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TR-8441A
John M. Bredemeyer III, President g�►Ff0(,f-c Town Hall,53095 Main Rd. �� Michael J. Domino, Vice-President P.O. Box 1179�� y� James F. King N Southold,NY 11971 631 hone Charles J. Sanders y � �� Telephone( )765-1892 Dave Bergen O 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 1 st day of construction '/ constructed V Project complete, compliance inspection 0 John M.Bredemeyer III,President �O��OF SO(/T�,olo Town Hall Annex Michael J. Domino,Vice-President 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold, New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,Trustee Ol�•�,OU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8441A Date of Receipt of Application: June 5, 2014 Applicant: Elizabeth Cantrell SCTM#: 117-1-7 Project Location: 2125 Grathwohl Road, New Suffolk Date of Resolution/Issuance: June 18, 2014 Date of Expiration: June 18, 2016 Reviewed by: Board of Trustees Project Description: Ten-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height 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 J.M.O. Environmental Consulting, received on June 5, 2014 and stamped approved on June 18, 2014. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder (Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 9 2 • 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. dF4— *V� &+/"�-W- John M. Bredemeyer III, President Board of Trustees r John Bredemeyer, President °�%UFFOtt�o Town Hall Annex Michael J. Domino, Vice-President �� 54375 Route 25 James F. King ; P.O. Box 1179 Charles J. Sanders Southold, NY 11971 Dave Bergen y�ol ,F ya°� Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionMork Session Report Date/Time: ELIZABETH CANTRELL requests an Administrative Permit for a 10 Year Maintenance Permit to hand cut the phragmites to not less than 12" in height on an as needed basis. Located: 2125 Grathwohl Road, New Suffolk. SCTM# 117-1-7 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 Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: • New York State Department of Environmental Conservation Division of Environmental Permits SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 Telephone (631) 444-0352 Facsimile (631) 444-0360 Alexander& Gronnis Commissioner May 6, 2009 Mrs. Elizabeth Cantrell JUN - 5 2014 P.O. Box 128 New Suffolk, NY 11956 "--Board of Trustees RE: 1-4738-03829/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please carefully read all permit conditions and special conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, cqu ' e R. Pasquini Environmental Analyst JRP/ls Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION FacWty DEC TD 1473843829 PERMIT Under the Environmental Conservation Law CL Permittee and Facility Information Permit Issued To: Facility: ELIZABETH ANN CANTRELL CANTRELL PROPERTY PO BOX 128 2125 GRA'l``woul,RqSCTM#1000-117-1-7 NEW SUFFOLK,NY 11956 NEW SUFFOLK,NY 11,956 (631)734-5924 Facility LocWon: in SOUTHOLD in SUFFOLK COUNTY Village: New Suffolk Facility Principal Reference Point: NYTM-E: 712.068 NYTM-N: 4541.491 Latitude: 41°5949.4" Longitude: 72°28'43.2" Project Location: 2125 Grathwohl Road -Watercourse-West Creek AuthoAzed Activity: Trim a 10'x 115'area of phragmites and mow a 25 foot area on an as needed basis. All work must be in accordance with the attached plans stamped NYSDEC approved on 516109. Permit Authorizations Tidal Wetlands-Under Article 25 Permit ID 14738-03829/00001 New Permit Effective Date: 5/(/2009 Expiration Dgte: 5/31/2.014 NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliftwe with the EGL,al applicablexegulatious,;and,alb coudidons included.as;,part of this permit. Permit Administrator:MARK CARRARA,Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY @ STONY BROOK150 CIRCLE RD STONY BROOK,NY 11790-3409 001/Authorized Signature: Date 5 / 7_/.�Od`� T Distribution List Marine Habitat Protection JACQUELINE R PASQUINI Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 14738-03829 Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL IMSOURCE PERMIT CONDITIONS-Apply to the Following Permits: TIDAL WETLANDS 1. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes;and no claim Fright to compensation shall accrue from any such damage. 2. Notice of Commencement At least 48 hours prior to commencement'of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project;the bottom portion of the form must also be signed and returned,along with photographs of the completed work. 3. PHRAGhMES Phragmites may be hand cut to a height of 12". 4. Conformance With Plans All activities authorized bq•this permit, tbe in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by JMO Environmental Consulting dated 2/20/08. 