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Home My WebLink AboutTR-7901A 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 November 14, 2012 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Emanuel Moraitis 40 The Strand East Marion, NY 11939 RE: EMANUEL MORAITIS 4965 THE LONG WAY, EAST MARION SCTM# 21-5-9 Dear Mr. Moraitis: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, November 14, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit #7901A to include the removal/cutting down of one dead cherry tree; and as depicted on the revised project plan prepared by Emanuel Moraitis, received on October 9, 2012 and stamped approved on November 14, 2012. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. James F. King President, Board of Trustees JFK:amn ,lames F. Krug. President [lob Ghosio, Jr, Vice-Prcsidcnl Dave Bergen Michael ,1. Domino PO Box 1179 Southold, NY 11971 Telephone (631 765- I §92 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ///~/)~.-~ EMANUEL MORAITIS requests an Administrative Amendment to Administrative Permit #7901A to remove or cut down one dead cherry tree. Located: 40 The Strand, East Marion. SCTM# 21-5-9 sOf area to be impacted: Itwater Wetland Freshwater Wetland Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other T,T,T~Ae of Application: Wetland Coastal Erosion dministrative__Emergency --Pre-Submission __ Info needed: Sound __Bay Amendment Violation Modifications: Conditions: P?,,s~ent Were: J. King B. Ghosio __ J. Bredemeyer. Michael Domino F ° r m fill ed~c~ut ~,~h.,~_ ,~/~-'t Mailed/Faxed to: Date: D. Bergen, D. Dzenkowski other 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 1st day of construction ~ 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.: 7901A Date of Receipt of Application: August 29, 2012 Applicant: Emanuel Moraitis SCTM#: 21-5-9 Project Location: 40 The Strand, East Marion Date of Resolution/Issuance: September 19, 2012 Date of Expiration: September 19, 2014 Reviewed by: Board of Trustees Project Description: To re-vegetate the disturbed/cleared areas from the top of the bluff landward. 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 site plan prepared by Creative Environmental Design, last dated on August 29, 2012, and stamped approved on September 19, 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 John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated 7J/2q/]2-- , / has been reviewed by this Board at the regular meeting of ~//~/I ~- and your application has been approved pending the complefior~ of'the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ Ist Day of Construction ($50.00) __ ½ Constructed ($50.00) Y Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees am 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: BY: James F. King, President Board of Trustees .lames F King. President Bob Ghosio. Jr. Viee-Presidenl Dave Bergen .Iohn Bredemeyer Michael .I. Domino PO Box 1179 Southold. NY 11971 Telephone (631 765-1892 Fax (63 I) 765-6641 Date/Time: Southold Town Board of Trustees Field Insl~ection/Worksession Report Creative Environmental Design on behalf of EMANUEL MORAITIS requests an Administrative Permit for the re-vegetation of the disturbed/cleared areas from the top of the bluff landward. Located: 40 The Strand, East Marion. SCTM# 21-5-9 T~f area to be impacted: __Saltwater Wetland Freshwater Wetland __Sound Bay Distance of proposed work to edge of wetland ,.~Chaf Town Code proposed work falls under: pt.275 Chapt. 111 other T~,~Ad of Application: Wetland __Coastal Erosion __Amendment ministrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: ~J. King B. Ghosio ~ ~ J. Bredemeyer ~ Michael Domino D. Bergen, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Tew~ot Southeid THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS PLACE OF OCCURRENCE I PCT .~,.