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HomeMy WebLinkAboutTR-8227A James F. King, President O~gtlFF01,r~, Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President h~ ~lly~ P.O. Box 1179 Dave Bergen ~ ~ Southold, NY 11971 w John Bredemeyer ~ Telephone (631) 765-1892 Michael I. Domino 1 ~ ~ Fax (63l) 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 ~F SQUT Town Hall Annex y 54375 Main Road Bob Ghosio, Jr., Vice-President 0~ ~ O P.O. Box 1179 Dave Bergen ~ Southold, New York 11971-0959 John Bredemeyer T Michael J. Domino ~ ~ p~ Telephone (631) 765-1892 ~ Fax (631) 765-6641 ~y~OUNT'I,~c~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8227A Date of Receipt of Application: May 31, 2013 Applicant: Kevin G. Geiger SCTM#: 103-3-10 Project Location: 2350 Beebe Drive, Cutchogue Date of Resolution/Issuance: June 19, 2013 Date of Expiration: June 19, 2015 Reviewed by: Trustee Dave Bergen Project Description: Ten-Year Maintenance Permit to hand cut the Common Reed (Phragmites australis) to 12" in height by hand on an as needed basis. 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 Kevin G. Geiger, received on May 31, 2013, and stamped approved on June 19, 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 Z N i g~~~4 / D C m I V FF,~, Hn 3~ , F, ~ z Z~ 1-~/ 3 1 2013 ° " ~ W < ~ ~ Dz ti Z~ / i ~ outhold own ~ ~ ~ m b / ~ m fTl _ / ~ G7 / ~ OJ ri rn y O 0 A ~ ~ m ~ £ ~ ~ o 0 o J v o gi i _ / o rn ~ ~ x ~ ~ ~ m C ~ \ ~ _ ~ N S ti y OJ ~ _ ~i ~ M x 1 a z ~ tL ~ry4-{ ry ~ z p'~ NMVI JO 390 j ~ o ~ s ~ ~ ~ o ~ N ~ ~ ~ ~S ~ / / \ r ZIOZ/LZ/90 NO 5391Nf 9NI11O5N09 ~ ~ / N ~ / / t ~ 1N3WNOMNN3 0 W f W ~ 0 3903 NN319 ~ j Sy WNV113 4 .j ~ ,i~0~' \ X l~ 91~ I ~ ~ l ~9 0 ~ ~ .1 ~ ~ ~ ~ ~ APPROVED BY u/ ZC O / O _ o ~ BOARD OF TRUSTEES z a r - ~ rTOWN OF s ~ / o SOUTHOLD b _ / T r1 ~ / / N / V_` ~a7 aC0 c ~ x Nir'~'b r y~'z, Nf ~ ~ ~ v / / ' o°~~~ y ~yo mr i SURVEY OF LOT 56 MAP OF MOOSE COVE FILE No. 3230 FILED AUGUST 30, 1960 SITUATE EAST CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-103-03-10 SCALE 1"=20' JUNE 28, 2012 I DECEMBER 5, 2012 ADDED PROPOSED SEPTIC SYSTEM TOTAL LOT AREA = 33,547 sq. ft. I i (TO TIE LINE) 0,770 OC. N NO ' : I CERTIFIED T0: v KEVIN GEIGER ~ rn.,l"D' I DEBRA GEIGER / JIB, / ~ I !I ~1k I I ~ FUG I I !I „ ~ I N 77`4 'g0 E ~ ~yMN ~ i~ j ~ ESE ~ I 1~ \ ~ x,11' \ ~I ttlk I I ~ ~ `I ~ r Ii APPARENT HIGH WgTER IA4RK ON 06'28/2012 ' ii ~ \ I ~ \ 1.9 \ I1 ~ ~ \ ~ A 1 li ~ L~~ ~ \ m I o, , A K ~ r ` ~ ~ FLOATING MOOD D~ £ z ~ gyFFO(M James F~_ King, President C~ P.O. Boa 1179 Bob Ghosio, Jr.. Vfcc-Presdcnl ~j~ Z Southold.NY 11971 Deve Bergen ti ~ Telephone (631 765-1892 John Bredemeyer ,y ~ Fax (631)765-6641 Michael I_ Domino ~ 'T' y~of ~ ~ao~. Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: ~ I I 5 ~ ~~j ~ ~ rYl KEVIN G. GEIGER requests an Administrative Permit for aTen-Year Maintenance Permit to hand cut the Common Reed (Phragmites australis) to 12" in height by hand on an as needed basis. Located: 2350 Beebe Drive, Cutchogue. SCTM# 103-3-10 Type of area to be impacted: 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: na.,~ Modifications: Conditions: a , ~ ~ ~ h ~z o[ 1 / ~ ~ e~ Present Were: J. King _B. Ghosio ~ Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: F. '-01 ire q i ~ + cam. t? 7~,_ , . ~r_;; c 7 . 1 ~ - A ~ ~ ~ _ ~ r _ 2.~:. _ ..--im •c. } P~'~~~ R ..::r .~'y` ~~tF '~i?~aY ~ s h ~t1 ttTt~:1, tt 4 i'~~~.' ~ i ~~R , ti 1 n,3 _a eis'. t ~~F4 6'~ ~ . 'p' ~ cc~ r,~. ? 7 ~ T ) ~ : .`~r•~;~ ,u t ,s 9; ' # ~ t ~ ~ t ~ ~ 3~ ~ w "Y'~ a ~E? sW` F t ! ~ ~ 1 ~ i' 1 qTi _ ~ i _ - .'R SZ~~ .4.._ y ~'1s3 _ - t wry ~ r.~. 'a. ~ 2 ~ /lie ! 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L © ~ ~ i 4 t 6 / ~r ~ r f a ? p J i ~ ~ ? b it ~ i . t t r O, nw,~ s ~ ,x n > - - - ~ wn¢ COUNiY OF SUFFOLK © e • ~q1 - ¢n O =u--,^ _ ~ Real P~tgxly TU $el'/Ib Bpeixy e _ ~ _ w,e. 103 • • pf SOpj MAILING ADDRESS: OFFICE LOCATION: y~ Town Hall Annex ~0 lQ P.O. Box 1179 54375 State Route 25 ~ # Southold, NY 11971 (wr. Main Rd. & Younge AveJ Southold, NY 11971 G Q Telephone: 631 785-1938 '.~P ~ Fax: 631765-3136 ~y00UNTV N~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM p E ~ ~ B V JUN 1 3 2013 To: Jim King, President utnomrown Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 13, 2013 Re: LWRP Coastal Consistency Review for KEVIN G. GEIGER SCTM#1000-103-03-10 KEVIN G. GEIGER requests an Administrative Permit for aTen-Year Maintenance Permit to hand cut the Common Reed (Phragmites australis) to 12" in height by hand on an as needed basis. Located: 2350 Beebe Drive, Cutchogue. SCTM# 103-3-10 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 ~ ~ James F. King, President ~OF SO(/~y Town Hall Annex Bob Ghosio, Jr., Vice-President ,~0~ ~6 6 P ~ 1Ro9ad Dave Bergen l~I # Southold, New York 11971-0969 John Bredemeyer Michael J. Domino ~ Telephone (631) 766-1892 `~CO~ ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicatio Wetland Petmit Application ~ Administrative Permit AmendmendTtansf /Ex ension ceived Application: 5 3 ~teceivedFee:$ E C E 91/ E Completed Application D Inwmplete SEQRA Classification: Type I___Type IIUnlisted ~dAY 3 1 2013 r _Cootdination:(date sent) ~LWRP Consistency Assessment Form Jr' 3 ~AC Referral Sent: uthold own Date of Inspection: j~ 13 _Receipt of CAC Report: Lead Agency Determination: echnical Review: ~ublic Hearing Hel j Resolution: ~l '~T~ Name of Applicant ` ~l1 i.n) ~ ~j ~ ~ p / 1 Matting Address ~-~s~ I ~ ~ C _ - ~ f s /mil v L ~[L 4tAM t ,N ~ ~ 6 ~ V3 Phone Number:( ) 7 ' ~ ~ 9 f i Suffolk County Tax Map Number: 1000 - ~Q ~ - ~ Property Location: ~ ~ ~ D ~ ~'Q~ -L~ ~ 0t•~ y "r~0 ('U ~ ~ N y (provide LILCO Po distance to cross streets, and location) AGENT: (If applicable) Address: Phone: i Board of Trustees Application GENERAL DATA Land Area (in square feet): h I Area Zoning: ~ 1 Previous use of property: Intended use of property: ~ Covenants and Restrictions on property? Yes _~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 Boazd of Appeals? Yes No If "Yes", please provide copy of decision. Will this project r ui 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): /li'~,C~1~` I ~ l fi C U B ~/'1~- ~,~1 f ~S i Hoar• f Trustees Applicatioa • ANDS APPLICATION DATA LAND/TRUSTEE L WET Purpose of the proposed operations: I, NI~- i Area of wetlands on lot:_.___ 1~_square feet Percent coverage of lot: a ~ ~ 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 ~I 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? ~ 1 ~1' cubic yards n ~ Depth of which material will be removed or deposited: I feet I Proposed slope throughout the azea of operations: NIA ! i, -1 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): PROJECT ID NUMBER 61720 SEAR - APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Onty PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 7. APPLICANT /SPONSOR 2. PROJE ,NAME 3.PROJECT LOCATION: ' Municipality County 4. PRECISE LOCATION: Street Atltless and Road Intersections. Prominent landmarks etc -or provide map a3~~ Q~~F ~(~i~~ ; 5. IS PROPOSED ACTION : ~ New ~ Expansion ~ Modiflcadon / aderatlon 6-DESCRIBE PROJECT BRIEFLY: i 7. AMOU NT OF LANG AFFECTED: i Initially acres Ultimately acres 8. WI ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ? No If no, tlescribe briefly: ~''i 9. WyAT IS PRESENT LAND USE IN VICINI7V OF