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HomeMy WebLinkAboutTR-8611AJohn 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8611A Date of Receipt of Application: May 28, 2015 Applicant: Nabil EI -Sherif & Gioia Turitto SCTM#: 70-10-61.1 & 62.1 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Project Location: 1800 Park Way & 40 Beachwood Lane, Southold Date of Resolution/Issuance: June 17, 2015 Date of Expiration: June 17, 2017 Reviewed by: Board of Trustees Project Description: To remove five (5) dead trees located in the wetlands along the shoreline. 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 Michael Kimack, received on May 28, 2015, and stamped approved on June 24, 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. John M. Bredemeyer III, President Board of Trustees A)a6il E I- Sherf ISSN@d Tox Gio;mTctrh4a Date b� . Address d THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD; N.Y. 11971 TEL.: 765-1892 A John Bredemeyer, President �OguFFOL4. Michael J. Domino, Vice -President° James F. King y z Charles J. Sanders o • Dave Bergen Date/Time: Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionMork Session Report Michael Kimack on behalf of NABIL EL-SHERIF & GIOIA TURITTO request an Administrative Permit to remove the five (5) dead trees located in the wetlands along the shoreline. Located: 1800 Park Way, Southold. SCTM# 70-10-61.1 & 62.1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Type of Application: Wetland Coastal Erosion Administrative Emergency Pre -Submission Sound ✓Bay Notice of Hearing card posted on property: Yes _ Storm Water Management Review: Yes No Info needed: Modifications: Conditions: Present Were: Bay Constable d Chapt.111 other _Amendment Violation No I/ Not Applicable Not Applicable -� Bergen Bredemeyer M. Domino J. King d-�anders Form filled out in the field by Mailed/Faxed to: Date: Other ON 4' -OW i Rs�iitAIF �� pq p �P rM47� �wr � " �n.. ..mss.. 41, Val e ' •' J It ARNI, - .yds Air- 4� ee, low L FF.— m PRINP9 "OT - Alkh--. te .00, A w _`Jr OWN Jr LOW ------------- MOM, pvp� I --dmwjgi ­Xw 0 -,I 64_240 �kg A . eol IN VW. 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S E °°- s> � � 'tr f 4 � , j .;:" o.. _ t P. D. 7a � �'- I ' 1! ��� •Ta�rT„on of ID n as ,.wa�cp,Ns�Nc � -- ----------s=�-�__�.._--- - \4 .w-or,wnrw�o •• _— � ,:n 65�\" '+) WitN te•C - L -" » - -- °�'•"'--'°'-- '- --^-- wrtcE o'�"%;COUNTY OF SUFFOLK © S___ 5Etrro4 No - - --, Real Property Tax Service Age, r 070 E ""' ______ rCJ� C,wNYIb•wNw<.Nv„eF N OY oN ..ocw ..-+� N RAN ” '- -� ,- --•-- r,---.-�— .•- �.y„ V rR<r yp ,000 PROPlRiY N•R 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 MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 12, 2015 JUN 12 2015 Re: Local Waterfront Coastal Consistency Review for NABIL EL-SHERIF & GIOIA TURITTO SCTM# 1000-70-10-61.1 & 62.1 Michael Kimack on behalf of NABIL EL-SHERIF & GIOIA TURITTO request an Administrative Permit to remove the five (5) dead trees located in the wetlands along the shoreline. Located: 1800 Park Way, Southold. SCTM# 70-10-61.1 & 62.1 The proposed actions have been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed actions ,-tk CONSISTENT with the Policy Standards and therefore are CONSISTENT with the LWRP. 1. This recommendation is predicated on the assessment that the trees pose a threat to health, safety and welfare of residents. Manual removal should be required to prevent damage to wetland species. 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 Ll John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee pF SO(/ryo� h O AV CA �y�OUNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application V Administrative Permit _A men dment/Transf /Ext nsion ✓Received Application: s Rkmpleted ceived Fee:$ l b , Application _Incomplete _SEQRA Classification: Type I Type II Unlisted _Coordination:(date sent) Q :�AWRP Consistency Assessment Form -1 AC Referral Sent: -(011611 Date of Inspection: _Receipt of CAC Report: Lead Agency Determination: clinical Review: _Public Hearing Held: 'S Resolution: Name of Applicant�f��/TTO�/L .L 1'h��•L�/� Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 MAY 2 8 2015 Mailing Address /6 0 4 6 5-1''y J'>' AP7 26 G Noly YaglL. N Y_ / 002/ Phone Number:( ) Suffolk County Tax Map Number: 1000 - 7 O -,/,0 -- 6.1, l -1,61, / Property 6® - Property Location: 4 0 AW 0.14waan IA/ /7a /D-- dr?-�i � /�tB0 90 /0 - 6/ ",)i J ,.007WaZ1 (provide LILCO Pole #, distance to cross streets, and location) AGENT: /V6V h2r klIA11"11C (If applicable) Address: ?Z/ "V"J7/DEW. PdVjrAri , i J Mailing Address /6 0 4 6 5-1''y J'>' AP7 26 G Noly YaglL. N Y_ / 002/ Phone Number:( ) Suffolk County Tax Map Number: 1000 - 7 O -,/,0 -- 6.1, l -1,61, / Property 6® - Property Location: 4 0 AW 0.14waan IA/ /7a /D-- dr?-�i � /�tB0 90 /0 - 6/ ",)i J ,.007WaZ1 (provide LILCO Pole #, distance to cross streets, and location) AGENT: /V6V h2r klIA11"11C (If applicable) Address: ?Z/ "V"J7/DEW. PdVjrAri , i and of Trustees Applicati-- GENERAL DATA Land Area (in square feet): 6). 