~ ,,,z~ ~t~ ~4z,~~ ,-, ~ .,~o~o. ~ I :MANLH-~L M ~ RA1TIS \POLLO RE~\LT~ CO 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 " OCt -9 2012 APPLICATION FOR AN AMENDMENT TO A WETLAND I'EICMIT OWNER ~q'~ r~ ¢4~% ~%\ ~ k'k('M~- k I PHONE ADDRESS AGENT PHONE ADDRESS PROPERTY LOCATION TAX MAP NO. %~ "f~ request an Amendment to Permit 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 , ; Date: September 19, 2012 Re~ Wetland Permit for EMANUEL MORAITIS SCTM# 21-5-9 Creative Environmental Design on behalf of EMANUEL MORAITIS requests an Administrative Permit for the re-vegetation of the disturbed/cleared areas from the top of the bluff landward. Located: 40 The Strand, East Marion. SCTM# 21-5-9 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 b/ Administrative Permit / Amendmentfl'rans fer/Bxtcnsion eceived Application: ~x~_~_ v/Received Fee:$ ]/~. ~{~ ,' i ~/Completed Application ~ 1 2tl I1% Incomplete ~ I " __SEQRA Classification: Type I Type I1 Unlisted ~LOordination:(date sent) WRP Consistency Assessment Form .~. . tn 7')1 ~7.~ Referral Sent: I¥]ff __Date of Inspection: __Receipt of CAC Report: __Lead Agency Determination:__ ~Teclmical Review: Public Hearing Held: 1~]1~ I1~__ Resolution: ' I" ~' AUG 2 9 2012 Name of Applicant ~ [V~_x_~IL~\ ~f'kP ~ ~'~ Address qO '"~-~ ~:3JrC4,dXck..1 ~&,.%'~ tv'ktg-4"~?n f~-k/ Phone Number:(~l) ~ 7 7 -- ~_~ i 4~) Suffolk County Tax Map Numbcr: 1000- ~)f~[ ~ ~ '~ Property Location: Z.J~, '~v~- zO ~'C~-t~& , .~JvL (provide LILCO Pole #, distknce to cross streets~ and location)d ! : ce~t: 917-,5~3- 02r,~ AGENT: (If applicable) Address: · --,,-,~,,~ ,-~,, v~m~m~mUd Design PO Box 160 Peconic, NY 11958 Phone: GENERAL DATA Land Area (in square feet): 5/~/, btSO Area Zoning: .~. -~ ~:~ ~ Previous use of property: ~ -~ Intended use of property: {)~ - %~) Covenants and Restrictions: /Yes 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 ~ No Does the structure (s) on property have a valid Certificate of Occupancy /.~"'~Yes Prior permits/approvals for site improvements: Agency Date ~O No __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend~aUby a governmental agency? t/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): Boar~of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: _square feet D % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest 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? /V/lk proposed structure and upland ~/f% cubic yards cubic yards 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: 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): 617,20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART~- PI[eJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR 2. PROJECT NAME 3 PROJECT LOCATION' ~ ~1 _ ~7 ~ Municipality ~.,,~ J~ ~ ~ ~ 4. PRECISE LOCATION: S~eet Addess and Road Intersecaons, Prominent landmarks etc - or provide map SEQR 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially ~'"-~cres ; ~'~ Ultimately ~-'/~"~ ,~. acres , I ~ 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~es [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~-I~dentia' E~ ,ndustba, [~ Commercial [~Agbculture [~ Park, Forest, Open Space ]Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fe~dera~tate or Local) E]Yes L__~lgqe If yes, list agency name and permit / approval; 11.UOE$ A ACTION ~FAVE a CURREN'TL¥ VALID PERMIT OR APPROVAL? ]Yes ~ If yes, list name and permit / agency approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUrRE MODIFICATION? I__...CERTIFY THAT THE INF~F-f~ED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor me Date: Signature ~ If the a~tion i~a ~stal A~r, and you are a state agency, complete the Coastal Assessme~6fl'l-f~rm before proceeding with this assessment PART II - IMPACT ASSESSMENT [To be completed by Lead A~lency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 if yes, con~linale the review process and use the