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Home My WebLink AboutTR-7946A James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Dom'mo 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.: 7946A Date of Receipt of Application: November 7, 2012 Applicant: Susan Burke SCTM#: 115-12-11 Project Location: 780 Deep Hole Drive, Mattituck Date of Resolution/Issuance: November 14, 2012 Date of Expiration: November 14, 2014 Reviewed by: Jim King, Trustee Project Description: To replace the screens with windows to enclose the screened-in pomh; repair/replace 2nd story deck and railings with new composite wood; repair/replace outside rear deck, railings and stairs with composite wood; replacing foundation under porch. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Nathan Taft Corwin III, last dated on June 28, 2012, and stamped approved on November 14, 2012. Special Conditions: None 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. James F. King, President Board of Trustees James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen Jolm Bredemeyer Michael J. Domino Town Hall Pamex 54375 Route 25, P.O. Box 1179 Southold, lqY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated I I/7/I ~- I / has been reviewed by this Board at the regular meeting of "'. { I//.L/L//~-- and your application has been approved pending the comp etion (~f tl~6 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 m-application fees will be necessary, You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $. ~_~'0, O~ BY: James F. King, President Board of Trustees James F King, President Bob Ghosio. Jr, Vice-President Dave Bergen 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 DateFI-ime: ~7 I '~ Zo/ SUSAN BURKE requests an Administrative Permit to replace the screens with windows to enclose the screened-in porch; repair/replace 2nd story deck and railings with new composite wood; repair/replace outside rear deck, railings and stairs with composite wood; replacing foundation under porch. Located: 780 Deep Hole Drive, Mattituck. SCTM# 115-12-11 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay .~"~ g££ tC Distance of proposed work to edge of wetland P.a~_/ef Town Code proposed work falls under: ¢"'Chapt.275 Chapt. 111 other T~Ad of Application: Wetland Coastal Erosion Amendment ministrative__Emergency --Pre-Submission -- Violation Info needed: Modifications: Conditions: Present Were:-J"' J. King B. Ghosio__ J. Bredemeyer.__ Michael Domino Form filled out in the field by ~,~ ,I Mailed/Faxed to: Date: D. Bergen, D. Dzenkowski other otograph Addendum_ ,Addre~ 780 Deep Hole Drive b~at tituck County Suffolk Zip Code 11952 Le~der/Cli~lEstate of Mary Eginton Len~ersAddress 69 ~erican Ave., Cor~, ~ 11727 Ap~a~se~Phyllis Atkinson, ~SB~ Appra~se~sA~ress PO Box 63, ~ttituck, ~ 11952 Subject Front Subject Rear Subject Street Address 780 Deep Hole Drive Mattituck County Suffolk NY Zip Code 11952 Lendei/Client~,state of Mary Eginton Lendel'sAddress 69 American Ave,, Coram, NY 11727 Phyllis Atkinson, NYSRERA Appmis~sAdd~ess PO BOX 63, Mattituck, NY 11952 Subject Dock & Waterview OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cot. 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 Date: November 13, 2012 Re: Proposed Wetland Permit for SUSAN BURKE SCTM# 1000-115-12-11 SUSAN BURKE requests an Administrative Permit to replace the screens with windows to enclose the screened-in porch; repair/replace 2nd story deck and railings with new composite wood; repair/replace outside rear deck, railings and stairs with composite wood; replacing foundation under pomh. Located: 780 Deep Hole Drive, Mattituck. SCTM# 115-12-11 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 Hail Annex 54375 Main Road P.O. Box 1179 $outhold, New York 11971-0959 Telephone (631) 765-1692 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only dw OaStal Erosion Permit Application etland Permit Application Administrative Permit Amendment/Trans fe[!Ex~on Received Application~ Received Fee:S_ _~L)' D*D ~ ~ ~, ~Completed Application~Z~ __Incomplete ~ __SEQRA Classification: Type I Type II Unlisted .~oordination:(date sent) / / ~/LWRP Consistency Assessment Form ~ t -/ i ~- CAC Referral Sent: __Date of Inspection: Receipt of CAC Report: Lead Agency Determination: p echnical Review: / / ublic Hearing Held: [I !lc{ [}~ Resolution: _ .' t NOV -7 2012 Suffolk County Tax Map Number: 1000 - Property Location: -~ ~r_.) '~ee ~ (provide LILCO Pole it, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning:. ~'x Ov Previous use of property: Intended use of property: Covenants and Restrictions on property?. If"Yes", please provide a copy. Yes ~No Will this project require a Building Permit as per Town Code? ~/ Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required· / Does this project require a variance from the Zoning Board of Appeals? __Yes V/ No If "Yes", please provide copy of decision· Will this project requir,cany demolition as per Town Code or as determined by the Building Dept.? Yes v~ No Does the structure (s) on property have a valid Certificate of Occupancy? v/Yes No Prior permits/approvals for site improvements: Agency Date ~/No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?. __ If yes, provide explanation: No Yes Project Description (use attachments if necessary): 5~ t3/~¢v,v_e~eJ, t'~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ke.