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HomeMy WebLinkAboutTR-8660A '`.......� Town Hall,53095 Main Rd. John M. Bredemeyer(I[, President 1,,� Michael J. Domino, Vice President idf�0 �Gy P.O. Box 1179 James F.King x Southold,NY 11971 Charles J. Sanderso y �p,� Telephone(631)765-1892 Dave Bergen iol_4t Ido. Fax(631) 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 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 X '/z constructed Project complete, compliance inspection l° ®u� John M. Bredemeyer III,President / � ��•��® Town Hall Annex Michael J.Domino,Vice-President ��� { • f l® 54375 Main Road P.O.Box 1179 James F.King,Trustee ' , t*:' Southold,New York 11971-0959 Dave Bergen,Trustee • G ° �® 1� Telephone (631) 765-1892 Charles J.Sanders,Trustee :®l� ^ ��� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8660A Date of Receipt of Application: July 6, 2015 Applicant: Nick Giakoumis SCTM#: 1000-139-1-4.1 Project Location: 1025 Westview Drive, Mattituck Date of Resolution/Issuance: August 19, 2015 Date of Expiration: August 19, 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. 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 Creative Environmental Design, last dated August 10, 2015, and stamped approved on September 10, 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: No other vegetation is permitted to be cut on the property without further review. Do not disturb any 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 (Baccharis halimfolia). Inspections: The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to request a Trustee inspection upon completion of the initial cutting. 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 John Bredemeyer, President ''s�F ,•- Fuc`"- Town Hall Annex Michael J. Domino, Vice-President ,''��d�� �%y\ 54375 Route 25 James F King ti = P.O. Box 1179 Charles J. Sanders �,,' Southold, NY 11971 Dave Bergen = �r ,�, 1,,„• Telephone Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: RA ai /,7/1° • Creative Environmental Design on behalf of NICK GIAKOUMIS requests an Administrative Permit to selectively prune for plant health the existing vegetation and trees of at least 6" caliper up to a height of 18'; to remove one dead tree; and for a Ten (10) Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. Located: 1025 Westview Drive, Mattituck. SCTM# 139-1-4.1 TyReof'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: C/Chapt.275 Chapt. 111 other ' Type of Application: Wetland Coastal Erosion Amendment c/Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No VNot Applicable Storm Water Management Review: Yes No 1Not Applicable Info needed: Modifications: /m f'1,12FIGij 5 7t) .�9O vial ani.tet1 of— 7ke_ Atikt o-0 -4-1 Conditions: seffll D tl3 - 4/) `AFP 54/lNsr rk � 4- exo-P r0--a/4v NRl 4.w/for'es MaP/64 ,7 Present Were: V J. Bredemeyer 1M. Domino "J. King D Bergen C. Sanders Bay Constable Other Form filled out in the field byr /611D Mailed/Faxed to: Date: "r' , •� k ' Vin'a. ,,' 4, ..•., 1. y ••• • .r -. V ,+ .•,w . • , , .., ..1„. ,.,,„ ...1.', 1:? . • • 5 + ', r! . 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Sanders ,o Southold, NY 11971 Dave Bergen =y�!or , , is°„,'' Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: t(h) L 21 / ' Creative Environmental Design on behalf of NICK GIAKOUMIS requests an Administrative Permit to selectively prune for plant-health. Located: 1025 Westview Drive, Mattituck. SCTM# 139-1-4.1 af Type area to be impacted: o�er t .b Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland 0 Part of Town Code proposed work falls under: �hapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment ,---Aa inistrative 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: A10EP1.49-.4) D 1 r 4J,:) A- C -7-is a ?