FULL EAF. Y .s [71.o WILL ~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be supemedad by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answem may be haodwritten, if legible) C1. Exleting air quality, surface or groundwater quality or quanffiy, noise levels, existing traffic pattern, solid waste production or disposal, potential for emslen, drainage or flooding problems? Explain bdefly: C2. Aesthetic, agricultural archaeologioa{, historic, or other natural or cultura( resources; or ~ommunlty or neighbochood character? Explain bdefly: I C3. Vegetation or fauna, fish, shell~sh or wildlife species, slgnlficent habitats, or throalened or endangered species? Explain briefly: C4. A community's existing plans or goals as offmially adopted, or a c~ange in use or intensity et use of land or other natura{ resources? Explain bdefly: C5. G{owth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdefly: O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTA6LISHMENT OF A CRITICAL ENVIRONMENTAL ARFJ~ tCEAI? [] Yes [] NO I I~f ~'e$, explain briefly: I E. IS THERE, OR IS THERE UKELY TO BEt CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex{olaln: PART III - DETER~IINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUC'llONS: For each adverse effect identified above, determine whether it is substantial, targe, important or otherwise signifidanL Each effect should be assessed in connection with its ia) setting (i.e. urban or renal); (b) probability of oceurfing; (c) duration; id) irreversi~ility; (e) geographic scope; and (0 magnitude. If necessary, add attachments or reference supporting rotter'mis. 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 eveluate the potential impact of the proposed action on the · nvironmental characteristics of the CEA. Checl( this box if yon have identifiad ene or more potentially lerge or signfiioant adveme impocts which ittAy ocsur. Then proceed ~-a'ectiy to the F UL EAF and/or prepare a positive deolamlion. Check this box Jf¥°u have deten~Insd, based on ~e information and analysis above and any suppo~lidg documentation, that the proposed actio WILL NOT result in any significant adverse environmental Impacts AND provide, on attachments as necessa[y, the masons supporting thi deten~inatien. Board of Trustees Name of Lead Agency Prinl or Type Name of Responsible Officer in Lead Agency na~tem of Respoesible Officer in Lead/Ag~ency Date President Title of Responsible Officer Signature of Preparer (If diffemnf 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 )~ ~ I ~'~ ~ STOIW-WATER~ GRADING~ DRAINAGE AND EROSION CONTROL PLAN Di~blot SeCtton BlOCk lot CERTIFIED BY A DESIGN PROFESSIONAl. IN THE STATE OF NEW YORK. SCOPE OFWORK - PROPOSED CONSTRUL,'t'ION ITEM # / WORK. ASSESSMENT J Y~ No a. What is the Total Ama el the Project Parcels? (Inctude T°tel Area °f all Parcals lecated within ~*{~ I Will this Pr°Ject Retain All Sterm'Water Run'Off Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This item will include all run-off created by see b. What is the Total Area of Land Clearing ciearthg andlor construction acUvitJes as well as ail and/or Ground Disturbance for the proposed ~'-71~1~,,,~ :~ ,-.~'I Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F.,^ms) 2 Does the Site P,an and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCI*,IFT[ON (Pro-~d,,~dia,..~ pages as t~le~ed) Drainage Structures Indicating Size & Location? This Item shall include all Proposeq Grade Changes and ~r~_._~.q~.~ ~r~ t~.~2 C~ ~ ~.~1 l.~ ~3~.~_~.' Slopes Controlling Surface Water Flow. ~'£r-~'.L,"',~ L~\-~4,~,~ '"'~'t.~,,,.~r~- ~L.t~,T~ 3 Does the Site Plan andlor Survey descdpe the erosion and sediment control prac§cas that will be used to V control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Peded. 