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Home My WebLink AboutTR-8358A 0 James F. King, President O~@g~FFO( fC Town hall, 53095 Main Rd. P.O. Box 1179 Bob Ghosio, Jr., Vice-President h~ Dave Bergen Southold NY 11971 W John Bredemeyer °y Telephone (631) 765-1892 Michael J. Domino 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 1st day of construction Y2 constricted 7 Project complete, compliance inspection 0 of souryo Town Hall Annex John Bredemeyer, President 54375 Main Road Michael J. Domino, Vice President P.O.Box1179 James F. King Southold, New York 11971-0959 Charles J. SAnders 4WD Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8358A Date of Receipt of Application: December 23, 2013 Applicant: Juliane & Russell Karsten SCTM#: 66-2-2.2 Project Location: 57908 Main Road, Southold Date of Resolutionlissuance: January 22, 2014 Date of Expiration: January 22, 2016 Reviewed by: Board of Trustees Project Description: For a Ten Year Maintenance Permit to hand cut the Common Reed (Phragmites australis) to no less than 12" in height and to cut the wild rose ramble to no less than the height of the existing fence 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 site plan prepared by Creative Environmental Design, last dated February 5, 2014, and stamped approved on February 10, 2014. 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. 6 John M. Bredemeyer III, President Board of Trustees 6 0 John Bredemeyer, President ~%UFFat r Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King P.O. Box 1179 ; Charles J. Sanders y • Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: Creative Environmental Design on behalf of JULIANE & RUSSELL KARSTEN requests an Administrative Permit for a Ten Year Maintenance Permit to hand cut the Common Reed (Phragmites australis ) to not less than 12" in height and to cut the wild rose ramble to 18" high on an as needed basis. Located: 57908 Main Road, Southold. SCTM# 66-2-2.2 ype 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: Conditions: ~ to i Present Were: ?J. Bredemeyer V M. Domino King e' C. Sanders Bay Constable Other Form filled out in the field by qvl Mailed/Faxed to: Date: • p ECEP~. D EC 2 3 2013 L. YZ -Am *A~ } 1 i:~~ AS ~ 1L1,1M YfY ~.'J!'~ MIDI- • ~ ~ 1 2S 1 Z'~+ (~`b YZ i 1 I s~ rr. i G ~A r 1 r 4 #x ,o-.~ ° ~~.@~ , ,V ryj ` ~~'i42~ ~j~ ~1~~~i,~t k ,y ~ VIVti`~ t~ ~ 4{~"; ;IF r~p 11aa jj~ p- ay ~ n j ~~~X ~J`f... ,~rryr? y:~ .`'.f~~ 3 ~`3q s~? - 3R~~a ~ - tea`;` ~ - f ` r ~ ~'L 'Sas ~ -..~in~i~'t r°j 1 i r I I j ~I I YI ( 9aMl ~C3) 44; O 9 IIf ~L~ O'/~ d •f f O. n r+Vq •a. 4 q i. ~ 4I • , O N~ ~ T O i A T~ I /.r S• G T O i COD T T 9~ F [ --f- an V ~ ram COUNTY OF SIIFFOLN ® • o uc,a.xo - _ FslPapsly Ta.4avimdperly v 66 0 0 SU(/ry0 OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) CIO Air Southold, NY 11971 ~O Telephone: 631 765-1938 com Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees JAN 22 2014 From: Mark Terry, Principal Planner LWRP Coordinator L C, I Date: January 21, 2014 b °'0 Re: Proposed Wetland Permit for JULIANE & RUSSELL KARSTEN SCTM# 1000-66-2-2.2 Creative Environmental Design on behalf of JULIANE & RUSSELL KARSTEN requests an Administrative Permit for a Ten Year Maintenance Permit to hand cut the Common Reed (Phragmites australis) to not less than 12" in height and to cut the wild rose ramble to 18" high on an as needed basis. Located: 57908 Main Road, Southold. SCTM# 66-2-2.2 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 TF" 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, The cutting of the wild rose ramble to 18" high on an as needed basis is recommended as CONSISTENT with the LWRP provided that: 1. The Board verifies the species of the wild rose and if it is indigenous; and 2. Vegetation indigenous to wetland systems in Suffolk County is left undisturbed to serve as a vegetated buffer between the residential use and the wetlands. 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 • ~QF sorry • Town Hall Annex Bob Ghosio, Jr., Vice-President 54375 Main Road P.O. Box 1179 Dave Bergen lx[ Southold, New York 11971-0959 John Bredemeyer N Michael J. Domino ~O Telephone (631) 765-1892 Fax (631) 765-6641 ~'f00UNf BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Permit Applicatio -Wetland Permit Application Administrative Permit / Amendmentrrransfer xte Sion nD r 'r- ^ r; l 1/ IIjjeceived Applicatio'nI:___ Inl j,XompledetedFee:$Application u u 3 DEC 2 3 2013 -Incomplete SEQRA Classification: Type I Type II Unlisted 4 CAC sent) - - vyWRP Consistency Assessment Form 1 -CAC Referral Sent ate of Inspection: ~ _Receipt of CAC Report: : Lead Agency Determination: _ echnical Review:~_~~-- ublic Hearing Held: I ?1 -Resolution: t Name of Applicant .Jul /AWNLc gj R?Sg&U- klq-25TEW I Mailing Address 5'7 LO9 /Y/gq~ 6q?fkold A,/L./ Phone Number:03J Suffolk County Tax Map Number: 1000 - I Property Location: 57 c/Og M A-1 ni ~A t~ JcoJ rlkot-~ 1.1 I (provide LILCO Pole distance to cross streets, and location) ~ AGENT: 7j)MG 0 tL1AsrNCbU11 L2 st ,S C* 16t; ~N~ 1 J tcs ilk rf (If applicable) p Address: < e~1 Phone: ~3~"7~7i3 d of Trustees Application Q GENERAL DATA Land Area (in square feet): V ~O Area Zoning: e-E,2-0 Previous use of property: Intended use of property: 2,t 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 Board of Appeals? Yes No If "Yes", please provide copy of decision. Will this project requir any demolition as per Town Code or as determined by the Building Dept.? No Yes Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date h i No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes I If yes, provide explanation: ~I Project Description (use attachments if necessary): 1 i 1lwx 0.~~~n'k Qh~~C~Q J w~ k C J~ la W fl [-Pa.)( 12'. O l 2ivt~.~ un~ ~ei? vl ~l 3 CJ t,, 0' lc~~,626 -45 IcI7 Boio of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: NMa A "1 t V1 e A Cl (ZN(,r,6:AAs 101\ ~.QSe -L Area of wetlands on lot: /Of 7 7 \ square feet Percent coverage of lot: ( 3 Closest distance between nearest existing structure and upland edge of wetlands: x-18 " feet Closest distance between earest proposed structure and upland edge of wetlands: N A _feet Does the project involve excavation or filling? _ No Yes If yes, how much material will be excavated? N A cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet f Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: rr i2o,Do~,e~~ M,u,o,~.enncvKC.~ k~cJL`t- -tv ~ c`unA t I Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 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 1 - Project and Sponsor Information Name of Action or Project: Zl/I% = 1 -e- Project Location (describe, Ad attach a location map): `5`7 0k i Ylac H era r So u`f -fl c) Brief Description of Proposed Action: Name cf A plicant or Sponsor: Telephone: r~ ~ 31- 73 U -7 2 CQQ dF &NV, JX SI G N ' E-Mail: e Z&A I C6AJVI)ES14N Ad ss: G U11" p. 8a n city/ State: Zip lCode: 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO YES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that IX I may be affected in the municipality and proceed to Part 2. If no, continue to question 2. rJ 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? 00 acres b. Total acreage to be physically disturbed? 0 acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? U acres 4. Check all land uses that occur on, adjoining and near the proposed action. Urban ?Rural(non-agriculture) []Industrial []Commercial esidential(suburban) []Forest []Agriculture []Aquatic ?Other(specify): ? Parkland Page I of 4 • 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ? ? 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? ? 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: ? 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? ? ? 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: " ? 10. Will the proposed action connect to an existing public/privates water supply? NO YES - If No, describe method for providing potable water: rkgF L I,t.p-i S v (p u ? 11. Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment: ? ? 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? 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: 'Shoreline ?Forest ?Agricultural/grasslands ?Earlymid-successional Wetland ?Urban ?Suburban 15. oes 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? O YES TT _FT 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? "§;fNO YES ? ? b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: r17NO ?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: TA ? 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: ("Q`~ ? 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 INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/Vonc name: \ \ \C W t Date: 7- a Signature: 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 I. 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? ? 3. Will the proposed action impair the character or quality of the existing community? ? 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? /1" AR 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ? reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ~ ? a. public / private water supplies? b. public / private wastewater treatment utilities? El 8. Will the proposed action impair the character or quality of important historic, archaeological, ? architectural or aesthetic resources? ICJ 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? ? 