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HomeMy WebLinkAboutTR-8595A4,M EaWc,ab� rs' yrs �SrgR,�t'r wig �vp; AW Na d4 I'`5i r� Fj M.«'.. a.•'� ,',;wed''!. yf'.oN�'(�2'ASAw �e • .!' �� � s �. � �" ?ice � to-- b .�"w, ri� S et �i �r��tc$�j� <�' � �1 40 �P e aa` ftp 30 zy.I jig �� `•fir �+� � ,•�� ;'•' .srd�'i � � yt r �. �, - a �l►p ' q `v TMa�E4 r ;tai a ; t. r b� 'An i s r �i .%i III S Y r 4,M EaWc,ab� rs' yrs �SrgR,�t'r wig �vp; AW Na d4 I'`5i r� Fj M.«'.. a.•'� ,',;wed''!. yf'.oN�'(�2'ASAw �e • .!' �� � s �. � �" ?ice � to-- b .�"w, ri� S et �i �r��tc$�j� <�' � �1 40 �P e aa` ftp 30 zy.I jig �� `•fir �+� � ,•�� ;'•' .srd�'i � � yt r �. �, - a �l►p ' q `v TMa�E4 r ;tai a ; t. r b� of PjAy, , t. John M. Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone,(631) 765-1892 Fax (631) 765-6641 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, silt fence 1St day of construction % constructed Project complete, compliance inspection John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee Permit No.: 8595A BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date of Receipt of Application: April 24, 2015 Applicant: Henry Silverman SCTM#: 123-4-12 Project Location: 2800 Deep Hole Drive, Mattituck Date of Resolution/Issuance: May 20, 2015 Date of Expiration: May 20, 2017 Reviewed by: Board of Trustees Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Project Description: A Ten (10) Year Maintenance Permit to maintain a 4' wide access path to water; and to prune trees overhanging house; with the condition trees are to be marked and inspected by Trustee before trimming. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Henry Silverman, received on May 28, 2015, and stamped approved on May 28, 2015. 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. r Z John M. Bredemeyer III President, Board of Trustees John Bredemeyer, President gUFFO� Michael J. Domino, Vice -President James F. King y = Charles J. Sanders • Dave Bergen Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board offrustees Field Inspection/Work Session Report Date/Time:� HENRY SILVERMAN requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand -cut the Common Reed (Phragmites australis) to not less than 12 inches in height; to remove the poison ivy by hand, on an as needed basis; selectively remove dead brush and trees throughout property; install a 15' wide access driveway from dwelling to the water; and add approximately 160 cubic yards of clean fill for the installation of public water and to re -grade an area adjacent to and landward of dwelling., Located: 2800 Deep Hole Drive, Mattituck. SCTM# 123-4-12 Tpe of area to be impacted:��°'� X'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 _ bD Administrative Emergency Coastal Erosion Amendment —Pre -Submission Violation z", Notice of Hearing card posted on property: Yes No ot Applicable Storm Water Management Review: Yes No _ZNot Applicable Info needed: ^ Modifications: A0 !fir ° &/aPC' P27 -A/ 7-0 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: Henry Silverman - 2800 Deep Hole Drive, Mattituck, NY 11952 4/22/2015 - 3:00 pm - Direction looking east 4/22/2015 - 3:00 pm - Direction looking south 3 F t 4 44 4/22/2015 - 3:00 pm - Direction looking southeast 4/22/2015 - 3:00 pm - Direction looking west _ --I Hx0o 3` .P."rryo .a,aCmrm..aAgency l 18X SByMr HsBfCrM�Y . asu.xoFrorn. 1000 FROP1G2R2 — E01 o�c�x TY 2m S SEE SEC NO „5 WE— NO. tt5 SEE SEC NO Its .2601 xn. [mw MATCH -Z—_ - - LIRE '\ >" MATCH ^. LINE nwi.r [urc - 0, -- 16W FON PCLNO. .1PW SEEC. NO >y 4Qp w 05W � PON PCL. a. F � W") '•\ " ) t �SAIc m t>A � � t ! e 9 0 14 .I 1 •,� SEE SEC. N U.G 11 O ,p yLcl S. f n _ CREEK K19 n !L 58 e1J ea y PNRk t 9��,p s� r�A eH`M is a „ O 1 o ,AHO 6 � - t21 i .p Dfa >14Ei 2 • � r`S CONIC R " "_u _ _P_ _ --"-- [a NOTICE LQ� COUNTY OF SUFFOLK © K v. D eECTION NO —� rs+I '�_ _ _ _ _--"—_—_ Real Property Tax Service Agency ro '- —a ----c12[3 PRpPF.RTY MM OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDU �a t To: John Bredemeyer, President MAY 1 8 2015-< I Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: May 18, 2015 Re: Local Waterfront Coastal Consistency Review for HENRY SILVERMAN SCTM# 1000-123-4-12 . HENRY SILVERMAN requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand -cut the Common Reed (Phragmites australis) to not less than 12 inches in height; and to remove the poison ivy by hand, on .an as needed basis. Located: 2800 Deep Hole Drive, Mattituck.. SCTM# 123-4-12 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 actions are CONSISTENT