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Home My WebLink AboutTR-7867A James F. King, President Bob Ghnsio, 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 ¼ constructed __ Project complete, compliance inspection 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 Permit No.: 7867A Date of Receipt of Application: August 7, 2012 Applicant: Diane Kelly SCTM#: 71-2-7 Project Location: 75 Harbor Lights Drive, Southold Date of Resolution/Issuance: August 22, 2012 Date of Expiration: August 22, 2014 Reviewed by: Board of Trustees Project Description: Ten-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis ) to 12" in height by hand, as needed. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Diane Kelly, received on August 7, 2012 and stamped approved on August 22, 2012. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Eider (Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the $outhold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. King, President Bob Ghnsio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Atmex 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 ~4~ ~ I,~ ~-Jr' ?, ~2 ~/.2 has been reviewed by this Board at the regular meeting of ~ ~ ~j .~.,/- ...9..~ ! 2 0/,2-- and your application has been approved pending the compl~tio~ of the tolloWing items checked off below. __ Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ 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: $ ,YD. ~)~) BY: James F. King, President Board of Trustees James F King, President Bob Ghosio, Jr., Vice-President Dave Bergen Michael J. Domino PO Box 1179 Soud~old. NY 11971 Telephone {631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: DIANE KELLY requests an Administrative/Ten-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed. Located: 75 Harbor Lights Drive, Southold. SCTM#71-2-7 Lype area to be impacted: of Saltwater Wetland Freshwater Wetland Distance of proposed work to edge of wetland Pa.,d,-of Town Code proposed work falls under: __Chapt.275/c-h~, Chapt. 111 other Sound Bay Type of Application: __ Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: ~) j ~ Pres ntWere' 4 Ki g ~B Ghosio ~J. Breder~eyer '7 M-~cha;I Domino / __ D. Bergen, D. Dzenkowski Form filled,~ut i.i.i~ the,field by Mailed/Faxed to: Date: __.other Diane Kelly 75 Harbor Lights SCTM# 71 8/15t2012 Southold OFFICE LOCATION: Town Hall 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 mo~ Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Seuthh01'3 Trustees Date: August 9, 2012 Re: Proposed Wetland Permit for DIANE KELLY SCTM# 1000-71-2-7 DIANE KELLY requests an Administrative Permit for a 10 Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12' in height by hand, as needed. Located: 75 Harbor Lights Drive, Southold SCTM# 71-2-7 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 EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "FF" which states: FF. Cutting phragmites to greater than 12 inches and vegetative restoration, provided that native wetland vegetative species are not affected or disturbed in any manner;; 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 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 Office Use Only Coastal Erosion Permit Applicatio~a Wetland Permit Application ~' Administrative Permit i --Amendmenffrrans'fe[/Estensi°n eceived Application:~- eceived Fee:$ _.,~ ,/~O' , ompleted Application ~ ! -7. ![ 2.- __Incomplete __SEQRA Classification: Type I Type II Unlisted LOordination:(datesent) ! WRP Consistency Assessment Form ~ .]'~ ]] ~' CAC Referral Sent: ~Date of Inspection: ~7_~ __Receipt of CAC Report: Lead Agency Determination: jpTechnical Review: ublic Hearing Held: C~ IZg"ll ¢ Resolution: v 1 ~ AUG - 7 20]2 Name of Applicant ~la~e I Address -]5 ~'-~,bo,~ ~'~qi~,45 Suffolk County T~ Map Number: Property Location: ~ ~ ~ q-'l 3g 8q ql.'- 7 (provide LILCO Pole #, distance to cross streets, and location) AGENT: (Ifapplicable) Address: Phone: Boar~of Trustees Application GENERAL DATA Land Area (in square feet): 2 o, 0 o o Area Zoning:_ -D~i0tndqX I Previous use of property: ~ e' % t d ( n~ ~t I Intended use of property: ~-~e'%t ~ ¢~ 4hc~ I Covenants and Restrictions: Yes f No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes . /~ No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes / No Does the structure (s) on property have a valid Certificate of Occupancy // Yes No Prior permits/approvals for site improvements: Agency Date A/,LA __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? r/ No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): Or~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~q~o C ,~4 c~ ~ rvx a ~-~ q-~ ~ Area of wetlands on lot: 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: feet Does the project involve excavation or filling? / No Yes If yes, how much material will be excavated? How much material will be filled? 