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Home My WebLink AboutTR-8614AJohn M. Bredemeyer 111, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen ~�o�pgUFFO(,�coGy a � o - W 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 1 st day of construction '/ constructed _X_ Project complete, compliance inspection BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8614A Date of Receipt of Application: June 1, 2015 Applicant: James J. Bradley SCTM#: 90-1-6 Project Location: 765 Cedar Point Drive West, Southold Date of Resolution/Issuance: June 17, 2015 Date of Expiration: June 17, 2017 Reviewed by: Board of Trustees Project Description: Ten -Year Maintenance Permit to hand -cut Common Reed (Phragmites australis) to 12" in height by hand, as needed between the bulkhead and waterline. 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 application received on June 1, 2015 and site plan stamped approved on June 24, 2015 § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder (Iva frutescens), and Groundsel Bush (Bacchads halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. *oF SO(�j� John M. Bredemeyer III, President ®l® Town Hall Annex Michael J. Domino, Vice -President ��Vv 54375 Main Road P.O. Box 1179 James F. King, Trustee ces Southold, New York 11971-0959 Dave Bergen, Trustee ® Charles J. Sanders, Trustee l�COUNTI,Nc� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8614A Date of Receipt of Application: June 1, 2015 Applicant: James J. Bradley SCTM#: 90-1-6 Project Location: 765 Cedar Point Drive West, Southold Date of Resolution/Issuance: June 17, 2015 Date of Expiration: June 17, 2017 Reviewed by: Board of Trustees Project Description: Ten -Year Maintenance Permit to hand -cut Common Reed (Phragmites australis) to 12" in height by hand, as needed between the bulkhead and waterline. 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 application received on June 1, 2015 and site plan stamped approved on June 24, 2015 § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder (Iva frutescens), and Groundsel Bush (Bacchads halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 2 If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. John M. Bredemeyer III, President Board of Trustees 15 Issued T Date'"i-y/le- #I w A now@ AWOL 765" Cec6- r 'j Frja FUSS THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE JOWN OF SOUTHOLD SOUTHOLD; N.Y. 11971 TEL.: 765-1892 John Bredemeyer, President S%�FFot Michael J. Domino, Vice -President �cOoy� James F. King y Charles J. Sanders o • 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 of Trustees Field InspectionMork Session Report Date/Time: 1 dh JAMES J. BRADLEY requests an Administrative Permit for a Ten -Year Maintenance Permit to trim the vegetation between the bulkhead and the waterline. Located: 765 Cedar Point Drive West, Southold. SCTM# 90-1-6 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound ___I/Bay 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 Notice of Hearing card posted on property: Yes Storm Water Management Review: Yes No Info needed: Modifications: Chapt.111 other _Amendment Violation VNot No Applicable Not Applicable Present Were: Y/ J. Bredemeyer ✓ M. Domino /J. King /D Bergen Bay Constable Form filled out in the field by Mailed/Faxed to: Date: Other ow. A;, AIM"- WW_- wi4u. _ , 1 .. .-.i,-_. _ . . Tpr�T.j� ;mss fit' z.`'`.. r ,� / '•'�,, •Ty�: J._'l�,'I la. _ �-7.� .._K". -_... t ` . `' :. 4, �' ,^:`�_ 'i��. ..,.. eta fP� �� i ��' I int', Nr'� i..' s� 4'�„,�� '�� ,., .__ -_- ;� � /� � �: �.� d:4. a. ... A � r j � _ < • _ s ,.,.., ., ,,. t�_ A ,. ,,-�4 j - Li f�fl ,�` V( -' `,F, J f 1� •C 1� I1 wk AW t gg -Vol nECK BAY -- --A— u..ir --»-- NOTICE • COUNTYOFSUFFOLK 'O `w --•-- �•—•---�•-- w �•^-,•• __,—__._____.__—_. Real Property Tax Service Agency e.nr c.rw..ww, x r nw• 90 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 JUN 1 2 2015 To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 12, 2015 Re: Local Waterfront Coastal Consistency Review for JAMES J. BRADLEY SCTM# 1000-90-1-6 JAMES J. BRADLEY requests an Administrative Permit for a Ten -Year Maintenance Permit to trim the vegetation between the bulkhead and the waterline. Located: 765 Cedar Point Drive West, Southold. SCTM# 90-1-6 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 action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. 