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HomeMy WebLinkAboutTR-8642A SO(/jy Michael J.Domino, President �pF�O� 0l0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders co, Southold,New York 11971 Glenn Goldsmith ® �Q Telephone(631) 765-1892 A.Nicholas Krupski lif'COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1333C Date: April 25, 2017 THIS CERTIFIES that the demolition of existing seasonal cottage; re-seed the disturbed area of the foolprint• and to clear vegetation in order to do trenchingto o burn the utility and power lines; At 4690 Blue Horizons Bluffs, Peconic Suffolk County Tax Map#1000-74-1-35.53 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 26, 2015 pursuant to which Trustees Administrative Permit#8642A Dated July 22, 2015, was issued and conforms to all of the requirements and conditions of the applicable'provisions of law. The project for which this certificate is being issued is for the demolition of existing seasonal cottage, re-seed the disturbed area of the footprint; and to clear vegetation in order to do trenching to bury the utility and power lines. The certificate is issued to Blue Horizons Bluffs LLC owner of the aforesaid property. Authorized Signature t_ SOF SO(/ry Michael J. Domino,President Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25� � P.O.Box 1179 Charles J.Sanders y Southold,New York 11971 Glenn Goldsmith • a� Telephone(631) 765-1892 A.Nicholas Krupski Ol�COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: tIA3 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction / % constructed V Project complete, compliance inspection. INSPECTED BY: NA COMMENTS: 6, �eM�,r��t c�5 +>•,7, yJa�„ ` Oeed Ja c& .t t, - ofW 6—a to'bt(S OK 4—o Y SSy z — w,*((/^ cr�a01 e y 7514 Til CERTIFICATE OF COMPLIANCE: John M. Bredemeyer lll, Presidentg1lEFQ( Town Hall,53095 Main Rd. Michael J. Domino, Vice-President ® ®Gym P.O. Box 1179 Cz James F.King Southold,NY 11971 honele Charles J. Sanders � �� TeP (631)765-1892 �Od O Fax 631 Dave Bergen )765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE A APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SMALL 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 \\,oF SO John M. Bredemeyer III, President ®� ., ®� Town Hall Annex `L ; T ' ® Michael J.Domino,Vice-President 54375 Main Road,',: r . :'. P.O. Box 1179 James F. King,Trustee Southold New York 11971-0959 Dave Bergen, Trustee Charles J. Sanders,Trustee `, � a Telephone (631) 765-1892 ®({ , Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8642A Date of Receipt of Application: June 26, 2015 Applicant: Blue Horizon Bluffs LLC, c/o Richard Principi, Jr. SCTM#: 74-1-35.53 Project Location: 4690 Blue Horizon Bluffs, Peconic Date of Resolution/Issuance: July 22, 2015 Date of Expiration: July 22, 2017 Reviewed by: Board of Trustees Project Description: To demolish existing seasonal cottage; re-seed the disturbed area of the footprint; and to clear vegetation in order to do trenching to bury the utility and power lines. 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 survey prepared by Hands On Surveying, last dated March 24, 2010, and stamped approved on July 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. John M. Bredemeyer III, President Board of Trustees John Bredemeyer, President �o$UFFol't Town Hall Annex Michael J Domino, Vice-President 54375 Route 25 James F. King y x P O. Box 1179 Charles J. Sanders o • Southold, NY 11971 Dave Bergen y�'�r , , �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: 7���Z- BLUE HORIZON BLUFFS LLC, c/o RICHARD PRINCIPI, JR. requests an Administrative Permit to demolish existing seasonal cottage; re-seed the disturbed area of the footprint; and to clear vegetation in order to do trenching to bury the utility and power lines. Located: 4690 Blue Horizon Bluffs, Peconic. SCTM# 74-1-35.53 Typg,,d 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 Type of 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: /. Bredemeyer M. Domino /J. King D. Bergen C. Sanders Bay Constable �Other Form filled out in the field by Mailed/Faxed to: Date: 1 P.445 JUN 2 6 2015 a sM ;. .. r. r -- _ �/ .� ► i ,w M'A��Y`�'r~ti�'� r-Lti '4~��,..�y„moi a J ,r, • ?aj r,.c-Y *�q 4qo BOG L JUN 2 6 2015 (Q•3• l 5�Cc-"'`^' `�i9ca rc1 Sac iTF4 �c.tzr.c,� oar•, ' ,ULlCi �Pxw SEE SEC NO re www `"°�.d... .