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 n ' nmental impact statement is required. this box if you have determined, based on the information and analysis above, and any supporting documentation, the proposed action will not result in any significant adverse environmental impacts. n of Southold -Board of Trustees 12- 3 A Name of Lead Agency Dat President ri [ or Typ o espon ' le Officer in Lead Agency Title of Responsible Officer -Signature of Respon cer in Lead Agency Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 UZ*J1 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.LM.a: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING DRAINAGE AND EROSION CONTROL PLAN T1' Er 79;Wn 'BScT - g CERTIFIED BY A DESIGN PROFESSIONAL N THE STATE OF NEW YORH. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORKASSE3SMENT Yes No a. What Is the Total Area of the Project Parcels? ff S.Y. (Include Total Area of all Parcels located within d~~ 1 Will this Project Retain AN Storm-Water Run-OR j t'kLt~ ? the Scope of Work for Proposed Construction) Generated by a Two (2) Inch Rainfall on Site? ' (This Item will Include all run-of created b b. What Is the Total Area of Land (s.F. f Ages) Y she Clearing _ clearing and/or construction adiWties as well as all and/or Ground Disturbance for the proposed /O l Site Improvements and the permanent creation of construction activg)? (S.F.tAaes) impervious surfaces.) Plan and/or Show 0'e,N. AaadmaPp..aN.a.al Z Does the Site Survey All Proposed ? PROVIDE BRIEF PROJECT DESCRIPTION Drainage Structur es ures Indicating Sizs e & 8 L L ocation? This l Item shall include all Proposed Grade Changes and rLYI L ( !11 V 2A-C A4 S Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to control site erosion and storm water discharges. This jr- n ()O~ Qo w1 C2 R p Y Item must be maintained throughout the Entire 1 Construction Period. 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural ? Existing Grade Involving more tiian 200 Cubic Yards of Material within any Parcel? § 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 Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred (100') feet of a Weiland or - Submission of a SWPPP is required for all Construcdon actMties invohing sol Beach? d1sWroances of one (1) or more acres; Including disturbances of less ion one acre mat 7 Will there be Site preparation on Existing Grade Slopes ? are pan of a larger corrvron pan that will ultimately disturb one or none acres of lend; which Exceed Fifteen (15) feet of Vertical Rise to Including CcosbuWon activtiles Involving soll disturbances of less than one (1) acre when, One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit Is required for storm water discharges. (SWPPP's Shall mast the Minimum Requirements of the SPINES General Permit 8 Will Driveways, Parking Areas or other Impervious ? for Sturm Water Discharges from construction activity - Permit No. GP-0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1. The SWPPP shall be prepared prior to the submidid of to Not. The Not shall be into and/or in the direcgon of a Town right-d way? submitted to the Department prior tome commencement of constmGlorr, acuity. 2. The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required, post-construabn storm water management practices that will be used andtor Removal of Vegetation and/or the Construction of any ? ( i constructed to reduce the pollutants in storm water discharges and to esaxa Item Within the Town Rightof-Way, or Road Shoulder _Tx compliance withthe temp and conditions of this permit. In addition, the SWPPP shell klentfy potential sources of pollution which may reasonably be expected to effect the Area? frtie tm cola NOTrncluM ew lmbNmce arndrmey Aprma) quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Cheek Nark 3. AD SWPPPs mat requite the posNonsbuctbn storm water management practice in a Box and the construction site disturbance is between koixt S.F. a 1 Asa in saes, component shall be prepared by a qu~ Design Professional Licensed in New York a Storm-Water, Gmdmg, Drainage 6 Erosion control Plan Is Required by the Tam of j that Is knowledgeable In tie principles and prectices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building pencil. (NOTE: AChedc *(!)adyarA fare Quesk 19Rapukedr«a Cgnpeb Appanuml STATE OF NEW YORK, Notary PtIDMc,Slolle of Now York OLIaWood In &gft& County COUNTY Q O1n,N C2 . ..being duly swim, deposes ar1Dd says that he/she is the l 14, ant for r hat I, bAr..!.A ...........................