1. This recommendation is predicated on the applicants request to manually trim vegetation (presumably phragmite spp.). Native, beneficial wetland species should be excluded from the action. 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 OW , ,3 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee pF SO(/jyo� AV yC®UNTI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD _Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Office Use Only _ Received -Application- — — — — eceived Fee: $ Completed Application: _Incomplete: _SEQRA Classification: Type I Type II Unlisted —Coordination: (date sent): LAWRP Consistency Assessment Form: CAC Referral Sent: Date of Inspection:(011011 _Receipt of CAC Report: Lead Agency Determination: Technical Review: _Public Hearing Held: Resolution: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 JUN m 1 2015 a e4q44d bb4) Name of Applicant: Mailing Address: PC). /S0 ,( 9 5� So A0 Phone Number: G3 �� • �� Suffolk County Tax Map Number: 1000- &,c. 0 9U, o® 13L ®/ . v0 45 CW a ®a® Property Location:5d �Q,C F'o r' /✓(�; U� G(J�ST 15-0Aot'd NV (provide LILCO Pole #, distance'to cross streets, and location) AGENT: /A (If applicable) Address: Phone: •t . Land Area (in square feet): Area Zoning: L,"4&&AAt- Previous use of property: ►ard of Trustees Applicat GENERAL DATA ,X 6 .5-3 Z .5. Intended use of property: Ar, 5 .'J MFi'a4t- Covenants and Restrictions on property? Yes No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review —and-Elevation-Plans-will-be-required.— Does nd-Elevation-Plans-will be -required. Does this project require a variance from the Zoning Board of Appeals? Yes 0( -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 X,—No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date &&r- 11hdrS! /1-®r aF igo,,C4. ti4 s Yl s l 10 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary):�d A* ty&*. T ►°M OF V t c� ;air b,7.,1,6fAI 13,11,k l,Fa4 4N4 ov�P LMS yard of Trustees Applicata WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:&- ; Q Wk 4L- y.-Q,#M r�®�,9, N4�ANe''E, ,4 —7 w#+44 AU,4 :�i a, ,-W A6,406 4 ®XL !4M . Area of wetlands on lot: Fi6y square feet Percent coverage of lot: f - moz ® % Closest distance between nearest existing structure and upland ---—edge-of wetYands: '6 ---feet — - Closest distance between nearest proposed structure and upland edge of wetlands: M fq feet Does the project involve excavation or filling? 0(_ No Yes If yes, how much material will be excavated? /r cubic yards How much material will be filled? / cubic yards Depth of which material will be moved or deposited: feet Proposed slope througho the area of operations: Manner in which rryderial 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): &v�c'f' &V/ -r,. 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 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: /� secrAotj / Project Locatiooy�nY-(describe, and attar -I na a lo-bomap): /q'y /i/h {j V 6, P 0VV S -V -C • 010-00 IV 4 01, 00 VV6e 000 Brief Description of Proposed Action: ICoCrr®'nir� V 7 ,� riy;�G`,� �'I A �' nw/ iA; 4NCIC Name of Applicant or Sponsor: Telephone: ltl�i sJ.�.l�tj E -Mail: 1i4d �S e-®fir®rae4iN� Address: �e � &:V6 �,v4v/ S7 City/PO: �o, — State: Zip Code: liC)x l 9 -5,0 0k IIct l 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinanc , NO YES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that ® F 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? 65- acres b. Total acreage to be physically disturbed? acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? a 6-. — acres 4. Check all land uses that occur on, adjoining and near the proposed action. Urban EJ Rural (non -agriculture) ❑ Industrial EJ Commercial Residential (suburban) ❑Forest ❑Agriculture (Aquatic EJ Other (specify): ❑Parkland Page 1 of 4 N67 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ ❑ ❑ ❑ kJ 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 ® ❑ 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: /V/19 NO YES R] ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: �� 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 - ❑ ❑ 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 ❑ 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: Shoreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid -successional ❑ 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 ® ❑ 16. Is the project site located in the 100 year flood plain? NO YES LL 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? ❑ NO DYES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ❑ NO ❑YES 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 ❑ ❑ 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 ❑ ® ❑ 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? 