HomeMy WebLinkAboutTR-7918A .lames F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredem~yer
Michael J. Domino
Town Hall, 53095 Maia 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) 705-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 7918A
Date of Receipt of Application: September 7, 2012
Applicant: Kathleen Milne
SCTM#: 107-9-4
Project Location: 3875 Wickham Avenue, Mattituck
Date of Resolution/Issuance: October 17, 2012
Date of Expiration: October 17, 2014
Reviewed by: Board of Trustees
Project Description: To fill in an area of land to prevent further erosion using
clean fill and topsoil and re-establishing the lawn area.
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 Kathleen Milne, received on September 7, 2012, and
stamped approved on October 17, 2012.
Special Conditions: Fill for creek-side of depression to be at grade, not to
exceed elevation of the bank
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
reviewed by this Board at the regular meeting of
~/7~/! /! has been
7 2-- and
your application has been approved pending the completion ~)f ill~e'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)
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:
BY:
James F. King, President
Board of Trustees
James F Krug. President
Bob Ghosio, .Ir. Vice-Prcsidcm
Dave Bergcll
John Bredeme)cr
Michael J. Domino
PO Box 1179
Somhold, NY 11971
'l¢lephone (631 765-1892
Fax (631 ) 765-6641
DateFrime:
Southold Town Board of Trustees
Field Inspection/Worksession Report
KATHLEEN MILNE requests an Administrative Permit to fill in an area of
land to prevent further erosion using clean fill and topsoil and re-
establishing a lawn area; and requests a Pre-Submission Inspection in
regards to rebuilding the existing dock and retaining wall. Located: 3875
Wickham Avenue, Mattituck. SCTM# 107-9-4
Ty.~q.. of area to be impacted:
Saltwater Wetland Freshwater Wetland
Distance of proposed work to edge of wetland
Part of Town Code proposed work falls under:
'~'Chapt.275 Chapt. 111 other
Sound __Bay
Type of Application: Wetland Coastal Erosion Amendment
· ~'~Administrative__Emergency --Pre-Submission -- Violation
Info needed:
Conditions:
Present Were: ~'/J. King ':JB. Ghosio__
,..,~J. Bredemeyer_ ~'~ Michael Domino
Form filled out in the field by
Mailed/Faxed to:
Date:
~'/D. Bergen,
D. Dzenkowski
other
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
(cot. Main Rd. & Youngs Ave.)
Southold, NY 11971
MAILING ADDRESS:
P.O. Box 1179
Southold, N~ 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: October 16, 2012
Re: Proposed Wetland Permit for KATHLEEN MILNE
SCTM#1000-107-9-4
OCT 1 6 2012 /
KATHLEEN MILNE requests an Administrat ve Permit to fill in an area of land to prevent further
erosion using clean fill and topsoil and re-establishing the lawn area. Located: 3875 Wickham Avenue,
Mattituck. SCTM# 107-9.4
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 action is
CONSISTENT with the Policy Standards and therefore, 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'
10 SEPTI~4BER 2012
't't]K SOu't'uOLD TOT~/N TRUSTEES
MAIN ROAD
SOuTUOLD, NEW YORK
DOCK PEm4IT f NY 5526 AA
& RETAINING WALL
3875 t~IL;~.AM AVENUE
HATTITUCIC, NEW. YORK ==-
· l'lt~ UNDERSIGNED gOULD APPRECIATE YOUR OPINION ON TttI~ CHANCES OF OBTAINING
A PERMIT TO REPAIR AND/OR RESTORE T.p:. EXISTING DOCK AND RETAINING
S IIqCERELY,
KA'J'H LAE/g H[LI~
3875 t,/~(:~LflAH AVENUE
POST Ol~t~.tCE BOX 1707
MATTITUCK, lq~ YORK 11952
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~
ZWetland Permit Application V/ Administrative Permit
Amendment/Transf~rfE~tension
Rece~vved Application:~
xf' Received Fee:$ .~
~-Completed Applicati~'n q. !'7 [I ~.~
Incomplete
SEQRA Classification:
Type I Type II__Unlisted
,~Coordination: (date scat)
LWRP Consistency Assessment Form
CAC Referral Sent:
__Date of Inspection:
__Receipt of CAC Report:
___Lead Agency Determination:
Technical Review: -
/Public
Hearing Held:
Resolution:
Name of Applicant
Address
Suffolk County Tax Map Number: 1000 - IO"l -
Property Location: 3~r'/~
Phone Number:() (_~{3
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Boa~of Trustees Appllcation
Land Area (in square feet):
Area Zoning:
Previous use of property:
GENERAL DATA
Covenants and Restrictions:
If "Yes", please provide copy.
Yes No
Does this project require a variance from the Zoning Board of Appeals __
If "Yes", please provide copy of decision.
Yes ~' No
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 ,)q 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?
'~ No Yes
If yes, provide explanation:
Project Description (use attachments if ~ecessary): ~alA~
Boar~of Trustees Application
Purpose of lhe proposed operations:
WETLAND/TRUSTEE LANDS APPLICATION DATA
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? cubic yards
How much material will be filled? ~>0 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):
Boar¢ of Trustees Applicatlon
COASTAL EROSION APPLICATION DATA
4
Purposes of proposed activity:
Are wetlands present within 100 feet of the proposed activity?
