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HomeMy WebLinkAboutTR-8610AJohn M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen ��o�OgUFFD(�-coG y� 0 x t� 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 1St day of construction '/ constructed XProject 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.: 8610A BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date of Receipt of Application: June 4, 2015 Applicant: John D. Heslin SCTM#: 145-2-1.2 Project Location: 60 Great Peconic Bay Blvd., Laurel Date of Resolution/Issuance: June 17, 2015 Date of Expiration: June 17, 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: For the as -built construction of a 20' diameter irregularly shaped bluestone patio on -grade; a varying width gravel path with a fire pit area on -grade at 4'6" in width; an area of 2'x3' bluestone pavers against bulkhead in front of proposed beach steps; and for the re -vegetation of the area. 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 Timothy Coffey Nursery, last dated April 20, 2015, and stamped approved on June 22, 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. Ir • I =Of John M. Bredemeyer, III, President Board of Trustees Issued 1 Date.(p/17Jj5- Address THIS. NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD; N.Y. 11971. TEL.: 765-1892 John Bredemeyer, President SUFFot Michael J. Domino, Vice -President James F. King ti = 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 of Trustees Field Inspection/Work Session Report Date/Time: 1, 1) AJ / 2-- /� G%' ` e Michael Kimack on behalf of JOHN D. HELSIN requests an Administrative Permit for the as -built construction of a 20' diameter irregularly shaped bluestone patio on -grade; a varying width gravel path with a fire pit area on -grade at 4'6" in width; an area of 2'x3' bluestone pavers against bulkhead in front of proposed beach steps; and for the re - vegetation of the area. Located: 60 Great Peconic Bay Boulevard, Laurel. SCTM# 145- 2-1.2 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: "Chapt.275 Chapt. 111 other TypW Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredeme er M. Domino . Kin C. Sanders D. Bergen Y 9 g Bay Constable Other Form filled out in the field by J, Mailed/Faxed to: Date: �`t f �•fia�.` r.f t �lYi rr- _ .. - .c Mia►- ,'� v i.I''.,, ``� w - M y;� z,_*ti-: (6) John Heslin Taken June 1 2015 Looking North A I ( + c a IIL•_s—�\'.144 ____ '� Y`L�ti N P I � f •p�c'� PROPERTY MAP 6 i q / . / r ,le 1 G A T S o r F9 A X90 , e NOTICE COUNTY OF SUFFOLK © x SOUTHOLo SECTIOMI 9' E q Real Property Tax Service Agency r 145 ..+..,�•�-.....�.__ °^'^"iz, y ... _ _— .r —_.—_ rw..--.«-- waw.. "P9 p r«cr xo 7000 PROPERTY 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: 631765-1938 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 Gate: June 16, 2015 Re: Local Waterfront Coastal Consistency Review for JOHN D. HELSIN SCTM# 1000-145-2-1.2 Michael Kimack on behalf of JOHN D. HELSIN requests an Administrative Permit for the as -built construction of a 20' diameter irregularly shaped bluestone patio on -grade; a varying width gravel path with a fire pit area on -grade at 4'6" in width; an area of 2'x3' bluestone pavers against bulkhead in front of proposed beach steps; and for the re -vegetation of the area. Located: 60 Great Peconic Bay Boulevard, Laurel. SCTM# 145-2-1.2 It is my recommendation that the proposed actions are INCONSISTENT with LWRP Policy 6, specifically 6.3 (below) and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The as -built patios and paver were constructed without benefit of Board of Trustee review and a Chapter 275 Wetlands Permit. The re -vegetation of the area is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application —Coastal Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: tfS Received Fee:j•� 1 Completed Application: _Incomplete: _SEQRA Classification: Type I Type II Unlisted Coordination: (date sent): , VLWRP Consistency Assessment Form: �! _CAC Referral Sent: _ _,Dale of Inspection: __� lQ Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant:LT�IJ ,Q �,i� j'��%I%m Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 JUN 2015 Mailing Address:,,._2--9y�✓ ._.......... f i .. - _ ..................._._._. Phone Number: _-l._.7........ Suffolk County Tax Map Number: 1000- /457— Q, -- % Z ..._. Property Location: ,60 4�F'ovy e-1- L 4 Ute, (provide LILCO Pole #, to cross streets, and location) AGENT: /V (If applicable) Address: ---Z/ R/V,�it',�/,Q ,e/ V,�. /pA,0 ... __..Phone:.. :... i?_7....-.. .I_D 3 L,q.1/&e John M. Bredemeyer III, President Michael J. Domino' Vice -President' is James F. King, Trustee �; Dave Bergen, Trustee i•/} ;;}t Charles J. Sanders, Trustee;. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application —Coastal Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: tfS Received Fee:j•� 1 Completed Application: _Incomplete: _SEQRA Classification: Type I Type II Unlisted Coordination: (date sent): , VLWRP Consistency Assessment Form: �! _CAC Referral Sent: _ _,Dale of Inspection: __� lQ Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant:LT�IJ ,Q �,i� j'��%I%m Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 JUN 2015 Mailing Address:,,._2--9y�✓ ._.......... f i .. - _ ..................._._._. Phone Number: _-l._.7........ Suffolk County Tax Map Number: 1000- /457— Q, -- % Z ..._. Property Location: ,60 4�F'ovy e-1- L 4 Ute, (provide LILCO Pole #, to cross streets, and location) AGENT: /V (If applicable) Address: ---Z/ R/V,�it',�/,Q ,e/ V,�. /pA,0 ... __..Phone:.. :... i?_7....-.. .I_D 3 L,q.1/&e Board of Trustees Application GENERAL DATA Land Area (in square feet): 93 Z Area Zoning:— 4 Q Previous use of property: ,� S'/Q5NW.,V L,. _... Intended use of property: _Zr,J��/►/fi�'/�L Covenants and Restrictions on property? Yes If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes _,X.—No If "Yes", be advised this application will be reviewed by the Building Dept, prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes Y No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s) on property have a valid Certificate of Occupancy? —X—Yes No 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?_ e No Yes If yes, provide explanation: Project Description (use attachments if necessary`f.�Ca^/�'j `,cj/" QQ,� 4 ON er ,y &1?4 v,61- �4r/a �lJ?„� P/ T�,OWL 4DL Ar4 i ei�iv rylaJr z 'X .;r U.L� J'�U-1/S Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: CON1l(e,dAZ c��L.CJ�✓4(gV Flp.e/P1,r 44511910jf5 -VWZR47To ANP )Py -W6 S' -D AAGo� M6 R14N"W 0.9 A1,dp/N!V AFJ72" 1?7 CS • J' 1'D!L J?VlBILLlp"�/ Area of wetlands on lot: —0 r square feet Percent coverage of lot: Closest distance between nearesl existing structure and upland edge of wetlands: feet Closest distance between nearejt proposed structure and upland edge of wetlands: ---AV�N feet Does the project involve excavation or filling? X 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 bexeRieved-or deposited: fe Proposed slope throughout the area of operations: ��Y y �L�q.� Manner in which material will be removed or deposited: _.. _ &'Aa az- '.qS &45Y Pua� 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 - 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: Project Location (describe, and attach a location map): _ _&0 P.E- C CAeV e Bey 91_YP., L_ �1 UAL _ Brief Description of Proposed Action:�Js 0U�L,r �'o/Y1T•e(%CP1-'eP4Y gr 2D ,x:-�lzAe�P/r GiV G,C'4D,E ¢L7 IG�CI >'� / �/��INGl� CVs /A/ L/P W/V 9Y !'�VAO • IN AL4 GLS . Ar 1'/ -10U -"N oN /"N, RXO/-PeSA6P dOel' Name of applicant or Sponsor: Telephone: /� A-2-1 C Address: E -Mai City/PO: State: 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 s 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: X . 3.a. Total acreage of the site of the proposed action? 01acres b. Total acreage to be physically disturbed? acres c. Total acreage (project site and any contiguous properties) owned or controlled by the appl icant or project sponsor? .0.4�acres ._.,.—_-_______o.cc____..._ _....---ain".----e..._....._..----e---____......_.............._...- _.............. _...--------- ............ M....._. ................... _........_......._........ ..... 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban ❑ Rural (non -agriculture) ❑ Industrial ❑ Commercial IgResidential (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, a. A permitted use under the zoning regulations? NO YES N/A b. Consistent with the adopted comprehensive plan? I L 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? 7. is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area`? If Yes, identify: _ 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? 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:/h 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: 11. Will the proposed action connect to existing wastewater utilities? N�R If No, describe method for providing wastewater treatment; _—W//4 rN M ............ _........ -_......___.._....._.._....__.__._-...------ .._ ........_,...- ........ .................._.... _............. __.... __ .............. .................____ _- 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NOXX YES Places? b. Is the proposed action located in an archeological sensitive area? - _1._._1___- ._...._.._.__ 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: .. ._........ -_ ......... _............................ ........ __... .._........ _.._.._-._.____._.___......-..._.._ ..._.............. - -- __._ ........ -- ...... _.......... ... . — 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 El Forest ❑ Agri cultural/grasslands ED Early mid -successional ❑ Wetland El Urban %Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed — _ NO by the State or Federal government as threatened or endangered? 16. is the project site located in the 100 year flood plain? 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 stone water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: VNO AYES AMA__ Page 2 of 4 NO YES YES YES 1 01 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids (e.g. retention pond, waste lagoon, dam)? small to large If Yes, explain purpose and size: _ impact t_._ . 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? occur occur If Yes, describe: regulations? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or NO YES ry {� t— __!_.._ completed) for hazardous waste? If Yes, describe: — _ _ __..... .............. __............ __..._. I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE �1 / Applicant/sponsor name: .. .... i�'�//._6l.//AWL �...s���G Date :................. {/IZ�.3� ._ Signature: 7 -we �l � - 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? El U _........... ._....... ..._. 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 L establishment of a Critical Environmental Area (CEA)? � j`�l ^I j� j (� 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 ...____ _.._.-• (�1 -.----___........._.....__._ reasonably available energy conservation or renewable energy opportunities? U 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, architectural or aesthetic resources? _ 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, T Elwaterbodies, groundwater, air quality, flora and fauna)? L t._.. 1 J Page 3 of 4 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage problems? 11. W ill the proposed action create a hazard to environmental resources or human health? 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 riot 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. ____... _.._.... 1... _... _ _ .............__....... ___.__...................... 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 Gage 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? 11. W ill the proposed action create a hazard to environmental resources or human health? 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 riot 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. ____... _.._.... 1... _... _ _ .............__....... ___.__...................... 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 Gage 4 of 4 Board of Trustees Application AFFIDAVIA' /i/ _.�. BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS NIAY BE APPROVED BYTHE SOUTHOLD TOWN BOARD OF TRUSTIt ES. THE; APPLICANTAGREES TO HOLD THE TOWN OF SO[iTHOLD AND THI? BOARD OF TRU STEES 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 TIIE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPF.cri'm,' PREMISES IN CONJUNCTION wn'II THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUJISTEESTO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL; EROSION PERMIT ISSUE[) BY THE BOARD OF TRUSTEES DURING TIIE TERi'vt OF THE PERMIT. kN\ e ot't'roperty OwTier SWORN TO BEFORE NIE'T`HIS -- DAY OF t -V _ 20 TREVARNO JAY DWYER Notary Public - State of New York NO. 01 DW6291877 Qualified in Kings County My Commission Expires Oct 21, 20z Notary Public Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1, ,7^01V Al' Lq residing atZ�_.�'�C��YP�,��1'�T, (print name of owner of property) (mailing address) f�,pr�a,�Yiv,. tidy .�/23J do hereby authorize Southold Board ofTown Trustees on my behalf*. ( wnes signature} (Agent) to apply for permit(s) from the APPLICANT/AGENT/REPRESENTATM TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibit~ conflicts of interest on the part ofown officers and emnloyeee The nnrpose of this form is to provide information which can alert the town of possible conflicts of interest and allow ii to take w Meyer action _i necessary to avoid same. YOURNAME: Iy/Cy��-.,-..