HomeMy WebLinkAboutTR-7841A James F. King, President �oF sorry Town Hall Annex
5475 Main Bob Ghosio,Jr.,Vice-President ��� dip Pap.Box 117 9 d
Dave Bergen Southold, New York 11971-0959
John Bredemeyer y • Telephone(631)766-1892
Michael J. Dominoes�
COU Fax(631) 765-6641 NfI��'
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0799C Date: September 14, 2012
THIS CERTIFIES that the installation of an 88' If stockade fence alone the south
property line
At 7065 New Suffolk Road, New Suffolk, New York
Suffolk County Tax Map# 117-5-30
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated May 11, 2012 pursuant to which Trustees Administrative Permit#7841A Dated
July 18, 2012,was issued and conforms to all of the requirements and
conditions of the applicable provisions of law. The project for which this
certificate is being issued is for the installation of an 88' if. stockade fence along the south
property line.
The certificate is issued to STEPHEN WALSH owner of the
aforesaid property.
o �+ C;
Authorized Signat{ •e
James F.King,PresidentOG Town Hall,53095 Main Rd.
Bob Ghosio,Jr.,Vice-President !(� P.O.Boz 1179
Dave Bergen y "��: Southold,NY 11971
JohnBredemeyer pyti�� �ph� Telephone(631)765-1892
Michael J. Domino N/1 yo Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: / /Z-
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1St day of construction
% constructed
__L Project complete, compliance inspection.
INSPECTED BY: i—
COMMENTS:
CERTIFICATE OF COMPLIANCE•
holrneowne� called
ry �
-Gr 6L in spe c4ian cl OJI L
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 ) 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
__ Ist day of construction
¼ constructed
V/Project complete, compliance inspection
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hail 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
Permit No.: 7841A
Date of Receipt of Application: May 11, 2012
Applicant: Stephen Walsh
SCTM#: 117-5-30
Project Location: 7065 New Suffolk Rd., New Suffolk
Date of Resolution/Issuance: July 18, 2012
Date of Expiration: July 18, 2014
Reviewed by: Board of Trustees
Project Description: Install an 88 If. stockade fence along the south property
line.
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
application received on May 11,2012 and survey stamped approved on July 18,
2012.
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 Fe~'ng, Pre~' sid~
Board of Trustees
James F King, President
Bob Ghosio, Jr., Vice-Presidcnl
Dave Belgen
John Bredemeyer
Michael J. Domino
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:
STEPHEN WALSH requests an Administrative Permit to install an 88' If.
stockade fence along the south property line. Located: 7065 New Suffolk
Rd., New Suffolk. SCTM#117-5-30
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:
~'/~Dhapt.275 Chapt. 111 other
~¥pe of Application: Wetland __Coastal Erosion __Amendment
Administrative__Emergency Pre-Submission Violation
Modifications:
Conditions: T'o .5'~-..-'¢ ~r~, '~(-e ~'/'~ c~ .~_ C (~-~'~
Present Were: '/" J. King ~/B. G hosio Z~¢/e;gen,
~/~t J. Bredemeyer M~ael Domino D. Dzenkowski other
Form filled out in the field by
Mailed/Faxed to:
Date:
t17
OFFICE LOCATION:
Town Hail Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY 11971
MAILING ADDRESS:
'P.O. Box 1179
Southold, NYl1971
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: MarkTerry, Principal Planner ~
LWRP Coordinator
. _. 14 2012
Souttlhold Town
R~rd of Trustees
Date: June 13, 2012
Re: Proposed Wetland Permit for STEPHEN WALSH
STEPHEN WALSH requests an Administrative Permit to install an 88' If. stockade fence along
the south property line. Located: 7065 New Suffolk Rd., New Suffolk. SCTM#117-5-30
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment
Form submitted to this department, as well as the records available to me, it is my
recommendation that the proposed action is CONSISTENT with the Policy Standards and
therefore is CONSISTENT with the LWRP.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in
preparing its written determination regarding the consistency of the proposed action.
Cc: Lori Hulse, Assistant Town Attorney
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
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
Coastal Erosion Permit Application
~Wetland Permit Application 7Administrative Permit
Amendment/Transfer/Extension
'~'Kece~vved
Application: ~-~. ~l I I ,~
~ceived Fee:$ ~"~ '~ '
· -Gompleted Application ~.~). ti ! ~
__Incomplete
__SEQRA Classification:
Type I Type II Unlisted
Coordination:(date sent)
~EWRP Consistency Assessment Form (O]l][ ~P
__CAC Referral Sent: ~
~ate of Inspection: In~, I .>
__Receipt of CAC Repo~: I
Lead Agency Determination:
__Technical Review:
..~P'ublic Hearing Held: [~ [ ~ [ t~-
Resolution:
NameofApplicant 37-ff. LeO/-./~/~ tO_ [A/t6, L3/~/
Address
Phone Number:(6~/}
Suffolk County Tax Map Number: 1000 -
~OL~
(provide LILCO P~e ~, distance to cross streets, ~d location)
AGENT:
(If applicable)
Address:
Phone:
~o of Trustees Application
Land Area (in square feet):.
Area Zoning: .t~/z
GENERAL DATA
Nrl 6 15
Previous use of property:.
Intended use of property:
Covenants and Restrictions:
If "Yes", please provide copy.
~. £51D6A/7-1A L
Yes _ ~ No
Does this project require a variance from the Zoning Board of Appeals Yes
If"Yes", please provide copy of decision. - --
Will this project require any demolition as
Dept. ~_Yes _~_No per Town Code or as determined by the Building
Does the structure (s) on property have a valid Certificate of Occupancy ~_Yes _
Prior Permits/approvals for site improvements:
Agency Date
_~_No
_No
~ No prior permits/approvals for site improvements.
Has any Permit/approval ever been revoked or susp~en/ded by a governmental agency?
If yes, provide explanation: ~ No~ Yes
Project Description (use attachments if necessary): 13/.~T,4LL,,~.~-[o,4/ oF
~- t,~/ooO - -
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: f ~O fE ~ 'f-? ~OE:~q /G/V.~ I"loA/
Area of wetlands on lot: [~ ~oo square feet
Percent coverage of lot: ~ ~ %
Closest distance between nearest existing structure and upland
edge of wetlands: ~ ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~%O feet
Does the project involve excavation or filling?
/~ No Yes
If yes, how much material will be excavated? ~ cubic yards
How much material will be filled? ~ cubic yards
Depth of which material will be removed or deposited: feet
Proposed slope throughout the area of operations: ~--
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
PROJECT ID NUMBER
PART 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 ,5 ~.2j~"'~O L K
SEQR
3.PROJECT LOCATION:
PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or [~rovide map
7o 5- /v w -so£-foLK.
IS PROPOSED ACTION: [] New [] Expansion [] Modification I alteration
6. DESCRIBE PROJECT BRIEFLY:
Hf H
7 AMOUNT OF LAND AFFECTED:
Initially (7 acres Urimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
,~Yes [] No if no, describe briefly:
9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
~Residential [~lndustrlal ~Commercia, []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)
]Yes J~No If yes, list agency name and permit / approval:
Yll DOES ANY ASPE'-C~OF~TRE~ACT[O~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes ~7~No If yes, list agency name and permit / approval:
~ CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant / Sponsor Name Date:
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
~ART II - IMPACT ASSESSMENT ITo be completed by Lead A~ency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, ox~diuate the review ixocess aad use the FULL EAF.
B. 1/~1~-AcT~NREC~EC~RD~NA1-e-DREV~EWASPR~v~D~DF~RUNUSTEDACT~NS~N~NYCRR~PART61?~6? IfNo. anegatlve
dedaratio~ may be superseded by aonther Immlved egoncy.
[~Yes [~No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOClAIED WITH THE FOLLOWING: (Answers may be ham~dtton, if legible)
CI. Existing air quarry, sudace or groundwater quality or quantity, noise levels, existing traffic pattern, sor~l waste production or disposal,
potential for erosion, drainage or floe~eg problems? Ex~ath bdefiy:
C2. Aesthetic, agdcu#ural, archaeological, hlatedc, or other natural or cultural resources; er coelrmmi[y or ne~hbodlond character? Ex.in b~iee/:
C3. Vegetation er fauna, fish, ~hoflfish or wi~ife s~ecles, slgnlficont habitats, or Ihreatesed or endangered species? F-qflain briefly:
i , ...................... I
C4. A commun ty s existing plans or goals as o fl'~atly adopted or a change in use or kRensity of use of land or ether natural resouroes? Er. plain b~egy:
C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly: '
C6. Long term, shod tenn, cumulative, ar other effec~'~ not identiged in C1 ~;57 Explain briefly:
! I
C7. Other impacts (induding changes in use of either quantity or l~1~e of enorg}~? E-~lain brieflyl
0. I/VILL THE PROJECT HAVE AN IMPACT ON THE E NVIRONME NTAL ';~.~ARACTERISTIC~ THAT CAUSED THE ESTABUSHMENT OF A CRITICAL