-d a f Modifications: Conditions: Present Were: J. Bredemeyer M. Domino J. King D. Bergen C. 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' - , E..�u,. ^^.'. lEc 1 m P\, 7J8 ' caa ae eYl1cmn NO'Sm. n or.. ix ,2 IA �w __ .+r —_ r�r..--w-- ,.ns m xmA Imxam. 1110 PROPERTY MAP .. �_ � . Fm w 7crt y ro F N k \--"--7)\---: 1110 o ------1 . at* 1 1'�5 Edi x _ _ � 1," u, f] _ an_`'i14 . Nitso % a • .••. , . 41/ 0 111111111II IIIiiiiii likl \ o r "T s •r 401111#110 Ct. ry / 99 ' , A, 1105y N ^ .R L .....n.... L.�,.0 r� O - ......w --a-- — --.-- NOTICE "'�.\ COUNTY OF SUFFOLK/ \ ix,. SECTION MO —�— . 1211 rn. T — © =mow——. .. ' Real Property Tax Service Agency x J. L b 0, 139 N....�a...M -. •.` r—. .. ,.. �__ ..w __._— nr.rw--.-- �. ,.�11 .� Ceuny Cmdmnim rM.e.N v 111W M �I✓�n. _ ___ A Jf4 ., " 0 w..... :h u.._1x I'x,M.I "w'� —� ...r... --.-- war...--.w-- �.,.0 .r,a..n. avn Irtm.u,.cnr TM scats[nmxra. V ^"• e oMaClw MN PROPERTY MAP ° pf OFFICE LOCATION: / MAILING ADDRESS: Town Hall Annex ,� l•® ' • P.O. Box 1179 54375 State Route 25 4F Ar • Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) ` Southold,NY 11971 ` -4%a 19 Telephone: 631 765-1938 �COUP(,�,,•� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD tint II MEMORANDUM pyi � - 1 AUG fi 1 3 2015 To: John Bredemeyer, President • Town of Southold Board of Trustees Southold` 8ga• f T e' From: Mark Terry, Principal Planner LWRP Coordinator Date: August 12, 2015 Re: Local Waterfront Coastal Consistency Review for NICK GIAKOUMIS SCTM# 1000-139-1-4.1 Creative Environmental Design on behalf of NICK GIAKOUMIS requests an Administrative Permit to selectively prune for plant health the existing vegetation and trees of at least 6" caliper up to a height of 18'; to remove one dead tree; and for a Ten (10) Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. Located: 1025 Westview Drive, Mattituck. SCTM# 139-1-4.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards; the cutting of the common reed is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "FF" which states: FF. Cutting phragmites to greater than 12 inches and vegetative restoration, provided that native wetland vegetative species are not affected or disturbed in any manner; The selective pruning is recommended as CONSISTENT. 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 / 0 SOU John M.Bredemeyer III,President 014*.,..,-:-- 15'0, - Town Hall Annex Michael J.Domino Vice-President tit ° :„o 0 54375 Main Road �� .$ ` P.O.Box 1179 James F.King,Trustee % -ar .,Il % Southold,New York 11971-0959 Dave Bergen,Trustee „G ;'¢' ° 1. Q % Charles J.Sanders,Trustee : '� ����� Telephone(631)765-1892 ;OIyCOU ii Fax(631) 765-6641 �I.. ., •t# • BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only iir r_ _Coastal Erosion Permit Application I + ))i _Wetland Permit Application X Administrative Permit U� J Amendment/Transfer/Extision 205 Received Application: /AP Received Fee:$ /a).---- Completed UU.� ,/ y j Completed Application 7/61 p e:: :s_• . _Incomplete / _SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) LWRP Consistency Assessment Form 7J/0//,5 CAC Referral Sent: y Date of Inspection: 7 /57/5' Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: 7/6,1„..)._)),5-- Resolution: Name of Applicant 4\,`, (,-`.c& S - Mailing Address '(: .