No Yes
Does the project involve excavation or filling?
No ~ Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? ~0 (cubic yards)
Manner in which material will be removed or deposited:
the nature and extent of the environmental impacts to the subje~:p, roperty or
erties reasonably anticipated resulting from ~ta.t. ion of the project as
ion increase or adverse effects o~.a~ral protective features. (Use
· PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
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
3.PROJEC.T _ LQCA.TIO. N:
2. PROJECT NAME
4, PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map
5. IS PROPOSED ACTION: '~ New [] Expansion [] Modification / atteration
6. DESCRIBE PROJECT BRIEFLY:
4
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
[~Yes [] No If no. descdbebdefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
~]Residential []Industrial [~Commercial E~]Agriculture r~ParklForestlOpenSpace [~]Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
~'-]Yes [---]No If yes, list agency name and permit / approval:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~Yes ~]No If yes, list agency name and permit / approval:
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
~Yes ~'~No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE
Applicant / Sponsor Name
Signature
IS TRUE TO THE BEST OF MY KNOWLEDGE
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 lTD be completed by Lead Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, pART 617.47 If yes, coordinate the review process and use the FULL EAF.
r-Iv?
B. WILL ~.CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
decleration may be superseded by another involved agency.
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwdlten, If legible)
C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, e~sting traffic paflem~ solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain bdefly:
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural reseumes: or community or neighbedmnd characle~' Explain bdefiy:
C3. Vegetation or fauna, fish, shellfish or w[4dlife species, significant habitats, or threatened or endangered species? Explain briefly:
I , , .............
C4. A communtly s existing plans or goals as officially adopted or a change in use or intensity of use of land o¢ other natural resources? Explain briefiy
Cfi. Gro~dh. subsequent development, or related activifio~ likely to he induced b~ the p~oposed action? Explain bti~fl¥:
I 1
C6. Long term, short tefra, c~mulafive, of othor effects not identified in CI-Cfi? Explain bdo§y:
C7. Other impacts Iindedin~l chanties in use of either (~uantit), or t}~pe of ener~}~? Explein briefl~/:
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (It yes, explain briefi),:
......... I
E. IS THERE, OR IS THERE LIKELY TO B~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Ifyes ex~leln:
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
IN S'I'RUCTIONS: For each adverse effect identified above, determine wbethe r it is substantial, large, important or otherwise sig nificanL F. ada
effect should be assessed in connecben with its (a) setting (i.e. urban or rural); (b) probability of occunthg; (c) duration; (d) irreversibility; (e)
geographic scope; and (0 magnitude. If necessmy, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that ail relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes, the dete talin etlon of signlficence must evaluata the potenital impact of the prepased actle n on the environmental characteristics of the CEA.
Cheek this box If you I~ve idnstltled ons of mom pe~enfially large or signlfleant adverse Impacts which MAY ocour. Then procoed directiy ta the FUU
FAF and/o*' prepare a positive de.fatten.
Check this box If you have detormined, based on the Information and analysis above and any supporting documentation, that tbe~ actle~
WILL NOT result In any significant adverse environmental Impacts AND pmvlde, on attachments as necessary, the masons supportk~
detormina6o~.
Board of Trustees
Name of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency
S~nature of Responsible Officer i~l~ad Agency
Date
President
Title of Responsible Offiser
Signature of Preparer (If different from responsible officer)
Town of Sout )ld
I : Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LO~ATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN
DIs~ct SeCtion Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT [ Yes No
a. What is tho Total Ama of the Project Parcels? I Will this Project Retain NI Storm-Water Run-Off
(Include Total Ama of all Parcels located within Generated by a Two (2") Inch Rainfall o~ Site?
the Scope of Work for Proposed Construction) (This item will include all run-off created by site F~
b. What is the Total Area of Land Clearing (S.F. / .~) clearing and/or construction activlties as well as all
aed/or Greund Disturbance for the proposed Site Improvements and the permanent creation of
construction activity? imperious surfaces.)
(s.F.,,~) 2Does the Site Plan and/or Survey Show All proposed
PROVH)E BII~' PRO.)[CT DF~CEIFTION (~,~),~ ~, Nee~ Drainage Structures Indicating Size & Location? This r~
item shall include all Proposed Grade Changes and
Slopes Controlling Surface Water Flow.
'~ ti (~f ~4 ~du~ t~'~4,, 3 DoestheSitePlanand/orSurveydescfibetheerosion
C~[D~ ~'~[,~ ~S~'i [, ~ ~' andsedim~tcontrolpracticesthatwillbeusedto
control site erosion and storm water discharges. This
item must be maintained throughout the Entire
Construction Period.
4 Will this Project Require any Land Filling, Grading or
Excavation where there is a change to the Natural ~ [
Existing Grade Involving more than 200 Cubic Yards~ __
of Material within any Parcel?
