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HomeMy WebLinkAboutTR-8309ABOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 CERTIFICATE OF COMPLIANCE # 1113C Telephone (631) 765-1892 Fax (631) 765-6641 Date: May 12, 2015 THIS CERTIFIES that the breaking up of a portion of existing driveway for replacement of existingsanitary anitary system in-place and repaving of disturbed area At 3360 Minnehaha Boulevard, Southold, New York Suffolk County Tax Map # 87-3-66.4 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 30, 2013 pursuant to which Trustees Wetland Permit #8309A Dated October 16, 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 breaking up of a portion of existing drivewafor replacement of existing sanitarsystem in-place and repaving of disturbed area. The certificate is issued to SEAN R. MCCOYD owner of the aforesaid property. -- IWVI% ,- Authorized Signature SO John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee CP 41C Dave Bergen, Trustee a� Ol�100m� Charles J. Sanders, Trustee BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 CERTIFICATE OF COMPLIANCE # 1113C Telephone (631) 765-1892 Fax (631) 765-6641 Date: May 12, 2015 THIS CERTIFIES that the breaking up of a portion of existing driveway for replacement of existingsanitary anitary system in-place and repaving of disturbed area At 3360 Minnehaha Boulevard, Southold, New York Suffolk County Tax Map # 87-3-66.4 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 30, 2013 pursuant to which Trustees Wetland Permit #8309A Dated October 16, 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 breaking up of a portion of existing drivewafor replacement of existing sanitarsystem in-place and repaving of disturbed area. The certificate is issued to SEAN R. MCCOYD owner of the aforesaid property. -- IWVI% ,- Authorized Signature BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: T Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1St day of construction '/ constructed Project complete, compliance inspection. INSPECTED BY: M " �—' ,-�� Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 CERTIFICATE OF COMPLIANCE: John M. Bredemeyer III, President OG, Michael J. Domino, Vice -President James F. King CQia at _P►s Dave Bergen w y • !� O Charles J. Sanders BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: T Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1St day of construction '/ constructed Project complete, compliance inspection. INSPECTED BY: M " �—' ,-�� Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 CERTIFICATE OF COMPLIANCE: 0 • James F. King, President �o�IFFOj r Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice -President ti�� filly P.O. Box 1179 a Dave Bergen Southold, NY 11971 John Bredemeyer �yTelephone (631) 765-1892 Michael J. Domino Gl Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE -CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line tat day of construction % constructed V Project complete, compliance inspection 0 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 9 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Permit No.: 8309A Date of Receipt of Application: September 30, 2013 Applicant: Sean R. McCoyd SCTM#: 87-3-66.4 Project Location: 3360 Minnehaha Boulevard, Southold Date of Resolution/Issuance: October 16, 2013 Date of Expiration: October 16, 2015 Reviewed by: Trustee Michael Domino Telephone (631) 765-1592 Pax(631)765-6641 Project Description: To break up a portion of existing driveway in order to replace existing sanitary system in-place and repave disturbed area. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Sean R. McCoyd, received on September 30, 2013, and stamped approved on October 16, 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 0 0 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael I. Domino Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: Qofi S/ g-0 /j? P.O. Box 1179 Southold, NY 11971 Telephone f631 765-1892 Fax (631) 765-6641 SEAN R. McCOYD requests an Administrative Permit to break up a portion of existing driveway in order to replace existing sanitary system in-place and repave disturbed area. Located: 3360 Minnehaha Boulevard, Southold. SCTM# 87.-3- 66.4 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: Modifications: Present Were: J. Ki _B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: 0 9 OFFICE LOCATION: Town Hall Annex OF S0(/ryO MAILING ADDRESS: P.O. Box 1179 54375 State Route 25 * # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 G� Q ��y00UNTY,�� Telephone: 631 765-1938 Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: October 15, 2013 Re: LWRP Coastal Consistency Review for SEAN R. McCOYD SCTM#1000-87.