos~ activitfl No / Yes Does the project involve excavation or filling? No v'/' Yes "'~0 o.~ ly If Yes, how much material will be excavated~' 6,0--/$ (cubic yards) How much material will be filled? -- 0 ~' _(cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) ~qO~ PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1, APPLICANT / SPONSOR ~ 3.PROJECT LOCATION: Municipality ~ '~ ( ~ ~, ~ 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 Coun~ ~. 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide mad 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification / alteration SEQR 7. AMOUNT OF LAND AFFECTED: Initially'~ , Id& acres Utiimately "~ .~Io acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~/Yos [] NO If no, describe bdefly: 9, WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~-~Residential []Industrial ~-~Commercial [--'~Agricutiure E~Park/Forest/OpenSpaco E~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 E~NO If yes, list agency name and permit / approvak 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~Yes []No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Applicant Signature I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE "complete the Coae~ment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT ITo be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 6t7.47 If yes, coo~flieate the review process and use the FULL EAF. 8. ~ ACTION ~ COORI~NATED REVIEW AS PROVIDED FOR UNUSTEO ACTIONS tN 6 NYC~R. PART 617.67 IfNo, a negative ded, ara~ort may be supe~eded by a~o~hor im~sed ageacy. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Aeswees may be handwdlten, if leglbie) CI. F_~lsting air quality, sudace or groundwater quality or quanlEy, eaise levels, existing frofl~ pattern, seed waste prnduc~m or ~-~SlX~sel, p~ential for erosion, d~deage or Ileading problems? Explaifl briefly: C2. AeslhMic. I~ldeal~ral, amhaeok~Ical, hlet~dc, or other natural or cultural resources; or communib/or eatghb~tmod cflam~or? Explakl bdelly: C4. A"*"'"',~nlys~'&'~;'~ Ple~s or~eis as ---,~;;)' adopted, ora cflangein use or intensity~use o¢[and or ~bernatumlresouress? Ex~ein bde~.. I C$. Growth, subseqea~t de~v,,,:nt, or ~eleted activities likely 1o be induced by the proposed action? Explain briefly: '--- C6. Long term, short tem~, cumulative, er other effects not iderlfir~d in C1~:57 Exp{ain bdeliy: C7. O~her knpac~ Ilednding changes in use of either qeanti~ or type of energia? Explain brlefl~ ...... D. VVILL THE PROJECT HAVE AN IMPACT ON ~HE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes eXPlain b~e~' t PART III - [,= ~ ~IWt~A~ OF $1GNIRCANCE (To be mmple~d by .N]ency) . INSTRUCTIONS: F~read`1eg~versee~e~de~U~edab~ve'detem1k~ewhetheritissubst~tia~'~rge~knpedant~r~~nL Each effe~ ~hould be a~_ _ _-~1 k~ m~me~tion with ~ (a) seta~g (i.e. urban or rural); ~) pn~ablr~ ~f occu, t~g; (~ duraaor~ (d) krever~lity;, (e) geo~ s~pe; and (t) me~nltu~e, ff necessary, add attachments or reference sup~ng matedab. En~ure fh~t e.~lanalto~,s oo~taln mdac:lent detaff to show tlmt all relevan~ adve~e Impa~ have been ide.lir~ and ~ ~, ffqu~ d ~p~t llwas c:~ dofem~ktatkm. Board of Trustees Name of Lead Agency Print or Type Name of Responsible Officer i~ Lead Agency President Date 'i'tfle of Responsible Officer Sigeaiure of Preparer (If different from mspoeslble officerJ' -- Town of Southold Erosion, Sedimentation & storm-water Run-off ASSESSMENT FORM PROPERTY LOCATION: $.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A I 0oo ~ ~.~ ~ I ~ STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN District Section BlOCk Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITIiM# / WORK ASSESSMENT [ Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within I ~"1'1 ~. o ~ I Will this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Construction) ~ , I;b (This item wtil include all run-ofl created by sitaGenerated by a Two (2") Inch Rainfall on Site? b. What is the Total Aria of Land Cleadng CS,F, I Acres) cleadng and/or construction activities as well as all -- and/or Ground Disturbance for the proposed ~°~oJ( 2. ~- ~- ~ ~', Site Improvements and the permanent creation of construction activity? impervious surfaces.) (e.F.,,~.) 2 Does the Sita Plan and/or Survey Show AIl proposed PEOI, rI~E BRIEF PROJECT DESCR]FHON (~'m,'~/~.~,~ ~.. Needed, Drainage Slmctures Indicating Size & Location? This / r"""l item shall include all Proposed Grade Changes and D~'J~[',,~. ~)c~.~,~-- .~lc~ S[opesControllingSudaceWaterFIow, · 3 Does the Site Plan and/or Survey describe the erosion J'"~ [ O.(~.~ '~)C~-~.~ ~.IC't v'~% ~t.-~.Jr~. ~ ~ J. { and sediment control practices that will be used to control site erosion and storm water discharges. This On ~'t0~5~ 4~. Z ~-~0~' "{~'J- ~'~"~C~. itemmustbemaintainedthroughouttheEntire Construction Pedod. ~¢,,~,~'~ A-Sfh~,lJr :;*~ c~ q .P'.er~/ 4 WJllthisProjectRequkeanyLandFilling. Gradingor J Excavation where there is a change to the Natural ~ ~ ~1~ ~ .~ ~.