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HomeMy WebLinkAboutTR-8237A James F. King, President O~g~fFO(,rcO Town Hall, 53095 Main Rd. Bob Ghosio, Ir., Vice-President ti~ rly P.O. Box 1179 0 Dave Bergen Southold, AIY 11971 John Bredemeyer ~•y A~~ Telephone (631) 765-1892 Michael J. Domino '~Ol ~ ~y 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 1 ~ day of construction %2 constructed Project complete, compliance inspection James F. King, President ~0 f SQU~y Town Hall Annex Bob Ghosio, Jr., Vice-President O~ 54375 Main Road ~ O P.O. Box 1179 Dave Bergen y ~ Southold, New York 11971-0959 John Bredemeyer T Michael J. Domino ~ ~ ~p~ Telephone (631) 765-1592 Fax (631) 765-6641 o~yCOU~,N~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8237A Date of Receipt of Application: June 17, 2013 Applicant: Marion Lake Restoration Committee SCTM#: 31-17-1 8~ 31-7-9 Project Location: Bay Avenue, East Marion Date of Resolution/Issuance: July 17, 2013 Date of Expiration: July 17, 2015 Reviewed by: Board of Trustees Project Description: Ten-Year Maintenance Permit for the wicking of phragmites as needed, and to hand-cut the Common Reed (Phragmites australis) to no less than 12" in height by hand and on an as needed basis surrounding Marion Lake. 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 Marion Lake Restoration Committee, received on June 17, 2013, and stamped approved on July 17, 2013. 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 i ~ suFFOt,r .lames F. King, President CQG P.O. Box 1179 Bob Ghosio, Jr., Vice-President ~ S Southold, NY 11971 Dave Bergen oy ? Telephone (631 765-1892 John Bredemeyer ~ ~ Fax (63 q 765-6641 Michael I. Domino yyof # ~aor Southold Town Board of Trustees /Field Inspection/Work Session Report Date/Time: ~ 1 ~ ~3 MARION LAKE RESTORATION COMMITTEE requests an Administrative Permit for aTen-Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to no less than 12" in height by and on an as needed basis surrounding Marion Lake. Located: Bay Avenue, East Marion. SCTM# 31-17- 1 &31-7-9 ~e of area to be impact d: -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 Type of Application: Wetland -Coastal Erosion -Amendment _Administrative_Emergency -Pre-Submission Violation Info needed: noh~ Modifications: n° N- C ~ ~ ~ P 4- Conditions: 1 s S4 r Present Were: King _B. Ghosio ~D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled o~lt in the field by t U- r Mailed/Faxed to: Date: .ra „~a'~ ~ , ey ~,.a~ t ...sue, 'V 4~.e b' e~ wr ~ G ~ J ~ ~ M ~ fv A .I t~ iYM O E1 ~ o N. ri '1MW aa. p ~ iI ,.N 99 iW ~ 9`/ N9 W~ Y o+yp° vwra N 9 u „M OfA I~ .Y • ~ ~ ~m / /i p _ ? gY ~N 9 tl J s f .1WRNW IAttE ~ ' ~ / W ® ~ . s tl .d ~ sa n r ,?,F~ x P ' awe ~ / y4" r .9 -0. C 9~ tlP a M1' lE a 9 i F ,r p` A4IRIONW(E ~g 9 ~ .P n ~ • / nWy xJ ~ { V ^ / I ~ ~ < ' ~ ~ m b~ yW4 1® j ~ w ~ d,.,~„~.. ~ u ' a~ rev// ~ e~ ~ an O ~ ~ "~r'c° COUNN OF SUFFOII( © e eecrrox xo NYPmpMyTC SY.Ya Rpmry ® e oxooe OFFICE LOCATION: ~~OF SO(/TyO ~1(-1NG ADDRESS: Town Hall Annex ,`O l~ P.O. Box 1179 54375 State Route 25 .IL ~ Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) T Southold, NY 11971 G Q Telephone: 631 765-1938 ~ Fax: 631765-3136 o~yCOU~,~~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM (n~ ~ ~ ~ ~ D uu D JUL 1 1 2013 To: Jim King, President Soutt;oldTown Town of Southold Board of Trustees ar rT e From: Mark Terry, Principal Planner LWRP Coordinator Date: July 9, 2013 Re: LWRP Coastal Consistency Review for MARION LAKE RESTORATION COMMITTEE SCTM#1000-31-17-1 &31-7-9 MARION LAKE RESTORATION COMMITTEE requests an Administrative Permit for aTen- Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to no less than 12" in height by and on an as needed basis surrounding Marion Lake. Located: Bay Avenue, East Marion. SCTM# 31-17-1&31-7-9 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 determination that the