(9 - QDK 1E)5 1 Vvla,nr' A-, a/ l 10 D Phone Number:( ) Suffolk County Tax Map Number: 1000 - 13q— i -L , I Property Location: 1 t2,9,6- (,0 -u,es-0 ' C'• \MV-ckkA rcc.LV\ (provide LILCO Pole#, distance to cross streets, and location) AGENT: i Ct C. rv949 kc.2 (If applicable) . Creative Environmental Design Address: PO Box 160 Peconic,NY 11958 Phone: 3 L(-71 a 3 / Elr--� d of Trustees Applicatio>>' GENERAL DATA Land Area(in square feet): '0,3.17 3 6 Area Zoning: \N—Lp a Previous use of property: P\rsO Intended use of property: 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 this project require a variance from the Zoning Board of Appeals? Yes t/---No If"Yes",please provide copy of decision. Will this project require y 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? Yes 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? VNo Yes If yes,provide explanation: Project Description (use attachments if necessary): 1 ;ue `rubra\ --0i*c,A- ed I 0 9(a-, vv oL.c,H.A "tc `TtZt vu. 97�12c.Lc� � X25 12 `� E t c (4,4 N S N-efu eck c�l�v bNl; e� c� �iZ9e r Fe t,,u.„ti � ,e4 l S� -� c�.2 5 - i�cs ti 1-p 4 I, 1,4—[ 1 `rtz_pR S c6 osite s to Boal " of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: €___ed_Gce7� 1644- 4ecd Area of wetlands on lot: 6-/A- square feet Percent coverage of lot: IN f P 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 filling?/ No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: - Statement of the effect,-if any,on the wetlands and-tidal waters of the.town_that_may result by .__. reason of such proposed operations (use attachments if appropriate): 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 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): (o - c49 ,fur Brief Description of Proposed Action: ,1� �c�v�i►�� �� ?\a-in1 Name of Applicant or Sponsor: Telephone: T rsape- 122L ve49 Cz E-Mail:CCe61,,4uVlt lr' COs11 Address: Creative Environmental Design PO ox 160 City/PO: Peconic,NY 11958 State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES S administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that n 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: ❑ 121 3.a.Total acreage of the site of the proposed action? A g 2,c. -acres b.Total acreage to be physically disturbed? (\, A acres c:Total acreage.(project site and-any contiguous properties)-owned or controlled by the applicant or project sponsor? � y- acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial D Commercial cifesidential(suburban) ❑Forest ❑Agriculture ['Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? t/( 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? kir 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: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO, YES v/ n b.Are public transportation service(s)available at or near the site of the proposed action? [1 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? V n 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: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 10 ❑ 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? o./ ❑ 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? n b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? 4 If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Id ntify the typical hitat types that occur on,or are likely to be found on the project site. Check all that apply: 101 Shoreline E Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland 0 Urban 0 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? VI ❑ 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? I21NO nYES b.Will storm water discharges be directed to established conveyance systems(run ff and storm drains)? If Yes,briefly describe: (run nYES 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: FZ( 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: 121/ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Agplicant/••�:--_ .:;;;'�� `L�nLW�Ccr9GZ Date: 7/0115 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 21/ 2. Will the proposed action result in a change in the use or intensity of use of land? 1/� 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 ❑ 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 ❑ ❑ 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, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,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 problems? 