Loading...
HomeMy WebLinkAboutTR-8229A James F. King, President ~~oF soury0 Town Hall Annex Bob Ghosio, Jr., Vice-President ~0 ~ 54375 Main Road P.O. Box 1179 Dave Bergen ~ T Southold, New York 11971-0959 John Bredemeyer G Q ~ • ~O Telephone (631) 765-1892 Michael J. Domino OIyC~ONTr ~ Fax (631) 765-6641 r• , BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0888C Date: August 14, 2013 THIS CERTIFIES that the installation of 6' high stockade fence along southern propertv line 55' long beginning 3' landwazd of split-rail post at edee of wetlands At 1780 Ole Jule Lane, Mattituck, New York Suffolk County Tax Map # 122-4-5 Conforms to the application for a Trustees Permit heretofore tiled in this office Dated. Mav 24, 2013 pursuant to which Trustees Administrative Permit #8229A Dated June 19, 2013, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of 6' hieh stockade fence alone southern nropertv line 55' lone beginnine 3' landwazd of split-rail post at edee of wetlands. The certificate is issued to STEPHEN FEALY owner of the aforesaid properly. Authorized Signature James F. King, President O~$UFff~(~CO Town HaII, 53095 Main Rd. Bob Ghosio, Jr., Vice-President ~ P.O. Box 1179 Dave Bergen ~ ~ Southold, NY 11971 John Bredpneyer Oy Telephone (631) 765-1892 Michael J. Domino ~4j * Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: fdLr / J /3 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 15t day of construction ' 2 constructed ~roject complete, compliance inspection. INSPECTED BY: I~/1JC~ COMMENTS: C v N FD te,vr s -r-~ P.F/z~ / T CERTIFICATE OF COMPLIANCE: Q , James F. King, President ~Og~fFO(,rc Town Hall, 53095 Main Rd. Bob Ghosio, Jc, Vice-President ~~O ~Gy P.O. Box 1179 Dave Bergen ~ Southold, N1' 11971 w John Bredemeyer ~y,~ Telephone (631) 765-1892 Michael J. Domino 1 ~ 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 151 day of constnJCtion Y: constructed Project complete, compliance inspection James F. King, President • ~OF SOU,, • Town Hall Annex Bob Ghosio, Jr., Vice-President ~ y~ 54375 Main Road l0 P.O. Box 1179 Dave Bergen ~ ~ Southold, New York 11971-0959 John Bredemeyer Michael J. Domino ~ ~ p Telephone (631) 765-1892 ~yCOU~'~,~a~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8229A Date of Receipt of Application: May 24, 2013 Applicant: Stephen Fealy SCTM#: 122-4-5 Project Location: 1780 Ole Jule Lane, Mattituck Date of Resolution/Issuance: June 19, 2013 Date of Expiration: June 19, 2015 Reviewed by: Board of Trustees Project Description: To install a 6' high stockade fence along southern property line with the condition that the fence be 55' long beginning 3' landward of split-rail post at edge of wetlands. 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 Stephen Fealy, received on May 24, 2013, and stamped approved on June 19, 2013. Special Conditions: Proposed fence is to be 55' long beginning 3' landward of split-rail post at edge of wetlands. 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 t_ t f ' mt, :i f Y ~ r_ _ ' ? J. _'Ir.. F~ -e - -h..: ti. ~Y s ~ . _ i ;e, ~ ~ .r ~ .irk i~ ` ` ~ _ ' $ ~ rr ~ r r $ •I,~. _ • ~ ~ ~ ter ,h ~ rY ~ ~ ~ ~ ; ; ~ ~ ~ : H.