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HomeMy WebLinkAboutSheehan, Diane 0 0 James F. King, President r4F so~ryo Town Hall Annex Bob Ghosio, Jr., Vice-President 54375 Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer co • ~O Telephone (631) 765-1892 Michael J. Domino Fax (631) 765-6641 COU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NOTICE OF DISAPPROVAL - ADMINISTRATIVE PERMIT Applicant: Dianne Sheehan Date of Receipt of Application: October 29, 2013 SCTM#: 59-1-1 Project Location: 1200 Leeton Drive, Southold Date of Resolution: November 13, 2013 Reviewed by: Board of Trustees Project Description: To install a snow fence along the beach dunes. Findings: The project does not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code as the Board determined that there would be no benefit to the surrounding dune area or help with erosion control in or around the subject property. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. James F.~ g, Pr ' dent Board of Trustee JFIVeac su> Foy r James F. King, President P.O. Box 1179 Bob Ghosio, Jr., Vice-President h~ Southold, NY 11971 Dave Bergen ? Telephone (631 765-1892 John Bredemeyer Fax (631) 765-6641 Michael J. Domino ,yo1 aao* Southold Town Board of Trustees Field InspectionflWork Session Report Date/Time: d Quarty Construction on behalf of DIANNE SHEEHAN requests an Administrative Permit to install a snow fence along the beach dunes. Located: 1200 Leeton Drive, Southold. SCTM# 59-1-1 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 T of Application: _ Wetland -Coastal Erosion -Amendment Administrative_Emergency -Pre-Submission Violation Info needed: Modifications: Conditions: Prese nt-Were: J. Kin Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in e fiel b Mailed/Faxed to: Date: Jig y 1 _ ..IIII~I ,sue. w ilium, L' C fir.. ~I i 4 i / X11///~ T Y y ' I I I , '~r ~ t~~jlll~ll ( n I' w _ + °r. w s' -Poe, IF G r f 8 a ~ii• p~Sq a + i S • aye 9 o J a a a i G rJ O • as a a a ! .G f'/f O , .n \ !„y4 •A•~ n `a vW ~ ^ !GS !'i C~ S~ S!F • „r `I S • ..V. ~ ~4p ' ! CJ • it! a w. rA. r ! q~ a, LDS a' J~ a p ~ 9•t` ~ e G 'T i a,. © ! a •ws © ! ! o a Oe A 3 ! ! • P )t i~~" ~ti a •s ..a M e e wy J (\~V i~ \I i$ O a •i a• \ e•'s swerr+v J e ~ S - ~~F .wa e ~ f 99 _ _ - xo.c[ COUNfV OF SUFFO © E . aernwin ~..P.srw..smxeNaav • S9 0 OFFICE LOCATION: OF SOUjyO MAILING ADDRESS: Town Hall Annex h~ l0 P.O. Box 1179 54375 State Route 25 l~ # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Q Southold, NY 11971 Telephone: 631 765-1935 Fax: 631765-3136 ~~y00UNT'I,Nc~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 22 Ca 22 p HL.. - 7 2013 To: Jim King, President Town of Southold Board of Trustees CGll~iIlu c From: Mark Terry, Principal Planner LWRP Coordinator Date: November 6, 2013 Re: LWRP Coastal Consistency Review for DIANNE SHEEHAN SCTM#1000-59-1-1 Quarty Construction on behalf of DIANNE SHEEHAN requests an Administrative Permit to install a snow fence along the beach dunes. Located: 1200 Leeton Drive, Southold. SCTM# 59-1-1 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 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 Town Hall Annex James F. King, President. ~UjyO 64876 Main Road Bob Ohosio, Jr., Vice-President P.O. Box 1179 Dave Bergen # Southold, New York 11971-0969 John Bredemeyer Michael J. Domino Telephone (681) 766-1892 Fax (681) 766-6641 BOARD OF TOWN TRUSTEES fir, p TOWN OF SOUTHOLD D OificeUceOnly OCT 2 9 ?Cl3 Coastal Erosion Permit Applica 'on Wetland Permit Application Administrative Permit Saitl nca to n _Amendment/Transfer/Extension 90 Received Application: o / 3 ReceivedFee:$ Completed Application/ -Incomplete _SEQRA Classification: Type I -Type 11-Unlisted Coordination:(date sent) R:LWRP Consistency Asmsment Form [#1-5 CAC Referral Sent: Date of Inspection: I IT _ G -Receipt of CAC Repoft: -Lead Agency Determination: Technical Review: Public Hearing Held: IJL3h2~ Resolution: V I Name of Applicant' VAct.yn e $h r{,1,uN 0 Mailing Addres,. > 3~ ~C~~ !f M~ra~,a sl*~ A~~/ ! 03 Phone Number:( yU i Suffolk County Tax Map Number: 1000 - ~i q - Property Location: /20,11 Pe d V Ga (provide LILCCO` Pole distance to cross streets, and location) AGENT: ( //iii z' / "o~, r~u t j s%r (If applicable) Address:/ 5' 7z-'lZ -71 , /G 4/1~5~ ;7 Phone: card of Trustees Application i GENERAL DATA Land Area (in square feet): /l )~O i Area Zoning: I /J e ~ I Previous use of property: p Q.c4Y «~.~/I Intended use of property: Covenants and Restrictions pn property? Yes E,/ 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 BuiDept. 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 -r--Does the structure (s) on property have a valid Certificate of Occupancy? -4yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. ittapproval ever been revoked or suspended by a governmental agency?