-3-66.4 OCT 1 5 2013 SEAN R. McCOYD requests an Administrative Permit to break up a portion of existing driveway in order to replace existing sanitary system in-place and repave disturbed area. Located: 3360 Minnehaha Boulevard, Southold. SCTM# 87.-3-66.4 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site (inplace), including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit and shoreline erosion control structures (including, but not limited to, groins, jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); 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 0 James F. King, President Bob Ghosio, Jr., Vice -President Dave Bergen John Bredemeyer Michael J. Domino BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application _A_ Administrative Permit _Amendment/Transfer�/E'x�Qra�sion Received Application: /N) 3 Received Fee:$ `-`� Completed Application r 3 _SEQRA Classification: Type I Type II_Unlisted Coordination:(date sent) �LWRP Consistency Assessment Form � l3 _CAC Referral Sent: Date of Inspection: lQ17113 _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: V Resolution: Name of SZ� 12. M C� 0 Town Hall Annex 64376 Main Road P.O. Box 1179 Southold, New York 11971-0969 Telephone (631) 766-1892 Fax (631) 766-6641 SEP 302013 Mailing Address 'Q<Je� Soj{(_o(of &? 1-t l _Phone Number:(ye) Gg o - 9 (S(o Suffolk County Tax Map Number: 1000 - '� 7 - 03 - (� C . -( Property Location: 33(n0 QAVJ l)`( (147 (provide LILCO Pole #, distance to cross streets, and location) AGENT: /\i (If applicable) 0 0 Board of Trustees Application GENERAL DATA Land Area (in square feet):_ 13 5C)`( S�1, F r ( , 3 t AC r e-S� Area Zoning: Les' -6c , c l Previous use of property: iL�s •e r L,Z l Intended use of property: (2-e-si ck.¢... k --k Covenants and Restrictions on property? Yes X' No If "Yes", please provide a copy Will this project require a Building Permit as per Town Code? Yes __y- 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 )C 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 x No Does the structure (s) on property have a valid Certificate of Occupancy? X 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_ If yes, provide explanation: Project Description (use attachments if necessary): Qre--1K- f/o" f c� �+--- aP�Q -s"'60-7' s":60-y Yes Board of Trustees application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Q e,_lL� i— P_" -v— Area of wetlands on lot: square feet Percent coverage of lot: -% Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? ' cubic yards How much material will be filled? 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: /\J 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 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) I. APPLICANT/SPONSOR 2. PROJECT NAME 3.PROJECT LOCATION: 33cop 1-ltiw�p l.G�(.�y (Jk�Ak Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc or provide map 5. IS PROPOSED ACTION: ❑ New ❑ Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: vct,y cis fPLQ s paQlr~c�.t3i,.���-r1 S�s�pa�� Pro \-ems 7,AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑ Yes ❑ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ® Residential ❑ Industrial El Commercial ❑Agriculture ❑ Park / Forest / Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local Yes ®No If yes, list agency name and permit / approval: CURRENTLYAPPROVAL? ❑Yes ©No H yes, list agency name and permit / approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Use 19 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: p Signature / - ZS - if 3 If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment Ad Y PART II - IMPACT ASSESSMENT(To completed bv Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑� No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. E] Yes Z No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑ Yes ✓❑ No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑� No If Yes, explain briefly: PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box ifyou have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determin Board of Trustees oc'T y zoi3 Name of LeadAgency ate um /eef tl--, President Pint or Type Name o TtesponsibOfficer in Lead Agency I rue of Responsible Officer Signature of Preparerdifferent from responsible officer) 0 0 Board of Trustees Application County of Suffolk State of New York C � �A C� a `f vl BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. k Signeer SWORN TO BEFORE ME THIS