~(~ a° f-, 1-ti ~ -`m - 7~ 1'r; ~ ~'i i' ~ ~ rt ~ i' 'S~y-"~ q~:~~ ~ i M~ y(, ;lam i - rki!Y~ ~ .l ~ Irv ~r;'" ` 1TC r, p .f•. r~ j _ ~ ~ 'Y~y'' L u a~ k ~1 F' :T.T ~_i,:- * ~ ~ t~~ y~; r '°1 QR., y`.~,r y.a'; ~ s .«-or ~ ~ ~_Y` 7. ~ - s a rNr , =~5,4~~ i ~ Kf'~. ~ _p ~ - `i' < ~ ~ ar~p~•`~~a H ~ ~ Ml r ~ } \ ~r,i?! Yt h ~ k~}~~ c~,~n ~ ~ ~"~1~ ( _ ' ] I - v"0}3r~ y.a~.y., ~qy'1, l 4, y.~ ~ ~ •T ~G~IiS' i;')" t ~ ~ ~ V _ ~ ~ , p'++>~ ~ . t. c ) 3 iF ~ _ ~t~,~ >g-,w,~1~ ~ a ~'~'~ay`'~i' ~ -xr 1! v`. - - ~ r 1r.e ~ Y r"•y 1 Y wt~~ r ~~~J 1~ ~ tr!y+ ^?by .yt ~ ^4X c^w -t y~ 1 ~ j(~~Y~~~+I ~ a~'yr 4 ~ nr ~ sy <,.ry>Z yq.° < ~ "'fffFFF L ~ f j~ 1~~`4` y.i a .{,y e: 'r5. 4 f ~ ~jr. X ~ ~ t d ,.etc ,~f ? ~ i ~,`~?M-*. ~ ~ l ~~1, t;. ~ f s9r, o) t ..x^.~; '"~Yi1`,'vgiP~ .1 +.-w. ~ a' < ~ ` ~ 1 ~ ~t ~ .'h' 'tephen Fealy, z ~ . ~ ~ :i~~ ~"`~w, rt '~ti .s r'` ~ _ h t y 1 ~ ~r ` R r p. 1780 Ole Jule Lane, Mattituck F~ ~ a+i, , ~f~L~,~~~~ ~ , "'i, _ ! Y' ~Yf~y C?M# 122-4 ~ t~,;• ~ ` ~ '7 ~5 0 1 b r} H t X. ~ 'G'am., 1 Y ~ ~ f ~ ~ - ~ , - ~ r ~ ` - -~4 ~i1 a , ~ +l ~`,?,f'j~~ V;)r~'bc4~ 'J~ ~~"~,~'t ~1 ~,-ti~~~. ~ aw ~A5 ~ M~. $ ~ * ~ ,i.+..~'-:`' .i~' F- ,w i- s f^T.t)f8 ~ .tiy' Y fl?T ~ M,, rrli ~ 1 : l ~ ~rF~ ~ ' ~ y ~ ~ ~ ! ` - _ +e-~~ '?$1~~;~~h7~?f :.~'!i!~~ l-3'~Ta~~ ~ . Y 4~. . i .~~':'T~tMR ~4Cy~lt~ Fr: -+r .b'rp. Y' +F~. "".ir~4y~~~~. ,y~~ v+, ,lug// ,bry SUFFO~~. James P. Kind. President r0~ C P.O. Box 1179 Bob Ghosio, .Ir.. Vice-President ~jZ ~d Southold, NY 11971 Dave Bergen ~ ~ Telephone (631 765-1892 ,lohn Bredemeyer ,y T Pax (631) 765-6641 Michael 1 Domino ~ ~ y'1jp1 # ~aor. Southold Town Board of Trustees Field Inspection/Work Session Report i~,'y s Date/Time: STEPHEN FEALY requests an Administrative Permit to install a 6' high stockade fence along southern property line. Located: 1780 Ole Jule Lane, Mattituck. SCTM# 122-4-5 Type of area to be impacted ~A~,~-1 ~a~2E'rr~ -Saltwater Wetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 _Chapt. 111 -other Typ of Application: Wetland -Coastal Erosion -Amendment ~ministrative_EmergencyPre-Submission Violation Info needed: i Modifications: iL19/CF j~l-`NCB .~;5 ST~/t Ti L~.~~i~~~~n ~F ~SPc}yT~.S+~G_ J°os'Tr~T /J~/~ D7` L.~F_ rLc3~D~ Conditions: Presegt Were: ''~J. King B. Ghosio D. Bergen, J. Bredemeyer ~tVlichael Domino D. Dzenkowski other Form filled out in the field by l:i~ ~ Mailed/Faxed to: Date: • ~~~o Y% ~y1 'A w t r~ ~ 9 'W~~ 1' - ~ ! ,L y~ t ` , 4,.v,, A y t ti4 ~ ,p.. t i ~ ~ ty ~ ~ a : ~k 1.. ~ ~ ~ 'X: w~ " tom.. ~ ~~~rfy,~ k ~Y ~ ~ { _ e ~ ~ s ` °d t _w'` 'Yi-~ a$iCnr •n' ~ 'z''"f,- se? ~ - 1~ 1 V ~ . as ~t t'~„} ~ *W y, - r r ' ~ ' ` ~ -•e, ' ~ ~ ~ ~ tw t ~ 'r ~ k ~ ^ vA 5 ~ ~'M ~ .s .y ~ 'mac.«. ~ , _F 1, a a - ,~f. .y,~,.• "-H 'F' ter ~~},~•~M .y'3xti„s } ~ _ r = ~ 4 d r ~w ~ q .,M• ~ *vr ~ ~u J a ~ a_. :t- 'F~ ~ y, 4 ~ +~s ~ ~ +n ~ ~ ...E adF. . _ +.ti . t t ~ ~ ~ t ~ ~v F ~ J~ ~ - ~ ~ ,ds R. -~~c ' _ y„'u;- L .6, um,.~ ~'dr^ =~'„*qs hfy} 'Fa~:° ~ ~_.5 ,~~0?ri~-^,~, k ~r&~~~~~~ r~f~ 3, c ,'.rt L f ! Y,,. ~'V-~~'~..? . t ~ ~y `j r~ ~ ~ ~ ~ n~ ~ 'nia•,a '"i.' •s, _ `r ~ v c i~ ~t - a` Yom-. .ff rd ~'.wc' g ~ vF~i.-4 a^~ca+,a Yta, Z-`-, ~ fi ~ ~ ,M~ ~fi~ c ~~~~~i ~ vim' ~~~~°V!" L ~~~-•L~,cs"* g . e~, ..?J dry ~ ~ i y :5. +E r ~ • ~ _S~W~.r.