11. Will 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 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. nCheck 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. nCheck 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 ' Boar�L of '.'��ii$te:es :Aptilica-tion _ . MASS -r� . Cottnty c '• , . . State of New`Yor. • ., N) ac- G ►A fr_o v:(0, s ° BEING,DUI 'SWORN ' , DEPOSES. D AFFIRMS THAT HE/SHE IS THE APPLICANT FOR;THE ABOVE - DESCR.IBED PERMIT{S)":AND-TI-HAT ALL-STATEMENTS CONTAINEDAIEREIN.ARE • TRUE TO TIM BEST'OFHIS/HER KNOWLEDGE.AND J3ELIEF,AND THAT ALL WORK , WILL BE DONE-IN THE MANNER SET FORTH.IN;THIS APPLICATION AND AS MAY , - BE APPRO"/ED- -BY'Th. sOUma r);TOWN BOARD OF`TRUS'fEES 111.b"APPLICA T"' AGREES TO HOLD--THE"TOWN, F:SOUTHOLD AND THE TON TRUSTEES; .HARMLESS AND, FREE FROM ANY:AND'ALL'DAMAGES:AND CLAIMS.ARISING- . • 'UNDER-OLBY VIRTUE•OF.SAID 'ERMIT(S),IF GRANTED. IN COMPLETING THIS.' " , - APPLICATION,I"HER`EBY..AUTHOR.IZE THE T.2USTEES,THEIR-AGENT(S)OR - REPRESENTATIVES(S),TO EN'1-E.R.ONTO MY PROPERTY TO INSPECT THE PREMISES WITH REVIEW OF'THIS APPLICATION. i / /Ignature : ..1 ` - SWORN'TO BEFORE ME THIS DAA'OF \-) VWJQ- ;2t?. , , , 40isisiir4oPm---, -1 Li_....iriginiiiiw . „ ' . . - Xptaiy Public ANTHONY LAllARO . NotaryPublic-State of New"York b • _ NO.01LA6262682, � . Qualified in Queens my My Commission Expires JJ4--dei6 I , , , . "Baar4 of "Trustees` "Application " ' AUTROita,ATION " {where:the applicant is not,thc:pwner) 1, /Y .) c. ,G.)`'yri V ,i › _ rbesliiiiig at V i (? g k `.. U , . (pxint twiner.of property): (trailing address) , David'Cichanowicz, Pres: /lA 404A g sC� Ai / I I(�3 b dig hereby authorize. ,. .." ., . - . . (Agent). , ., , . . Creative Environmental Design... . to apply for per it(s)from the Southcild"Board Of To vii Trustees on my beb4, ' 0,'wner's;0 ; } ; • 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: &u i c, C.\C ,n 01-(9`LZ (Last name,first name,i,niddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,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 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 •• ;Aa ay of „gem 20t' Signature — _ _P_ L_ Print Name Lar_►.l� .� Tip.%� Form TS 1 3 ` ,Town of Southold -- LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# \2 : e - • PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity,agency regulation,land transaction) ❑ Financial-assistance-(e.g. ant,loan subsidy) — — _ ( g•-�' � (c) Permit, approval, license,certification: Nature and extent of action: T `, fie( O l�C MO-i atik 6W4 c -\-tom. i" �.-cls 4 X21tj KA 6-.9 0-29S- of • q2k wt"!Xc 4, d NC Cit Q e- VgAi ; t. ory . v P 4-6 I ` 14ks � ef2 t e 5 n a te,t (, ` cA-E . • I Location of action: 1,D36- L0\ EJB.' Dc Nv-d--o` 1(-- Site acreage: 9-3-1`6-35 - Present land use: .-l Present zoning classification: I0 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: (V`04-, (b) Mailing address: pe - '-)O St\i\et VV( 1(01Z) (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 ElNo"2I IfY es, 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. s n No n 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 dNot Applicable f, ' 1 I Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRPection III—Policies Pages 6 through 7 for evaluation criteria v/Yes No n 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 Pa s 8 through 16 for evaluation criteria Yes 1111 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 —P licies Pages 16 through 21 for evaluation criteria Yes No ❑Not Applicable tvk,W,W.