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: cubic yards cubic yards 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): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3,PROJECT LOCATION: Municipality .~ ~7 ¢ ~ 617,20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map 5. IS PROPOSED ACTION: [] New F~ Expansion E~Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres B WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ZYes [] No If no, descdbe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply,) [~Residential []Industrial I~Commercial C~Agriculture I~Park/Forest/OpenSpace J~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 yes, list agency name and permit / approval: 11. UL)E5 ANY ASFECI OF I H~. ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~]Yes []No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name ~l~,",4 J~'ll~ Date: ~ ',--%~-(~--- Signature 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 ITo be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. I--J w.s 171No B. WILL ,~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answees may be handwffdetq, if legible) C1. Existitlg air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain bdefly: I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultund resources; or community or neighbethood character? F_xpla n e y: I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity et use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explath briefly: C6. Long term, shod term, cumulative, or other effects not identified ~n C1 -C5. Explain briefly: C7. Other imf)acts Iincludin~] chan~es in use of either quantity or t3/pe of ener~];/. Explain briefly': ' ' D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRiTiCAL ENVIRONMENTAL AREA ICEA/? Ill )'es, expiate briefly: ~---~ Yes ~']No E. IS THERE, OR IS THERE LIKELY TO BEI CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~SS ex{olain: I--'lYes ["~ .0I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. u~oan or rural); (b) probability of occurring; (¢) duration; (d) in'evereibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or refemnse supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significent adverse Impacts which MAY occur. Then proceed direcfiy to the FULL FAF and/or prepare a pesi~,'e dedaraiton. Check this box If you have determined, based on the information and analysis above and any supporfing documentation, that the pmpesed acfior WILL NOT result in any significant edveme environmental impacts AND provide, on attachments as necessa[y, the masons supporting thi., determleatien, Board of Trustees Name of Lead Agency Print or Type Name of Responsible Officer in Lead. Agency Signatul~)f Responsible Officer in Lead Agen~l~ Date President [] Title of Responsible Officer Signalure of Preparer (If different 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 STORM-WATER~ GRADING, DRAINAGE AND EROSION CONTROL PLAN ~ Dietflct SeCtion Block L~t CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITELM# / WORK ASSESSMENT ] Yes No a. What is the Total Ama of the Project Pamels? ~{~,"~ I (InciudeTotalAreaofallPamelslocatedwithin /~i.;I~Z ~.4~- I Will this Project Retain AlI S~m-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Propesed Construciton) (s.;. / Acr~) (This item will include all run-off created by stle ~/' r'~ b. What is the Totel Ama of Land Cleadng ~ ~-pc~ ¥¥ clearing and/or construction activities as well as afl and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? _ Z: ~v-0 impervious surfaces.) (a.F.,~) 2 Does the Site Plan and/or Survey Show Ali Proposed PROVIDE BR~_J? PROJECT DES~ON p,.,eao ~.=~ P,s-. ~ Drainage Structures thdicating Size & Location? This j,./~,~ r~ Rem shall include all Prc~3sed Grade Changes and ' '' ~ ~ J~ ~ O UC r~ ~ ~ ¢' O. ~ V3q I"~-~ ; ~ Slopes Controlling Surface Water Flow. -- 3 Does the Site Plan and/or Suevey descdbe the erosion k,)'~-~ ~- ~ I~{~ ~ l/~/~ r-~ ,--~ and sediment control practices that willbe used te · control site erosion and storm water discharges. Thisl/,~ ~ ~- [.", (,. ~'3 '~ ~ item must be maintained throughout the Entire Construction Pednd. 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 Cul~c YardsL~J ..z.- of Matedal within any Pamel? 