PROJECT? (Choose as many as appy.) Residential ~ Industrial ~ Commercial Agriculture ~ Park /Forest / Opan Space ~Olher (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Faders Stale or Locap Yes No If yes, list agency name and permit /approval: A R VAL? Yes o If yes, list agency name and permit /approval: 12. AS A E T OF PROPOSED ACTION WILL F~CISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es No ~ I CERTIFY THAT THE INF TION PRO D ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor Name Date: Signature ~ J ~ ~ ~ 3 If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART it -IMPACT ASSESSMENT So be tom feted b Lead A en A. ODES ACTION EXCEED ANY TYPE t THRESHOfD IN 6 NYCRR, PART 81T.47 If yes, coordinate ale review process anduse ale FULL FAF. - Yes ©No B. WILL ACTION RC-CEIVE COORDINATED REVIEW AS PROVIDED FOR l1NLISTEO ACTIONS IN 6 NYCRR, PART 617.67 If No, a negaaw: dedaraaon maybe srg>erseded by anoarer trlvolved agenq. Yes ~ No C. ('X)ULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOGATEO WITH THE FOLLOWING: (Answers may be handwdaea, a legible) C1. 6dstMg air quality, surface «groundwater quality «quantily, noise levels, existing traffic paaem; solid waste production «disposal, polenaal f« erosion, drainage or aoodGg problems? F~Iain briefly: cx. Aes(hedo. agriadlural, aldlaedogira4ldstodc, «eth« natural «eulasal resburces: «cemm «neighbolhood dtalad0r7 FJgllaln btieaY: : C3. Vegetation «fauna, fish, sheflfa 'or wgdfifespecies, sigruficenl habitats, er axeatened «endargered spades? F~lain briefly C4. A community's exisan9 plans ar goals as oRdady adopted, or a~change in use or intensity of use or land «other natural resources? F~rplain briefly: C5. Growth, subsequent development, or related adivAies likely io be induced by the proposed action? Explain briefly. C6. Long term, stronlerm, wmulauve, or o(her effects not identified in C1 CS? Explain briefly: C7.~ Other im ads indudin than es in use of either uan6l or t of ene ? E lain 6defl : - - - - D. WILL THE PROJECT HAVE AN IMPACT pN THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA7 If . s, lain brie Yes a No _ EIS THERE, OR IS THl3tE UI(KY TO CQNTROVERSY Rt]ATEO TO POTENTIAL. ENVIRONMENTAL IMP If . laim Yes ~ No PaRT fft - oET~aalNAnoN oP sroNlt:lcANCE (Te be completed by agency) kISTRUCTiONS: F«eadlariVerseeffadiderttifiedatwve,detenninewhedleraksubstaa6al,large,important«dhenviseslgniat~lf. Each eNad should be assessed trr oonrlea6an N'Itl1 As (a) sexing (~e. urban «ruraq: (b) probabip(y of oaa+rtirt€1: (c) duration; (d) IrrereratAiq; (e) gaograpltk scope; and {p magnAlke. ff tlecessary, add altadulleMs «referenoe aupporang matedals. Ensure that e:gllanatkats contain - sufAciarttdetaA toshowthat aprelevant adv«ae impatdshave bean klenafied and adequately 91td(e$$rld, ff glrasA«1 d Of part A was dltfdted yea, ate decanttlnaAon of signir«~1loa mast evaiuateu,e pooetlaal impa~xa a,a ppeposed ar~iatr an afe envlmraner,tal a,aradetisa~a of ale t~ Chock orb bozffyau tlaya k1erARad one«mae potelrtkaYWrge «slgNficeraadwxse MtpadswflkhMAY coos. Then proceed directlyto the EAF andf« prepare a positive dedaraann. Ctreck elk box if you•flave dekllnkled, based on the Informafron and analysis above and arty suppaang documentation, drat the Proposed WILL NOT result M arty rigniGCant adverse ernkonmental impacts AND provide, on attachmeMS as necessary, the reasons supporting all - determination. Board of Trustees ~ ~ ~ Z ~ ~ 3 Name of Lead Agency/ / ' / Date J~9 ~^r` f /C/N fi' President U Pnnl or Type Name of Responsible Officer in Lead Agency rifle of Responsible Officer ~ Sgnature of Responsible ORa:er in Cead Agency Signature of Preoarer of ddferenl