A0 DAY OF_4 20 � 35 \c�CQ Notary Public VICKI TOTH Notary pu'C.p of New York No.01'f0 ()696 Qualified in Suffolk Count Commission Expires Julv ZR APPLICANT/AGENTMEPRESENTATWE TRANSACTIONAL DISCLOSURE FORM neeessary m avow same. Q - YOUR NAME: M C, C, C) (Last name, fust name, {riddle initial, unless you aro applying in the name of someone else or other entity, such as a company. If so, indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (if "Other-, name the activity.) Building Trustee ✓ Coastal Erosion Mooring Planning Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any offiar 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%ofthe 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 applicantlagentlrepresentative) 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 the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non- orpomte entity (when the applicant is not a corporation); C) an officer, director, partner, of employee of the applicant; or - D) the actual applicant. DESCRIPTION OF RELATIONSHIP - Submitted this 2-(o day of 5 -- 200 3L Signature a� Print Name Form IS I 0 da Town of Southold ®Erosion, Sedimentation & Storm -Water Run-off ASSESSMENT FORM PROPERTY LOCATION: s.C.rn. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A S -7 -O a Cofo `{ I Do,> • S WATERR DRAINAGE AND E GO PLM( s-6TSkT 3su h '9 eTi 1"oT I.IF1ED�r q DESIGNPROFESSIONAL� O N SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSMENT Yes No — a. What is the Total Area of the Project Parcels?(In Tote/ Arra of all Parcels boated NAII this Project Retain All Stam -Water Run -0(f tion) �1 the Scope of Work for Proposed Construction) Lo �q' Fr the Scope Generated by a Two {21 Inch Rainfall on Site? b. What M gle Total Area of Land Chad (&F. f PQ®) n9 (This dem will include ad runoff created by site clearing andlor construction activities as well as all ❑ and/or Ground Disturbance for the dSite Improvements and the permanent Creation of constructionactivity? (l impervious surfaces.) 2 Does the Shia Plan and/or Su / Survey e&LoctlProposed t—/ ❑ Drainage Structures Indicating Size &Location? This Item shall include all Proposed Grade Changes and PSOVIDE BRIEF PEO.iE(,T DESCRIP7iON lPanN.amhiar Pa -N.etae Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe tire erosion J�—� GSA e�n�\Ic //�hG.( .� &A and sediment control practices that will beused to control site erosion and storm water discharges. This Item most be maintained throughout the Entre Construction Period. I - 1 ict-C�� 54... i 1 " S lei. 4s k .h.. h.. rO tr�C>Z -.6..a r f�f^r ¢ WII this Protect Require any Land Filing, Greclrlq or Excavation where there is a change to the Natural r y �^ ^ � C Existing Grade Involving more than 200 Cubic Yards _ _ of Material within any Parcel? 5 Will this Application Require Land Disturbing �0,�,� . A1C : l h, a e- Acgviues Encompassing an Area in Excess of Five Thousand ✓' (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the ❑ Site? Is this Project within the Trustees jurisdiction (/ or within One Hundred (100') feet of a Wetland or General DEC SWPPP Requirements: Submbilm of a SWPPP is required for a Conehuction actMtles Involvtrq soY Beach? dlsam partnoea More (1)r mom that uMmat dbhrrbmcea of Was then oreacre Wel ere pert ore Plen lhM cog uXNnNe one a eau Of fend; 7 Will there be Site preparation on Existing Grade Slopes stuctom clivi rbanawb iodating Canshuctbn emvities itvoNirg soy tlMWNences of leas than one (t) acre where then the DEC has drEsm&iad that a SPDES permR M required Mr Won water diachargea. which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? —L El (SWPPPY Shall nreettha Minlraura Require Wan of the SPDEa eery err Mmet for storm Water Discharges lair Caubuctlm acawty - Pend/ No. GP -040.001.) 8 Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm -Water Run -Of ❑ 1. The SWPPP shall be Papered puler tote subhalet of die NO]. The Not SW be sthpnitod M We Deparhnenl Pdorto the convrohhconera of consWctbn ac Way. inlo and/or in the dire Won of a Town right -or -way? 2. The SWPPP ataldesoft a IM amlon and sedkoi nt control pmcdras are where 9 Will this Project Require this Placement of Materiel, requtrW, poNtarolmdbn slerrri water rrerogenant practicw that will used erhNar Removal of Vegetation and/or Ute Conshuction of any constructed to reduce the PhOulents In storm water d ICII&Wa and to assns compasece win the tame and condPoare ofWa permit. In addition. the SWPPP Shelf �. Item Within the Town Right -of -Way or Road ShoulderEl identay Potential s nwa of Pollution which may reasonably