E. I~ THERE. OR IS THERE UKELY TO BE, CONTROVERSy RELA ,'~_D TO POTENTIAL,~SE ENVIRON~IENTAL IMPACTS?
PART III - DETERMINATI°N OF SIGNIFICANCE (To be completed by.a~enc~y) . ~
INb-'ll~UCTION$: F~eachadvemee~entident~fiedabeve'detsm~new~ether~tis$ub~ta~tia~a~e~r~s~n~nL EaCh
effe~ should be assessed kt ce~oection with its (a) satang (i.e. u~oan or rural); (b) ~.~ ~occunfag; (o) derailed; (ali i~eversiblli~, (e)
~,eographlo soepe; and (0 magnitude, ff necessary, add attachments or re~orenee r~oo~ng malmlals. Ensure. that e~tiens oofltsin
Ched~ this t~x If you have detenalae~ based on the inf0mtafk~ and anal~ above and any ~ d~ ~t ~ ~ a~e~
WILL NOT result in any significant adverse emamnmefltal in.acts AND provide, off attachments es ~ece~ap/. Ihe masons suppofflng thl:
determination.
Board of Trustees v/~/~. ~ ;Z.~/~_
Name of Lead Agency Date
Pdnt or Type.t(ame of Responsible O~cer lo Lead A~oncy ~ of Responsible Officer
Signatu~ of Responsible Officei-in ~ed/~3.~'~T Signature of Preparer (If diffemnl from responsible office0
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
STORM-WATER~, GRADING~ DRAINAGE AND EROSION CONTROL PI.AN
Disbtht Section Block LOt CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT ] Yes No
a. What is the Total Area of the Project Parcels? /~J,/~/
(Inctude Total Area of all Pamcls located within 1 Will this Project Retain All Ston'n. Water Run-Off
Generated by a Two (2') Inch Rainfall on Site? fi////~ j~j
the Scope of Work for Pmpoesd Construction) (This item will include all mn-off created by site
b. What is the Total Ama of Land Cleadng (S.F. / AC~eS) clearing and/or construction activities as wall as ale --
and/or Ground Distuthance for the proposed Site Improvements and the permanent creation of
construction activity?
impervious surfaces.)
(s.l:.lAcres) 2 OoestheSitePlanand/orSurveyShowAtiProposed /~
PROVH)E BI~,]~' PRO]E,C'T DF~CRHq'ION gh,~d. A~dttk~'.,~ ~,;.. ~t Drainage Structures Indicating Size & Location? This
item shall include ail Proposed Grade Changes and
/~,~'--~,~/../.._ ~¢)Q ~-(~. C./~/0~0~' fC~/~/C-~ Slopes Contmlling Surface Water FIow.
3 Does tho Site Plan and/or Survey descdpe the erosion ji///A J ~"'.~'=1
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.
4 Will this project Require any Land Filling, Grading or
Excavation where there is a change to the Natural ~
Existing Grade Involving more than 200 Cubic Yards~L~ --
of Material within any Parcel?
5 Will this Application Require Land Disturbing Activities ~
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.) Square Feet of Ground Surface? --
6 Is there a Natural Water Course Running through the ~
Site? Is this Project within the Trustees jurisdiction
V
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?
dislurbances of one (1) o~ mom ac~s; including disturbances of less than one acre that 7Will there be Site preparation on Existing Grade Slopes ~
arepanofala~gercomrr~)nplanthatwiilullimateydisturboneormoreacmsofland; which Exceed Fifteen (15) feet of Verticel Rise to [
v
including Construction activities involving soil disturbances of less than one (1) acm where One Hundred (100') of Horizontal Distance~ ~ --
the DEC has determined that a SPDES pem~t is required for storm water discharges. ' O
SWPPP's Shell meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious
for Stom~ Water Discharges f~om Construction activity - Pem~it No. GP-O.il0-O01 .) Surfaces be Sloped to Direct Storm-Water Run-Off