•" Obee nR —ON - --LnE j _MNTC«----- ——————— ———— -- : ---- Y� _ Wa ry I .iN soul FOR—NO SIEE awowNO oio SEESFC No v Q 061 ssr - Ro. wn ,d IS 065 m� �� x',�*sO • i J 'g '� MN n ,Nx • �xo�`. aJ ? '�• q�� ,'4ry rqa Olin o� �4 <,�5•` „n.r xxle) �s� ,•� a.wrh q"�3w H, 'E �,b q� t TONm a sou+«aP 4 I i ..R • e R rovnv ar Swr«aO � I 5x5 I w.Er..NENxN.NrS� x.6Nc, ';9t' s I rlt .9d ,d ♦ � rra �� Nvd " I13 O«Pc_NO SEE SCC NO. S,pNcl 03601 fGJ e couxry � OI I'CL NO I .n O ru 1—«O 3� u s f-1-110 NO . oesexeam° O 4E?BM.TC« ___Le+F xlAlcl __- --rsrmx -- �_ FSEC NINE 5 \ UrtN R SE E 9FC n0 r5 L f[c w us SLF SEC � NO aes Q _ -- ,..,_ --..,-- �,.. --.-- NOTICEa%n;"� COUNTY OF SUFFOLK © e swn,Oio SECTION NO E,._,,.,.,.. —�— oil Z �-� --r-- — -- Real Property Tax Service Agency r M:Fa c... ------ ^— _�__ — -- °— --rr-- A Ce nx yM.rMwNw..N.,,r M. 74 N .r.. o-.... u. '..,.. --:-- --� v M rn�cr xo ter O...r H Ix,Nav,x,. '^ ^^�� ---- -- — r r `y'ni✓' PROPf RTVMM F ""MMme' je VZ. -4 641 ✓.'WM OFFICE LOCATION: ®�®f ® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 �� Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM F9-0 E � VF 1p JuLx To: John Bredemeyer, President _ Town of Southold Board of Trustees �� ry. From: Mark Terry, Principal Planner LWRP Coordinator Date: July 21, 2015 Re: Local Waterfront Coastal Consistency Review for BLUE HORIZON BLUFFS LLC, c/o RICHARD PRINCIPI, JR SCTM# 1000-74-1-35.53 BLUE HORIZON BLUFFS LLC, c/o RICHARD PRINCIPI, JR. requests an Administrative Permit to demolish existing seasonal cottage; re-seed the disturbed area of the footprint; and to clear vegetation in order to do trenching to bury the utility and power lines. Located: 4690 Blue Horizon Bluffs, Peconic. SCTM#74-1-35.53 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. 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 James F_ King, President *OF SO(lTy® Town Hall Annex Bob Ghosio,Jr.,Vice-President O l 54375 Main Road ® P.O. Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer cn ,r Michael J.Domino Telephone(631) 765-1892 Q Ql� ^tea® Fax(631) 765-6641 oUNTY I �C.v BOARD OF TOWN TRUSTEES - T9- TOWN OF SOUTHOLD IIDi --� L, To: Southold Town Building Department �� JUL �, � ��� � Verification Re. of Building Department Permit Requirements _ ;L«c K. SCTM#: / ✓ � ' �� ' � � Property Owner Name:3f ae— 4r i or-, bl J kJ1ar rl nco' T, Date Sent to Bldg. Dept.: /5 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? WIII the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: ®-7 Signature of eeviewer Date John M.Bredemeyer III,President ®T_ S®(/rg,® Town Hall Annex Michael J.Domino,Vice-President �® lQ 54375 Main Road P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G �► �9 Telephone(631) 765-1892 Charles J.Sanders,Trustee ®l�C®UNTV Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit —Amendment/Transfer/Extension 2015 Received Application: 9_5 Received Fee:$ l � Completed Application _Incomplete F -- _SEQRA Classification: Type I Type II Unlisted _Coordination:(date sent) LWRP Consistency Assessment Form 7/� _CAC Referral Sent: _Date of Inspection: Receipt of CAC Repo t: _Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant 11 ,C"W1")Lln6Pv Mailing Address ®CA ® �� Z92, Phone Number: Suffolk County Tax Map Number: 1000 -f -j ® f Property Location ( or ic. (provide LILCO Pole#, distance to cross streets, and location) AGENT: 1 tG (If applicable) Address: 0� I T o 11171 ( Phone l I Q B d of Trustees ApplicatiO3 GENERAL DATA Land Area(in square feet): !SP0 •�`S t Area Zoning: 0- 22 1 wis 32 Previous use of property: 7/4. Intended use of property: WA.� 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. V0001-Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? V Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes VOOONo Prior permits/approvals for site improvements: Agency .01 Date Saw SOMLL 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): Ilk 4L'#--T o dvii #,4,40 -T 141 Boa of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of tbe proposqd operations: MWANk Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: / ' feet Does the project involve excavation or fill? No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: 1 ®" Veet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): 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 iZlt-tRO i2►rec I -Coq®4 TA E-of Action or Project: Project Location(describe,and attach a locatio map): PaftNic. till . Brief Description of roposed Action: IYI�C.I`fcory tV I S?I v� ® ��/t•/ 6RCM - cftosp ) Name of Applicant or Sponsor: Telepho `L � AJf* ( E-Mail: ING( t Q Q Ad ress: City/M: State: Zip Code: AJV ®1 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 ❑ 191 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: P. Saoxmmo s o '5a470" WTI • ❑ 3.a.Total acreage of the site of the proposed action? Ia 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? 