action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "FF" which states: FF. Cutting phragmites to greater than 12 inches and vegetative restoration, provided that native wetland vegetative species are not affected or disturbed in any manner; 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 6/11/13 ~ECEIVE D Marion Lake Restoration Committee D c/o Lori Luscher JUN 1 7 2013 163 West 23'd Street oe own Deer Park, N.Y. 11729 To the Trustees of Southold, I formally request a waiver for the most recent permit application fee requesting a 10 year maintenance agreement for the invasive weed, Phragmite. It is my understanding that the normal fee would be $100 and have high hopes that this fee will be waived to assist in the momentum of the group. Thank you for the cons' eration. Lori Luscher s President Marion lake Restoration Committee i. James F. King, President ~OF SOpTy Town Hal] Annex f O~" b4376 Main Road Bob Ghosio, Jr., Vice•President ~O p.0. Box 1179 Dave Bergen ~ Southold, New York 11971-0959 John Bredemeyer w a~ Michael J. Domino ~ ~ ~O Telephone (631) 76b-1892 Fax (631) 76b-6641 l'`~OUN(Y,Nc~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD l Office Use Only i Coastal Erosion Permit Applications -Wetland Permit Application ? Administrative Permi _AmendmenVTransf r/E ension D ~ ~-(C'~"~ a ~eceived Application: L ~ ~ f^ ~ompletedApplication 13 ~.1 _Inwmplete JUN 1 7 2013 _SEQRA Classification: ~ Type I_Type II_Unlisted_ f _ J Coordination:(datesent) ~ _1, SoulholdTown ~WRP Consistency Assessment Form 1 I~J ~ S - i -CAC Referral Sent: _~LDate of Inspection; D i -Receipt of CAC Report: Lead Agency De[erminafion: hnical Review: I -Public HearingHel ~'~C~'~C~~''77~~'"` -Resolution: ,A _ _ I Name of Applicant '"lryQt tuJ ~`t«~ I 'to ,Q~ 1 ~ ~ ~ MM ~ 1 i ~ ~ Mailing Adpdress ~~o Lu SC++£2 ~ ~3 w ~s ~ a 31y!) ST £ T I172~Phone Number:~3~ ~ S - $ 5-79 ~ i Suffolk County Map Nttmber: t 000 - .3 3 ~~7' 9 QQ ~ Property Location:_I.~y ~V ~7C~rz ~1l- tiT/ Y1.4-(Zu N~_ (provide LILCO Pole distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~oard of Trustees Application GENERAL DATA i Land Area (in square feet): t. Area Zoning: Previous use of property:~(~ £.S £ ~1/~F T r O Intended use of property: ~-'~Y. SE ~2 T t d ~ I j. Covenants and Restrictions on property? Yes ~ No If "Yes", please provide a copy. Will Phis project require a Building Permit as per Town Code? Yes c~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. I Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes x No i Does the structure (s) on property have a valid Certificate of Occupancy? Yes ~ No Prior permits/approvals for site improvements; n OF~OUTi-{OL.~ T~U~££S tI' I a~ I \ O # 72~ y No prior permits/approvals for site improvements. Has any permidapproval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): 11~~A , N l N~~ ~,r ~ wf,>~ PaR~crE-r ~ N-r aN~~- , -~r T - l ITF ~ a i' ~l[T ~/1> ~ JU~~ ~ D , ~ 1 >~d of Trustees Application . WETLAND/TRUSTEE LANDS APPLICATION DATA I Purpose of the proposed operations: TP ~Q,it 1 tiC'f R~ nl ~tt`z ~ !~"'r~~ C ONOtTIGn/ G F LFt~c~ g~i Kf.a' P~ti?C~-~-r CL4,4~ gn/~ ~2~£ nF I~?A-s~?~ E ~l~tRafTMITE~ Area of wetlands on lot: square feet j Percent coverage of lot: ~ ~ i i Closest distance between nearest existing structure and upland ~ edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet ~ r Does the project involve excavation or filling? No Yes i~ If yes, how much material will be excavated?cubic yards ~ How much material will be fi11ed7~_cubic yards Depth of which material will be removed or deposited: feet i Proposed slope throughout the area ofoperations: Manner in which material will be removed or deposited: Yl/1~N U +<k-L I 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): 1!1 T}) Ll ~A-'<<ot~ ND n/l!~ l JJfC~FFwI e ~ O ~ ~tK~ IN p~Ec*~9~DS to ~£62~s t?/VRSt?