5. State May Order Removal or Alteration of Work If future operations by the State of New York require-an alteration in the position of the structure or work herein authorized,or if,in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waftiv or flw- d flovws or endanger the Health,'� yV it 'tYf`h op1e`of t11t Stats,or cause loss or destruction of the natural resources of the State,the owner may be ordered by the Departnmmt to remove or alter,the structural work,obstructions,or hazards caused thereby without expense to the State, and if,upon the expiration or revocation of this permit,the structure, fill,excavation,or;other modification of the watercourse hereby authorized shall not be completed,the owners,-'shall,without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any sucl rdmoval or alteration. 6. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids,sediments,fuels,solvents, lubricants,epoxy coatings,paints,concrete,leachate or any other environmentally deleterious materials associated with the project. Page 2 of 4 0 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 14738-03829 7. State May Require Site Restoration If upon the expiration or revocation of this permit,the project hereby authorized has not been completed,the applicant shall,without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill'and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. GENERAL CONDMONS -Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility,including felevant records,is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit:and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SADA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the-permit area when requested by the Department. A copy of this permit,including all referenced maps,drawings and special conditions,must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is'a viola Tari oTdiii permit. 2. Relatiowhip of this Permit to Othbr Department Orders and Determinations Unless expressly provided for by the Department,issuance of dfls permit does not modify, supersede or'rescind any order or determination previously issued by the Department or any of the terms,conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal,modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal,modificat oi`i organ& graiitedV WeDW r ent nus't die i'n writing. Submission of applications for permit renewal,modification or tranafor are to be submitted to: Regional Permit Administrator NYSDEC REGION 1 HEADQUARTERS SUNY @ STONY BROOK150 CIRCLE RD STONY BROOK,NY 11790-3409 4. Submission of Renewal Appgcation The permittee must submit a rafjewal application at least 30 days before permit expiration for&fb4lowing permit authorizatibht: Tidal Wetlands. 5. Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification,suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; Page 3 of 4 0 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 14738-03829 b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions,relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issuedpermit conditions,orders of the commissioner, any provisions of the EnvironmentalzOmigerVati6n LAW or regulations of the Department related to the permitted activity. 6. Permit Transfer Remits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee,excepting state or federal agencies,•expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York,its representatives,employees., and agents("DEC")for all claims,suits,actions,and damages,,to the extent attributable to the perrhittee's acts or omissions in connection with the permittee's undertaking of activities in connectioim with,or operation and maintenance of,the facility or facilities authorized by the'peiinit whether`in compliance or not in:oom Place with the terms and conditions of the permit. This indemnification does not extend to any claims,suits,actions,or,damages to the extent attributable to DEC's ownn-negligent or intentional acts or omissions,or to any claims,stints,or actions naming the DEG.,and arising under Article 78 of the New York Civil Practice Laws and kules or any citizen shit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors,employees,agents and assigns of their respo Wbility,to cor*,y, with this,penmit,.including all special cond tions,while acting as the. permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions fear violations of the Environmental Conservation Law as those prescriUed for'lhe permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals,lands,easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to TreslJass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title,or interest in real or personal property held or vested in a person not a party to the permit. Page 4 of 4 ' � TICE OF OMMENCE NT C N TtOIV RETURN THIS FORM TO: COMPLIANCE OR FAX TO: 631-444-0297 Aft Marine Habitat