_ o~ No Yes Has an 7 1 If yes, provide explanation: ~r Project Description (use attachments if necessary): 17n ,dc f/LLh/ / I Sod of Trustees Application. WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 5,1? &42 Area of wetlands on lot: M fD square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands:&go 1" !_feet Closest distance between nearest proposed structure and upland edge of wetlands: keX fro 1 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: 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): b/ g 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part I - Project and Sponsor Information Name of Action or Project: na, ,l Project Location (describe, and attach a location map): J/267'-) / Brief Description of Proposed Action: q/ ? -0 C'..2 Gi/ ~Glh~f Name o plicant or Sponsor: FelephonMail: Add ess: 9/1 ity/PO' State: Zip Code: L 1. Does the proposed action only involve the legislative adoption of a plan, local law, or nance, NO YES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that ? may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES If Yes, list agency(s) name and permit or approval: ® ? 3.a. Total acreage of the site of the proposed action? /r 5ela acres b. Total acreage to be physically disturbed? acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on, adjoining and near the proposed action. Urban []Rural (non-agriculture) []Industrial []Commercial V Residential (suburban) []Forest []Agriculture []Aquatic []Other (specify): []Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ? 12 ? b. Consistent with the adopted comprehensive plan? ? ? ? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ? El 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NO YES If Yes, identify: 0 ? 8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES ® ? b. Are public transportation service(s) available at or near the site of the proposed action? ® ? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? W ? 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements, describe design features and technologies: P ? 10. Will the proposed action connect to an existing public/private water supply? NO YES If No, describe method for providing potable water: .4. 14 0 ? 11. Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment: V4- [A ? 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ? b. Is the proposed action located in an archeological sensitive area? ? 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain NO (YES wetlands or other waterbodies regulated by a federal, state or local agency? ? L~ b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? ? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: IRShomline ?Forest OAgricultural/grasslands ?Early mid-successional ? Wetland ?Urban ?Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? ® ? 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge, either from point or non-point sources? NO YES If Yes, ® ? a. Will storm water discharges flow to adjacent properties? ~ NO YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: [ONO ?YES Page 2 of 4 • • 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: P F1 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes, describe: ® ? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or NO YES completed) for hazardous waste? If Yes, describe: ® ? 1 AFFIRM THAT THE INFOR IDN PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/s e: Date: '~~/2 t~ /20 / 7 _ Signatur : Part 2 - Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ? regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ~i1" ? 3. Will the proposed action impair the character or quality of the existing community? F-1 4. Will the proposed action have an impact on the environmental characteristics that caused the ? establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ? affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate I' ? reasonably available energy conservation or renewable energy o ortunities? LJ 7. Will the proposed action impact existing: ? a. public / private water supplies? b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, ? architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, © ? waterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 No, or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage ? problems? 11. Will the proposed action create a hazard to environmental resources or human health? 1:1 ? Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ? Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees 111111-3 Name of Lead Agency Date ,1i9a f 6 f 6 IZI A) r,- President Print or Type Name of Resp~on~sible Offi er in Lead Agency Title of Responsible Officer Sign ure of Responsible Officer in ad Agency Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 PROJECT ID NUMBER 617'20 SEQR ' APPENDIX C 0 STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by plicant or Project Sponsor) 1. APPLI /SPONSO 2. PROJECT NAME .r o M 3.PROJECT LOCATION: MunicipalityQ ,~11" ?.G CduMy / i 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map o0 Q 5. IS PROPOSED ACTION : New Expansion I~Modi0cation / alteration 6. DESCRIBE PROJECT BRIEFLY: LEI S//O/N ivo.,C do laK.re r 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres /Vo 17 'e 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ? No If no, describe briefly: L.F 19 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) presidential Elindustdal IlCommerciai Agriculture Park/Forest/Open Space E]Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes 174o it yes, list agency name and permit / approval: APPROVAL? 10 Yes ?No H yes, list agency name and permit /approval 12 AS A ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? B8 No I CERTIFY THAT TH INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spon rse h7 ur~ ~clGe~~' Onrl raa Iii Date: S ature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment _ i APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM Ill Town of Southold's Code of Ethics whibi'° conflicts of inerest on the tract of town otliars and emoloveea The Itim a of this form is to provide information which can alert the town of possible conflicts of lnterra and allow it to take whatever action is _ neoesaarv to avoid scone. - YOUR NAME: ~y/1 c , (East name, name, spiddk initial, unless you ero applying in the name of someone else or other entity, such as a company. If an, indicate., the.other person's or company's new.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval ofplat mooring Exemption from plat or official map Planning Other 0" (If"Odin", name the activity.) Swok/ e.~ Z On n4 f Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship.with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business itderesL "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% of the 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 Tide or position of that person Describe the relationship between yourself (the applicant/ageat/mpresentative) 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 then 5% of the shares of the corporate stock of the applicant (when the applicant is a corporationk _B) the legal orbeneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); Q an officer, director, partner, or employee of the applicant; or D) the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of Signature Print N Form TS 1 BqV of Trustees Application County of Suffolk State of New York `a h e, BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE(SW S THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND T ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS#OWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 20(3 Notarf Public ANTHONY A. MERGIU-DO NOTARY PUBLIC. `hate of New Yore: No. q9 5382 puamW M Nassau Z coyrAy Caton Exp. d of Trustees Applioatioa~ AUTHORIZATION (where the applicant is not the owner) I, 0 fQn YC, Stieehavi residing at S3 Ac Nec e- / hGtQSSG /v~/ //0 3 c7 (print owner of property) (mailing address) do hereby authorize / oM a UcIV7 (Q!/Ct?1~ ~Oi1S~/v (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ?1 ( wnee signature) /ZOO Le&-6kA ~ ? l 1 I I ~-Ls tt~ o~tl ~ ` f 0 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM '4/ Yom" eROPaarr LOCATIM Sr-TA. e. s TIC FON.UMNO ACTIONS MAY VJ1AM D THE SUMMBSMN OF A EROSION CONTROL PLAN 15affir 19al - - Eflul - -Et- C A SCOPE OF WORK - PROPOSED CONSTRUCTION rrEm # / WOR)iASSESSMENT is No- e. What Is the Total Area of the Project Parcels? (Include Total Area of all Parcels boated within Will this project Retain All Sbnn-Water Run-OR the Scope of Work for Proposed Construction) Generated by a Two (27 Inch Reirm on Site? (This Item will Include all runoff created by site ? b. What Is the Total Area of Land Clearing clearing and%or construction activities as well as all and/or Ground Disturbance for the proposed tiOq Site Improvements and the permanent creation of construction a~ (&P.fAar) Impervious surfaces.) Z Does PROVIDEBREEPPROISCrDESCRUMON lPw.reaaddWrPeawwrtrwra Drainage ge the Site StructuPlan res Indicating dstsaize & & Show AN Location? This This V? Iwn shell Include all Proposed Grade Changes and Slopes Controlling surface water Flow. 3 Does the Site Plan and/or survey describe the erosion d and sediment control practices that will be.used to control site erasion and storm water discharges. This item must be maintained throughout the Endre Construction Period. 