~ W ~~pS . PROJECT ID NUMBER 61720 SEAR APPENDIX C ' STATE ENVIRONMENTAL OUALfiY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM i for UNLISTED ACTIONS Only RART ~ • PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJEpCT NAME/,, i. it/t ONf~/ f £ T ~yM.v~~L 3.PBDdECT hOCA O(.~ - Muni ' rt/~9~c€Tq,$T ~~1/ County J vF/-vL K O'.?~ I. 4. PRECISE LOCATION: Street Adders and Road Interne ti s. Prominent landmarks etc • or orovlde moo I ~3Ay gtr~v~, ~srM.4~.~oN N~. ,r~39 5. IS PROPOSED ACTION : ~ New pansion ~ Motliflcadon / attera0on I 1 6. DESCRIBE /tP~RO~JECT BRIEFLY: p ~ T ~VV'f'1 ~ltT/k1l~ ~l~l~ C~i.'~[F~~L INV/IS \vf. 1 •`YY•t ~11'~1T~L T Ct_~J~ Q~PjQ1s ~2~L S-rbR.V• OAMab-s , o ~ ~~?~N« PRNI r t T / ~I ~f-l Rr46-r~t(~ ES f 7. AMOUM' OF LAND AFFECTED: ~ Initially acres Uldmaley acres i 8. WILL PROPOSE CTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? I i ?Yes No If no, describe briefly: i 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as appy.) ~2BSidenOal ~ Industrial Commercial ?Agriculture ~ Park /Forest /Open Space Other (describe) 10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANV OTHER GOVERNMENTAL AGENCY (Federal, tats or Locaq - ~Yes ~If yes, Ilst agency name and permit /approval: A VAL7 Yes o K yes, list agency name and permit /approval: 12 AS A RE U F PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicanl /Sponsor Na Da Signature 6 If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART 11- IMPACT ASSESSMENT o be com feted b Lead A eac A. DOES ACYtON DCCEED ANY TYPE f TFiRESFiOt:D IN 6 NYCRR, PART 61T.47 N yes, coerrlmale gre review process anduse the FULL F11F. Yes Q No B. WN_L /1CTION RECEIVE COORDINATFA REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR PART 617.67 If No, a negative dedaration may be superseded by anafller imrolvr:d agenq. ? Yes Q No C. COl1LD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING (Answew may be handwnttea, If legdlle) Ct. F~dstitlg ak quatigF, s«face «graxMwat« qualdy «quarltily, noise levels, existing traffic panertt solid waste production «disposal, eMial for erosion, drainage «floodkp problems? F~lain txkfly: - cz Aestllee0. agricult«al, archaealogkal, hkfortc. «atll« natural cr adtwai resbaoes: « «neighb«Iwoe cflaradefl Explala brit~y: C3. Vegetation «fauna, Gsh shefles ~«wild specks. significard habflats, er flxeatened «endangered spedesT Explain brefly: C4. A oommuniiy's existing plans or goats as omrdady adopted, or a change-M use or intensity of use of land or other rwlural reswrce57 FxpWk akfly: C6. Growth, subsequent devebpmem; or related advities likely to be induced by the proposed action? Explain briefly: C6. Lorg lertn, sMM1 term, rxrmulalive, a other effects not identified in C1C5? Explain breay: C7: alrer impacts ndudin Bran sin use of either uanat or t of ~ - ~ ~ ~ ~ ' E sin bdefl : . O. VNL.I THE PROJECT HAVE AN IMPACT PN THE ENVIRONMFJJTAL Ct/ARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF R CRITICAL ' ENVIRONMENTAL ARFJi T k Q Yes Q Na : E iS TH6iE, OR IS THERE UK9.Y TQ REIATEO TO P07EMIAL f34VpiONpAENTAL pNP If . latrr Yes Q No . PART Ip - OETERMINATION~ OF SICINCE (Fo be cArtpieted by Agency) _ IMS'fRl1CT10N8: ForeaohadvelseeiFacfldellUfiadalnove,de6oamdnewmamarulsaubata6ealtelge,~IpattaDf«ah«twseaigBifaxnt Eadt oBeot aboard be aisaeSSed in oormaetlon veal its (>y semng (ice arban «furaq: (bj plobabiNty of ooculrirtg; {off dlxa6olr (d> irterrersbifiry; (e) > ara t4 rlregnlHMe. a IIBpBSSaly, add amdanents a n:ferelloe sllppolfirtg moralists. Enstala ulat e>g1ltalaNolls conmin - - - allNioktltdefaL toallow Nletay televafltadvelae kllpaUShew been idengfied and adequately addterised. Ifquasfba d ofpalt Rvyas dladced yea, the dela6on of aignifaxnoe laustevdua6etlle PohenNtiaal kn(radof the poposed aa6al rm the ~l ~lar> of lkle CFA C110dc alb box Hyouflaye ldetltiWad onO«morePaMYlar9eorsigNflcarrtadverse trrpadswNdlMAYoogx. Then proceed diredlyto lfle EHF and/or prepare a pasiB~e dedaragm. CIIe4t