~ ~ l~~'-~ r ~s x, ~r 3g f c4'a,,yfa~ts+~M 'R .-p. „y~,,, Y"y,~Jkv,,''"'~ s ~ 5r~• y ~ •3~~Y•, ~ _ Y ~,~~~~f _,~~}Fy'.~.R~`^ f; 1~a r 3 r'P"_ c ~,:`e ,s.:~ ~~r. 1Hq!" - ~'k ~ tx a ~ ,sy . - r., yu E _ ? ~ r ~s J"~ ~ F~ ,s-#,fIIa' 8 ~ _ a t~ ~'/w" ;4°j ~a:- ~ c S -w:,. 3s ~ 1 `a tit ~ '"wF ` Y ~c ~ _ F$ t.,;XYyf~„n' ~,P7 ~ `w.*.. L ~ x ~ ~ Ilk G 4 yy 94` e-af a~ i rz 1 -Yi. 2 r•~ I 6c rr ~"'~~fu. ~,M ~4 { ~ ,t _l ~ ~ yv~Ni'_ tv:~ s'6 d~/+ esry S - { ~ ~ t .r f~ ti . Y t t~ • , > Y , e ~ r ~ ~ <4~ ~ r x ~ s " v ~ y~ H 5 i~'k~~~ ~.a-~.~ .a3 .:.N _ e...; i„,. ..-_,.f_a. ~ ~+:y~ ~~f, 3h ~ r ; ,r;'~ "'>r pF`,~.; r ~I MAY ~ 4 2013 outfiald Town Tr ees d ~~l c~ ~ a , ~ . Tyra.- s4 ~ - ~i F,f~ 14~ 1 . s. , ~ it + e:y . F f :tom.. w ~ s _ yawn ~ + s :w.- ~ tom-' w~ 4 o- 't'^ ?y. ~ ~ a w r b ~N~ ``~sv t ~ ~ ~ nt ~ ~ . r f K y~ ~ saaV ~u~ t n Qk i s ~ x W ~f ~ ~r ~ y. ltd + ~ ~ t 'p'zy'{,~,~~" ~ ~ - - ~ ,tom £ ~ i + ~ ~ - y'L.~ ' ~ t f}'. r ~ ~ „ ~ T""4 '4. ,.,a~ A, ~ r ; a. rt 5~ tr J ss ~ ~.~wa ~ i ~ 1~ :~o. . ~ e Q ~ ow•o ~ II o~~w. . .m " m~w~ w y ~ 'F - ¢iW ~ ~ f. pw ~ ~ y S ivp ~ Wn np ~ i .u y e } ~ u ovm w •'a, / a~ I II © ~ °~q , q ~ © I, N aam , v y^ ~ Y1 ~~YYI~ i o: ~ ~ ,r ' q ~ a ~ ~ ®'j i~ j ~ i..mm.. ~ q q ~ ~ e aY O / S i 9' a ±g ~ ~ ~ • ~ •qe~ b q S !WO re ~ 9 ~ ~ ~ ~ a s y L ~ / \ u / r l I i i OO \ ~ ii ~ ~ ~o~ q / : ~ ~ a i 9 A ~ I o~ ~ e. F _ ) ~ a u q1~ q q' 9 q tau a,~ { ~ ~ .T q q , a° p ~ -ec°~ ~ ~ uwe J ..a -z--W. ? ~i ~ Y S~~me wiu' - eEE VC. w.u .tY 4r b' qa ~ - ~ _ ~ rgrrw COUNTY OF SUFFOLK © i P' s mwr~ O ~ ~ ReY PmputF TU SSrvm /pncr ~ '.e ~12T~ OFFICE LOCATION: ~~OF SO(/ryO MAILING ADDRESS: Town Hall Annex l0 P.O. Box 1179 54375 State Route 25 # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) H ~ Southold, NY 11971 G, Q Telephone: 631 785-1938 ~ i~ Fax: 631765-3136 ~y00UNT'r,~~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ~ ~ ~ ~ ~ ~ ~ nn~ !J~ JUN 13 20!3 J Southold Ta~,vn To: Jim King, President oar ;?r,~~o_g Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 13, 2013 Re: LWRP Coastal Consistency Review for STEPHEN FEALY SCTM#1000-122-4-5 STEPHEN FEALY requests an Administrative Permit to install a 6' high stockade fence along southern property line. Located: 1780 Ole Jule Lane, Mattituck. SCTM# 122-4-5 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 actions are 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 James F. King, President • ~~F SDUJy .Town Hall Annex Bob Ghosio, Jr., Vice-President ,~0~ 54375 Main Road P.O. Box 1179 Dave Bergen l~t ~ Southold, New York 11971-0959 John Bredemeyer Michael J. Domino ~ ,0 Telephone (631) 765-1892 O~,COU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicatio Wetland Permit Application ~ Administrative Permit Amendment/Transf r/Extension ~eceived Application: J~ 3 D ~ ~ ~ ~ ~ ~ D ?Ijeceived Fee:$ Completed Application S 13 D Incomplete MAY 2 4 2013 _SEQRA Classification: Type IType IIUnlis[ed Coordination:(date sent) uthold Town ~CWRP Consistency Assessment Form S 3 3 r Tr to CAC Referral Sent: ~Da[e of Inspection: (Q Z 1~ Receipt of CAC Report: Lead Agency Determination: ~echnical Review: ? Yublic Hearing Held: 3 Resolution: Name of Applicant j7"E~ M G ^a V • r6~4LZ Mailing Address I ? 