5 Will this Application Require Land Disturbing Activities r~ 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~ ~eneral DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Suhmissien of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1) ot mom acres; irmluding d~sturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common pran that will utiimateiy disturb one or rnore acres of lend; which Exceed Fifteen (15) feet of Vertical Rise te including Construction activities involving soil disturbances of less than one (1) acre ,..,hem One Hundred (100') of Horizontal Distance?I~1 the DEC has determined thai a SPDES permit is required for storm water discharges. SWPPP's Shall meet th~ Minimum Requirements of the SPDES General Pemlit 8 Will Driveways. Parking Areas or other Impervious ,for Storm Water Discharges fi.mn Construction activity. Permit No. GP.O.t 0.001 .) Surfaces be Sloped to Direct Sterm-Wate~ Run-Off t~/~ ~ 1. The SWPPP shall be prepared prior ~o the submittal of the NOl. The NOI shall be nto and/or n the direction of a Town dghFof-way? I~1 -- required, post-construction SfoCTn water management practices that will be used aeq/or Removal of Vegetation and/or the ConsthJ~'tion of any ~ gl'ATE OF NEW YORK, 1].,4-C ex I~{~ NOTARY P. F!r'~ , U~.~.~,;.~:t~,'e o~ hew That ! ......................... ~,.z..:.....:_...~. ................................ bem~ du y sworn, deposes and says d~t hc/sbe is ~he applicant [or Permit, And that he/she is the ..... ..O....~..~...C..C ...... Owner and/or representative of the 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 txue to the best of his knowledge and belief; and that the work will be pefforme~;t in.the manner set foith in the application filed herewith. Sworn to before me thi/, ~k/// /// FORM- 06110 / Board of Trustees Application County ofS-,fF,,tk [~ State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS Signature J C:~mmlss~on Exp; eS fl 30, 1'9~' Board of Trustees Application 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 The Town of Southold's Code of Ethics nrohibits conflicts of interest on the vart of Wwn Officers and emnlovees. The numoSe of this form is to orovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is nec~ssav/to avoid same. YOUKNAME: 12.~ Ih4 ~ ,a,'.~ [- (Last oared, first name, ~iddle initial, unless you are applying in the name of someone else or other cntity, such as a company. If so, indicate~thc 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 ILl ? (lf"Other", name the activity.) ' ,,A4 r. t 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 applicanffagentJrepresentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-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 RELATIONSHIP Form TS 1 Submittedthjs ~ dayof ,z~.~q~,t 20~ 2. Signature ~ ~ Print Name ~'o t ~.n( ICe II~ 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 detcm~nination 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 si~ificant 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. Thns~ each answer must be explained in detail~ listing both supporting and non- smmortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# t-tq3~¢q~ --] I . - ~2. - 7 PROJECT NAME ~x¢ 11~ A copy of the LWRP is available in the following places: onlin~ at-the~Tow~a, of- ,Sp~_ &% -~, webs,te (southoldtown.northfork.net), the Board of Trustees Offi¢¢ ! thO¢Pl i ?e_ e'nt! all local libraries and the Town Clerk's office. ~ .,U .~ - ., * AUG - 7 2012 -/ The Application has been submitted to (check appropriate response): TownBoard [] Planning Board [~ Building Dept. ~] Board ofTrustees~' Category of Town of S outhold 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) Mailingaddress: ;~0 ~L.-~4dr,d. ~ t (--~al-~0~ O-~J"O [~l./ I t.~ ~ o (c) Telephone number: Area Code ( )~lb '~{~'t 2- c](? Q (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. Sec LWRP Section III - Policies Pages 3 through 6 for evaluation criteria Yes [~ No [~57[ 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 ~7~ 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.ges 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 Applic0 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 ~7[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~ No [~7] 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 ~77[Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. Yes ~ No~//I 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 "~ tf, i,r,( · ¢~ i [h TITLE 0 ~c/~x/~f DATE SUR'v'tE'r' OF LOT 43 MAP OF HA, P-.BOP-. LI®HTS F,ETA'I"ES, SECTION FILED IN THE SUFFOLK COUNTY C. LEI~.K'~ OFFICE AS MAP NO. 46¢1 51TUATE, BAYVIEI/,I TOINN; 50UTHOLD SUFFOLK OOUNTY, NY %URVEYE~ I - 12 - 04 SUFFOLK: COUNTY TAX ~ I000 - -/I - 2 - ~ Di~u~ 1~,11 Palrick F X x, APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE/-'/,.,'6- ~ Z_ '2 o/Z N NOTES, / i ,,,i / j ,' ..¥ / / ;' , '" X x. o~ ............ PIPE FOUND RESAR FOUND 0 ELEVATIONS I~EFEP. ENCE SUFFOLK COUNT"r' TOFO HAP5 AREA = 20,000 5F OR 0.46 ACI~E5 ®RAPHIC. kCALE I"= DO' '~00, 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\~-Ip server~d~PROS\03-321A.pro JOHN C. EHLERS LAND SURVEYOR / / C 0