--Le--- 11 ©u.0-4- Oa-42C baLl 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 2 for evaluation criteria. I ` f Yes No Not Appi. __elle - 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. n Yes n No of Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. :ee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ' of 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. ❑ Yeg No 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 L ; RP Section III—Policies; Pages 47 through 56 for evaluation criteria. Yes No M Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estu 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 eva ation 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; ages 65 through 68 for evaluation criteria. Yes No Not Applicable PREPARED BYTES k, LL6A0 oeu9\Lzi TITLE rib: n,k ' DATE 1 15 L Ill' as cl\--‘1 km\ \.), '11/4 N , • i •-••••\ o , • - , . , 0 o •42s,, - - - , 0 0 1:::Fk .„ . . , \ 1 1 _ ii ‘low _ , . . . , - - - . . . 1. 1 mt,' NEI GJ-II3ORS 1,'''''-'''\ :' (:)()-161'4' - ., t4223 / \ • GARAGE , . - - - - • ,. (:::) itYA,'' rwERRY °LOCUST 1-`- . , ._ \ ,- , . - - , ' e . 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Giakournis Environment .I■ ■_ Date: 8/10/2015 1 10' . • '.. • ,... . ..; 011'Is air l IL € • • sl Yum' .. & Yot ng, Land •, 'itveyors, .' •0.111: • , ijimrti . •WO Ostrander verdue.t Riverhead, ?ietxw York'. 1'1901 j ;; te-72.7-'2 03• .14E4 °It; Aiden 1f, r. ' Young, P.E. ' L.S. ( OB-t89� rill trg Yt i . -1 04.vord F. Young,:Land Surveyor ThomG A'atp7"rt, n�fes417ria.i EN/Inver I . ;"` , Jc>~?Worms.o1m Schnurro,Land: Surveyor • •• ,PifrRleg E m s ,, • I - uo(tri�£NT SET P- 1IIN1MENT FDUl ,i,•• 3TA SET A. S1'*KE fCJ! o- PIPE ft7Ut+i}''�• , f;12.0 - PROPOSED,sem{ EVA1 C45 —02)— - PROPOSED CON Si 0 1 � , " 12--- E STIN0 Ca 11AS • i�.D • E�!'S7t�.:scot EtEVAnc�Is , ° ,( • - • ' )) , J . ,... ' i * S.n---- 934 . S:9°‘ . . 0 .F , IA ' t 113 . . . , .1 til , , i , . . • . NOTE O E s _ ^w- liyi „ '' k- ! AREA - 22,835 SQ. FT. ' tbi. a I .- • VERTICAL DATUM = N.G.V. DATUM (M.S.L. 1929) • • HEALTH DEPARTMENT REFERENCE NUMBER 11:11 ape ' ,, , "XRa-1 D-96-CD 9' !Lig i • ..--------- „.�-�"� 0•1 • THE WATER SUPPLY AND SEWAGE DISPOSAL FACILITIES SHOWN nib i _ .•• '” I HEREON SHALL COMPLY WITH THE STANDARDS AND REDUIREMENTS . R • W ['"� 0 THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE. IN • � jof me Og 9 ooOc� q,. „„z ra141rQ41 EFFECT AT THE TIS=••E OF CONSTRUCTION - 1Ito\ FA (2, ,ti;;~�'�L .F , , THIS PARCEL IS LOCATED IN !► ZONE AL. BASE ELEVATION COQ pr o^ # .-,.o • 11.0 AS INDICATE) ON FLOOD INSURANCE RATE PANEL NOMEr'RS ilg t • �, �d5 roam �,. J � ie•Qsa 360813-4816, LAST DATED MAY 4, 1998. it . ron a 13,,3.1 a' ,.. V....... I ritktEs . '-1i~ ,� -.tom •• + .Yom' OM ' t . `",cc d ate' j}, \- •G•T• • , fi: of .Y� \!� f-'' Yp" _ ■ - >`.* + T ' �1��',� '1 74,4;eit•Iti el 1•' • �*i y $...'. q1 5+S'�� �~�i ' \" • %r. '¢�' ~ , • F t ea5 ' {; t Yom.. , '� r, r.: f„ .►+ s • 44.\ &� x Y� 6CEE 1 147E (14}-4 f �+- _ - , • • kpctl)Ia? ''' !ill • I * ,rl \ r /7"1411-1724t:e 44* 1/1/61426f t 1.- 11771 ''' —I • Ilii ` g �.ct; tax[7) , 1� 4t 1 HOWARD W. YOUNG, N.Y.S. L.S. NO. 45B9S�r'.. - f s 1a %ao 47“4-y- ' --•° _•_13 , \ k E��5 e TiiOM'S C. WOLPERT, N.Y.S. i'.E. Na 6143 's e '��S$'3 <c. -� . 7 • 1 •c Q,:‘ Sg Th �' ' 'i .gyp" �� of -� 7". . •• _ . ...- .. - - I CERTIFICATION t '�" (� yLpi of 1-1-1..1- . �� __.__.._ -•---•, '4 1 t. 2 4�0 / �'' �U• JUL - 6 2015 .� • WE HEREBY CERTIFY TO RICHARD J. PRAETCIRIUE ' I ' 4. i ' +I � / �ela • - - - THAT THIS SURVEY WAS PREPARED IN ACCORDANCE ':PITH THE ' I �� ��Ca ,! › 1.-____:_-..,-- ..__- " ` i CODE of PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW o 42.> YORE' STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. —.1 - 7 °F N ,'l ill 5 , , / S / , -44 yA;t , .J' _.. 't= - - ' Ase �*` �t���� ��� fJOI*4 SOHNQRR, N.Y.S. L.S. NO, 49517 ''(1 c•-, , ..gi. t.0% ,' �� HOWARD W. YOUNG, N.Y,S. 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