8•t7 bt-t Su ~t L. ~ /yJ~9-7~r ITUC C l~~y 11 ci .SZ Phone Number:Q~/) ~ -7 7 Suffolk County Tax Map Number: 1000 - Ill - 5 Property Location: 1 'T c-Y ~ ~Sa t ~ ~ ~ ; !'!•tT7 ~ ~c t Ic ~ l I ~ 5 L (provide LILCO Pole distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Boa~of Trustees Application • GENERAL DATA Land Area (in square feet): ~ q(0 8~ Area Zoning: s„y~~~ F 651 a ~ue~ Previous use of property: ~ Intended use of property: s ~ Covenants and Restrictions on property? Yes ~C No If "Yes", please provide a copy. 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 No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _~No Does the structure (s) on property have a valid Certificate of Occupancy? _~Yes No Prior permits/approvals for site improvements: Agency Date 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): ~i/ ; f~ ~ / y' (-Fig Y,'lDC ~C~Nt~ /~C.J J: ;~~~--.cnda/~~~' ~~~'D ,2ra ~ , Board of Trustees Application • • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:] ~ R I luSigG~ HG7ti1 H~GtF- 57~cK ADE FGUC6 Area of wetlands on lot: J ~O D squaze feet i Percent coverage of lot: ~`J Closest distance between neaz t existing structure and upland edge of wetlands:__~feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the/p'roject involve excavation or filling? V No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? N/~- cubic yards Depth of which material will be removed or deposited: 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): ~/o ur PROJECT ID NUMBER • 6t7'2g • SEAR APPENDIX C STATE ENVIRONMENTAL QUALIN REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME S H N V, F6~Fty SX>GK ttAt FtYN~t 3.PROJECT LOCATION: ~ -7 ~p 6 L/,r j,y L q- Municipality (Yt /-1-)'~ r ?DCC.(c County ~jLt l F6 ~ K 4. PRECISE LOCATION: SVeet Addess and Road Intersections, Prominent landmarks etc - or provide map 17~ OLt 7uL~ LANt>' GRvss RD - NEB St+Fio~/c ~Ju~ /N~FTriT+*c-tt 5. IS PROPOSED ACTION : n New ~ Expansion ~ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: / N9?.9L~ ~r A10dD S7ac fc/HDc. lGwpLt RLdN~ S cGt7'ftBKN P~CaPaszTr L~aC f}®It'iPD1rlM~i 2y i ~'~)i 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ? No I( no, describe brieFly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ~ Industrial Commercial ~Agricuiture ~ Park /Forest /Open Space Other (describe) 10.~DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stale or Local) nlYes ~No If yes, list agency name and permit /approval: l~~'r.IUOES~CN~ASPELTZ3F~THETCT10F7 A~V~A CZ1R-REN Y VTl_ ALID PERMIT OR APPROVAL? Yes iC~No If yes, list agency name and permit /approval: 1f2~. 'lA'S A RESU-LIT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? LJres No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spons ame ~DOt Signature ~~y ~ J If the action is a C tat Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART If -IMPACT ASSESSMENT o be co leted b Lead A eat A GOES ACf1IXJ EXCEED ANY TYPE t THRESHO(D IN 6 NYCRR PART 61T.4T tt yes, coordinate die review process and use dre FULL EAF. Yes Q No 8. VNLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS M 6 NYCRR PART 