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 of Matedal 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 Runnrng through the 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 Constmctien activities involving soil Beach? distotbances of one (t) or more acres; including distu~ances of less than erin acm that 7 Will there be Site preparation on Existing Grade Slopes am part of a larger common pien that will ultimately disturb one or more acres of land; which Exceed Fiffeen (15) feet of Vertical Rise to ira;Iud/ag C°nstmctien activities inv°~ving s°il distur~aances °f less than °ne (1) acre wh~re One Hundred (100') of Horizontal Distance? -- the DEC has determined thai a SPDES permit is required for storm water discharges. SWPPP'I Shall meet the Minimum Requirements of the SPDES General Permit 8 W/il Driveways. Parking Areas or other Impervious ~'~ for Storm Water Discharges from Co~3structlon activity - PermR No. GP-O.10-001 .) Surfaces be Sloped to Direct Storm-Water Run-Off 1. The SWPPP shall be prepared prior fo Ihe submittal of the NOI. Tim NOI shall be into and/or in the direction of a Town right-of-way? -- required, post~onstmctJon sfoml water management practices that will be used and/or Removal of Vegetetion and/or the Construction of any"----I I constructed to reduce the p<llistants is storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder STATE OF NEW YORK, Notary Public, State of New York COUNTY OF ........................................... SS No. 01BU6185050 ~'""~., , - Qualified in Suffolk County.)4D/~ That l ..~.[~.....of~.~aj~.b~..'.'.Q.~..c~¥.t~...C....~.: ......... being duly sworn, depoCs°esma~m~'~[°y~ ~t~[~h~jl~.a2ppli.~t for Permit, And that he/she is the ................................... .C..~.i..~..q,,~;.:~;~........co,~,~i.d,.~..,~,.~.~i.~.~..~....:: ........................ Owner and/or representative of the Owner or Owners, and is duly authorized to perfom~ 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. Swom~ '~t° before me this;~/I f~,~~~ ~ '~. hlic: ............................... FORM - 06/10 ~- ' Boa~oE T~ustees ~ppl~cation 0 County of Suffolk State of New York '~_J,/~/ ~---"~O(d) i'6~---~ 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 ~~ON. ~ Sign~r~--~ SWORN TO BEFORE ME THIS DAY OF '~(~bv.z~ ,20~ 3- Notary Public CONNIE D. BUNCH Nota~ Public, State of New York No. 01 BU6185050 Qualified in Suffolk County Commission Expires April 14, AUTHORIZATION (where the applicant is not the owner) I, ~rn,qmod4. YY]o,~A~Tt',-% residingat (print owner of property) (mailing address) / ~,~ Ctc~,~ to apply for pe~it(s) ~om the Creative Environmental Design PO Box 160 (Agent) Peeonic, NY 11958 Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Soothold's Code of Ethics prohibits conflicts of interest on the tort of town officers and cmnlovees. Thc ouroose of this form is to erovide information which can alert the town of uossible conflicts of interest and allow it to take whatever action is necessary to avoid same. CFeative Environmental Design YOUR NAME: _PO Box 160 (Last name, fl~li~ll~ri~l~,.~lileis 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 "0ther", 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, nlarriage, 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.%.~hares. 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 o£ that person Describe the relationship between yourself (the applicanl/agenffrepresentative) 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 applic0nt (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, par~er, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 S ubmi.e~s~l~a~ Signatur~ Print Name~~ Town of Southold INSTRUCTIONS 1. LWRP CONSISTENCY ASSESSMENT FORM ~ i 2 9 2012 All applicants for permits* including Town of Southold agencies, shall ~bmp~:: ~flfis CCAF, for proposed actions that are subject to the Town of Southold Waterfr0nt-C6nsi~f~n~-?Remz~TE~i~. 