tl1116 tqx uyoufiave dat¢rnlined, based on pro Inforlnatial and analysts atxwe and arty slpportirlg doanrleMation, slat fhe proposed a - IIIIn.L NOT result trl any sigrliflcerd adverse emlhonmental knpacts ANO provide, on' altachmanfs as necessary, eIe reasons supporting lhi determination. Board of Trustees ~ Name of Lead Agency Date President ~ Pnnt or Type Name of Responsible Officer m Lead Agency isle of Responsible Officer finnahva nr Ru<nnnei{,le nm...,.:., r n____. ado Town of Southold Erosion, $edimentatlon & Storm-Water Run-ofF ASSESSMENT FORM y. PaoPeRrv LpcATION: S.c.T.n. a: THE F04lOWiNG ACTIONS MAY REQUIRE THE SUBMISSION OF A 1 ~ ~ STORM-WATER, GRAbINti, DRAINAGE AND EROSION CONTROL PLAN -6"lrrk't" ~ ~7«Tc- -C't- CERTIFIED BYA DESIGN PROFESSIONAL IN THE STATE OF N ORK. SCOPE OF WORK - PROPOSID CONSTRUCTION ITEM # / WORgASSESSMIIVT Yes No a. What as the Total Area of the P rojsd Pamels7 ~ Will this Projed Rereln All Salmi-WaterRun-Otf (Include Torel Area of aA Parcels boated vdthln Generated by a Two (2~ inch Reinfail on SAeT the Scope of Work for Preposed Consfnlction) (s F /A~ (This Item wiA include aA mnoR craated by site b. What Ls the Total Area of Land Geadtg ) clearing and/or eonstrutAbn at:UviOes as well as ell - - I andor Cxound Disturbanoa for the proposed Site Improvement and the pannanent creation of ~ constnrctlon actNAy7 impervious suKacesJ I (a.F.IAOeaI PROVIDE BRIEF PROJECT DESCRIl'TCON (P~eulLr kaauonm P.waarkNedl 2 Does the Site Pian and/or Survey Shaw Ali proposed I. Drainage SWdures Intlkatlng Size & Location? This Item shall include all Roposed Grade Changes and ~ ~ ~T SloPes Contrdlin9 Suttees Water Flow. - - $Does the sire Plan andor survey desvibe the erosion ~ 6- M (T ~G S and setllmeM wnhoi fxadioes Utat wAl be used to I ) T r I _ contrni site erosion and stone wafer dlschalges. This - v /At rQ~ t/1Z Fp ~ 6" I item must be maintained ihraglwra the Fstlre ( ~l.r.,p i-F~_ I~p£.b ConaWCtlon Periotl. - . ~ 6 4 Will this ProJed Require any Land Fiping, Gredng or Excava0on where there is a change to the NaWrel Fasting Grade Involving cows than 200 Cubic Yards ~ ~ _ of Materiel within any Pame7 5 Will this Apgiption Require Land Disturbing Activities Encompassing an Area in Excess of FWe Thousand ~ ~ (5,000 S.F.) Square Feet of faYOUnd Surface? s Is there a Natural Water Course Running tlxough the Site? Is this Projed within the Trustees jurisdictlon General DEC SWPPP ttswiramama: a within One Hundred (100') feet of a Wetlantl or Sutxnkstan of a SWPPP b naryted foreA ConaWGion eaivhlas invclvhq soy Beach? dkluNarces ~ron~(1)aeore ea~~;6Wdkg dhWrbencee ofieas men one acre chat 7 Will there be Site preparetlon on Fxistlng Grade Sbpes are pert of a largercomitgn plan mat wAl ukanetely dialurtr orre ormore earn olleM; which Exceed Fifteen (15) feet of Vertical Rise to biduasyt Canshucbn acUVllies arvWing sot dbWNencea of less men one (l)eas where One Hundred 100' of Horizontal Distance? Ina OF~hm determhed mete Sf+DES pemylkrequlred Pot alarm warerdkrAalgoa. ( ) - (SWPPPY 8haa meat the Minimum RegWrements otme 9PDE8 cieroral Pemat 8 Will DrlveWays, Parking Areas or other Impervious for Stone Water DbcMrges 4an Cautnseon actlvigr. Psmdt No. GP-0-fe-0a1.) SUrfaCOS be Sloped to Direct Storm-Weref RUn-0ff f. Tna 3WPPP ahen be Prepared prbr b me sarmltm of tM Not. The NOI chat ae into and/a (n the diredMn of a Town d M-of-wa aulxneledbme Deparurlenl pdwbthe commencement ofoorKtructbn adivdy, g ~ j z. The SWPPP:naedaeama the eredon ens sodenent oxnrd prectlwe era w,ere 9 Will this Protect Require th Placement of Material, rites J-'~Srltr// requked, poslcmraWgbn abxm webrmvugamant pnrctlcea that wa be uses anabr Renaval of Vegefatlon and/or the Construction M arty wnaltmmaed to rectum iM payulema h elaarw8lerdbdorgea ens b eswre Item Within the Town RI htof-W a Road ShoNder ~mpllerwa wPh iheammsend uondlWxm oftlue PamriC In