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HomeMy WebLinkAboutGillooly, Lisa John M.Bredemeyer III,President �O�L yO! Town Hall Annex Michael J.Domino,Vice President O 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 � 10DUFax(631)765-6641 N I`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 9, 2014 Lisa Gillooly P.O. Box 98 Orient, NY 11957 RE: WETLAND PERMIT & COASTAL EROSION PERMIT APPLICATION 450 HARBOR ROAD, ORIENT SCTM# 27-4-7 Dear Ms. Gillooly: The Board of Trustees are in receipt of your"as-built" application for permits under provisions of Chapter 275-Wetlands & Shoreline and Chapter111-Coastal Erosion Hazard Area Law application dated March 31, 2014. Specific provisions of Southold Town's Wetlands and Coastal Erosion Laws control construction activities in high energy wave and erosion areas such as Long Island Sound, Gardeners and Peconic Bays and Orient Harbor. Among these are a ban on new bulkheads on the bays (Chapter 275), a ban on all construction on "Beaches" within the mapped Coastal Erosion Hazard Area (with the exception of approved Coastal Erosion Control Structures built to a 30 year construction standard) and a ban on projects that may cause erosion of adjacent lands. (Chapter 111) As your application is requesting as-built approval for a structure built without required permits which fails to substantively meet all the aforementioned requirements of Town law, the Board of Trustees would recommend you consider several alternatives, or your request for "as-built" approval may be denied with a loss of application fees and a likely return to court: 1) Amend your application by submitting detailed plans to scale depicting a rock revetment "face" addition to the existing structure along its entire length, comprised of 1500-2000 lb. stones to bring the structure into compliance with the "30 year standard". This construction will mirror that of your two neighbors to the North who have made recent changes to their structures in compliance with Town code. 2) Amend your application to propose removal of the existing structure to construct a de novo rock revetment or gabion wall, built to the 30 year standard. Thank you for your assistance in this matter. Sincerely, 6 5—�/tub� John M. Bredemeyer III, President Board of Trustees Cc: Board of Trustees L. Hulse, Asst. Town Atty. g1iFFt1t,��O Donald Wilder,Chairman - Town Hall,53095 Main Rd. CIO Lauren Standish,Secretary P.O.Box 1179 `1C Southold,NY 11971 Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., December 5, 2007, the following recommendation was made: Moved by James Eckert, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit & Coastal Erosion Permit applications of LISA GILLOOLY to construct a bulkhead along 103' of shoreline using vinyl sheathing, a 12'X 24' platform and 4'X 10' catwalk. Located: 450 Harbor Rd., Orient. SCTM#27-4-7 Inspected by: James Eckert, Doug Hardy The project was not staked, however, the CAC reluctantly Supports the application (see attached letter). Vote of Council: Ayes: All Motion Carried CoCt 5 December 2007 Comments on Lisa Gillooly Application for Bulkhead Construction. This is a high energy shoreline evident by a steep beach profile and the sediment is composed of coarse gravel. Active sediment transport is evident, driven south by north-west winter winds. To the north of the Gillooly property are a series of groins, revetments and bulkheads installed by private property owners who cheerfully have passed their erosion problem to their southerly neighbor. This entire shoreline is starved for sediment because of this hardened shoreline to the north which has captured sand available for transport.The Gillooly property is last in line and is now enjoying accelerated erosion of their beach bank face. All these properties will be vulnerable to storm surges. Of more serious concern is the erosion of the undeveloped and unprotected shoreline immediately south consisting of the end of King St, a parking lot, and a long stretch of a berm fronting tidal wetlands. The asphalted end of King St and that of the parking lot is currently under erosion with asphalt on the beach and evidence of erosion continues south. Storm surges are apt to break thru the protective berm flooding not only the wetlands but overtopping King St and possibly flowing into Harbor Rd. This shore to the south will undergo accelerated erosion and environmental damage in the near future The Trustees should seek professional counsel for long range management of this area. [ �3In8 C �c� �� James F.King,President pF SO(/jyo Town Hall Jill M. Doherty,Vice-President SCJ �� 53095 Route 25 Peggy A.Dickerson P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. Telephone (631) 765-1892 e"'UNTYFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: LISA GI LL OOLY requests a Wetland Permit & Coastal Erosion Permit to construct a bulkhead along 103' of shoreline using vinyl sheathing, a 12'X 24' platform and 4'X 10' catwalk. Located: 450 Harbor Rd., Orient. SCTM#27-4-7 Type of area to be impacted: Saltwater Wetland Freshwater Wetland _Sound /ay Distance of proposed work to edge of above: Part of Town Coc e proposed work falls under: _Chapt.275 Chapt. 111 _other Type of Application: Wetland-Coastal Erosion_Amendment_Administrative _Emergency Pre-Submission Violation Planning Info needed: Modifications: / `"� �'`1 J. -(" Conditions: Pres nt Were: VJ.King Doherty P.Dickerson D. Bergen_ B. Ghosio, Jr �H. Cusack_D. Dzenkowski_Mark Terry other Form filled out in the field by Mailed/Faxed to: Date: Environmental Technician Review Use � aM rocks pl,►ca o+ �okn1 sAYIIA(�W4t �s ts� V g; 1 f t/ I+ - -r _ n # _ r a 4 visions I 4 j SEE SEC t o,1 m au-n an TO PLL.N6. J SEE SE[.NO. l� 2ANc1 't � 1 l l.Llcl NS y A VVV i 1.1.1.1 to.un2. 6 Y SA• " 5.W \\ F.O. 5"Y.