-,��� CTG (Last name, first name, 4piddle 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 T 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, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has evcn 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_m 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 oflicer 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 applieW (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 _/Tday of- U 0 Signature Print Name Form TS 1 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 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 he explained in detail, listing both Supporting and 11011 - 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# � -+Qz -__Z, Z PROJECT NAME _,TVWW A �, of Al 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: 9 Nature and extent of action /V17IV6 P44N, `/V /`4RGO , H -J ✓/vC"Iv r i -- - - Location of action: G G'�,7%I/l gAY R l/P. ZAU/eZL— Site acreage: Present land use:C�f,Z,�,�1/�/4 L� Present zoning classification: L 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:./I/� ��,f%�/.,_ (b) Mailing address: 2 977 G�N (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 0 No X 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. 7 Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III — Policies Pages 3 through 6 for evaluation criteria Yes ❑ No 9 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III — Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable 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 X 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 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, Yes No Not Applicable 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 []Noy 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 1:1 No X 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 Yef] No J4 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water -dependent uses and promote siting of new water -dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No tZ 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. 1:1Yes 1-1NoNo If 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 V<j Not Applicable i PREPARED i ,/ Ui! /. //l , DATEi eP'14 �a°E ° o -Lz15 '0 o Y� a I%k1� CP F- + n • ° °°,�° so�� f a +\+ 111¢ x1Z8 �.. Y \ 0 1241 \ • 1 Q \ \ it \ f\ i� 1 1 + I 1 1 s.e F1yAM1 1 N � x19.y 'a o N C x11'8 u' \ cT / Oo � - C A* I to 1 1 II 1 N O 1 1 \ 1 \ o 1 ` 1 '\ o II x42 SEP K '{F \ .\ 0— un —N mUp t7 x N x NOIt ..\O f f h "6 R � ' ' f \ r� \ �L 10 SURVEY OF PROPERTY SITUATED AT LAUREL TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-145-02-1.2 SCALE 1 "=40' NOVEMBER 2, 2005 JANUARY 13, 2005 ADDED PROPOSED HOUSE AUGUST 7, 2006 REVISED PROPOSED HOUSE MAY 26, 2011 STAKE SOUTHERLY PORTION OF WEST PROPERTY LINE NOVEMBER 1, 2012 REVISED PROPOSED HOUSE DECEMBER 7, 2012 REVISED NOTES & PROP. HOUSE LOCATION DECEMBER 26, 2012 SHOW PORTION OF DRIVEWAY REMOVED AUGUST 12, 2013 REVISED PROPOSED HOUSE SEPTEMBER 10, 2014 ASBUILT SURVEY DECEMBER 16, 2014 LOCATE HIGH WATER MARK FEBRUARY 17, 2015 FINAL SURVEY AREA = 22,932 sq. ft. (TO HIGH WATER) 0.488 ac. NOTES: 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:JU EXISTING CONTOUR LINES ARE SHOWN THUS: — — — — —s— — — — — F.FL - FIRST FLOOR O. FL. - GARAGE FLOOR T.B. - TOP OF BULKHEAD B.B. - BOTTOM OF BULKHEAD T.W. - TOP OF WALL B.W. - BOTTOM OF WALL 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO483 H ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); BASE FLOOD ELEVATIONS DETERMINED ZONE X: AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN. 3. ADDITIONAL STRUCTURES AND FEATURES IF ANY ARE NOT SHOWN DUE TO SNOW AND ICE COVER AT DATE OF FINAL SURVEY (FEBRUARY 17, 2015). SEPTIC SYSTEM TIE DISTANCES COVER HOUSE CORNER"A" HOUSE CORNER"B" SEPTIC TANK 17• 22' OUTLET COVER N O �6 CESSPOOL 28.5' 38' COVER 1 VA CESSPOOL 41' 42' COVER 2 74 X15 Tn �1 i / N O �6 T 7.x N VA C) y y 74 X15 Tn + O / o RO�cK/ o \Al / �0 X000 \ 0.0 p 1'7 lip GONG. '°'?y0 S�t6 P \� f2.s iVER�I \\ I16 123 '\\ �s \ \\ \ 10 JUN— 4 2015 o N , O � 13 CO. 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 ASSOCIATION. _ p`I- Q` tl P404,46�. 1O� Y CP 0� N.Y.S. Lic. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF han Taft Corwin III SECTION 7209 OF THE NEW YORK STATE LA EDUCATION LAW. Land Surveyor 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 Successor To: StanleyJ. Isoksen, Jr. L.S. ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE Joseph A. Ingegno L.S. TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND urveys - Subdivisions - Site Plans - Construction Layout TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. X631)727-2090 Fax (631)727-1727 S LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. �I ---b LE YLA0, arc, r)EN-vti—j'., I t -'1A n lim LA woo l�L-��If r3L.1r-o0� , r. 4 20 PAY L,•I . L- Y. Pz6 F. L5HtL.p -. 101 I o� r✓I�IL�� t Mcliti� 0 MLj L�-H FRr +I` t L! p -e --j4 a NE . q W N m 4- z z zz o z N Z o � 1 m �-�< W J_ d I w IL Z � d qo 4 Q Q 4 N O 00 I LlM /ICrA I � qi(3c4 R0�M APPROVED BY BOARD OF TRUSTEES ..TOWN OF SOUTHOLD