adtltlon, the SWPPP stay Aree7 trraann x1p rrora-rw. aw ime.me.a aeryY polenyN soumas ai popWen vAdch may reasonaby be enacted to axeame aMwar M-a~l quaDy of atamwaterdbMapes. NOTE: If Arw Answer to Ouaatloru Ona through Mrw la AnawarM wxh a ehacfc faarN 3.MSWPPPa met repuireme pmtcal50uctlon abrmwetermenegement preclloe Ina Bm and Uu conatrucaon seadWudrarieebr,alwwh gaaoSF.il amabam, I~ component ghat ba txerored bye Wanted Deabn Pmkssbnal Lkensedb New York aabrm•WaWA Bradsg,Dnlnapaa FJwbn Corthol Plan bltaqutraa bytM Tam of I: that is knwdedamblahme pdridpba and predkea of 9tortaWatx ManatrananL aoumea ana Nuat ba SUbmxbd brtNNawPdwao lacusrrosMAny eWa9ng Pwmk pdGTE ~aerxw~kNl.~wor,v~xamt~,mo.aa~raeror.ompK•Awao,em> S7 ATE OF COUNIT OF ~~ql IL SS That I, ~:.S.i::.1.... LU ~h4 r being drily sworn, deposes and says that he/she is the applicant for Pemtit, (Name of IndNEuel alantrp DoameM) Mdthathelsheisthe ...................~:A->net~ (Ormer, Conhacbr. Aeent. Capaeta ~IIiear, stn) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this zpphcation are true to the best of his knowledge and 1xlieE, and - that the work will be performed in the mazmer set forth iri the application fled herewith. Sworn to before me this; 41-- ...............l.ra...................... day Df... Jul ~.,...,...~~o.~.~ Notary Public:._!...1.~.L~:~Z..Q......... M 13 Isrgnatae orappiwml FORM - 06/10 G ~ tateorN~~xk ~ No. Ot MC8252699 Qualified in Suffolk County Commlasion Expires December 12.2013 APPLICANT/AGENT/REPRESEN't'ATTVE TRANSACTIONAL DISCLOSURE FIDRM I i The Town of Soutltold's Cade of Ethics orohibits conflicts of interest on the part of town bfflcers and emolovees. Thepuroose of I this forth is to provide information which can alert the town of possible conflicts of interest and allow i[ to take whatever action i necesserv m avoid same. e ~ ~ n I U~ YOUR NAME: LoFZt1,.V$CH'L'~-- ~1-vt~te.N ~tKL 1-CSToRA7ieuJ ~D~+.~ , (Last name, first name,-0tiddie initial, unless you ere applying id the name of i~ someone else or other entity, such as a company. If so, indicate, theother person's or company's name.) - NAME OF APPLICATION: (Cheek all that apply.) ~ ~ - ~ - ~ Texgrievence Building ~ ~ i~ Variance Trustee ~ t. Change of Zone CoasfalErosion Approval of plat Mooring Exemption from plat or official map Planning Other - (lf`Othet'',nametheactiviry.) ~'f~4)'(WANCE OFNl412rs+N LrlKC Do you personally (or through your company, spouse, sibling, parent, or child) Have a relationsttip.with any officer or employee - of the Town of Southold? "Relationship° includes by blood, nlerriage, or business ihteresL "Business interest" means a business, including a partnership, in which the town officer ar employee has even a partial. ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. - ~ i i 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 applicanUagpnVrepresentative) and the town uflicer oremployee, Either check the appropriate lint A) through D) andfor describe in the space provided. . The town officer or employee or his or her spouse, sibling, parent, or child is (check all~tliat apply): A) the owner of greater than 5°h of the shares of the corporate stock of the applicant (when the applicant is a corporation); ~ B) the legalorlxneficial owner of any interest in a non-corporate entity (when the - applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or ~ - _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted tbis day o V and 3 Signature. PrintNama ,fir G Form 151 ' Town of Soathold , I.WRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pennits* 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 j 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. 