9,?. / % .?70 dP7X Area Zoning: Previous use of property: ,&-X1-)P-zW ,qL Intended use of property: P�,J'"/1J�V 47 LL Covenants and Restrictions on property? Yes hC No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes 5e 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 >e' 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 )e No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No N1,4 Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): ,5!! y&OV I- D ib iR,�, y /N w6rrumv e .V OM& P/-/.OA,.OL- L//✓E 77*14y' �UBb�cr r,O Jac r `AvmWMAI ,�or� .IyAAv� y ,Qi✓,D odd 'vet- R� �o vin Bi d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ?F,6!J OI/,4L '� � V,E/0, 6.q/� 71225,1' IAI 7-44 NW A/5// Area of wetlands on lot: 6 40 square feet Percent coverage of lot: ,—_% / 6/./) Closest distance between nearest existing structure and upland edge of wetlands: &,�4 feet Closest distance between ne rest proposed structure and upland edge of wetlands: M1,4 feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? Nd lJ,"� cubic yards How much material will be filled? —O - cubic yards Depth of which material will be removed or deposited: N09 feet Proposed slope throughout the area of operations: �Liyp' Manner in which material will be removed or deposited: 27,4,E5 GUG��� ,BAIZ{��� r -o r/zvcx ,�•�i, Dis�os� o� IAI 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): HIAWAVIeL ,o����Cll= 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Information Name of Action or Project: !&-77'64l .1PIVA! 5 WX =6&40V,4 }9 TGStN Project Location (describe, and attach a location map): AOG TD UPJ�i�Ol1J 40 A9W1VW0AP Z'"15 '$eI Brief Description of Proposed Action: Name of Applicant or Sponsor: Telephone: SW 727' 2f ,0.7 E -Mail: lG VA 0z 2 A v&V ZD . /VE L' A LA- AQWA 06 Address: City/PO: State: Zip Code: /V/ l/ a/ 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 VNJ 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? —0 — acres c. Total acreage (project site and any contiguous properties) owned by the I o 9 acres or controlled applicant or project sponsor? 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban [—]Rural (non -agriculture) ❑ Industrial ❑ Commercial °Residential (suburban) El Forest ❑Agriculture ❑Aquatic ❑Other (specify): ❑Parkland Page 1 of 4 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ ❑ ❑❑ rol 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 M ❑ 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 ❑ � ❑ 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 ❑ 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: 141,/9 NO YES 19 ❑ 11. Will the proposed action connect to existing wastewater utilities? h If No, describe method for providing wastewater treatment: N/f7 NO YES ❑ 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 ry( L&J ❑ ❑ 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 the wetland or waterbody and extent of alterations in square feet or acres: NO YES El 1Z 14. Id ntify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional (r"' Wetland El 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 rVI LLN��O��II ❑ 16. Is the project site located in the 100 year flood plain? YES 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? FXNO DYES b. Will storm water discharges be directed to established conveyance systems (ru ff and storm drains)? If Yes, briefly describe: �No QYES NO YES L� ❑ 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 ❑ 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 jam( ❑ ❑ ❑ 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 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 ❑ 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/sponsor name: y�—/%�t�'/ �. �. G 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?" Page 3 of 4 No, or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El El 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 ❑ 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 El ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a. public / private water supplies? b. public / private wastewater treatment utilities? 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, F] ❑ 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. r] 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 President 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) 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 ❑ 1-1problems? 11. Will the proposed action create a hazard to environmental resources or human health? 0 0 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. r] 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 President 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) PRINT I Page 4 of 4 and of Trustees Application AFFIDAVIT G/,11-4 TU.P,[il�� 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 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, INCLUDING 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. ?