HomeMy WebLinkAboutTR-7881A James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall, 53095 Main Rd.
P.O. Box I 179
Sou~old, 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.: 7881A
Date of Receipt of Application: July 10, 2012
Applicant: FJ Gerard Holdings, Inc.
SCTM#: 115-9-13
Project Location: 495 Airway Drive, Mattituck
Date of Resolution/Issuance: August 22, 2012
Date of Expiration: August 22, 2014
Reviewed by: Board of Trustees
Project Description: To grade, level and maintain original site which is to be
used as organic material storage.
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 prepared by E. Danowski & Son, Inc., D/B/A Cutting Edge
Landscaping, received on July 10, 2012, and stamped approved on August 22,
2012.
Special Conditions: Storage area restricted to no more than 55' north of runway
pavement.
Inspections: None.
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.
James F. King, President
Board of Trustees
meters "" ~00
Gerard Holdirtgs
~95 Airway Drive
SCTM# ~t5-9-t3
James F. King. P~esident
Bob Ghosio. Jr.. Vice-President
Dave Belgen
John B~demeyer
MichaelJ, Domino
P.O. Box 1179
Southold, NY 11971
Telephone (631 765-1892
Fax (631) 765-6641
Southold Town Board of Trustees
Field Inspection/VVorksession Report
Date/Time:
E. Danowski & Son, Inc. on behalf of FJ GERARD HOLDINGS, INC. requests an
Administrative Permit to grade, level and maintain site to be used as organic
material storage. Located: 495 Airway Dr., Mattituck. SCTM#115-9-13
/~Se of area to be impacted:
altwater Wetland Freshwater Wetland
Distance of proposed work to edge of wetland
~chOf Town Code proposed work falls under:
apt.275 Chapt. 111 other
Type of Application: __ Wetland
~Administrative__Emergency
Info needed:
__Sound Bay
Coastal Erosion Amendment
Pre-Submission __Violation
Modifications:
/-
Present Were: //~J. King '~B. Ghosio__
,/--'-37Bredemeyer // Michael Domino
D. Bergen,
D. Dzenkowski
Form filled out in the field by
other
Mailed/Faxed to:
Date:
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
To:
Jim King, President
Town of Southold Board of Trustees
From: Mark Terry, Principal Planner
LWRP Coordinator
AUG 1 0 2012
Southhola Town
Board of Trustees
Date: August 10, 2012
Re:
Proposed Wetland Permit for of FJ GERARD HOLDINGS, INC.
SCTM#1000-115-9-13
Edward Danowski & Son, Inc., D/B/A Cutting Edge Landscaping on behalf of FJ GERARD
HOLDINGS, INC. requests an Administrative Permit to grade, level and maintain original site
which is to be used as organic material storage. Located: 495 Airway Drive, Mattituck.
SCTM#1 t5-9-13
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 INCONSISTENT with the denoted following Policy
Standards and therefore is INCONSISTENT with the LWRP:
Policy 6. Protect and restore the quality and function of the Town of Southold
ecosystem
6.3 Protect and restore tidal and freshwater wetlands.
A. Comply with statutory and regulatory requirements of the Southold Town
Board of Trustees laws and regulations for all Andros Patent and other lands
under their jurisdiction
1. Comply with Trustee regulations and recommendations as set forth in
Trustee permit conditions
The action was conducted without a permit pursuant to Chapter 275 Wetlands and Shorelines
of the Southold Town Code.
Additionally, if the action is approved and to further Policy 4.2 Protect and restore natural
protective features and Policy 6; it is recommended that natural vegetated buffer
incorporating existing vegetation landward from the wetland to the cleared area be
established. Consider 50' in width. An example definition follows:
NATURAL VEGETATED BUFFER -- a land area of a certain length and width where existing
vegetation occurs prior to the commencement of any grading or clearing activity. Vegetation
shall be maintained to achieve a minimum percent ground cover of ninety-five (95) percent. To
achieve the percent ground cover indigenous, drought tolerant vegetation shall be planted.
Survival of planted vegetation shall be (ninety) 90 percent for a period of three (3) years.
Maintenance activities within the buffer are limited to removing vegetation which are hazardous
to life and property, trimming tree limbs up to a height of fifteen feet (15') to maintain
viewsheds, replanting of vegetation and establishing a four foot (4') wide access path
constructed of pervious material for access to the water-body.
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.,.
ZWetland Permit Application ~" Administrative Permit
Amendment/Transfer/Extension
/~Rece~vved Applic.atio~9~t Q ~
....--Received Fee:$
~..Completed Application c} Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination:(date sent)
.~LWRP Consistency Assessment Form CAC Referral Sent: ~?
.~-Dateoflnspcction: _ I-.~[..~ _
Receipt of CAC Report:
Lead Agency Determination:__
Technical Review:
/"'Public Hearing Held:~l.~_
Resolution:
Name of Applicant ~--..~ C.~ <dl..~)
Address '~.~_.,, ~ ~_4t~'l , IOo~I-T~..~O~
Phone Number:q~a~), Z~Or~ -
Suffolk County Tax Map Number: 1000 - ] I ..q-- ~i' - [ ~
Property Location: 1~ f-'(~ {~;r~o-[ E)c[~--
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Bo~d of Trustees Application
Land Area (in square feet):
Area Zoning:
Previous use of property:
Intended use of property:
GENERAL DATA
Covenants and Restrictions: Yes ~'/x No
If "Yes", please provide copy.
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 per Town Code or as determined by the Building
Dept. Yes ~x No
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 suspended by a governmental agency?
~ No__ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Bo~d of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: IE~c~ &~ ~4,M~'-' Eaq~%
Area of wetlands on lot: I 0 t o o o square feet
Percent coverage of lot:. % ~ %
Closest distance between nearest existing structure and upland
edge of wetlands: (o~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~f~ feet
Does the project involve excavation or filling?
No / Yes
If yes, how much material will be excavated? 0 cubic yards
How much material will be filled? /q 0 cubic yards
Depth of which material will be removed or deposited: '~ I 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 I - PROJECT INFORMATION
6'17.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
SEQR
'1. APPLICANT / SPONSOR 12. PROJECT NAME
3.PROJECT LOCATION: I.~ j~/t~.~ lj~/~/~
Municipality County ~c.,~ ~,~
PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or I~rovide map
IS PROPOSED ACTION: [] New r~ Expansion ~Modification / alteration
6. DESCRIBE PROJECT BRIEFLY:
7 AMOUNT OF LAND AFFECTED:
initially acres Ultimately acres
8 WIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes [] NO If no, describe briefly:
9 WHAT IS PRESENT LAND USE JN VICINITY OF PROJECT? (Choose as many as apply.)
[~]Residentiai ~]lndustrial [~Commercial r~Agriculture [~Park/Forest/OpenSpace ~Qther (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING,
AGENCY (Federal, State or Local)
~Yes [~ No If yes, list agency name and permit / approval:
NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
11 IJU'c5 ANY ,~SP~CI OF [HE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[~Yes ~No If yes, list agency name and permit / approvak
12. AS AR:~F~LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?.
I CERTIFY THAT THE INFORMATION PROVI~D ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Signature ~ ~ I ~.
If the ac~on,isf'a Costal Area, and you are a state agency,
complete the Co~stai Assessment Form before proceeding with this assessment
PART II - IMPACT ASSESSMENT (To 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.
r~Yes r~lNo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
[~1 Yes [~]No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing 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, agdcultura, archaeo og ca, h storic, or other natural or cultural resources; or community or nmghborhoo character? Explain briefly:
C3. Vegetation or fauna, fish, she fish or w d fo species, s gn ticant habitats, or threatened or endangered species? Exp am b e y
C4. !communitylse×isfing p,an~orgcal~ as off-~ciallyadopted, or~ o~n'~e"i~ u~e ori.te.$ityo,~seofiand or other nai'~'~ resources? Explain bhefly:
I
C5. Growth, subsequent development, or related activities likely to be induced by the p;oposed ~cfion~l=xpi;irl
I .....................
CS. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly:
D. WILL THE PROJECT HAVE AN iMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (tt yes, explain brlefl)':
[ Yes r N°l ...............
E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: F~reachadversee~ecth:~enti~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therwisesignificant~ Each
effect should be assessed in connection with its (a) setting (i.e. u~an or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e)
geographic scope; and (f) magnitude. If necessary, add attachments or reference 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 significant adverse impacts which MAY occur. Then proceed directly to the FULl
EAF and/or prepare a positive declaration.
Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio~
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi~
determination.
Board of Trustees
Name of Lead Agency
Print or,~e Name of Responsible Officer~n Lead Agency
S gl~itture of Res~ns b e Offi~ in Lea~gen~
President
Date
Title of Responsible Officer
Signature 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-WATEI~ GRADINGI DRAINAGE AND EROSION CONTROL Pl..AN
olstrlct sscuo. .~:~ ~t 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 Tota~ Area of the Project Parcels?
(Incfode Total A~'ea of all Parcels located within 1 Will this Project Retain Att Storm-Water Run-Off
the Scope of Work for Proposed Consthmtion) Generated by a Two (2") Inch Rainfall on S~te?
b. What is the Total Area of Land Clearing (S.F. ~ A~) ('rhis Item will include all run-off craated by site
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? impervious surfaces.)
(s.~.~.) 2 Does the Site Plan and/or Survey Show AIl propo,~d
PROVIDE BRIEF PROJECT DESCRIFTION (P~, ~ad~ ~.. N,,~,~ Drainage Structures Indicating Size & Location? This ~'1
,.~ Item shall include all Proposed Grade Changes and
~ C~ ~..~(~'~,. ~ .~'t~n..~ Slopes Controlling Sudace Water Fiow.
lt)t ~v,~-~, 3 Does the Site Plan and/or Survey describe the erosion r~
_ and sediment control practices that will be used to __
(J control site erosion and storm water discharges. This
¥'~ ~Oo~ . Construction item must bo rnaintained throughout the Entire Peded.
4 Will this Project Require any Land Filling, Grading or
Excavation where there is a change to the Natoral ~ //
Existing Grade Involving more than 200 Cubic Yards~ __
of Material withth any Parcel?
5 Will this Application Require Land Disturbing Activities
Encompassing an Ares in Excess of Five Thousand
/
(5,000 S.F.) Square Feet of Ground Surface? --
6 Is there a Natural Water Coume Running through the r~
Site? Is this Project 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 ct one (1) or more acres; incJuthng disturbances of less than one acre that 7Will there be Site preparation on Existing Grade Slopes
are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen (15) feet of Ve~cal Rise to
including Construction activities involving soil disturbances of less than one (1) acre where One Hundred (100') of Horizontal Distance?
the DEC has determined thai a SPDES permit is required foe storm water discharges.
SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious
for Storm Water Discharges fTOm Construction activity - Pe~it No. GP.O-I 0-~01.) Surfaces be Sloped to Direct Storm-Water Run-Off
1. 'i'he SWPPP shall be p~epamd prior to the submittal of the NOL l~e NOI shall be into and/or in the direction of a Town right-of-way?
submitted th the Department I~or to the commen(~ement of consb,~ffJon activity.
2. The SWPPP shall describe the erosion and sedtment control practices and where 9 Will this Project Require the Placement of Material,
required, post-constmctio~ storm water management practices that wtil be used and/or Removal of Vegetation and/or the Construction of any
constructed to reduce the geflutants in stem1 water discharges and th assure Item Within the Town Right-of-Way or Road Shculder
STATE OF NEW YORK, ~ ~ 4~-~ ir
OF .................. ss
That I .............. .~....~.....~.0~.....~._...~.. ' being duly sworn, deposes and says that he/she is the applicant for Permit,
And that he/she is the
Owner and/or representative of the Ovmer 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 the 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 befo/re me this;
· 64008 (signau.~ o~
FORM - 06/10
Board of Trustees Application
County of Suffolk
State of New York
t
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.
Signature
SWORN TO BEFORE ME THIS
1~ DAYOF.~ 1 Od! ,20/c~
tN6tatry P~blid
LAUREN M. STANDISH
Notary Public, State of New York
No, 01ST6164008
Qualified n Suffolk County
Commission Expires April 9, 2Cji.
Bo~d of Trustees Application
(print owner o~property)
AUTHORIZATION
(where the applicant is not the owner)
(mailing address)
do hereby authorize. I~. 'L.~2~t,~,,,ok2
(Agent)
to apply for permit(s) from the
S~~.a'fistees on my behalf.
(Owner's s~natul'e)
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics nrohibits conflicts of interest on the oatt of town officers and emnlovees. The t~ur~ose of
this form is to erovide information which can alert the town of~ossible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: ~. \"~.~XXO~.', ~,, ~ ~'-' ·
(Last name, first name, ~niddle 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 business interest. "Business interest'? means a business,
including a partnership, in which the town ofl]cer 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
lfyou 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 applicanffagent/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 applicant
(when the applicant is a corporation);
__.B) the legal or beneficial own~:r of any interest in a non-corporate entity (when the
applicant is not a corporation);
__.C) an officer, director, panner, or employee oftbe applicant; or
D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
Submitted this
Signature
Print Name
___day of 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 ~lrea.
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..ogificant
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-
sum~ortin~ 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
scm# 0oo -
P OJ CX N a,m
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 (1;50 ~1
(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
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
At~ach 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 IIl- Policies; Pages 22
through 32 for evaluation criteria.
Yes
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. Sec 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 thc 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 POLICIF~
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria.
[] Yes ~'~ No [] Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
~'~ Yes [] No ~7~ 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 ~ 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
APPROVED BY
BOARD OF TRUSTEES
TOWN OF SOUTI'IOLO
I"iONL HEN]'
0 PIPE
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N~,dM~.N~¢E ~ATE MAP NUMDER 5~10~004~2 ~
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Sou&had Town
Board of T'ustees
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EATUATE: 1,4ATTI'I-UC, K
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c.~i.)FPOLK COUNTY,
~URVEYED 12 2! i'L
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I000 - 115
F,l G]~.,ALD HOLDINGS, MJZ
COMMON~--ALTH LA~D T~iLE INSURANC~ COMPANY
* 36"E , ' '
o 42.87' m ',,
N89°13'00"W 147 67'
JOHN C. EHLERS LAND SU~,VEYOR
6 ~EAST MAIN STREET N.Y.S. LIC. NC). 50202
RIVERHEAD, N.Y. 11901
REF.-TIGERLPROS\99 -~07B J
369-8288 Fax ~69-8287