617.6? If No, a negative dedawlion maybe superseded by anafhw involved agency. - - Yes a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOVNNG: (Answers may be handwritten, if legible) Ci. Existing ak quality, surface w groundwatea quality w quanti{y, ndse levels, ez7sltrlg traffic pattern, sofW waste production er disposal, . potential fw erosion. drainage w floodir>!q problems? Explain briefly: C2. Aestileflq agtlwltwal, ardraeological, histadc, w otlar nalrttal or cultural resbwces; w w charade(1 Explain bdegy: C3. Vegetation w fauna, Fish shellfishor wfldlifespecies, sigrxficanf habitats, or Threatened w endangered species? Explain briefly. C4. A community's exisang plans or goals as officially adopted, or a change in use or intensity of use of land w other natural resources? Explain briefly: C5. Grow[h, subsequent developmenQ or relaletl adivdies bkely to be induced by tfre proposed adios? Explain briefly: C6. long lens, short term, amulafrve, or other effects not idenUhed in Ci-C5~ Explain bnetly. _ C7: Dlhw impacts indudin than es in use of either uanM or l e of ene ? Ex lain bnefl ; - ~ _ _ O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTALCHARACTIFRISTICS THAT CAUSED THE ESTA6LISHMENF OF A CRITICAL ENVIRONMENTAL AREA CEA? If es, in briefl: Q Yes Q No E IS THERE, OR IS THERE LIKELY TO 8 CONTROVERSY REtATFA TO POTENTIAL E ENVIRONMENTAL IMP If Yes Q No PART NI - DETERMINATION OF S1CiNIFICANCE (TO be oompleled by AMY) . kISTRt1CT10NS:. Fareachadversel3ffedkteiitifiedabove.detertninewhefhwifissubpsta~ntiral~,Imge,(rflpartanterothepMsesignifrf~rit Each ett'sd SIIOfAd bC 8see$Sed M caftnemgorl wlgl its (a) setgng (Le. Ufbarl or NfBQ; tb) r" 7 d OCplfdtl~: t0~ dUf8tKK1; (d) inBV818ib~itJr, t0) gaogfaphk soop~ and (Q magnihde. If necessary, add attachments a reference stlppargng ma6etials, Ensure chat e>QflanaNons oodairf . sTdflCI81A defefl lb show gtat all relevT6Tt actuates impacts have been IdefTdfied ant adequadely addressed, NglTeagott d afpaRF was dlgdced Ices. gle de6ef minafion of signlfirrgnnea must evaluatetlie Potential kitpadof the prept>~d ac6oti on the erMrortrnentat aharactetisdcs dtlie CEA t~radcgiisbwrlfywharreanswrtarepoterpiasyWrgewsigriificaMadv~erseNnpadswMgiMgYooau Then proceeddrcectlytogie EAF aMlw prepare a positive dedaratian. (Yledr tllis box Hyou have deMmlkad, based on dte Information and analysk stave and any supporting documerdagon, that the proposed a iMU. NOT result in arty significant adverse emirolttnental impacts AND provide, on~ attachments as necessary, the reasons supporting lhi determination. Board of Tfustees n ?v A/ / 9 ZO/3 NameLo~f lead Ag/ency Da e JlirfaES / . ~C/r(~ ~ President ~ Pnnt or Type Name of Responsible Officer In lead Agency Title of Responsible Officer gnalure of Responsible Officer in Lea~Agency $Wnatufe of Preoarer (If ddferenl barn rr<nr.n<Ihlo „ra,n,t d~~~ Town of Southold Erosion, Sedimentation 8 Storm-Water Run-off ASSESSMENT FORM PROPERTY OocAnoN: s.c.T.M. p: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN s-6f51Te c'S-'won o~fTe ~ 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 Total Area of the Projed Parcels? ~ Will this Projed Retain All Storm-Water