`..............bei T Pemu (Name or kn&Mual agnirg Dooxnent) PP t, And that he/she is the (Owner, Corwaclor, I. Agent: CorporaIs Ollloar, etc) 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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Swom to before me this; a~a dec. 3......../.....................`clay o[(........{.p...........~...A...r.._.......... ,10..'~ Notary Public: Q...._.. .n . (Signature of AwN FORM - 06110 d of Trustees Application • County of Suffolk State of New York ~l QIVA~ a va4elti 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. Signature SWORN TO BEFORE ME THIS _DAY OFj9~20 a Notary Public CONK E D. BUNCH Notary pP11b1oIpt,BU~8t o 5 York pwM ed in &dki c Ceunry_ p I CommWbn Expir" April 14, Z"( b Ord of Trustees Applicatic AUTHORIZATION (where the applicant is not the owner) I, /2fil~e 1aP5tt44l_ residing at S-7gOk (print owner of property) (mailing address) SIAQ do hereby authorize David Cichanowicz, Pres. (Agent) Creative Environmental Design to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM i The Town of Southold's Code of Ethics prohibits conflicts of interest on the Hart of [o~yn officers and employees The purpose of this form is top vide ' f rination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid` same YOUR NAME: ' 1 ~IG(•}q-rJa.~JtCZ,~j {~/tG\ (Last name, fast name, griddle initial, unless you are 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 Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship' includes by blood, marriage, or business interesL "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. j 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 applicanUagenUrepresenta[ive) 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-corporate entity (when the _ applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP - I I Submitted this day of 200 _ Signature Print Name it~\ t rtortitDu rr"o Forth TS 1 ' Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion 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 si cant 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, listine 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. ~D? E Q F ~p CS B. DESCRIPTION OF SITE AND PROPOSED ACTION VII D SCTM# ouv u DEC 2 3 2013 i`J~ PROJECT NAME A'Q-c-i~ 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 %ent of acti or `1 /I2 (II.P S t-t& C C~- IM Q.yL'1~~yt AM Lem -Q^~ er. O ~2,ae A D ~`eotivt E lL--- . over Project Des`cription` (use attachmen ifnecessary): CIU 10.x~ U YV1dvn~ ev~(i v~ Ct P:eW VVL~ 4-o C_A i P=4 CZ %A'A L i /2 Location of action:_ C~ ~0. inn o (TA ~ d 1 L~ A Site acreage: ( r Present land use: .Q S lU~t Present zoning classification: ' L ~ZO 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( ) (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No ? If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ? Yes ? No ® Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ? Yes El Now 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 M 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 El No K Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. ? ? Ye§ No Not Apple 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 El No Not Applicable I I i 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. II ? YeF-1 No Not Applicable II Attach additional sheets if necessary WORKIRG COAST POLICIES 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. j ? Yes ? No Not Applicable f 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 PM~ ~C (n16W iC2 TITLE 2 s , DATEC7,-23-/3 / l c"I 70 wa - , n BOTTOM OF NATF / .NORTH v4~ NT BLASE-CHERRY j - O 10 '04 DUB/ AcZk~qs MACK a-u~/ - P k \ BLACK _ BLACK~CHEWYS i2Ys 77 I , APPROVED BY i T c LAWN AREA Z-A - To do \ BOARD OF TRUSTEES VEGET S u ID, GARDEN - 4Dj qs \ TOWN OF SOUTHOLD T POQ DATE ~ , - l 1 _ J r ` IF,C TI ~ I I TOP OF BLLFF \ MAPLE I`T i 1 f POOL A ` ~i. I - DECK I , PATIO T- r ~v vev vov v i a v a v v V v v V v v v 776 V v V v v i ov v„v vov v~ L 1 \ . ~ Tl i v v OR~V v v v V V a V-, v v" v v v v v I ~ V Q V Q V V v v v V v I vov vn i v v v v v I a V ! vov v v v v v i V v - I vov i v v v V v v V V I I v n v v v v ! V V v v^v I a v v i v v V a v I v vov; N v a [AWN AREA V v V Q V V v n ~r 111 t!1 A? ~.1 v a i .aL_a++~3~ 1. iv tt ~ _r4iLitjFx~+~L6t-JL.bU~--1+~•. ls\ ov vnv OWN v v- v V 5 V N v v _i}i \ L~ - t}.1M1~ - _ ~tu:.'~_iw ~LQ"y+i..~6`c•HT111s_'-3:_,)~-c.-~_ixJ:~.t7=}.~q~CUU'~.\ I \ n ~~a2p+4A~c: n r• FED - 5FOLK MTY TAX # 1000-66-2-22 Revision Landscape Plan: 12-17-13 Date: 2/5/2014 Karsten Residence Scale: Landscape Design by: David Clchanov ianowicz 1/16" _ if Creative Environmental De Design