1. The SWPPP shall be prepared pdor to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way?
2. The SWPPP shall describe the erosion and sedi~nt control prac§ces and where 9 Will this Project Require the Placement of Material,
required, post-construction storm water management practices thai will be used and/or Removal of Vegetation and/or the Construction of any ~ ~
constructed to reduce the poilulants in storm water discharges and to assure item Within the Town Right-of-Way or Road Shoulder~ --v
STATE OF NEW YORK, ~ ~
COUNI~/' OF ...~k~.,'~ ..-~2~.L .t...'7. ......... SS
That I, ..~....~._~ ......... ....~......~...-._~...~. ~...~ing duly sworn, deposes and says that hedshe s the applicant for Permit,
Owner and/or representative of lhe Owner or Owners, and is duly authorized to perform or have performed the said work and to
make and file this application; that all statements contained in this application are true to fl~e best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed herewith.
Sworn to before me lifts;
................... ..................... day or.. ........ .. ..........
· - ,j. ,~AT~.Nk~EN" L. MOLL~'l';;~'t'~];';';,;~i ..........................
FORM - 06110
~ew York
No. 01MO6112016
Qualified in Suffo k County
Commission Expires June 28, 20,.L~
County of Suffolk
State of New York
BEING DULY SWORN
DEPOSESIAND 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 H1S/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
Signature
SWORN TO BEFORE ME THIS
,20 12--
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of Southold's Code of Ethics omhibits conflicts of interest on the tvart of town officera and emulovees. The numose of
this form is to omvide information which can alert the town of~ossible eonflict~ of interest and allow it to take whatever action is
necessary to avoid same,
(Last name, first anm~, ~iddle initial unless you arc 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 alt that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other", name the activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest'* means a business,
including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
YES NO
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/agent/representative) and the town officer or employee. Either check
the appropriate line A) through D) and/or describe in the space provided.
The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):
A) the owner of greater than 5% of the shares of the corporate stock of the applic0at
(when the applicant is a corporation);
B) the legal or beneficial owner of any interest in a non-corporate entity (when the
applicant is not a corporation);
___C) an officer, director, partner, or employee of the applicant; or
__.D) the actual applicant.
DESCRIPTION OF R.ELATIONSHIP
Form TS 1
Submitted this ~.,~.~dty of A4tal ~ .. 200
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
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 detail~ listing both supporting and non-
suooortim, 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# l/7 O J'- 30
PROJECT NAME /~/A
The Application has been submitted to (check appropriate response):
TownBoard [] Planning Board [~ Building Dept. ~ BoardofTrustees ~,
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:
/M,5~'-ALLAF/o/V ol~ ~' ~[IV~A~_ t~-~F ot: v~oot~ STociK~D~
Location of action:
Site acreage: .
Present land use: l~ t; .5'IOEIVT"[ di L
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: ~ ~'~?/~/4.ffg/O.
(b) Mailingaddress: ¥7 ~r~'['''°gv'tg''~L~ ~["~,. ~[---~-' t~/ tg'.'~,
(c) Telephone number: Area Code ~; ? [ 3(-- 3 -- O ~ [ 5-'-
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes ~] No [x~] If yes, which state or federal agency?_
C. Evaluate thc 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
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
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 ApplOle
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
[] Yes ~ No ~ 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.
V~ yeJ~ No ~ 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 Peconie
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
~ Yes ~-~ No ~ Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for evaluation criteria.
[-~ Yes [--] No y 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
PREPAREDBY.J 5T~t~t-JeA/ 19. ~,~L..5£{ TITLE C;~XA//Vt~t~ DATE
202.~
83'47'20. W ~'
/d/~ C~ O.L
ORCHARD STRF_,F_,T
202.68'
SURVEY OF PROPERTY
SITUATED AT
NEW SUFFOLK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-117-05-.,0
SCALE 1 "=30'
APRIL 5, 2001
AUGUST 14, 2007 LOCATE PILES
JUNE 4, 2009 fiNAL SURVEY
FEBRUARY 28. 2012 SET CORNER MONUMENTS
AREA = 20,265 sq. ff. 0.465 ac.
NO TES:
1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM.
EXISTING ELEVATIONS ARE SHOWN THUS:-m~
Nathan Taft Corwin III
Land Surveyor
o1-154