Run-Off (Indude Total Area of all Parcels opted within Generated by a Two (2') Inch RaiMall on Site? the Scepe of Work for Proposed Construdion) (S F I Aaes (This item will include all mnofl created by site b. What is the Total Area of Land Cleadn ) 9 clearing andlor constmction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construdbn activity? impervious surfaces.) (S.F.I Aaes) PROVIDE BRIEF PROIF.CI' DESCR[PIYON (ProNda AmlltlonY Fapeso NeetlN) 2 Does the Site Plan and/or Survey Show All Proposed ? Drainage SWCtures Indipting Sfze 8 Location? This ~i' r Item shall include all Proposed Grade Changes and - yfS ~ ~LG ~ 1 ~ ~ ~ Slopes Controlling Surface Water Flow. r -~'1 3 Does the Site Plan and/or Survey describe the erosion o"C/YS L° ~'1'L[/),t C Soy T I?Ce N and sediment control practices that will be used to control site erosion and storm water discharges. This ~,G1/,Qt~2iy Ll/y ~ ~U ` L o ti ~ item must be maintained throughout the Entire -T~-- Constmction Period. 4 Will this Projed 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 Pamel? 5 Will this Appliption Require Land Disturbing Activities ? Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? s Is there a Natural Water Course Running through the ? - Site? Is this Projed within the Tmstees jurisdiction Geneal DEC swPPp Reaulremants: or within One Hundred (100') feet of a Wetland or Submksion of a SWPPP k required for all Constmdion activities involving soil Beach? dislurbaxes of one (1) or more acres; induding dkNrbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ? - are pan of a larger common plan that wiN ultimately Disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertipl Rise to including ConsWCtion activities involving soN dkturbences of less than one (7) acre where One Hundred (100') of Horizontal Distance? the DEC has tletertNned Thal a SPDES permit krequired /or storm water discharges. (SWPPP's Shall meet the Minimum Requlrementa of gra SPDES General Permit $ Will Driveways, Parking Aroas or other Impervious for Storm Water Disehargas from Conatmdlon actlvlly -Permit No. GP-0.70-001.) SuKaces be Sloped to Diced Storm-Water Run-Off 1. The SWPPP shell be prepared prior to the submittal of the NOI. The NOI shall be into and/Or in the diredion of a Town d ht-0f-wa v - submihed to the Depanment prior to the wmmexement of censbuction activity. g y' 2. The SWPPP shall describe Ina erosion arM sediment mntrd practices antl where 9 Will this Projed Require the Placement of Material, ? required, posiconstruction storm water management practlces trial win be uses andlor Removal of Vegetation andlor the ConsWCtion of any \ i mnsWCted to reduce th poNUhan6 in storm water dkcharges and to assure Item Within the Town Rightq(-Way Or Road Shoulder ~7 compliance with Me lama end conditions of thk permit. In addNbn, the SWPPP shall area? (mra rrom wm xoT r,ckrae m. r,.mnarea er onnw.y Apom.t itlenliry potential sources of ponution which may reasonaby be expected m e0ect the quality of storm water discharges. NOTE: 11 My Mswer b OuesOons One through Nine is Mswared wkh a CMOk Mark 3. NI SWPPPs that require the post<onslnxdion storm water management prectlce in a Box