� s zva o L2Nc1 i a z.to c Ph s.o• ,. 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Main Rd. &Youngs Ave.) y Southold, NY �� Telephone: 631765-1938 Q Fax: 631765-3136 �yCOUNT'1,� LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President D E V E Town of Southold Board of Trustees j From: Mark Terry, LWRP Coordinator ' DEC 7 Principal Planner SentbMW Town Date: December 7, 2007 So$fd of Trnatm Re: Wetland Permit for Lisa Gillooly SCTM#27-4-7 LISA GILLOOLY requests a Wetland Permit & Coastal Erosion Permit to construct a bulkhead along 103' of shoreline using vinyl sheathing, a 12'X 24' platform and 4'X 10' catwalk. Located: 450 Harbor Rd., Orient. SCTM#27-4-7 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 INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The proposed bulkhead is a prohibited action pursuant to & 275-11. Construction and operation standards section B. 1. (d)which states: (h) New bulkheads in creeks and bays are prohibited, unless the operation involves construction of a low-sill bulkhead. Chapter 275 defines a low sill bulkhead as LOW-SILL BULKHEAD --A subtidal structure designed to stabilize the toe of a slope or shore and often associated with boat basins or other navigable waterways. In addition, the proposed 12'x 32' deck, located on the beach, associated with the catwalk is prohibited pursuant to Chapter 275-11,A. (6) Decks and platforms. No decks or platforms shall be permitted on or near bluffs. Platforms associated with stairs may not be larger than 32 square feet. [Amended 10-11- 2005 by L.L. No. 17-2005] (8) No structures on beaches, bluffs or dunes unless approved by the Board at its discretion based on its site inspection. [Added 10-11-2005 by L.L. No. 17-2005] No structures are allowed on the beach, pursuant to Costal Erosion Hazard Areas Chapter 111-12 (d)which states: D. All development is prohibited on beaches unless specifically provided for by this chapter. It is recommended that the applicant utilize vegetative methods to control erosion. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. B. Use vegetative non-structural measures to manage flooding and erosion hazards. 1. Use vegetative non-structural measures which have a reasonable probability of managing flooding and erosion, based on shoreline characteristics including exposure, geometry, and sediment composition. 2. Use vegetative measures to increase protective capabilities of natural protective features. D. Use hard structural erosion protection measures for control of erosion only where: 1. Avoidance of the hazard is not appropriate because a structure is functionally dependent on a location on or in coastal waters; located in an area of extensive public investment; or reinforces the role of Maritime Centers or Areas for Concentrated Development. 2. Vegetative approaches to controlling erosion are not effective. 3. Enhancement of natural protective features would not prove practical in providing erosion protection. 4. Construction of a hard structure is the only practical design consideration and is essential to protecting the principal use. 5. The proposed hard structural erosion protection measures are: a. limited to the minimum scale necessary b. based on sound engineering practices 6. Practical vegetative methods have been included in the project design and implementation. 7. Adequate mitigation is provided and maintained to ensure that there is no adverse impact to adjacent property or to natural coastal processes and natural resources and, if undertaken by a private property owner, does not incur significant direct or indirect public costs. The site was inspected on November 13, 2007. Erosion of the bank where the bulkhead is proposed is moderate with scouring of the toe of the bank. The applicant attempted to stabilize the bank with vegetation, however, the vegetation failed to stabilize the bank and the root balls are currently exposed. Therefore, due to the fetch and exposure to the water body the Board may consider a hybrid erosion control method consisting of vegetation and a rock revetment, with the vegetation planted landward of the structure. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. MT/hkc • James F. King,President ��0f SUUryO Town Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen G John HolzapfelO Telephone(631)765-1892 I�COU '� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only V'Co tal Erosion Permit Application _ etland Permit Application Administrative Permit _AmendmentT nsfer/Extension ARpplicati r��1 _Received Fee:$ APO �-- _Completed Applic 3 _Incomplete ,`i`:' 1 " ler ✓ _SEQRA Classification: Type I Type II Unlisted _Coordination:(date sent) Southold Town _LWRP Consistency Assessment Form Beard of Trustees —ICAC Referral Sent: I mate of Inspection: _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: ___P-ublic Hearing Held: _Resolution: Name of Applicant -Sft Address JT UL1 P, 17 �� �E,1•, 1 �I I�S Phone Number:(a,r Suffolk County Tax Map Number: 1000 - Property Location: -In D 1-(Z l°j 0 k- b K (provide LILCO Pole#, distance to cross streets, and location) 1 AGENT: n 4 CA (If applicable) Address: Phone: Board of Trustees Applic*n GENERAL DATA Land Area (in square feet): y q a .