4 Will this Project Require any Land Filling, Grading or Excavation wfrere there is a change to the Natural / Existing Grade Involving more than 200 Cubic Yards d of Materiel what in any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ? (5,000 S.F.) Square Feet of Ground Surface? 6 is there a Natural Wetar Course Running trough the SRO? Is Cris Project withinthe Tnatess oladb8on ? , j eanarst DEC SINFPP RSadmnens: or wtthlm One Hundred (IOY) feet of a Wetland or Sunntrbn of a SWPPP Is ragrrked for ON Conshudlon aclNldes involft as Beach? dhaaharnec aaatt)w more acrr; pdumrp dhhrMnoea a Wet then one acre tlat 7 Will there be Site preparation an Existing Grade Slopes net part of a WW oorarm pan UWwg utanelydaubare wrrmre saasaImp, which Exceed Fifteen (15) feat of vertical Rine to kKkx%'C CwmkucCan sdlvDes bwaMng as dbW'ban`° of less dwwe(1)sne xf(am One Hundred(IW) of Horizontal Distence? the DEC has deftiA that a SPDES penal Is regWeM br stem WQW I I roes. (S1tlPPPb Well neat as Lllelemm Requiremeeb of On SPOES 6marN(wmk 6 WIRDdveways, Paling Areas or other lmpeivious for ntam Wdw alsesxges aonr carmtrucaac nadviy-Pamdt No. rrT440401.) Surfaces be Sloped to Direct Storm-Water Run-Off a , 1. The SwPPP Well be prepared pdab the submlW atlas NOI. The N01 shall be Into and/or In the direction of a Town dgMol-way? suW~ to tin DepaMrenr prior to do comnanmmem aambaaion adkA'. z. The SWPPP shell describe the ermkn and searnnt oaad PVcHwandwham 9 Will this Protect Require the Placement of male". rewlwA potowntrucbm seam walermwgemart preclor het wi be used moor Remove( of VegebCoa anifwthe Construction of any corrhauaad to reduce tla pokhnta In alum wnadiadmW end to sense Item Within the Town Rightof-Way or Road Shoulder ow"arce wah do Wma and ccetdaom oracle pem* In Season. Me SWPPP daO Arse?pw as »arorasru.resro.aad..wrM«..t - - Mwdffypc&mM amens of poaakn wtft mey mecaneW be 00800d n aea tin grdya six. ealerdechwgm NOTE: VArryAnmerls Our"m oaadwough Nbn Is Answwodv aCheek Wrk 3.A1SWPPP%1WM lrs,apeM,oautroawrs P wearmmegamentpaWoa Maeo: Ndaa nawwtmaasdwwwno.tab.tw..o ti edg sP.atAamaams, cmponeMstWbepmpered bye 11 Design Praeslonal Linrnedh NMYadr aerrmieWr.ar&dIr&nmlaaga•[raatan Cawml Wank RSga' bytlnlr w of met isftm%ftemble in as Mocirlrend wacgrsa sownwaar rAenag«nara aouaaderrdmebeaa6eVbdrwR.dwvdaaaaunalaArgr Rrelarg Pwmr. (NOTE: AChwktavk(,F) aalwM fwaah OeWmkRm*Wftreemom Awkslor) STATE OF NEW YORK, < C, p V COUNTY OF 1.i~ SS That I,1~~.. .crrrraaa _.......j................... hauling drily sworn, deposes and says that he/site is the applicant for Permit, ( a log Doa.naa And that he/she is the (11.7 f rC.t.(lPr (Owner. Cnb-W. Agent. Caparsn OMay air) Owner and/or representative of the Owner or Owners, and is drily authorized to perform or have performed the said work and to snake 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 this'.. 2 day of t1iXISpe..... ~ \3 ON< C; Notary Pubhc:...1 F... c r . 1112..0..] . (SgnMUOdAppNWm) NOMA" FORM - 06/70 Nd"Rd.gt ) QRfdied in Suffolk Coun - Commission Expires Town of Southold M 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 ezplamed in detail, listing both supportL 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# O S,0% PROJECT NAME/Qy The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building 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) Permit, approval, license, certification: Nature and extent of action: Location of action: Ol zer V" f~,• Site acreage:- &j U-// Present land use: 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: e L~724Z 11-7-71 (c) Telephone number: Area Code ( ) G7/ 76 s' 7c~~ S~/G 63s Z/79 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No M 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 PA 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 5! 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 [ r4 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 HI - Policies Pages 8 through 16 for evaluation criteria 1:1 Yes E1 No s~" Not Applicable Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of Southold. See LWRP Section HI - 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 HI - Policies; Pages 22 through 32 for evaluation criteria. ? ? Yes No Not Aploble 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 FO 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. ? Yeso No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE* 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 R.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 Tot 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 P 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 B TITLE r-e DATE