kam racnnndhb ..rfi.,,~l ! • Board of Trustees Applicatioa County of Suffolk State of New York ~V ~7~) ~j ~YJ ~ 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 REPRESENTATNES(S), TO ENTER ONTO MY PROPE TO IN PECT THE I PREMISES IN CONJUNCTION WITH REVIEW OFT APPLI TION. ~ Signature Property Owner SWORN TO BEFORE ME THIS~DAY OF~~~ ,20~ I I. otary Public i JOANTRONOLONE Notary Public, State of New York N o. Ot TR6033178 Qualified in Kings CounTy Commission Expires Nov. 15, 20 / 3 I • • , i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Th Tov of C~~thold's ode of Ethics prohibits conflicts of interest on the part of town hfficds and emolovees The purpose of the form is to provide information which can alert the town of possible conflicts of interest end albw it m take whatever action is ii ntxessarv ro avoid same. G G YOUR NAME: `~'I tG.t- 1~ I (Last name, first name, fiddle initial, unless you are applying in the game of someone else or other entity, such as a company. If so, indicate the.other person's or compeoy's name) i NAME OF APPLICATION: (Check all that apply.) - Tex grievance Building Variance Trustee 'r Change ofZone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (]f `Other', name the activity.) Do you personally (or through your company, spouse, sitiling, parent, or child) have a relationship with any offiar or employee of the Town ofSouthold? "Relationship" includes by bloo4 marriage, or business ihterest °Busincss interest" means a business, ~ including apartnership, in which thetown officer or employee has evenapartialowrwrship of (or employmen[by)acorporation , in which the town officer or employee owns more than 5 0 of the shares YES NO I f you ansvered "YES", complete the balance of this form and date and sign where indicated. I I Name of person employed by the Town of Southold _ Title or position of that person Describe the relationship betwcen yourself (the applieantragentrrepresentative) end the town officer or employee. Either check the appropriate lint A) through D) and/or describe in the space proVidcd. ~ The town officer or employee or his or her spouse, sibling, parent, or child is (check all Dial apply): ~ A) the owner of greater then 5°k of the shares of the wrporate stock of the applicant L. (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corpotaoe entity (when the j applicant is not a corporation); I C) an officer, di¢MOr, partner, or employee of the applicant or ~ D) the actual applicant. I DESCRtPT10N OF RELATIONSHIP Submitted this day of 200 _ Signattue Print Name Form TS 1 I I Town of Southold Erosion, Sedimentation 8 Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.TJI. t. THE FOLLOWING ACTIONS MAY REGVIRE THE SVSM18310N OF A '4[ ~ STORMFMATE 6RAD1 DRA1 ApE AND 6ROSNl ROL PLAN 'o651eT xF ifan 'O~Tc ZoT' C FIED BY A ON PNOFESSIONAL IN THE STA OF NEW SCOPE OF WORK - PROPOSID CONSTRUCTION ITEM # / WORKASSES511iIIVT Yes No a. What S the TtNaI Area of the Project ParceLa? (lrrdude Total Area of aA Pamela kNated wErln ~ WIII th(s Pro)ect Retdn All Stomt-WaterRun-Off Iha Scope of Work for Proposed ConetnwTbn) GNrtaated 6y a iwo (2') Inch Rainfall on Stle? b. What is the Total Area d land Clead (s.r. r Rao) (This Item wig indude ag runoff created by site n9 clearing and/or rxmstructbn ttcOvitias as wall as all and/or Ground DisWrbence for the proposed Site Improvemenla and the pennaneM aeatlon of con~~On may? ImperNous surreees.) ~ J PROVIDE BRIEF PAOIECI' DESCRIP"ITON tPrwa. aeadaW P.a~ae Nrrara) 2 Does the SRe Pian and/or Survey Show AI Proposed ~ ~i Drainage SWtdures IndMatlng Size & Location?This ,I Item shall indutle all Proposed Grade Changes and N t~~ ~ ~ Slopes