�-• Area Zoning: *�e5 e n-h w Previous use of property: e S kCAe n am Intended use of property: S er,4,r�� Covenants and Restrictions: Yes ✓ No If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date la�-i r�v�vJ s ouJ►� �-� (CCJ itk (4 ( Y�iSS��rt 0. �dui Pry��e r1.6s-r c' nt�� -16, b\ iYX No prior permits/approvals for site improvements. - no \7 NJ`N C 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): h� 6�nog[e. P S�—. b,�kz,-� L to o,-� Board of Trustees Applic*n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ,p c-e J nk k.LT r 1 e_r 2,r vS 10 ►'► , i t �fj d r a'Y\�- Ct-e_earc a• h a-,r n �- Area of wetlands on lot: C." square feet Percent coverage of lot: n C-- % Closest distance between nearest existing structure and upland edge of wetlands: c, feet Closest distance between nearest proposed structure and upland edge of wetlands: n \ 0. feet Does the project involve excavation or filling? No V 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: n feet Proposed slope throughout the area of operations: n G. Manner in which material will be removed or deposited: Vul a-n v A-t_- 0 2 L-A ('V+-f v e nrtC'40 T 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): _'(moo 5 Vim09 k l Z� S O t a.,n c! re d Q t'A e,4-pskay-\ Board of Trustees Applic*n COASTAL EROSION APPLICATION DATA Purposes of proposed activit5krA- k 1 !�—' 0 Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? Nom Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? I;)- ( (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 0 c t r1 sL , � ,� !se CX- ,RC2 �� �� NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD InA the matter of applicant: ' 1 I—l5 l�1 L-L(-) d \, y SCTM# D00 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: tq Seo_ SYto e 5hee.4 F I 1 n 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: -TDC)C-8,-e r 5 6 h n�- 6r1 _ hov Slee 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: . You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: G-tii-L'o 6 MAILING ADDRESS: a PHONE#: - d - Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,residing at ,being duly sworn, deposes and says that on the day of , 20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) (registered)mail. Sworn to before me this Day of , 20 Notary Public 0 PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME 3.PROJECT LOCATION: Municipality County 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map yob Vmf-e)ov- RD, aQ?,le�,S-1 ,1\ 1q 11,15-1 5. IS PROPOSED ACTION: 91 New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: ve eA cel o n © n P r o ff C �j , 5e o-w o• 1 \ S h Gf-p v 0.-r A- v 1 Yl L O 51r\e-Q-A- 7.AMOUNT OF LAND AFFECTED: �(�3 )yj2In, t Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) FResidential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL A�NCY (Federal, State or Local) Yes '-No If yes, list agency name and permit / approval: -D C-C a-om-( co(�IPS aU(zr2. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes �No If yes, list agency name and permit / approval: 12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes W No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name L ,9 Date:10 4/ l ao07 Signature If the action is a Costal a, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 0 PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes [:] No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes [:] No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantiort pe of ener ? Explain briefl : D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If xes,ex Iain briefl : ❑ Yes No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Xes explain: ❑ Yes E-1 No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring; (c)duration; (d)irreversibility;(e) geographic scope; and (f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date 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) SeBoard of Trustees A licaf�on PP County of Sv6eik A t r c CAI State of New-*wk IV t LJ t{s e .a Cw- I Lw �L' I 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/BER 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 OF ,200 7 Notary Public BARBARA PALMroTiO A Nokq PrMic Of Newb►W Mycomaaiu m up*Jamieg30= Board of Trustees Application County of Suffolk State of New York a 6; �w ��-� 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 OF ,20 Notary Public 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 pu=se 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: h—\t)1� N < <Q C� ('- (Last name,first name,ipiddle 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 !1 ,/� 60 l—`-- I� A D -. (If"Other',name the activity.) v�1`L,� C'�C 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 NO � If you answered"YES",complete the balance of this form and date and sign where indicated. y ( Name of person employed by the Town of Southold I I `c-- Title or position of that person t CA- 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 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�-C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day o 200_ Signature Print Name LCA - Form TS I 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 LJ5 a LL-b 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: L J a T ®16—A-(sa,Y ag � a-" (C x 10 Location of action: �uy Site acreage: l n P cam/ - l A-t 4-zk-( 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: i (a) Name of applicant: - 10' (b) Mailing address: ��__ f ' h I G` - -7 (c) Telephone number: Area Code( )_ _ _ s n Io, (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? � If yes,which state or federal agency? Yes F-1 No 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 ❑ XMYes ❑ 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 f Not Applicable U— 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 1 v it A 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 L -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. ❑ r Yes No NoAplicable • tA U S 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.I. � Not Applicable s1� i - s 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. n 1-1 Yep--1 No 1� Not Applicable Attach additional sheets if necessary WORKING 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 �Q Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No I 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 1� Not Applicable PREPARED BY TITLE DATE