~, k~¢o- ~eo_~,'~a c] - ~eao[~¢~, ~ac) Area of wetlands on lot: 0t~ .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? t,J 0 ~ ~-~ 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 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME County SEQR 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominen landmarks etc - or provide map 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: 9. W T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~Residenbal r-~lndustrial E~]Commercial I~lAgriculture r'--l Park / Forest / Open Space r~other(describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federa), State or Local) [~Yes I~qo If yes, list agency name and permit / approval: 11, [Jut::5 ANY - CIJRRENTLY VALID PERMIT OR APPROVAL? E~]Yes L~No If yes, list agency name and permit / approval: 12. AS ARE~ESJS'LLT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Signature Spons~e~ ~'~ '~' ~~. ] Dat,7/: 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 tTo be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, com'diflate the review process and use the FULL EAF. I-I Ye.s 171"o WILL ~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be supemeded by another invol~ed agency. 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, pullout;a; for erosion, drainage or flooding problems? Explain briefly: I / C2. !esthetic, agdcoltural, archaeological, historic, or other natural o~ cultural resOUrce~'i"'e~ community or neighb.,,, hcod character? Explain bdetiy: i C3. Vegetation or fauna, fish, shelffish or wild ire sbec~es, significant habitats, or threatened or endangered species? Explain bde6y: I I C4. J commun tys existing plans or goals as offic~a,y adopted. ...... ora change 'in uso or 'mtensily of use of land or other natural resources? Explain bdefly* C5. !row~h, subsequent development, o;' mieted activities likely to be indu'ce(~'"b~' the proposed action? Explai~ b~efly: C6. Long tern1, shorl terml cumulative l or other effects not identified i~ C1 ~C57 Explai~ bd~': I I I ...... - ~ X, i~ bdeft 07. Other impacts ncludn~lchan~les n use of either quanflt~/ or t~/pe of ener~/. E pa D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? Ill '/'es, ex,)lain briefl't': [~Yes r'~No E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTFkL ADVERSE ENVIRONMENTAL IMPACTS? If yes eYhclain: I--I es [Z]N° I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~dete~minewhethe~itissubslentia~a~ge~imp~rtant~r~the~visesigniticanL Each effect should be assessed in connection with its (a) setting (i.e. ud~an or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (0 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 sig nifican ce must evaluate the potential impact of the p ropesed action on the environmental characteristics of the CEA. Check this box if you have Identl~ed one or more potentiafiy ta~ge or significant adverse impacts which MAY ocour- Then proceed directly fo the FULl FAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting dm:urnentsflon, that the pmpssod ac~i~ WILL NOT resu6 in any $1g~icant adverse environmental impacts AND provide, on attachments as necessary, the masons supporting thi: detenaination. Board of Trustees Name of Lead Agency Pdnt or Type Name of Responsible Officer in Lea~J Agency Si~atum of Res~nsible Offi~r le Lead Ago~ Date President [] 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.TAI.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORI~WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN Dlst~t Scoff. s~c~ cot CERTIFIED BY A DESIGN PROFESSIONAl. IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION 1'1'1~I#/WORKASSESSMENT I Yes No a. What is the Total Ama o~ the Project Parcels? 1 Will this Project Retain All Ston'n-Water Run-Off (include Total Arco of all Parcels located within Generated by a Two (2') Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This item will include all run-off oreatad by site r~ b. What is the Total Ama of Laed Cleadng (s.F.t Aa~) cleating andlor construction activities as well as all aud/or Gmuud Disturbance for the proposed Site Improvements and the permanent creation of construction activin? impen/ious surfaces.) (s.F.,~.) 2 Does the Sita Plan er~d/or Survey Show AIl Proposed PRO~J]~E BP. ZF_,F PROJ'ff. CT D]ESC~-J])T[ON ~ ~ P~ -~='} Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and ~'~:~u~- ~!,~c',o~I ~?-~[~'T0~y' ~oo~ 3 DocotheSitoPlanand/orSun, eydescdbetheeroslon r~ and sediment control practices that will be used to control site erosh3n and storm water discharges. This ~...~..~J¢ ~,l[l'~J~.~ L.uF~¢~.-7.-~:)~-'.P.t'*k~ item must pe maintained throughout the Entiro Construction Period. oo-r~'~ ?,z~ ~w~;o~')~loo~e. ~u/i'~e~' 4 Will this Pmject Requira any Land Filling, Gradingor · Excavation where them is a change to the Natural ~ 8 ~r~)~-t['~l~ ~0Or0~/o}O I~tOC~i~ ~'-~UC"~'~ Existing Grade lnvolving more than 20O Cubic YardsI--I -- · of Matedal within any Pamel? ~. ~2-~ v~-rI 1o~ '~oo tiff- ~-'~0_¢.~ l~ch,,~.. ~-.)