~ P~ tl J~t'o. el ¢-~ ID'('-q~ r I ql[.t~l~ , Existing Grade Involving more than 200 Cubic Yards I t of Matedal within any Parcel? r'~j¢~,~ ~:~'>~h~ ~$l~,1 ~[L(, {ri 5 Will this Applicati°n Require Land Disturbing ActivitiesD / Encompassing an Area in Excess of Five Thousand I~ ~o.o~.. (5,000 S F ) Square Feet of Ground Surface? -- I - 6 is there a Natural Water Course Running through the ~ / Site? Is this Project within the Trustees jurisdiction U General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction actlaiites invoivimj soil Beach? disturbances of one (1) or more acres; including disturbances of less than one acre that 7Will there be Site preparation on Existing Grade Slopes are pad of e larger common plan that will ultimately disturb one or mom acres of land; which Exceed Fifteen (15) feet of Vertical Rise to V incMding Construction activities involving soil distu~:~ances of less than one (1) acre where ~ One Hundred (100') of Horizontal Distance?I~J -- /he DEC has determined that a SPDES pmmit is required for sform water discharges. SWPPP's Shall meet the Minimum Requirements of ~3e SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious ~ for Storm Water Discharges from Construction activity. Permit No. GP-0.t0-O01.) Surfaces be Sloped to Direct Storm-Water Run-Off 1. The SWPPP shall be prepared prthr ts the submittal of the NOL The NOI shall ha into and/or in the direction Of a Town dght-of-wpy? submitted to/he Department pher fo the commencemer~ of construction activity. 2. The SWPPP shall desedbe the erosion and sediment control practlaes and where 9 Will this Project Require the Placement of Material. cequired, post-construction sto*m water management practices that yell be used indict Removal of Vegetatfon and/or the Construction of any constructed to reduce the pollatsnts la storm watsr discharges and ts assure Item Within the Town Right-of-Way or Road Shoulder~l -- compliance with the terms and conditions of this permit. In addition, the SWPPP shall COUN~'Y OF ............ That I, ..,d..(,d...,.L-./1 .-.~.~.....; ............................... be ,g duy sw6m, deposes and says that he/she is the applicant for Permit, And that he4'she is the (6~r. '~,~i ,'~;'t ~~'& ~ , '"" ~; : ~ ,~i~ ................................. Owner and/or representative of the Ovmer or Owners, and is duly authorized to perform or have performed thc said work and to make and file this application; that all statements contained in this application are tree to thc best of his lmowledgc mid belief; and Ihat thc work will be performed in the manner set forth in the application flied herewith. Sworn to before me this; Notary ................... Public:["~"~.....Q..~.....~ ................. __ day °f '"*~"~"~"' ' 20'~'/{ ! / pE~v_~n_/:.L~_... ....... ~'~r~ ..........-/ /j ~ FORM - 06110 Nota~/~"~, State o! Ne Qualified in Suffolk County .~ - ,,'~ Commission Expires Sept. 29. d of Trustees Application0 County of Suffolk State of New York ~ d Vt ¢ q ~"///&/4--~.~ 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~O~INSP~ECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APP~LICATIO'I~L SWORN TO BEFORE ME THIS DAY OF ~ ~A'L/,~'" .,20. Notary Publi~ PENNY BEDELL Notary ,p, u b ~c~,~S,.t ~a~,, o~ f., ~N.,e w YorR Quatifi:~d in SuffO..Ik County Commission Expires sept. 29, APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the vart of town officers and emnlovces. The ournese of this form is to omvide information which can alert the town of oossthle conflicts of intereSt and allow it to take whatever action is ne to ay id sam. (Last name, fu'st name, Middle initial, anloss you ar* 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 Soathold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ 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 yourseif (the applicanffagenffmpresentative) 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): __fi,) the owner of greater than 5% of the shares of the corporate stock of the applic0nt (when the applicant is a corpors6on); __JS) the legal or beneficial ownqr of any interest in a non-corporate entity (when the applicant is not a corporation); C) an officer, director, partnei', or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 PrintName ~/v '~dLlc9 ~t~tl~-~:~t.4 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for pen'nits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" 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 detaii~ iistinfl both supporting and non- suovortin~ 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 OOO - l[~ ~ -t~ The Application has been submitted to (check appropriate response): TownBoard ~] Planning Board [] Building Dept. [-~ BoardofTrustees Categozy 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: P-e. fl ce -fro, Location of action: ~ Site acreage:_ '2?. (o b ~/ Present land use: ~ - q 0 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 COASTPOLICY 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 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 I~] 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 App~le Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section HI - Policies Pages 32 through 34 for evaluation criteria. [-~ Yes [-~ 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 use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [-~ Yes~ NoG Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ 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 Peconie Estuar~ and Town waters. See LWRP Section HI - Policies; Pages 57 through 62 for evaluation criteria. [] Yes Po X Pot 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 .SURVEY Ot= PROPERTY -~ITUA'r~ HAT'I'I'rU~K ~T'FOI..K C, OUNTY, NY rOSI~t['VBOAI~ DEC 15 2011 NOTES, ~reo = 15~{,-/E~O .~. Ft:. LOT 41 ¥ ¥ ¥ ¥ LOT 45 ~RAPHIC, 5GALE '5O IOO JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STEEET N.Y.S. LIC. NO. 50202 I~/~,~F~D, N.Y, 11901 369,-8288 Faz 369-8287