and Ne oanstrucaon aita dkturbanw k batwevh 5,000 S.F. a t Am M area, component shah be prepared by a qualified Design Prefessbnal Licensed in New York a Sbnn-Water, Grading, Drainage 8 Erosbn Gonbol Plan is Raqukad by the Tawn of that k knowledgeable n rice prindples and prectkes of Stomr Water Management. Soumold and Must be Submitted for Review Prior to hswrra of My auildirg PearnlL (NOTE: A Cheri MeR aMla Answer br eadr Ouedian b Reari2d bra C»mplele Applkalbn) STATE OF NEW YORK, COUNTY OF ....`.N.><.~c. i. K SS That I . ..............•~Name of iMivMuahsigning Document) being duly SWOm, deposes and says that he/she is the applicant for Permit, And that he/she is the (Owner, Canbador, Agent, Coryorate Officer, etc.) Owner and/or representative of the Owner or Owtters, 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 before me t}vs; 7 ,Jn , day of S'11NE~~iIG Notary Public .....C~t,~,Q%f.,l,~X(~-.,,,, . bliq,.S(et901NeWY0lk - ~ ..SJ...:..:~.5-:{~.. _-o. 01N~~1~~418 ~Slgnawre or Appndnq FORM - 06/10 n Expltq$ Jan. ~a, t6 Boar~f Trustees Application • County of Suffolk State of New York 1 L h2~,. BEING DULY SWORN DEPOSES AND AF IRMS THAT HE/S EIS 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. ~ Signa re of Property O er SWORN TO BEFORE ME THIS ? DAY OF Jl~,~ ,20 /3 ~~Pi~rvcS~ Notary Public ~ JUSTINE NEfiZIG Notary Public, State of New York No.01NE6180918 Dualified m Suffolk County Commission Expues Jan. 14, 2(116 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits confliMS of interest on the rrarr of town officers and employees. The purpose of this form i< to provide information which can alert the town of possible conflicts of interest and allow rt to take whatever actwn is ttecessarv to avoid same. YOUR NAME: FrAcY~ S~PH~'~? (Lest name, first name, r?tiddle initial, unless you are applying m the name of someone else or other entity, such as a company. If so, indicate theother person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change ofZone 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 relafionship 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%oCthe 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/agenUrepresentative) 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 [he applicant is a corporation); B) the legal or beneficial owner of any interest in anon-corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) [he actual applicant. DESCRIPTION OF RELATIONSHIP Submitted th dax of _200 _ Signature Y Print Name S P Mt N 1/ • F '~1'~' Form TS 1 Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. 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 Haaard Area. 2. Before answering the questions in Section C, the prepazer 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 simificant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3. 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 standazds and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standazds 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 librazies and the Town Clerk's office. D E C E I V E B. DESCRIPTION OF SITE AND PROPOSED ACTION ~1AY 2 4 2013 SCTM# J o o n - 121 - .S PROJECT NAME ~ r /pct outhom Toen The Application has been submitted to (check appropriate response): nn Town Board ? Planning Board ? Building Dept. ? Board of Trustees ~J 1. 