Controlling 3urtace Water Flow. g Does the S(re Plan and/or survey desWhe tfre erosion - I--~T~ end aetliment control practlces that wgl be.ueetl to 'u/I /I~AA A. A• pp ~-n control she erosion end storm water discharges. TNs /~/'W"1 V ~ ~ ~ r7+~) y item must be malnlained throughout th Fsare ' CansWCHan Period. _ 4 Wdl this Projed Require any Land Filing, Grading or f~ U ~ M I Excavation where theta is a Menge to the NaMal / . l~ / I E~dsting Grade Involving more than 200 Cubic Yan1s v of Material within any Parcel? - ' f-` § Will this AppliraOOn Require Land Disturdng Adivities ? ? ~,I E ~YV ~ Encompassing an Area in Excess of FWe'ftlotrsand (5,000 S.F.) Square Feet of dountl Surtece7 j: ( ~ 6 Is mere a Natural Water Course Running tMCUgh the ? SIte9 Is IhLs ProJed within the Trustees jurisdidion BanaN DEC 7tWPPP Raeuiromenb: Of w1tl11n One Hundred (100') feel ofa Wetland or Submbabn of a SVRPP b reputed for Y ConaWdm edFdtba nvdNrp aaY Beach? diaMbarcee d ana (1)or more ease; indudFg dhWrhar,ma orbs Men one eve Met 7 VYill there 6e She preparedon on Existing Grade Sopes ere pad ore larger wxreron panther wa WYnablydMUrb one or mom ease of brM; which Exlxted FMaen (15)feet of Vertical Riseto Indudutg Canatudbrr edNllbs twoNir,a sot dbWrbanoee d less Man one (11 sae where the oEC has detemtr,ed Met a SPDES pem8 b required for atom webrdxharym. One Hundred (100') of Horizontal Distance? (SWPPWa Shall moat the Mlnimrmr Requinnrds etMa ePDEB 6erMrd Wrrrdt j; WII DrNeweys, Paddrtq Areas or dhar Impervqus rot 9mnn Nreesr DboMryea Iran Carwhaauar aedWey • Pemdt No. 6P-0.10.00t.) Surfetxts be Sloped m Direct Stone-Water Run-0IF ? ' 1. The SWPPP shall De prepared prior b the subrrr8el or tla NOI. The NOI aMl nor into enlist M ttre directlon of a Town O t-0 ? cubmxbdbda Depadrranl pderto ea commas,anemdamaeudbn edNxy. ~ f-wey z. Thor BWPPP eIW deealba the eroebn erM sedanent coned predfcee aM vA,are 9 WIII Olis Projed Requre the PltrcemeM d Material, ? - required, postcCnstructbn atom warernampamnt preNOea Met wa be rasa noror Rertpvel of Vtrgetatlon enlist Ore Conatrrrction Of arty mrehuded to reduce the polubnb MMamwaterd4chagas and basnre Item Within the Town Rlghtof--WayaROad Shoulder mmpbnce vAM the lemo end rondabnedMb peme.lnamDOn, Ma SWPPP pall Aree?mw msrao NOTYa3,asaa haWrrnn deawre, prang) identhy PobnON sourwa of WBdbn wlsoh may ,eewrredy be a%Pacte7 to ehacl the graAYNSlam tmiter dbchaltree. NOTE: RAn, Amwarm Qwtloru Ono MruuBhMro bAneWad wtlha Cheek Wrk 3. AI SVVPPPe Met requlm Me po9laoneWdbn afam wetermw,pn,entpstlka Inaaox and era eonabuutlmapdiabubarcaabNwsen 4daa s.Ratba Nary cwrponed ahel be prepared by a wagfied Deelgn P,o/eada,el Lbenaed'n New Vark a Sbmr.YTabr, rtraabg, Drdnsge 8 Erwlnn Capol Pin b Ragrdratl by da Tam m tMt b kmwbdgubb h Me pdndples and predbee d Slgml wabr Management BeuNeM ntl Nrsl M eahrrr8rad for Ibvbw Pdxm bwnw arArry erdlmryt Parmk ~i MOTE: AO,W IAVk(~)ar,d'a Naaabrmd, Waatla,YRagi,y bra COnVNrapPb9a,) S7'A1'E OF NEW YORK, ~ ~ • CCOUNTY O~F SS That I, •••••~Y~•~. ~......`:.~.:.....C'~~.~~..IU~........... being duty sworn, deposes and says that he/she is the applicant for Pemut,~ (Name dFddduelsyn Doomed) \ And that he/she is the (I/ X11(`r..".SC~...........---............................................................................... C (?Meer. ConUedw. Apem. Coryamle ONber, elc,l• Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have pedtumed the said work and to make and file this application; thaz all statements contained in this appGgtion are true to the hest of his knowledge and belief, and that the work will be performed in the manner set forth in the application filed herewith. Sworn W before me this; `of , 203 Notary Public:....,/~T:.!:4. JOAN TRONOLONE ~ (slvam,dnpplmm) FORM • 06/10 o ary u i , No. 01TR6033178 j Qualified in Kings County Commission Expires Nov. 15, 20 / 3 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicarrts for pemits* 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. 