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- sunnortin~, 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# PROJECT NAME 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) n n (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage:. ! Present land use: ~ -- Present zoning classification: 0~~ If an application for the proposed action has been filed with the Town of Southold agency, the following (a) Name of applicant: (b) Mailing address: information shall be provided: (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [-~ No [~ If yes, which state or federal agency?. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED 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 [-~ 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 Southoid. 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 Sectio/~[II - 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 - Polices Pages 16 through 21 for evaluation criteria I L,z 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 Applic~ Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 3/Ythrough 34 for evaluation criteria. I~ 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. ~No [-~ Ye~ No t 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~WRP Section III- Policies; Pages 47 through 56 for evaluation criteria. ~] Yes [] Nor~q/iL/Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic E~Yes and Town waters. See.LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] 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 forevalua/fion criteria. [] Yes ~ NoI--]JN~gNot Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP S~~I - Policies; Pages 65 through 68 for evaluation criteria. No ~ Not Applicable PREPARED BY ~"~a.gg- C-~L~e. OXL~LO~L'7..~ Creafi ve En,,ironmental De,~ign PO Box 160 Peconic, NY 11958 TITLE DATE TITLE NO. G3.'~¢45S L.M: SURVEY '- 'vIEW: SURVEY _- ,¢.,,o:,.' 0 x" ¢,.,,;¢. %o /--¢ / , eY '%00 . ' L()T 1 ~fi , - 'N LOT ..: . .... ~ 159 45.00' q_//q~,b'x THE :STRAND , Bonacci & Van Weele, P.C. REVISIONS: ~,O0, T,O. TO T.,S C iv iL ENGINE £RS/SURV BYORS/PI~.NNE P~ TION LAW 1?SA Commerc~ Drive, Hauplmuge, NY 1i788 t TEL 631/435-11 Il FAX 631/435-10; LOT 139 BLK. -- '- 4AP OF: PEBBLE BEACH FA?MS SITU~ATED AT: EAST MARION, TOWN OF SOUTHOLD FILED. JUNE 11~ 1975 NO. 6266 CO.SUFFOLK co,.,~s o~- ~s s~vs¥ ~.,~,, CERTIFIED TO: ¢)~x~:~B.~.v.,P.c. V~'(OR'S S~UR* EMANUEL A. &:: VASlLIA MORAITIS CONSign"ED A VALIb lf-tDt CO ASTORIA FEDERAL SAVINGS & LOAN ASSOCIATION JOB NO. A030649 CHICAGO TITLE INSURANCE COMPANY DATE JULY 3, 2003 GUARDIAN LAND ABSTRACT DR, A.V.R. CH. W.J.B. SCALE: 1" = 50' DIST. 1000 SEC, 21 BLK. 5 LO'r 9 LoNe, 19LANP UNP APFP-,OX. FIGH WATER - MAIRK A5 LOCATED T~. o~ ~.u~ 71312003 ON 71312003 i~i", AUG 29 20'2 RE-VEGETATED WITH NATIVE SPECIES PLANTINC, S 100' ~M To¢ OF BLUFF LINE UNDISTURBED VEC4ET, ATION AREA CLEAI~F_.D TO BE P-,E-VEC4ETATED 100' ~,oM TOP OF BLUFF LINE EXISTING PRIVET ON i'i3~RING PP-.OPE~TY ~F_ARBERRY .OW BUSH BL~RY MLLOWLEAF COTONEASTEI~ )WARF DDJTZIA ]4C4.1SH IVY ~4-DP-,E JUNIPEI~ LEUCOTHOE VINCA, MNOR PACHYSAh~ _P.A --PROPERTY LINE SCftC¢ 1OOO-21-5-9 Revision #: Date: 8/29/2012 1"-- 20' Landscape Plan: 8-24-12 Emanuel Moraitis Landscape Design by: DaVid Cichanowicz Creative Environmental Design 100' r~M OF BLURT LINE LONg ISkANO UNP APP~X..~ WA~ ~k ~ow~ o~ou~.o,~ MARK AS LOCATED :'~A'fE ~0E ~ ~ 71312003 OCT -9 201t VEC4ET, ATION E~ISTN; VE~ETAll~I OPEN SPACE AP, EA CLEARF_D TO BE RE-VEC4ETATEP 100' mOM TO~ OF BLLFF LINE EXISTING; PRIVET ON NE]C4~ PROtld4TY -- PROPERTY LINE , AP-,EA TO BE RE-VEGETATED VVITH NATIVE SPECIES PLANTINC_4~ BEARBERRY LOW BUSH BLUEiSE~I~Y W1LLOV~ COTONEASTER DWAt~ DEUTZIA ENGLISH IVY SNORE JUNIPER LEUCOTHOE VINCA, MNO~ PAENYSAI'~ _ 1000-21-5-9 Revision :fl:: Date: 8/28/2012 Scale: 1"-- 20' Landscape Plan: 8-24-12 Emanuel Moraitis Landscape Design by: David Cichanowicz Creative Environmental Design