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: f, f..~~ ~ f I P~57ALG ~~,o~ ~~WbOD ~'JDI.~ /~%~ei FE'NC~ /4(,dN4 s~-7?r- PRoPr~it~r ~aN~ Location of action: R ~ A~~ S ~ ye"r yft~ • • Site acreage: . ~ AYiKI Present land use: 5 ~ Present zoning classification: 2. 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 ( ) (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No p 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 Secretion III -Policies Pages 8 through 16 for evaluation criteria lot Yes ? No ? Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III -Policies Pages 16 through 21 for evaluation criteria Yes ~ No ,Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III -Policies; Pages 22 through 32 for evaluation criteria. ? ? Yes No Not Applic~ • 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. ? Ye~ No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES S • 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 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 R - ~_,~L'---.~~, PIPE d'ff 3 ~y r µo~ ~7 V~ M hN ~ ~~~9V~ a ZW o fr1AY 2 4 2013 N/O~F CLAUDE Oq yS & rn ~ o Southold Tawn ar of Trus?ecs a ~ 3ss/•t `S 84 5620° E N 1 z 1 w - . cKwr 222.25' \ ~ oae. Js' PLyE- /62.74' PK A 1 ~ a0 • ASPNµT ~ SET N`I ~ ~ ~ N O m m aL~T ~ C 410 v ~ as.s d Q Z 0o 4 W m D ~ r. m 6.4• 44.1• O 1 ' o wx 1 ~ . 01 W ~ ~ Q w ~ O 1 n`! ^.2 10.4 D D - n/e sTS` o ~ o 19 B t ~ ~ Q ~ ~ ROW OF E4ERCRE£/yS ~^0 'O ~ ~ n Q ~ N/O/p C/NDA & ER/C ~ ~i ~ HAAS ~o Om r ~ ~ ELEVA TIONS REFERENCED TO NA VD '8B. ANY ALTERA770N OR ADDITION TO THIS SURVEY lS A VIOLADON SEA=.19 5 OF SECAON 72090E 7NE NEW YORK STATE EDUCADON LAW. ' EXCEPT AS PER SECnON 7209-SUBDIVISION 2. ALL CER77FlCATIONS To Deed Line HEREON ARE VALID FOR 7HlS MAP AND CoaiFS n-iFacnc n.,, ~ N SURVEY OF PROPERT Y AT MATTITUCK ppE TOWN OF SOUTHOLD o. SUFFOLK COUNTY; N. Y. ~N 1000-122-04-05 y N A~ A2E o~=30' D ~ ~ ~ ~ ~ ~ A 1 mW ° MAY 2 4 2013 m N~0/F CLAUDE DA V/g ,g W1FE ~ ° 0 x outhold Town v (T e 3s.s/•$ 'S 84 5620" E. ~ . ~ CF_RTIFIED TO' z ~ 22225' oca STEPHEN V. FEAL Y Z1 162>q• \ pp FIRST AMERICAN TITLE INSURANCE COMPANY A ro _ ~sr~+~7 ~ sEr OF NY a w m ~ ~ a m ro`, o v N C f o m y cu~vERT ~3. ~ ~ o ~ o ~ p u w - ~Z (7 ~ Z 4~ 44.1 O(f'4 D ~ A V1 m~ MJR D ~ ~ m 6. 1•CLiyJ r , u ~ D=A 1 2 p S °1 W i g ~ w z~~ ~ ~ o ~ o o a ~y ~ 10.4• _ 31.064 ~ Ng a ~ . _ 37.5' O O O ~6AR seT /9z,g94 ~ O O- N83 43'50"{y 3, ° Row a~ e~RCREEws > o r~i ~ ~ o ,~~oF r~EW y ~E ~ ~P r~ N~0/F C/NDA of aT. MF ~ ~'i- o r & ER/C HAgs ( ~ as ~+2 ~ ~ ~ i f ~ y a ~ .o- .a is cr ~ti ELEVATIONS REFERENCED TO NA VD 88. ANY ALTERATION OR ADDl770N TO 7HlS SURVEY lS A VIOLA170N N. Y.S. LIC. NO. 49618 OF SEC770N 72090E 7HE NEW YORK STATE EDUCATION LAW. ECONIC U YOBS, P. C. REA-.I9~425 SQ, EXCEPT AS PER SECTION 7209-SUBOINSION 2 ALL CERTIFlCA7/ONS (631) 765-5020 FAX (631) 765-1797 T o Deed Line HEREON ARE VALID FOR 7}//S MAP AND COPIES THEREOF ONLY IF P. O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 7NE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 10-1 O`t