2. 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 nronosed action will be evaluated as to its significant 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 C affect the achievement of the LWRP policy standards and conditions contained in the consistency I review law. Thus, each answer mast be exulained in deta listine both sunnortine and non- i supportin¢ 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. DESCRIPTIONS OpF~jSITE AND PROPOSED ACTION ~ D ~ ~ ~ ~ ~ r r MAY 3 1 2013 V PROJECT NAME The Application has been submitted to (check appropriate response): outhold Town a Uu ees Town Board ? Planning Board ? Buildmg Dept. ? Board of Trustees 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) Pemit, approval, license, certification: /y , afore and extent of action: P~1~' IT ~ IL i a y n~2S Q ")1'/~NI~G~ ~.A.~v9 ~T I_ ~°1r~ M t`~~ s i Location of action: a ~ S nn Gr~ ~ ~ ~,lU 1~ ~ - Site acreage: ~ ~ ~t--Ic-~' Present land use: ~ ~ d`~ h~ j-~v~~ Present zoning classification: ~ ~ 51 i-A 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be rovided: P (a) Name of applicant: ~ 1 ~ C ~ ~ C7 dU ) L F~ (b) Mailing address: ~ 1 ~ ~ / (c) Telephone number: Area Code ( ) ~ ~ 7 ~ ~ ~ / ~ ~ ~1 ii (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? j Yes ? No ~ If yes, which state or federal agency? j C. Evaluate the project to the following policies by analyzing how the project will further support or I'~, not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be retarned for completion. j I DEVELOPED COAST POLICY Policy 1. Foater 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 LWRP Section III -Policies; Page 2 for evaluation I~. criteria. Yes ~ No Not Applicable I~, I Attach additional sheets if necessary Policy 2. Protect and prese a historic and archaeological resources of the Town of Southold. See LWRP Section III Polici 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 HI -~Poli/cies Pages 6 through 7 for evaluafion criteria ? Yes ? No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES j Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III -Policies Pages 8 through 16 for evaluation criteria ? Yes ? No ~ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III -Policies Pages 16 throw 21 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 SigniTicant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III -Policies; Pages 22 through 32 for evaluation criteria. ~ I ? ? i Yea No Not Applicable 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 3,4~for/evaluation criteria. ? Yes ? No~ Not Applicable II. Attach additional sheets if necessary ICI I Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. ee LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? No Not Applicable f PUBLIC COAST POLICIES i I 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~ N Not Applicable I i Attach additonal sheets if necessary f . ~ ~ WORHING 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 ? 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 ifnecessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III -Policies; Pages 62 through 65 for eval ion criteria. ? Yes ? No Not Applicable I I I Attach additonal sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; P es 65 through 68 for evaluation criteria. i ? Yes ? No Not Applicable PREPARED BY TITLE DATE