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 ® ❑ of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or infrastructure for El I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname: Date:/ Signature: kV 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 ❑ 11regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or infrastructure for El ❑ affect existing 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: ❑ ❑ 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 1:1architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, El Elwaterbodies, 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. F1Check 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. F1Check 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 Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency President Date Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT 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 1:1 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? D 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. F1Check 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. F1Check 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 Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency President Date Title of Responsible Officer Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 - and of Trustees Applicata AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HEAHE 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 O -F SAIDPERMIT(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 THE PERMIT. DURING THE TERM SWORN TO BEFORE ME THIS "4 DAY OF A , 20 I -T C&fl%ti neYi� WY V Notary Public, State of New York No. 01 SW5082484 Qualified in Orange County Term Expires July 28, 22 ao 17 APPLICANT/AGENT/REPRESENTATIVE 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: : 1.4mcs 71 • &J4 oy (Last name, first name,.rpiddle 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 Variance Change of Zone Approval ofplat— — - Exemption from plat or official map Other (If "Other', name the activity.) Building Trustee Coastal Erosion Mooring — -- Planning 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, n}arriage, 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. 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 eday *11 200.1_ Signature Print Name s o 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 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: o e Town of Southold's website (southoldtown.northfork.net), the Board of Truste i e, the Planning Depar�rir� nt, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION JUN e 1 20 ; SCTM# PROJECT NAME -� 0-K c bj ,, ,%y 119W 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: a Nature and extent of acti NrG Location of action: f-6 2 go;Ar Aw U(- ZVC :r . �3u'A'am AY 1/1-7/ Site acreage: V 141-1 Present land use:,"9 Present zoning classification: i Ar. 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: — mrr, s 7T. d 0-44 LF (b) Mailing address: (c) Tele–hone 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. WYes ❑ No ❑ Not Applicable I%94j�,j M4:4r/'-f yq yc,&m�zrr�Y— ✓J,r,N�;G;�r� �S� of s�� Lm yaa. 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 1:1 No A 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 0 Yes ❑ No ❑ Not Applicable UF,444,►f,'av 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 IRNot 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 11Yes 1:1ron No 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. 1. r Yes No Not Ap able 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 W'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. �j 1:1YeO No RJ Not Applicable Attach additional sheets if necessary ' W6RKING COAST POLICII 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 [Z 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 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III — Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No ❑ Not Applicable PREPARED BY "*/yfS _-_X, &44 TITLE OWN" DATE j ,.s John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 OTHER STATE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY at Stony Brook --- ----------------- - ---- --- -----------50-Circle-Road------ — Stony Brook, NY 11790-3409 (631) 444-0355 Wednesday & Friday only during the hours of 8:30a.m. — Noon & 1 p.m. — 3p.m. Email: r1dep(a)-gw.dec. state. ny.us Suffolk County Dept. of Health Services Office of Wastewater Management 360 Yaphank Avenue, Suite 2C Yaphank, NY 11980 (631) 852-5700 Email: WWM(aD-suffolkcountyny.gov U.S. Army Corps. of Engineers, N.Y. District Attn: Regulatory Branch 26 Federal Plaza, Room 1937 New York, NY 10278-0090 (917) 790-8511 Website for applications & helpful information: http://www.nan.usace.army.mil/Missions/RegulatorV.aspx N.Y.S. Department of State Division of Coastal Resources Consistency Review Unit One Commerce Plaza 99 Washington Ave, Suite 1010 Albany, NY 12231-00001 (518) 474-6000 Website: www.nyswaterfronts.com C13 z BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 OTHER STATE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY at Stony Brook --- ----------------- - ---- --- -----------50-Circle-Road------ — Stony Brook, NY 11790-3409 (631) 444-0355 Wednesday & Friday only during the hours of 8:30a.m. — Noon & 1 p.m. — 3p.m. Email: r1dep(a)-gw.dec. state. ny.us Suffolk County Dept. of Health Services Office of Wastewater Management 360 Yaphank Avenue, Suite 2C Yaphank, NY 11980 (631) 852-5700 Email: WWM(aD-suffolkcountyny.gov U.S. Army Corps. of Engineers, N.Y. District Attn: Regulatory Branch 26 Federal Plaza, Room 1937 New York, NY 10278-0090 (917) 790-8511 Website for applications & helpful information: http://www.nan.usace.army.mil/Missions/RegulatorV.aspx N.Y.S. Department of State Division of Coastal Resources Consistency Review Unit One Commerce Plaza 99 Washington Ave, Suite 1010 Albany, NY 12231-00001 (518) 474-6000 Website: www.nyswaterfronts.com JUN _ 1 2015 9 _ r "APPROVED BY BOARD OF TRjSTEES TOWN OF SOUTHOLD DATE 1 IAT 137 Y. S. LIC. NO. 49618 ANY ALTRA71ON OR ADDITION TO THIS SURVEY IS A VIOLATION S. P. C. OFSEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW. EXIrEP.T AS PER SECTION .7209—SUBDIVISION 2. ALL CERTIFICATIONS 0p FAX f63/1 765 -1797 HEOEON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y 11971 199-26d 0 rl G N SURVEY OF PROPERTY. AT BAYVIEW '?.�.��►� TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-90-01-06 ' SCALE: 1"X30' JULY 27. 1999 oiwgh 25, •2015 = ` Az t� ' .i+ • ,w all. . may+ " ` Lot numbers refer to MapV of Cedar.ftd�h- Park filed. irf the Suffolk County Clers • . 110 4tCERTIFIED T0- - - JAMES J. BRADLEY MARIANNE C. BRADLEY FIDELITY NATIONAL TITLE INSURANCE COMPANY AREA = 28,532 it. r sq. io lie line ' ■ =monument ' e � T. MET2c 'pl G nd-'k 3 R :S f 1 and ewk. 0.1•N So. PPE 89,oa t IAT 139 Y. S. LIC. NO. 49618 ANY ALTRA71ON OR ADDITION TO THIS SURVEY IS A VIOLATION S. P. C. OFSEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW. EXIrEP.T AS PER SECTION .7209—SUBDIVISION 2. ALL CERTIFICATIONS 0p FAX f63/1 765 -1797 HEOEON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y 11971 199-26d 0 rl G N SURVEY OF PROPERTY. AT BAYVIEW '?.�.��►� TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-90-01-06 ' SCALE: 1"X30' JULY 27. 1999 oiwgh 25, •2015 = ` t� ' .i+ • ,w all. . may+ " ` Lot numbers refer to MapV of Cedar.ftd�h- Park filed. irf the Suffolk County Clers • . Office on .• Dec. 20, 1.927 as File No. -9 0. 4tCERTIFIED T0- - - JAMES J. BRADLEY MARIANNE C. BRADLEY FIDELITY NATIONAL TITLE INSURANCE COMPANY AREA = 28,532 it. r sq. io lie line ' ■ =monument ' ceOFNEWy0 � T. MET2c 'pl Y. S. LIC. NO. 49618 ANY ALTRA71ON OR ADDITION TO THIS SURVEY IS A VIOLATION S. P. C. OFSEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW. EXIrEP.T AS PER SECTION .7209—SUBDIVISION 2. ALL CERTIFICATIONS 0p FAX f63/1 765 -1797 HEOEON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y 11971 199-26d 0 rl G N B JUN - 1 2015 C, TOWN O._ NTY UT OL, SUFFOLK COEW YOREe LOT 137 LOT 39 1000-90-01-06 SCAM. I" =30' FEB. 97 2000 f f1pai I ANY ALTERA'Ir U, t1. _ y'v% .S A %:OLA ON OF SECTION ,' 09 T.�, `PVEV =.r S A7E -'Du:ATiUAJ LAW EXCc'-"1 AS.yCR SE-? .Fr-. <0i_�r `—PD iV.-s 'P,; ALL CE p?lF; C _T,,;^l';, uE.Rr Old ARE VALID *'; ,1 A AND CC,P'ES TurcEOF ONL' !F SA+D lk4AF ilii C0PfE &f A-- s`�, N-?..�i�'C. Jct C. (SEAL OF ! 4E, .:URVEYC WHOSE' Lot numbers refer to "Map of Cedar Beach Park" filed in the Suffolk County Clerk's Office on Dec. 20, 1927 as File No. 90. AREA p 28,532 sq. ft. to tie lime =Pip - 7 11 C . ,r ..,, r. r, ..w t$ ` -AX !630 765 - 1797