5 Witl this Application Require Land Disturbing Activities
Encompassing an Area in Excess of Five Thousand '(/0
(5,000 S.F.) Square Feet of Ground Surface?L~J --
6 is there a Natural Water Course Running through tt~
Site? Is this Project within the Trustees jurisdiction
General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or --
disturbances of one (1) or mom acres; inc~ding disturbances of less than one ecru ~hat 7 Will there be Site preparation on E)dsting Grade Slopes
am partofa latgercommon plan thai will ulUmatsly disturb one or more acres ofland; which Exceed Fifteen (15) feet of Vertical Rise to
required, ~ost-constmction storm water management practices ~hat will be used and/or Removal of Vegetation and/or the Construction of any I ~
STATE OF NEW YORK, ~,
COUNTY OF ....~...'~....~..¥..t.~....~... ........... SS
That 1 .. i'~;~i ........... being duly swam, deposes a~d says that re/she s the applicant for Permit,
And that he/she is the
..................... ~ ............ ~.---.--?...~ ......... .&;;~j ................................................................
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 ill this application are t~ue to rite best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed herewith.
Sworn to before me this;
....................... g.;~.-2L~.i.WC~x,,,..,,~T.;~.¥v=- .......................... ,/~r'-~. t',. ./ J~ I,
............ ......................
FORM - 06/10
~619069E
Qualified in Suffolk County ~/
Commission Expires July 28, 20LL.,I~'
Board of Trustees Application
County of Suffolk
State of New York
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
SWORN TO BEFORE ME THIS
Notary Public
VICKI TOTH
Notary Public, State_ of New Yor~
No. 01T06190696
Qua fled in Suffolk County ~1~,
Commission B(pires lu V 28 20 ~.._'?Y
(print owner of
Southold Board of Town
(Owner's signature)
Boar~f Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
residing at.
address)
do
(Agent)
~ermit(s) from the
~ behalfi
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics nrohibits conflicts of interest on the ~ of town 6fficess and emaloveee. The nuroos~ of
this form is to provide information which can aler~ the town of oossible conflicts of internst and allow it to take whatever action is
n to avoid e.
(last name, f~ nam~,x~iddle initial, unless you ar~ applying in thc name of
someone else or other entity such as a company. If so, indicate the other
p~rson's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Building
Trusiee
Coastal Erosion
Mooring
Planning
Variance I~
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(If "Other', name thc activity.)
Do you persoanlly (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
oftbe 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 thc town officer or employee owns mose than 5% oftbe shares.
YES NO ~
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or. position of that person
Describe the relationship between yourself(the applicant/agant/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) thc owner of greater than 5% of thc shares of the corporate stock of the applic0nt
(when the applicant is a corporation);
__.B) thc legal or beneficial owner of any interest in a non-corporate entity (when tho
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
Submittedt thj~.
Signature~tfi~/N
Print Name
200
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
Ao
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. Thns~ each answer must be explained in detail~ listinl~ both supporting and non-
suooorfin~ 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 LWXP 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.
SCTM# t~dO _ {03 _ Oq'
PROJ CT t [ e
DESCRIPTION OF SITE AND PROPOSED ACTION
The Application has been submitted to (check appropriate response):
TownBoard [] Planning Board [-~ Building Dept. [] BoardofTrustees []
Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action:
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) Nameofapplicant: [g~t~3glA. ~)~I'I. IL
(b) Mallingaddress: ~)~t~/~c'~ (]~ I~']~q
(c) Telephone number: Area Code ( )(._(,077 e2'q~-8V]I''2''~'~
(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. Sec 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 Applica~
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 I~d~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.
/
~ Yef-~ 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 ~ NOPSI 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 [~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
N 89°27'42"
46.11',
39.08'
E
o. TE
[ BOAJ OF'rRUSTEES I
!AUTHORIZED ALTERATION OR ADDITION
THIS SURVEY IS A VIOLATION or
SUFFOLK
'-C TAX
SURVEY OF PROPERTY
SITUA T£
MATTITUCK
TOWN OF SOUTHOLD
COUNTY, NEW YORK
No. ] 000- ] 07-09-04
SCALE 1"=30'
7 20i2 ~ MARCH 7, 2000
i'-'~ '~AY 18, 2012 STAKE EAST & WEST PROPERTY LINES
:--z.c: :~ :'~ AREA = 36,188.40 sq. ff.
(TO TIE LINE) 0.831ac.
CERTIFIED TO:
COMMONWEALTH LAND TITLE INSURANCE COMPANY
TITLE No. RH-80001053
SUFFOLK COUNTY NATIONAL BANK
KATHLEEN MILNE
NOTE:
S.C.D.H.S. REFERENCE No. 91-S0-89
PREPARED IN ACCORDANCE WITH THE MINIMUM
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
BY THE L,LAi,S. AND APPROVED AND ADOPTED
FOR SUCH USE BY THE NEW YORK STATE LAND
TITLE ASS 0 C~~O~.N~
~Lic, No. 504(
Nathan Taft Corwin III
Land Surveyor
Successor To: Stanley J. Isaksen, Jr. LS. Joseph A Ingegno L.S
~tle Surveys -- Subdiv~ions -- Site Plans Construction Layout