Protection NYSDEC 50 Circle Road—SUNY Stony Brook,NY 11790-3409 PERMIT NUMBER: ISSUED TO: PROJECT LOCATIONIADDRESS: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir Pursuant to Ganonrl Condltlon of the referenced permit,you are hereby notified that the authorized activity shall commence on . We csw*that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions.We have Inspected the projed site and can complete the project as described in the permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions.The permit sign,permit and approved plans will be available at the site for inspection in accordance with general Condition No.1. (Both signatures required) PERMITEE DATE CONTRACTOR, DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT AND /OR ANY ASSOCIATED REGULATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE,POST THE PERMIT SIGN,OR HAVE THE PERMIT AND APPROVED PLANS AVAILABLE AT THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS. Cut a this line 0- ----- x x >e .......! _......»........................»............................ .;C x x ........».....................»...................»...........»...................................»...................................»..._.......».»... NOTICE OF COMPLETION OF CONSTRUCTION RETURN THIS FORM TO: COMPLIANCE OR FAX TO: 631-444-0297 Marine Habitat Protection NYSDEC _ 50 Circle Road—SUNY Stony Brook,NY 11790-3409 PERMIT NUMBER: ISSUED TO: PROJECT LOCATIONIADDRESS: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir. Pursuant to General Condlt/on of the referenced permit,you are hereby notified that the authorized activity was completed on .We have fully complied with the terms and conditions of the permit and approved plans.(Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE, WITH PHOTOGRAPHS OF THE COMPLETED WORK AND/OR A COMPLETED SURVEY,AS APPROPRIA7E, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. 955-20-1(11103)-9d New York State Department of Environmental Conservation N -0-TIC The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted - at -this site. . For further information regarding the nature and extent of the approved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Numbe r q13S� ROGER EVANS Expiration Date 90l NOTE:This notioe is NOT a permit �.-_ s �t� �c ___--- ,� _ • _ i i � �._ �. - �� ,. ,. �r. �. � ft _- �..,...e. .. .. .r.. ,.. ,.. .: �� ��� .. .. ., .. . ., - a� zx , .�>. .. �... .. ,_ •,. .� «... ,�..,, t - �. ...:��,.,, ,., ,: a. y, .r:,..., <:. r* y' .. ... t'--.err.. •.: - ,: �. _ E • .e .Kr � y mna� m a t 2 a s NAiCN Z I,HE 0.360] .J 1`t--)�► --- � ;t0 N,_x0. +'mac I o' i L RD. � ,� IL [) rso) rU2 3 2 = e a 1 ,� ran rcL.,a. ,a eEE 6Ec.N0. U=� 2 E ,'iiKq ,Kq R A tWq c j. I Ansa, A xAA 4. e I ' - cEbxOE .,.n w. ,,,, z• O A '� A6 A` CUTCHOGUE m ® s .. ` 2t1 9I HARBOR W — \ ' e ,o 10 v,sNE,x AnF•,A, x �.�� a.u.) q,cNwn ze .. ,t E t0 A � • a 21 a . ➢a 1501 Za p ' C� Z_ 1y S K UR R' ,• sum. S A AAt 9] ,A, 10.3 Z IB t a, swcuo•' • A g. 0 1 M ; IE n •) 2 1 N O]ANcI _ O• . X31 . p0nv0,N 1 A ,) \. 1 _- seg • SIU, 1 s 1 p0 AA + NEW SUFFOLK '`�' to 1221— r �•"°°""q•y x t e.t 0.f 0 1•N[) ,a. -3 2A IA 1yAcIN ,.1Nq xaVF) O N" m 2S w� YaGxeOry (�' 1 � t1 ,01$103 am � �a�,Nca li 11 3.,M<I I,eYq 05 It i IN.) ,.e » M., 2yp 3 / 11 •t +/ h +/ a IE ,aA Pp,90 u 1 { w SAY ! PECOW �ee..� s GREAT E �... —�— y (2t) O --�-- �.. --.-- wnce -�� COUNTY OF SUFFOLK © e . LOUTH= secrloNWo _ Real Property Tax Service Agency r Nr „a„ o. o r. > _ w 117 — — ---- `az AAA OFFICE LOCATION: �o��of SU(/TO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) rn Southold, NY 11971 �p� Telephone: 631 765-1938 O Fax: 631 765-3136 `yCOU�m,��' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM s_ JUN 1 6 2014 To: John Bredemeyer, President Town of Southold Board of Trustees .,s'u f Tr From: Mark Terry, Principal Planner LWRP Coordinator Date: June16, 2014 Re: Proposed Wetland Permit for ELIZABETH CANTRELL SCTM# 1000-117-1-7 ELIZABETH CANTRELL requests an Administrative Permit for a 10 Year Maintenance Permit to hand cut the phragmites to not less than 12" in height on an as needed basis. Located: 2125 Grathwohl Road, New Suffolk. SCTM# 117-1-7 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 CONSISTENT with the Policy Standards and therefore is 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 0 John M.Bredemeyer III,President �� Syo Town Hall Annex 54 Main Road Michael J.Domino,Vice-President �� l0 P.O..Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,Trustee 0��. Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit App licatio VLJUN Wetland Permit Application Administrative Permit Amendment/Transf /E tension Received Feelication: S - 5 2014 _VGompleted Application 5 _Incomplete _SEQRA Classification: Type I Type 11 Unlisted oordination:(date sent) LWRP Consistency Assessment Form 5 CAC Referral Sent: Date of.Inspection: (01111 Iq _Receipt of CAC Report: _Lead Agency Determination: �echnical Review: ublic Hearing Held: Resolution: Name of Applicant Z"A canTl Mailing Address 1o�4 Phone Number:( Suffolk County Tax Map Number: 1000 - 7 — Property Location: o�5 (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: and of Trustees Applicati GENERAL DATA Land Area(in square feet): 5 Area Zoning: Rea,A2n T )r a Previous use of property:�,��c_njs Intended use of property: 65 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 _X—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 require any demolition as per Town Code or as determined by the Building Dept.? Yes �_No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date 952L ,Ids TG,57� � (1 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes,provide explanation: Project Description (use attachments if necessary): m o,-, as ne_eJ4 b,- sis 74 %D- ry)ain 60 nce- Verrt r ` f B4Fd of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Cdn a %'/iQ_ en C-or,— en a Area of wetlands on lot: qC� sqwxre� Percent coverage of lot: SSC7 % Closest distance between nearest existing structure and upland edge of wetlands: /3-S— 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? U cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: C) feet Proposed slope throughout the area of operations: 0 Manner in which material will be removed or deposited:�Lke,2 �2 kC- 600 SSGt fl; Tan i �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): .lUcnP 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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 1 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: hl^a Project Location(describe,ao attach a location map): a� roti 1Rd Brief Description of Proposed Action: ^-Q 1 /o — t eGtl /VIQ/t77���_1112-'r, ra'tC C�T:/, 1er�� 0n an as � Name of Applicant or Sponsor: Cao 6 3/-7 /I Co�re f/ E-Mail: Address:po City/PO: State: Zip Code: sufrt.--)1k 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 rtJ El 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: -DEL ❑ IR 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? /p'x /l acres-- c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 44L_L_acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial NResidential(suburban) El Forest ❑Agriculture EJ 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? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ L� 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 91 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 ® I ❑ 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/private water supply? NO YES If No,describe method for providing potable water: � ❑ 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? Lki ❑ 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 El Forest ❑Agricultural/grasslands E3 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, m a.Will storm water discharges flow to adjacent properties? ❑NO OYES I`��' ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO OYES 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: ❑ 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: F] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor am �/11 t/ Date: 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El E]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? F] 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 ❑ j� reasonably available energy conservation or renewable energy opportunities? tt._JJ 7. Will the proposed action impact existing: ❑ a 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, El ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, El F]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? EI 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. EICheck 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 Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Ke_ ' Town of Southold z Erosion, Sedimentation Storm-Water Run-off ASSESSMENT FORM g PROPERTY LOCATION: S.C.T.M.III: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN r� 3ectMon -BICC -lot— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a• What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) is item will include all run-off created b ❑ (S.F./Acres) Crn Y 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 Site Improvements and the permanent creation of construction activity? (S.F./Acres) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (ProvW--didonalPageaasNeeded) Drainage Structures Indicating Size&Location?This ❑ Item shall include all Proposed Grade Changes and 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 item must be maintained throughout the Entire 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 than 200 Cubic Yards F] of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities M — 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 Wetland or F] Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a urger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to — including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for stone water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas Or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The NO[shall be into and/or in the direction of a Town right-of-way? F] submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any F-1 — constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall Area?