-- Signature of Property Owner SWORN TO BEFORE ME THIS 25� DAY OF A94 `0 , 20` NOTARY PUBLIC. STATE OF NEW YORK Registration No. 02KI5056823 Qualified in Nassau County _ Cmnmission Expires March 11, 2018 Notary Public __ard of Trustees Application AUTHORIZATION (where the applicant is not the owner) G1,0ir9 _,alei 7'o residing at /6 a , ,� 6,�'M /.- � - VC (print name of 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) APPLICANT/AGENT/REPRESENTA.TIVE 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 name, .ip ddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate. the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship. with any officer or employee of the Town of Southold? "Relationship" includes by blood, njarriage, 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 X 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 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 this'*of HV 20.Y Signature17 Print Name ,0 /z j %��,L �- e/G'/L Form TS l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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 icant 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 Of g Dep local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION MAY 2 8 2015 SCTM# PROJECT NAME rZ)12/1TT0/,,eL 1'/ ji'�_12,�/`l0 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees 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: k> r dka.L 015 An4417 0�57-Z MP Location of action: !�f��,gCl,1 iN L�1/ / 1,FOd Pi)P1epV, Y _r,4, Site acreage: Present land use: �/�/, f�,NT/�i L Present zoning classification: ef- 46 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: 6161A 7V, -g/ 77-6 / &.4% 11- ,& (b) Mailing address: 6 O 9 A-5- -v4hJ!7.- ApT Z6 C A&E Gtr y� Y/% f iV (c) Telephone number: Area Code ( (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency?. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ❑ Yes [:]No F\ -/ 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 1147M 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 X Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III — Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No '2—"'1 Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of .Southold. See LWRP Section IH — Policies Pages 16 through 21 for evaluation criteria F]Yes ❑ ro No I� 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. SEENWO-1 Yes No Not ApI 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 Z 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 14Z 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. ❑ Ye�] No 9 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE 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 D< 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 V�J 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 tZ Not Applicable PREPARED BY % TITLE �GNr" DATE z /Sr NECK -ROAD PROPERTY LINE TEST HOLE DATA (TEST HOLE DUG BY McDONALD GEOSCIENCE ON SEPTEMBER 22, 1997 AT 3:54 PM) tL. b.V 0' BROWN SANDY LOAM OL 2' BROWN LOAMY SILT ML 3' LE BROWN FINE SW COURSE SAND 7.6' ITER IN PALE BROWN SW 4E TO COURSE SAND 14' N �C? J� ZONE X* \ ZONE AE (EL. 7) �0 0 �OJa O' O P moo* sT�O a � rm 11_5 ®/00 ., 11, s ry 3.1 AoJ 1F�o M� ttl_I, �I 3 0 S 0 �/ � y / i ° 6.3 op U, 6.2 0 D 6.5 STT1 1U (04r 4 yr U� Fri r CY 4 3� Syep SURVEY OF PROPERTY SITUATED AT PINE DECK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-70-10-61.1 SCALE 1 "=20' OCTOBER 21, 1997 FEBRUARY 21, 1997 REVISED GRADING PLAN & ADDED LOT COVERAGE MARCH 4, 1998 SET LATH FOR D.E.C. MAY 17, 1999 ADDED ADJACENT WELL & CESSPOOL LOCATIONS SEPTEMBER 9, 1999 ADDED ADJACENT WELL LOCATION DECEMBER 15, 1999 REVISED AS PER S.C.D.H.S. NOTICE MAY 23, 2000 REVISED PROPOSED SEPTIC SYSTEM & ADDED WELL RELOCATIONS JULY 18, 2013 UPDATE SURVEY MAY 20, 2015 UPDATE SURVEY TOTAL AREA = 19,770 sq. ft. (TO TIE LINE) 0,454 ac. UPLAND AREA = 13,315 sq. ft. WETLANDS AREA = 6,455 sq. ft. (TO TIE LINE) C) 0 z 0 0 z NO TES: 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:�4 2. LOT NUMBERS SHOWN THUS: LOT 11 REFER TO "MAP OF SOUTHWOOD" FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON NOVEMBER 24, 1953 AS FILE No. 2141 3. ZONING USE DISTRICT: R-40 4. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO166H ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE X*: AREAS OF 0.2% ANNUAL CHANCE FLOOD; AREAS OF 1% 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. D �^ eo D e \Q O D 0 •00, F Fed colo CF OC oti PXayvsFa fVv,6 est m y m:E -5 To Be ee"awp APPROVED BY �� : BOARD OF TRUSTEE TOWN OF SOUTHO D DATE r � i' MON_ 13i�,ACi1�^'�OD , _. 2 8 2015 i I 1 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 THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF f0 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. 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 ySTATE LAND TITLE ASSOCIATION,"} QPC pMn� c y`'r ;_OrIk� N.Y.S. Lic. No. 50467