~ot~ s Will this Application Require Land Disturbing Activities / Encompassing Area in Excess of Fhte Thousand Ii (5,000 S.F.) Square Feet of Ground Surface?I--I -- 6Is there a Natural Water Course Running through the Site? Is this Project within the Trustcos judsdicben General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or~ -- Submission of a SWPPP is required th~ a~ Construction eofivities involving sail Beach? disturbances of one (I) or more acres; including disturbances of less than one ac~e that 7Will there be Site preparation on Existing Grade Slopes am pad of a larger commo~ p~an that will ultirnateJy dis{u~ one or more a~res of land; which Exceed Fifteen (15) feet of Vertical Rise to ~ i including Construction activities inw3k, iog soil disturbances of less then one (1) acre where One Hundred (100') of Hodzontal Distance?L=~J -- the DEC has determined that a SPDES permit is required for storm water discharge~. ' SWPPP's Shall n~-~et the Mthlmum Requirements ef the SPDES Oeneral Permil 8 Wi~ll Driveways, Parking Areas or other Impervious r~l for sform water Discharges from coaofruofion activity. Permit Ne. GP.~-I 0~01.) Surfaces be Sloped fo Direct Sform-Water Run-Off 1. The SWPPP shell be ptbeared I:~or to the submittal of the NOL ~ NOI shall be into and/or in the direction of a Town right-of-way?~L~ -- submitted to the DepaPcnent prior to the commencement of construction activity. 2. The SWPPP shall describe the emalon and sedla:eof coofml pmctfces and where 9 Wild this Project Require the Placement of Matadal, required, post~or~trucaon sto~m water management prac~ces that will be used and/or Removal of Vegetation and/or the Construction of any ~ i coast~cted to reduce the polbthnto in storm water dischacges and to assure item Within the Town Right-of-Way or Reed ShoulderL~ identEy potential sources of pollution which may reasonably be expected to affect the compo~t shall be prepared by a qualified Design professior~al Ucensed io New York a Storm-Water, Grading, Drstnage & Erosion Controf Plan la Required by the lr~ of coum'~ oF~l&~.~.[ ................ ss And that he/she is the .......................................................... .{~...[2..)....Q..~ ................................................................ 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 true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~da in the application fded herewith. Sworn to before me this; FORM-06/IO Boa~of Trustees Application County of Suffolk State of New York ~ ~2..~ O,_W~, t~ Zx c-~. 0.~ 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 IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THIS "2 DAY OF AJ ~ v ,20 Notary Public Notary Public, State e,f New Yor~ - No. 01T0619,~596 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) (print owner o'f~pr,operty) residing at (mailing ad~lress) do hereby authoi'ize (Agent) to apply f°r permit(s) from the Southold Board of Town Trustees o~ehal~,, ·/~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the hart of town officem and emolovees. The nuroose of this form is to orovide information which can alert t~ town of ~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first anme,~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 ali 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 'WES", 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 applicanffagenffrepresentative) 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) thc owner of greater than 5% of the shares of the corporate stock of the applic0ut (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entit~ (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 Submitted~is Signature Print Name ·, 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- suooortin~ 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. ~ [~ ~,~,' i}~ ~i ',~ ~ ,. i:~ B. DESCRIPTION OF SITE AND PROPOSED ACTION The Application has been submitted to (check appropriate response): Town Board ~ Planning Board [~--] Building Dept. [--] Board ofTrustees [~ 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) Nature (c) Permit, approval, license, certification: and extent of action: Location of action: ~ ~-~9 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 (b~ (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 throu~gh 21 for evaluation criteria [] Yes [] No~t~ 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 m - 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. Yes~ 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 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 [-0~/Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ~-] Yes [] No ~ Not Applicable PREPARED BY ~~~ TITLE DATE Z S 87'19'20" E 76 3' 877' N 87°19'20'' W WILLIAM N. NIEDORODA & lfATHRYN NIEDORODA 2 STORY FRAME HOUSE 2.5'S. SHED PAUL J. CONNoR CONSTANCE A. CONNOR APPROVED dY ~:)ARD OF TRUSTEES TOWN OF SOUTHOLD DATE SUF'FOLK AVb NU 0 9'S C) 192.76' OF YEWS ~RA~- CAR PORT FOUND 89:80 PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE LI.ALS AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND ~W~Sg~/-- ~ N.Y.S, Lic. No. 50467 SURVEY OF PROPERTY SITUA TED A T MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-115-12-11 SCALE t"=20' JUNE 28, 2012 AREA = 9,594 sq. ff. (TO TiE LINES 0.220 OC. & BULKHEAD) 0 NOV - 7 2012 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION, CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. Nathan Taft Corwin III Land Surveyor Successor To: Stanley J Isoksen, Jr. L.S, Joseph A. Ingegno L.S, title Surveys -- Subdivisions -- PHONE (631)727-2090 OFFICES LOCATED AT 1586 Main Rood Jamesport, New York 11947 Site Plans -- Construction Loyout Fox (651)727 1727 MAILING ADDRESS P.O. Box 16 Jomesport, New York 11947 32-128