(This item will NOT include the Inatallaeon of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&t Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark(4)and/or Answer for each Question is Required for a Complete AWication) STATE OF NEW YORK, COUNTYOF...........................................SS That I................(N. e.of.in individual .....................................being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) And that he/she is the (Owner,Contractor,Agent,Corporate Officer,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. Sworn to before me this; ...............................................day of............................................,20..... NotaryPublic: ........................................................................................... ............................................................................ (Signature of Applicant) FORM - 06/10 B d of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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 INTHIS 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. ature of Property Owner SWORN TO BEFORE ME THIS *""1 DAY OF Notary Public CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires Acprii 14,22=_� BWd of Trustees Application AUTHORIZATION (where the applicant is not the owner) lresiding at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first nam6,diddle 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 M ion from plat or official map Planning ty.) 14� A �er',name the activity.) f�,�n i�5 �l� /coM 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 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%of the shares. YES y- 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 IZo�e.(Zn Can Ire V Title or position of that person (C. iPS Describe the relationship between yourself(the applicant/agent/representative)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 applicgnt (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 Submitted thi d of S 2 _200 Signature Print Name Form TS 1 f 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, listing 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# PROJECT NAME Co-n The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees, !Q 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: /l O - ectd� n �� cc p4 TG ra. �f le /a " i A&1422 On a bA 53 Location of action: 61—JWO Aiew Site acreage: 6 �S Present land use: R3'✓G�=G✓ � P rl"�'a/� Present zoning classification: P-0-I 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: PFJ P- 2r New Sc,� o l 4 N Y l/75L (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 14 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 W 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 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 ❑ Not Applicable L SGen i`C: �°cZcJ Cf�' otk � d"c " 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 8 through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No y 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. L ❑ ❑ Yes No Not Apo-able �! MarsA has been omUe e d A t 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 F 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. F] Ye n I No Not Applicable Attach additional sheets if necessary WORKING COAST POLICILO 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 W 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 ❑ NoTP 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 a Not Applicable PREPARED BY Z-ct 4 a (<;n�ff TITLE QC,,)Gl P — DATE / w _ FS F 0 Awga Rd \ JUN - 5 2014 Y . 5�Wi1;E;;c :4Aft I f F in9Rd ar_d Tr t s 1 n d os Rd t Jackson St YS APN OVED AS PER TERMS AND CONDITIONS OF PERMIT N dddd� DATE S o3�d9 MAN) URED APPROVED BY AFx'94 BOARD OF TRUSTEE. PA IT6 TOWN OF SOUTHOL °�ao .o% LA OF PHARAGM II TES DATE HM . qy� �ARAV ! At .'Applicant: Elizabeth Ann Cantrell I M Location: 2070 Grathwohl Road, ' New Suffolk WEST C REEK Datum:Apparent Low Water Locus: 059' 72028' TWL,AHW&ALW located by Q Just ..Purpose: Phragmite control S.C.T.M.No. 1000-117-1-7 20 Feb'08 SCALE 1:40' SHEET I OF I J.M.O. 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