be ehpected N ated the Am? cm, me, waharirvas aw u.narmn sod+Pq•aps1al quaky of atom waterdlschahges. NerE: If My Mahwrm Ouaetloria ens (hmhrplr Niro N Anawret Mae Clasp Nark 3. AI SWPPPS (hat require the poal ostrucrbn stormwatrmarugmhem predke In a Box and the canatnrcaor she 11.1awbaroe M between 6,000 a F. i l Mn M was, component shal be propered by a qualified Design Professional Licensed M New York a Sbm•Warr, Drainage A Erosion Cwnboi Plan M Required by to Town of that Is knowledgeable in We Pdnclples and Practices of Slam Water Manegmeni,SouWeld end Hort be Sub Lftdfr Review Prior br euea of Any Building ParParse.m (NOTE: ACbd Mrk(4) ehdbrarawrrond,gho kR,,&WfraC.OMAppko I STATE OF NEW YORK, COUNTY OyyFF.�........................................... SS ... That I, ....... ..._!..h' u ` .................... being duly sworn, deposes and that he/she is for ser the (Name orinddh)hiefPo Ys applicant Permit' Andthat he/she is the............................................ ................. ..............................................................................-........... Conbador, Agent, CorPorare efllnr, ale.) 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 application are true to the best of his knowiedge and belieF and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this, QQ ............._ C—V.:}.......... - gof...4 ........... , 20L IC NotaryPublic: ....... ..............._{{pp ..... ........................5...........? ......_..................... _. rw.r.SL ..f Now Vnrk (qua dAppican FORM - 06/10 0 0 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 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 proposed 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 affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail. listme both supporting and non - supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE/AND PROPOSED ACTION SCTM# 5�7 PROJECT NAME Q 1d V Y 119 7/ The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees 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: !_Zre,,L lrT�Oo,�. •��. �re.,�►we_ �:,��-�� �sl,._�+— a0u�, C�-...pV-E,u... EG �{ra�ea�-. 0 0 Location of action:__ 3 (o G M -N.".t"L�- Q (vf l rr" k-� Y-- Site G Site acreage:. 3 \ Prr- c 13 SU q Present land S c Present zoning classification: (Les -'du' %-'- 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: ee' N (b) Mailing address: 33� \� v. P te. 4c, Q ("A (Q�-J 41-x.0 t l (V 11 I \ � -? l (c) Telephone number: Area Code (fid 6 cf O - `7 l S ro (d) Application number, if any: W-4— (-��vc- We-� (A -,,et Q -� Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No D4 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 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 0 Yes ❑ No [21"1 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 O Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III — Policies Pages S 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 IH — Policies Pages 16 through 21 for evaluation criteria Yes 1:1 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 HI — Policies; Pages 22 through 32 for evaluation criteria. ! 0 Yes No NotApplicable 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 IN 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. ❑ Yes10 No ® Not Applicable Attach additional 9 WORKING COAST POLICIES 0 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 �"" e c"""r DATE 5' -2-(0 -l3 TEST HOLE DATA BY MCDONALD GEOSCIENCE 12/6/12 EL 4.6' DARK BROWN LDAM OL ----- 0.5' BROWN SILTY SAND SM 4' BROWN CLAYEY SAND SC EL -0.1' WATER 4.7' WATER IN BROWN CLAYEY SAND SC 7• WATER IN PALE BROWN FINE TO MEDIUM SAND SP n' N89'46'070E TIE LINE r Q ,r,, \ Zx w J rod, kl" 00&41C wq14J aQ2; -'kt It r F SURVEY OF PROPERTY AT LAUGHING WATERS TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000-87-03-66.4 SCALE. 1'=30' DECEMBER 19, 2012 C k 126 03 \ ELEVATIONS REFERENCED TO N.A.V.D. APPROVED Ir", BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE 3 I am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the permit to construct. The location from field o FLOOD ZONE FROM FIRM MAP NUMBER 36103CO166H SEPTEMBER 25, 2009 ANY ALTERA77ON OR ADDITION TO THIS SURVEY IS A WOLAT70N OF SEC77ON 7209OF THE NEW YORK STA 7E EDUCATION LAW. EXCEPT AS PER SECT70N 7209 -SUBDIVISION 2. ALL CERTIf7CA77ONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. L?e & public water shown hereon are from data obtained from others. N.Y.S. LIC. IONIC VEYORS, P.C. 31) 765-5020 FAX (631) P.O. BOX 909 ���--- 1230 TRAVELER STREET[1", q S SOUTHOLD, N.Y. 11971 11�C n. 765-1797