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 orooosed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town) I 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 mast be exulained in detail listing both suoportine and non- sunQortine facts. If an action cannot be certified as consistent with the LWRP policy standazds and conditions, it shall not be undertaken. i A copy of the LWRP is available in the following places: online at the Town of Southold 's website (southoldtown.northfork.net), the Boazd of Trustees Office, the Planning Department, all ~ local libraries and the Town Clerk's office. D ~ ya 2-= B. D CRIPTION OF SITE AND PROPOSED ACTION ~ M LS ' r~ sCT 3~_l7~ 11 ~ u ll JUN 11 2013 'I=~ I- PROJECT NAME t tp ar ~rosics The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees i I I . Category of Town of Southold agency action (check appropriate response); j i (a) Action undertaken directly by Town agency (e.g, capital ? I construction, planning activity, agency regulation, land transaction) ? I (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: / ~ ~t1 ~.IT4n/~Fn~ 1 ~ ~t t'- ~o f P t,,,~ +~RA£~/Lt l i ~S Utz Ta l z' ~ f--f ~(s-~}-` _ Location of action: Site acreage: P Present land use: £ S ~ D rt~T~A(~ ~E G ~ mil- Tt o~vf( r± Present caning classification: i . i 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be prov11ided: f ~ p ~ \ (a) Nameofapplicant: L0~1 1-t15ckF~-Q_ to([ i°IFF~tati ~y~~ ~STaR~-T1Gt~ (~MMI-C'CL ~ (b) Mailing address: ~ I,l)E S't 7- ~O £E t t'1-t, ~ (c) Telephone number: Area Code ((~3/- y/ $ = ~ 57 ~J i (d) Application number, if any: Will the action~ectly undertaken, require funding, or approval by a state or federal agency? Yes ? No If yes, which state or federal agency? I 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 completiou. F DEYELOPED 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 I minimizes adverse effects of development. See LWRF Section III -Policies; Page 2 for evaluation ~ criteria, Yes ? No ? Not Applicable t-l~-i~6- ItiL4~GN c~_ !a E Qtyf}Ti 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 r Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Polici Pages 6 through 7 for evaluation criteria ? Yes ? No Not Applicable i i Attach additional sheets if necessary ~ NATURAL COAST POLICIES i Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP i Section HI -Policies Page through 16 for evaluation criteria ? Yes ? No ~ Not Applicable I i I Attach additional sheeu if necessary ' Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III -Policies Pages 16 throu 1 for evaluation criteria Yes ? No Not Applicable i I 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 Seetion III Policies; Pages 22 through 32 for evalnati criteria. ? ? i Yes No NotApable • i I Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LW1tP Section III -Policies Pages 32 through 34 for aluation criteria. i' Yes ~ No Not Applicable ~ i Attach additional sheets if necessary j ' Policy 8. Minimize enviro mental degradation in Town of Southold from solid waste and hazardous I substances and wastes. ee 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 j resources of the. Town of outhold. See LWRP Section III -Policies; Pages 38 through 46 for evaluation criteria. Ye~ No Not Applicable j Attach additional sheets if necessary WORHING COAST POLICIES • Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations, See Section III- Policies; Pages 47 through 56 for evaluation criteria. ? Yes ? No Not Applicable f I I Attach addrtronal sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat . See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? No Not Applicable I Attach additional sheets if necessary I Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III -Policies; Pages i 62 through 65 for e~valu~a 'on criteria. ? Yes ? No Lam" Not Applicable Attach additional sheets if necessary Policy 13. Promote a ropriate use and development of energy and mineral resources. See LWRP Section III -Policies; ages 65 through 6S for evaluation criteria. ? Yes ? 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