1 .25 acres 4. Check all land uses th occur on,adjoining and near the proposed action. [-IUrban [Rural(non-agriculture) ❑Industrial [—]Commercial residential(suburban) EKorest L�Agriculture ❑Aquatic ❑Other(specify): ❑Parkl and Page 1 of 4 5 Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ Er ❑ b.Consistent with the adopted comprehensive plan? ❑ Ln ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 20 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES Et El b.Are public transportation service(s)available at or near the site of the proposed action? Et ❑ 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? NO YES If the proposed action will exceed requirements,describe design features and technologies: E El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ Ln 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES 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: l-1 14. Ide,pffy 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 NO YES by the State or Federal government as threatened or endangered? IT ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? MINO DYES b.Will storm water discharges be directed to established conveyance systems(runo d storm drains)? If Yes,briefly describe: NO [—]YES Page 2 of 4 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)? If Yes,explain purpose and size: ❑ ET 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? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applican or n ��BtQ 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?" 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? ❑ ❑ 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 ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El El 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 11reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: E 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, F] Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 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 Elproblems? 11. Will the proposed action create a hazard to environmental resources or human health? El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. F] 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. EICheck 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 Page 4 of 4 B d of Trustees ApplicatiO3 County of Suffolk State of New York Ric BEING DULY SWORN DEPOSES AND AFFI T AT 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 WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si tur of Property r SWORN TO BEFORE ME THIS 1 DAY OF 1 U,. _,201-5 'Q'4��yx'_ Notary Pd lic WEN®Y L KUKLA NOTARY PUBLIC-STATE OF NEW YORK No. 01 KU6176871 Qualified In Suffolk County My Commission Expires November 05, 2015 APPLICANT/AGENTIREPRESENTATIV E TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the hart oftown officers and employees The purpose of this form is to grovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid sameqtm��� YOUR NAME: �,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,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 50,'of th 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 applicantlagent/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 ® da ox f Alt 204 Signature ,(���•• • Print I`iame Form TS 1 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 sigqificant beneficial and adverse effects upon the coastal area(which includes all of Southold To)yn). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - 7 •of - 95,53 PROJECT NAME ?4LJtQg% ev 114 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance (e.g. grant, loan,subsidy) (c) Permit, approval, license,certification: Nature ajW extent of action: A Location of action: 499- 49 (Siff Site acreage: A Present land use: Present zoning classification: Jeo 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: l o (b) Mailing address: ®® 24 LZ 11971 (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 LI 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. Fryes ❑ 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 1:1Yes ❑ No [- Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ 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 ❑ 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 1:1 Yes 1:1 No u 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 Appli,...e 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 �=1 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 u 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 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 1 14, TITLE bwAa DATE C� i John M. Bredemeyer III, President n�y�pS�FFOC Co Town Hall Annex Michael J. Domino, Vice-President u'��� _ oy�h 54375 Route 25 James F. King P O. Box 1179 Charles J. Sanders La © Southold, NY 11971 Dave Bergen , off % Telephone (631) 765-1892 Ol Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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 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(cD_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 COASTAL EROSION HAZARD UNE AS DEPICTED ON O THE COASTAL EROSION HAZARD AREA MAP SURVEY OF TOWN OF SOUTHOLD, SUFFOLK COUNTY,NEW YOR `b3o LOT3 PHOTO NO. 57-556-83 SHEET 6 OF 49 MAP OF o , BLUE HORIZONS iso. �10�52°�� % c ; SI TUATEAT :ys PECONIC / TOWN OF SOUTHOLD / SUFFOLK COUNTY, NEW YORK S.C.T.M. DIST. 1000 SEC. 74 BLK. Ol LOT 35.53 GODS// , ti� �1?��%�►; �� �` // Z '� / 0 15 0 30 60 90 120 150 180 210 240 270 / 4* _ 41 `V // SCALE.1'=60' DATE NOVEMBER 2, 2009 / 9� SSS W03 / _ - TBCOf 61M41: 9000, .000 PLOWMANDWEAWnWagM APPROVE® BY FROMMLOMAREnAARMW .00 ARffA0T&nVMWQ"Dff ®� BOARD OF TRUSTEES imm /� ��� ) g o � s ei•� �/ LOTS TOV4/IV OF SOUTH®' M7MSLO&AU6UIQYMAmfOY roT/7 R=ALANoMNORAF FECfKV1 MOW n!A!W VMWATE COFFES OF TM dam,�(� J r \\ \ '� .. c by °� /.�.� °W WXCRoa+® \` rlf.��+v D ��;l C C�, �`,J 1 5- roeeAVAuormtmw ISFROVAM m 10 fm AOF1�/l�IB�PB of cidtolT % OkWOU / LO a ` A DENOTES STAKE SET ON PROPERTY LINE o LOT AREA AS PER METES&BOUNDS:54,509 SQ.FT. = 1.251 ACRES LOT CERTIFIED T0: _32- JOB NO.:2009-182 MAP NO.:7974 FILED:SEPTEMBER 30, 1985 REVISIONS. -r-L-A ND \ � ADD ZONING LINE&CALC'S I Oaa PLOT CEH LINE 3/24110 \t y I �O 05036 ,F JUN6 20�� h OP NE LICENSE NO.:050363 HANDS ON SURVEYING 26 SILVER BROOK DRIVE N FLANDERS, NEW YORK 11901 '*ECURRENT ZONING RR&R-40 TEL:(631)-369-8312-FAX.(631)-369-8313 RR.22,274 SQ.FT. MARTIN D.HAND L.S R-40 32,235 SQ.FT. COASTAL EROSION HAZARD LINE AS DEPICTED ON SURVEY OF THE COASTAL EROSION HAZARD AREA MAP TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YOR vLOT 3 PHOTO NO. 57-556-83 SHEET 6 OF 49 S Ria`` MAP OF P 10� � M ore BLUE HORIZONS SITUA TE A T G PECONIC TOWN OF SOUTHOLD v,01, ��,o �' �. �%� � �; Og10 /� '��\�� // SUFFOLK COUNTY, NEW YORK / S.C.T.M. DIST. 1000 SEC. 74 BLK. 01 LOT 35.53 0 30 60 90 120 150 180 210 240 270 SCALE. 1"=60' DATE NOVEMBER 2, 2009 EASEMENTAND'DR SUBSURFACE J \ O•n N g A V 5f�6 // STRUCTURES RECODEOOR / UNRECORDEDAREN ANTEED oCALLYEVMTATTNE w03 nMEOFSURVfl N J�•�r'VJ '� c < / THE OSiOR DMRNS)ND7W EEONOpp MTHECTAE7 HE CPROPERTY(1NES ARE FORASPECIFIC I PURFOSEANDUSEANDTNEREFORE O / MON.' ALLS POOI$Pn0.�PANDNO EAL'S OF FENCE9 RETAINING ® D TO GLIDE THE ® ''�roAFI"voaix�m�caT�°s�rAuc"roN IZED odepI ' OVER �P ��� ® O� \\ SEC OLINAUTNAM09�FS E��STA E N / O•�' �pW �\ / \\� EDUCAnDNUW y CORES OF THISSUAVEYAW NOTBEARING THEIANDSURVEYORS INHED SEAL OR ' J\•� \2a�' A \ SEA -000/ EMBOSSED D nL COCOSH NOT BE CONSIDERED t` _TO BEAPY. CERTIFICATIONS INDICATED HERON SHALL RUN ISRETHEDFDON199 OBEfNLFroTHESURVEY nUCOMPANY,GOVERNMENTAL AGENCYAND TO TI fEM"ONUS"BLEZ EON,AND \ �\ T llcy,OERI/FICA70Ni ARENO,ITRANSFERPBLE SHED / \ LOT 3 OWNERS ONALUSTIrUT ONS DR GUBSE0UEN7 OWNERS. R ® \ AoDENOTES STAKE SET ON PROPERTY LINE .000 / sQ ® s�s�ag LOT AREA AS PER METES&BOUNDS:54,509 SQ.FT. = 1.251 ACRES SOT 2 CERTIFIED T0: N�r82sAOR' ar \ 3p� JOB NO.:2009-182 _ MAP NO.:7974 _ —30 \ FILED:SEPTEMBER 30, 1985 _ REVISIONS: ,-AND i ADD ZONING LINE&CALC'S 11130109 PL0TCEHLINE 3/24/10SIN a�. '�°�050363 Q�• I, hry CO)F NE �RryBs �\ �- `, AW 2 6 2015 "F°R� qy C.3 LICENSE NO.:050363 ^ya Tr HANDS ON SURVEYING 26 SILVER BROOK DRIVE N FLANDERS, NEW YORK ` 11901 ' E CURRENT ZONING RR&R-40 TEL:(631)-369-8312-FAX.•(631)-369-8313 RR.22,274 SQ.FT. Pk MARTIN D. HAND L.S R-40 32,235 SQ.FT.