with the below denoted Policy Standards and therefore are CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application ✓ Administrative Permit /Received tx; ensjon �/ Received Application Received Fee:$ 4/ Completed Application y / f5' _Incomplete _SEQRA Classification: Type I Type 11 Unlisted _Coordination:(date sent) ZLWRP Consistency Assessment Form' , a�r— _CAC Referral Sent: Date of inspection: 5 I _Receipt of CAC Repo : _Lead Agency Determination: Technical Review: Public Hearing Held: p I Resolution: Name of Applicant, Mailing Address 536 si/verh-ja- i vee /19(-)( 0 Phone Number:( ) Suffolk County Tax Map Number: 1000 - If `• Property Location: � go --o ,)cam (provide LILCO Pole #, distance to cross streets, and location) AGENT: 104 (If applicable) Address: Phone: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 APA 2 4 2015 ..J 1 S�uth�Itl TeTei=,n��W _.� GENERAL DATA Land Area (in square feet): + i Z Area Zoning: Previous use of property: A0 M(1 Intended use of property: Sy kyvner�, �O m<,2 Covenants and Restrictions on property? Yes I/ No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes V/ 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 df No Does the structure (s) on property have a valid Certificate of Occupancy? Yes ✓ No Prior permits/approvals for site improvements: Agency Date pore -7F-OMn i VI /0i 30.5- V No prior permits/ap�rovals 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): vr- �a be r emored h w h a p d. SeJecfi've% Inern©ve dead b rush and Ir r®tt� amael,�25's �rri�e�r 161wide f'r01l) hOUSe -�n `ager. add a ��mr eL rho ya s -for Imola-bion a pWic water aM re- Pade- J WETLAND/TRUSTEE LANDS A�PoPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: y 9 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: % V-A feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 61Z20 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 .I - Project and Sponsor Information Name of Action or Project: 0�l,— Per ri\ 11 It' AV7011 Pro' ct Location (describe, and attach a location map): zv--oo &eo gde_ ,a,. �1'iu_c_ Brief Description of Proposed Action: cif ,'.�++mss �� iz���,w� �o►s�,, z-,�, ,�o ��o Na a of Applicant or Sponsor:. %��1�'bV\ Telephone: in �^ ��/ Q E -Mail: S %/Ve(/yn-h Address: S30 City/PO: / State: IVI Zip Code: 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 r may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES If Yes, list agency(s) name and permit or approval: 3.a. Total acreage of the site of the proposed action? acres b. Total acreage to be physically disturbed? d SO acres c. Total acreage (project site and any contiguous properties) owned / < or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban []Rural (non -agriculture) ❑ Industrial ❑ Commercial Residential (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other (specify): ❑Parkland Page 1 of 4 G© " 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A j�'°l LLE F] F1 0- El 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO YES Q ❑ 8. a. Will the proposed action result in a substantial increase in traffic above present levels? 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? NO YES ❑ F4 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: NO YES 1 ❑ 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES ❑ ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES 0 ❑ 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES D ❑ 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain 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 thew lanor waterbody and extent of alterations in square feet or acres: �e2 o ho G 2`� �i 1_,_ , , -fie—.S_. NO YE ❑ 14. 4entify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: LLI Shoreline [I Forest ❑Agricultural/grasslands El Early mid -successional E6 Wetland ❑ Urban ❑ Suburban 15. Does the site of the proposed.action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO YES 9 D 16. is the project site located in the 100 year flood plain? NO YE 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, a. Will storm water discharges flow to adjacent properties? E!rNo DYES b. Will storm water discharges be directed to established conveyance systems (ru ff and storm drains)? If Yes, briefly describe: MNO DYES NO YES ❑ Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO YES small to large impact impact may 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: NO YES occur I . Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES (� jam. _ 4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1 establishment of a Critical Environmental Area (CEA)? I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spons' me: v ` �$ v' ��'� Date: Signature: J 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?" Page 3 of 4 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? a 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 El 1:1 establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or Elaffect 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 reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: El E a. public / private water supplies? El EL b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, E l � waterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees 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 I Page 4 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? IL Will the proposed action create a hazard to environmental resources or human health?101 El Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold - Board of Trustees 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 I Page 4 of 4 I' Mrd of Trustees Applicatic" County of Suffolk State of New York h v 3r j /U,;z V-1 rf v4r-1--\ 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 BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. / _ sr SWORN TO BEFORE ME THIS ,,3 DAY OF ,204,T NINA L. NICCHI ... _ Notary Public, State of New York No. 4814500 y Qualified In Suffol o n Notary Public ommission Expires APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE,. FORM The Torn of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees. The Durpose of this forret is to gp llow it to take ovide. information �e hich can alert the town of possible conflicts of interest and awhatever action is necessary to avoid same. YOURNAME: —�' ��I� 'Gd► h (Last name, first name,.nriddl nitiitl, unless y u are applying to 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 personilly (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 oll- eror employee -owns more than 5% of the shares: YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person 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 orbeneficial 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 2 day -o 4pr" 20jt;:� Signature. -} Print Name e k, - Form,- Form TS l 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# OdO - 123 - — PROJECT NAME 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: /O "y e,-, v-- �..� `r 0 01 PIX !r cps Irl ,4, "k Location of action: Site acreage: II_ Present land use: AO vYz' Present zoning classification: 6 `TD k '�Jy o�-Z 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: 91;�: h !��, � (V -C r (b) Mailing address: ff/ ,v-lp_ (c) Telephone number: Area Code ( . ( " 7,E! ( — 2 1�'Kc (d) Application number, if any: AI -A Will the action beb je directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No U 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 ffNot 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 0 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 — PoliciesPages8 through 16 for evaluation criteria 1:1 Yes 1:1 No No u 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 oNot 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. ❑ D 1�fN'A a Yes No Not Apl ."`ble 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 E 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. ❑. Yeo No EfNot Applicable Attach additional sheets if necessary WORDING 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. ❑ Yes D No u 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 Z Not Applicable J PREPARED BY ��^� v ' �� TITLE �� �� 2 Z S ,% DATE _"VG SURVEY OF PROPERTY SITUATE MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-123-04-12 SCALE 1"=30' MARCH 24, 2015 CRY BOARD bf TRUSTEES TOWN OF SOUTHOLD DATE b �- I Nathan Taft Corwin ■ Land Survevor SURVEY OF PROPERTY SI T UA TE MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-123-04-12 SCALE 1 "=30' MARCH 24, 2015 TOTAL LOT AREA = 48,860 sq. ft. (TO TIE LINE) 1.122 C1C. UPLAND AREA = 40,364 sq. ft. WETLAND AREA = 8,496 sq. ft. CERTIFIED T0: HENRY SILVERMAN WESTCOR LAND TITLE INSURANCE COMPANY S: FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO482H ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE X": AREAS OF 0.27. ANNUAL CHANCE FLOOD; AREAS OF 17 ANNUAL CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD. rn O t` u0ck APR 242015 PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIA �. OF a Y �� 564 U 7 L• . :S. Lic. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THEPERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED.