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HomeMy WebLinkAboutTR-8700A John M. Bredeme er III, President y��oSUFFO(k�0 Town Hall Annex Michael J. Domino, Vice-President ��� . Gyp',` 54375 Route 25 Glenn Goldsmith y P.O. Box 1179 A. Nicholas Krupski w ® Southold, NY 11971 Charles J. Sanders Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 St day of construction % constructed Project complete, compliance inspection. INSPECTED BY: Y,(�qSy-, COMMENTS: - t,� Cr,�Pl�oaie CERTIFICATE OF COMPLIANCE: John M.Bredemeyer III,President ®f S0 Town Hall Annex O� ®� Michael J.Domino,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith CA Southold,New York 11971 A.Nicholas Krupski ® a� Telephone(631) 765-1892 Charles J. Sanders �'yC®U� � Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1238C Date: June 21, 2016 THIS CERTIFIES that a Ten Year Maintenance Permit to hand cut Common Reed (Phragmites australis)to not less than 12"in height by hand, as needed; At 14915 New Suffolk Avenue,New Suffolk Suffolk County Tax Map#1000-116-3-17 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 26, 2015 pursuant to which Trustees Administrative Permit#8700A Dated November 18, 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 a Ten Year Maintenance Permit to hand cut Common Reed(Phragmites australis) to not less than 12"in height by hand, as needed. The certificate is issued to WILLIAM H CORWIN owner of the aforesaid property. Authorized Signature John M Bredemeyer 1[1, President ,��'�SV�FQ(,� '= Town Hall,53095 Main Rd. , Michael J. Domino, Vice-President /4' Gy ; P.O. Box 1179 11971 James F. King � N � � . Southold,1\1‘;' Charles J. Sanders f # • -i•1 Telephone(63 1) 765-1892 01' Dave Bergen ' ,,,,, 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 % constructed Project complete, compliance inspection 4 „, *®F SOUtz;- John M.Bredemeyer III,,President 0. 4J Town Hall Annex 4 ®lQ • 54375 Main Road Michael J.Domino,Vice-President ;4114:,.% AtEA P.O.Box 1179 ' James F.King, Trustee t ; n ,s xr Southold,New York 11971-0959 cis Dave Bergen,Trustee O , 410 a j Telephone(631) 765-1892 Charles J.Sanders,Trustee � ' Fax(631) 765-6641 COUNTV, '� o'‘ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8700A Date of Receipt of Application: October 26, 2015 Applicant: William H. Corwin SCTM#: 1000-116-3-17 Project Location: 14915 New Suffolk Avenue, New Suffolk Date of Resolution/Issuance: November 18, 2015 Date of Expiration: November 18, 2017 Reviewed by: Board of Trustees Project Description: Ten-Year Maintenance Permit to hand-cut Common Reed (Phragmites australis)to not less than 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 submitted by William H. Corwin, received on October 26, 2015 and stamped approved on November 18, 2015. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb'native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder(Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 2 If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. - John M. Bredemeyer III, President Board of Trustees , ._ .s_ �,. "if . . f -•' ...1;ir,iii„ - e _ 10 t { a Requested maintenance permit for 40 y 114, • .„, ; „., .. ' .se• 1°04filft , +fill' • 44 4S common reeds in the blue shaded area. 4.#7;.. • - x - 2 j ✓4, i Fl„ .. • a y r. . k. ii,t* : .- - sIlle : +.. a 1•� "..+" .w . t'4 -4. . 401 IL 1 , ' .'Wit, 1: 4#6. ,..:, ^ — .`.... . 416t 4.1r i ),, , ... . t .. „ ..0 4111 .,._. 4004 giWiltRIZINCIp_. ` APPROVED BY , . ..,.,i - . ' e Ail tt ... 1 5 _- :'. •1'41 • ,.. ES -. TOWN OF 'r� .* �1 it ,ll . DATE moveiftw iS, 0/5" ii . OCT 2 6 2015 elligirliri i L . - . .J ILI 100 _. 910s J 25 2 �� _- ?18 3.0A(C) 1 ; 100 0 25.1 N / 3 17 19 21 'g o 1 3A(c) ff I �� 2.9q(c) 225 125 100 � '--/ I '',..---/- , , \ 365s 543s\ Qb CASE RD. (495') � soes \\ '�� \ a 225 225 O 281 1 N rat 0 16:1 22.3 3.2A(c) 1 � �" c '"----.'-, gas / - Ts \ 225 225 p \ L'-'•� \. 113 113 < \ ^� _ W �• J \ 1$ 2 o zos ,05 14 "'22 1 22.2 ' 225 113 113 16 200 \ / ---�__-- \ 17 111 123 s s s '''l 23\ 14°js i\ 15 80s 30 4es e, 8 9A(c) 16.1 as 14 4----- No4P t? i S 14A(c) 2.9A(c) j 209s �� N18.1 'i 'A R 15 N 161 7A17 1c ��s �, rt 1.1A(c) ( ) 15 0\ $ 19 2 43s 33s 186 { 14 X04 1:0 8 18A -e \-- ti 16� m $ s0 r ,os 245 X501 15 z 175 58 173 6 N 12js 110 269 30u /� Y 167s 100 21.1 25s ns H try M / iM _, ;, 1.1A(c) gp04 TOWN OF.�OUTHOLP (sa) SHORELINES- \ SHORELINE 1000s 35s ._ �QINBER ATER LAND) 12� jos .-- oS�---Tr,,----------„.... 22.2 1+" 4 1A(c) -... •Or. ; \ 40 o\ \ 24.1 • e'9Y _\ N 281,400 0 0 0 0) v N W COUNTY OF SUFFOLK © K 109 TOWN OF SOUTHOLD SECTION NO Real Property Tax Service Agency Y �o 4 "' County Center Riverhead,N Y 11901 115 115 117 VILLAGE of 116 4,.. SCALE IN FEET M Ay. 200 0 200 40D g-E ! A - ��, P 123 134 DISTRICT NO 1000 GREAT PECONIC BAY PROPERTY MAP CONVERSION DATE Feb20 2013 0 43 n O w N 306,782 420 Quitclaim Deed,with Covenants against Grantor's Acts—Individual or Corporation CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. THIS INDENTURE,made the .' day of June,2015 BETWEEN WILLIAM HARLEY CORWIN,Survivor of Joan H.Corwin and William H.Corwin, residing at 388 Stoner Creek Rd,Lakeside,Montana,59922,party of the first part, and WILLIAM H.CORWIN REVOCABLE INTER-VIVOS TRUST,residing 388 Stoner Creek Rd.,Lakeside, Montana,59922,party(s)of the second part, WITNESSETH, that the party of the first part, in consideration of ten dollars and other valuable consideration paid by the party of the second part, does hereby remise, release and quitclaim unto the party of the second part,the heirs or successors and assigns of the party of the second part forever, ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected, situate,lying and being in New Suffolk,Town of Southold,Suffolk County, New York bounded and described as follows BEGINNING at a stone monument located at the intersection of New Suffolk Avenue and the east boundary line separating the property now or formerly of Elizabeth Faucon and Olympia Kouros; THENCE RUNNING in a northerly direction along said boundary line to a stone monument,which is near the mulberry tree, THENCE RUNNING west and bounded north by other lands of said Olympia Kouros,to an iron stake in the meadow near the water hole,which water hole is the boundary between the meadowland now or formerly of Elizabeth Faucon and the heirs of J.G Tuthill, THENCE continuing along said water hole to an iron stake which separates the meadowland now or formerly of Elizabeth Faucon and the heirs of J G.Tuthill; THENCE RUNNING in a southeast direction along the meadowland of the heirs of J.G Tuthill to the center of the ditch separating the land now or formerly of Elizabeth Faucon and the heirs of J.G Tuthill., THENCE RUNNING southwesterly along the center of the ditch to a point 200 feet north of New Suffolk Avenue; THENCE RUNNING in an easterly direction to a point 14 feet from the east boundary line separating the property now or formerly of Elizabeth Foucon and Olympia Kouros; THENCE RUNNING in a southerly direction 200 feet to a point on New Suffolk Avenue 14 feet west of the stone monument at the place of the beginning THENCE in an easterly direction to the stone monument at the place of the BEGINNING. BEING AND INTENDED TO BE the same premises conveyed to the party of the first part by deed dated January 9, 1989 recorded in the Suffolk County Clerk's Office on January 23, 1989 in Liber 10783 page 385 TOGETHER with all right, title and interest, if any, of the party of the first part, in and to any streets and roads abutting the above•described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises,TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so requites IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written IN PRESENCE OF Grantor(s): WILLI M H LEY CORWIN- STATE OF NEW YORK . ss.; 'COUNTY OF SUFFOLK . On the 3 _el day of June, 2015 before me, the undersigned, personally appeared WILLIAM HARLEY CORWIN, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is(are) subscribed to within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the Individuals)acted executed the instrument Notary Public BRIAN A.ANDREWS Notary Public,State Of New York No. 02AN5014509 Qualified In Suffolk Cou Commission Expires 07/15/ l)1' John Bredemeyer, President Town Hall Annex Michael J. Domino, Vice-President ,��'�°°�O ,�cOoy 54375 Route 25 James F. King ti #. z ; P.O. Box 1179 Charles J. Sanders °� �,+ Southold, NY 11971 Dave Bergen =:oi �aTelephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: i I /10 //Sc WILLIAM H. CORWIN requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut the Common Reed (Phragmites australis) to not less than 12" in height on an as needed basis. Located: 14915 New Suffolk Avenue, New Suffolk. SCTM# 1000-116-3-17 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 Type gf'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: I',,0 c,, 01 Present Were: J. Bredemeyer —ivi. DominoJam. King D Bergen C. Sanders Bay Constable Other Form filled out in the field by .�, Mailed/Faxed to: Date: I , ,ik, �-� ..ic ` � seoe 41 V " ' ,_.., ,,,_ 4/ y i ,. r Figure 1:View of common reeds from existing deck. Y` ks ` e i F w t '�a '�s �1rwt C - Figure 2:View of vegetation and common reeds from backyard of residence. r . r .. -- ,rte _ F� .\ , c. } r \ J/ 4i n'ry i � ^ ..... ,.T $.,...' `i4„ Figure 3:View of vegetation and common reeds from backyard of residence facing tidal marsh. A �v1 r iiiiii or ,f, 1 ' _" j r 1 t1 `1 41 ir'il F i f, , 1; \It,,': \ 41 i . e • fI7Y + 7 1cN �Ae ui "6/i .i ; 41 4 ` 1 - y ��1:. I�i/{v airr .-lr2 t.,,kA.,,,e . Figure 4: View of common reeds from tidal marsh facing east. c • f, r : g -t , (R -ik`4" .,», f p-" ,,G ,, ,o:,-Ti..4 < ":.-4,;-,--.'-.i.,, Fry e n it ��'! a' �� &jr � -e ` n, s �1 Y G- 1: _ <iIiiiiii � i !1 ‘,.1:_, ,..w..::;.:,,,. ,\,: i,„, , ,.....:,, ,, , . 1.', r 1 �` a .. it if , h 'i,ysa w e }�i ;4_1 ' iT ;if ` /'yt t f �i r , '� x t ( 1,' q,y 4 iti 41)1 ' a. 1 `" _N' r i ' i I /l' l� '� 77, ' � {Jif d it �� + l.' k e"r .._ � *4,,.,,, � i�� J ' i7� z Yet :,;..'s..,,,. � i p ',1,! yY� � f t , j 9. iif''. ' I Yil'I; 1 i ki :' r Iii�l� + aye ., 11-3 _ d, ,w, .,�,, , 1ryc E 129 , �� it �iL � f i II f� F 1� f a y If � 111 I i,�,� it, � � ��' � ' iua � t' ..� i ' � �' �,i ,i401 0, 1,1{ � ' F ar ri' 6 , 1.';2,, ,r, . l', ,. 'A'' 1 ,, v:,-,- , ' ,: g , #i 1 j�t / i Figure 5: View of common reeds from tidal marsh facing west. k. • :T,—•'' y; rA r ;4.- - >t_ r , y 1. ' ft 2J 2015- le di Google earth Imagery Date'S/23/2015 lat 40.9920bb°Ion -/2.4511b35 elev 4 ft eye alt 2b/It 0 Figure 6: Aerial view of proposed project area. atii_- �� ' - w:. ..,_ yrb -,.:� .+*+ _,.:� ,k�.. ...�'. .,,o Sao _ ,.. »-.- Nxe NO MATCH T SEE SEC NO 109 -Z — uNE MATGII._.. _ LINE 1.....7 \ A I \ FOR PCL NO FOR PCL NO F R SEE SEC NO M . . I = SEE SEC NO 100.0}008 ,0804.008.3 t . \. ... v WI N 7 ONO _ 33 8.1 593A(C) p I z 1A(c) S \�D 9 2 fit M / ." TOWN OF SOUTHOLD I TOWN OF SOUTHOLD / B.3 • / a F.eU.•N.�.w r�G�D 15 35 PECONIC LAND TRUST 4.W(4 �N AL 83.N IcoNSFRw.�ary E.scNeNn �/ I / ryvVMtr Ec s�F<ut BeC t� / x 3.3$0 • •Ot rvTtxcrvTsl / / an fl e © F. 3 0 -c , e l \ 4'it _ I / U 12 TOWN OF 1� . ] 8 SOUTHOLD 85 \\/\ j / „Nc) 38A1•)- , '-.r 27NU I n 1 7 .. S 2.3A(e) / \ I r T = L 1a{ CLAN• ' ssN4 ,�2 1 • x.....-yo, .. $ isa —.\ 332x....x.....-yo,ls voF SFgA PECANIC LAND TRUST ,Ig \ Rx.NISI- ICd+sERgTIw EA•EMENn $ Er \/ _ I ii --2-- I \ s SE CASE RD. m(av•SI \ *4' a --'i' L `\ --5.--- iiiiiii, p S 1fi.1 8 Z1.3 _ 5 O 32e 1 1A(U}�" 1 \ --. \\ SUFFOLK u, i 2.0*)) i i 8 1 TDWN OFSOUT✓OlA _ $ t g 2_ \ / I I $ \ -_-_ - w • 3] `/ _ 3.BNe) f n\.rte 8 .4 82211 2x12 w `C\ . / \\ ''/\ t] .� ' 1.]A a O I 1 , AVE. m D\ ..1-""--- .\ L 8.811(c� 13 E - ^ a w14 likaL I / \ 1 8ee'I(U tµq 101®�Nc) r12MU TiT '4°)... 3 ,4 ^ , 4 1e1 F. WTCMOGUE 1 11 14A(C) 2SNc) �666a 1 /14110/0 F NEW SUFFOLK w t 3A14 ] �-$ i, IF go fi1]1 ) PARK DISTRICT +i STA(U i0,i ,]Nl. " e rM ..' _ . ® - 410* ' I l 12 a.. g �.�.�J - \ IN N �N i 8 211 p //''S SL ,OWN ,U(c) , p`O \.\�� T 1 z s T , ..---- \j_— \ --I /� \ N4 ' �1 Toss" - _ ,?N` rW4 sajTNoin ..../-,--.;# PECONIC \ � • 5 <, 1.2NU13 1 p' f Q\. ��/ % \s WO / ---iivo .otili , 'DrL.D. 5 -- 4\ 94 A 71110 11A(0. 41110 --------- SEE SEC NO 134 Pp 90 Lola IDRFJt 41), \ T 90 lewliititk" ) / SWIG 1 ./ q1 g - 2201>/I L ? frit \- *.3-% A L "_"" "" '""' '.. .C. °`• --" E n ra• vxro m ( CO U,ryNTY OF SUFFOLK © K —C H' D.N., SOUTHOLD SECTION NO a..Ac. —. .....ma. w (21) ..» O ...u. r Ter —. — oco v<o Real Pro Es .N •+un[oE .: - . .. _ _ . ver e. wr116 ...u. • r .�_ r R mos sic co-mT a.awe OFFICE LOCATION: i ®4�'®F S®Ujy®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 * Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) % co Southold, NY 11971 �@ r��� Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: November 12, 2015 Re: Proposed Wetland Permit for WILLIAM H. CORWIN SCTM# 1000-116-3-17 WILLIAM H. CORWIN requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut the.Common Reed (Phragmites australis) to not less than 12" in height on an as needed basis. Located: 14915 New Suffolk Avenue, New Suffolk. SCTM# 1000-116-3-17 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. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed actions 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 r . iIii h'-xte"+ �' •,,' r •7), 1,4 ,4 NOV 1 2 2015 • soothe,1 Tour 5 S /F iii_� ' � 01 John M.Bredemeyer III,President ���I��O�,S®Uj"0 _ Town Hall Annex t` l 54375 Main Road Michael J. Domino,Vice-President :14°1-'. ::::!:%.:;',_:1:1'% ���iliti , .'%-; :-,3:7:i.:.; i A:< d ` P.O. Box 1179 James F.King,Trustee % " .'-'4 ., �, sf � Southold,New York 11971-0959 Dave Bergen, Trustee ` 'O ---,• Ie Telephone (631) 765-1892 Charles J. Sanders, Trustee ?�i�'�s®UNM,� .��' Fax(631) 765-6641 ,•s' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - -__-_ Office Use Only r _Coastal Erosion Permit Application ' Wetland Permit Application (?� y� Administrative Permit OCT 2 6 2015 i Amendment/Transfer/Extension Received Application: 10-2&•15- _______J/Received Fee:$ 100,00 Southold-Town V Completed Application: IC-26-0- Board_of Tnsiees _Incomplete: SEQRA Classification: Type I Type II Unlisted / Coordination:(date sent): LWRP Consistency Assessment Form: 11.646- _ CAC Referral Sent: Date of Inspection: i f h lag/5- - Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: Il 1f'/5- - --- ----Resolution: - — - ---- -- -- - - -- - Name of Applicant: W i b l E' G Rd i wlVVA Mailing Address: i'.— e-6(!L( J ,4,(C , '4(r; 1 ' �'9('1 Phone Number: t;Oep-- oTh--"V oigetL• Suffolk County Tax Map Number: 1000 - t t td-(�. �° t7 Property Location: WM 157 NI fAil St"/C0 LK Aile-7, aemic os(It, C'Jy ttaice (provide LILCO Pole#, distance to cross streets, and location) AGENT: . (If applicable) Address: Phone: --Lrd of Trustees Applicati, GENERAL DATA Land Area(in square feet): D,'7 c.0 I ( "Cf Area Zoning:-:T._Y'6.14?i_-- . , Previous use of property: '5j;(' , -I G4 � a Intended use of property: Covenants and Restrictions on property? Yes %.0/ No If"Yes",please provide a copy. k7 Will this project require a Building Permit as per Town Code? Yes k/ 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 NZ 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 No Prior permits/approvals for site improvements: - Agency — - - -- Date -- -- — - N/ 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): r �% a 60) Wear e 44 1y i ,,�'/pyit! 1 a 1.� i�'-� ter:AiV�, vti F,Irl• T 3` 16 5 tv rec +0 v tcy SS- �,a 1106[41- C FA k as-10 a4" bosis , :rd of Trustees Applicati; WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t VAo Vr C 4e4-14,6„),. . C _ � y „ 4 Area of wetlands on lot: ti .' square feet cjvt + i mar-51,) Percent coverage of lot: II 05 3% 1ftG (Act( 1mC1.( ,, ) Closest distance between nearest existing structure and upland / edge of wetlands: 3 feet Closest distance between nearest proposed structure and upland edge of wetlands: N,- 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: 14A 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): f I 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses- -- become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part I. 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 -P oject and Sponsor Information 1 It i ct.wi R I Cir VI , Name of Action or Project: C�a� \4.,? ' T ice - :06+—; .i jr Project Location(describe,and attach a location map): ° t = lc' �` oC K ie , --4, �� ;t4ç iy' u a Brief Descripion of Proposed A tion: it Vetbir ,m r `l, , m N el'V:ts.,,,,_ �11, an am as,., vle„,,:,.= „-i; il. X vif , #. C e CA 1 1 4te..-CM:04,40 , Q.ea 1 ir)hrtlAare3 A-1,1-,-etti...S). ''6 *f— t C 16 3 itAILM' ' tilt 1 In tk,:iclifit s. Name of Ap licant or Sponsor: /�,,��®� Telephone: i5+ '''-p;;.,....„0574.-. d ��� _ ` s{ t �� �o/Q' E-Mail: } - A?l r s: a ---— --------------- ----- K. ZCK2 City State: Zip' Code: Mt e,-/ w.- Adsicivl I.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 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: ,vif❑ 3.a.Total acreage of the site of the proposed action? Op ',-I; acres b.Total acreage to be physically disturbed? 67,,d i!,-.17-;_ acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 04-37 acres 4. Check all land uses that occur on,adjoining and near the proposed action. El Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial [`Residential(suburban) CI Forest El Agriculture El Aquatic El Other(specify): CI 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? 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: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? Ni/f-f c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 1/ 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: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: YAK n 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO Fl 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 laad_s adjoining_theproposed_action,contain—_—_NOLO YFS_ __ wetlands or other waterbodies regulated by a federal,state or local agency? or 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. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Wetland oreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑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? 16.Is the project site located in the 100 year flood plain? NO 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? [ NO EYES b.Will storm water discharges be directed to established conveyance systems(run and 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: 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: 1**117 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam ; t Date: O t 22 2.06 Signature: ///`/lar 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? l 4. Will the proposed action have an impact on the environmental characteristics that caused the I� 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 t0 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? Er 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 potentiarfdr erosion,flooding or drainage -- — problems? 11. Will the proposed action create a hazard to environmental resources or human health? i Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail, identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. • Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. 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 / l' '"P)5 Name of L gency Date i—b / e d0_40/ President Print or Type . e of Responsible Off Lead Agency Title of Responsible Officer Sign.. re of Respons' e Officer in Lead A ency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 • ,Lrd of Trustees Applicati,- • AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of ' operty Owner SWORN TO BEFORE ME THIS 76'ft"' DAY OF OCJ , 20 /5 �' 4�yri''''''g9c`9y-IA HOLLY HARSHBA I NOTARY PUBCRGEthR * NOTARIAL?* State of Montana t SEAL = Residing at Kalispell,Montana (2.7 eVe--Z-41(-7<72.4—ilagt.0 �, �F My Commission Expires o,,4; �`� August 28,2017 .iu��p�j�jQP�`- Notary Publi r' 'Lrd of Trustees Applicatin AUTHORIZATION (where the applicant is not the owner) residing at (print name of owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. _(Owner's signature) _ • APPLICANT/AGENT/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. If Ile YOUR NAME: V`914ti& ft? -(, cwvv (Last name,first name,_piddle 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 "fy� ,) r s (If"Other',name the activity.) /��,, s E` {\ ilre =�a( ehavt 'T 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 off the shares. YES NO `�f • If you answered"YES',complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold ___Title or position of that person _ _____________..__-_`_ _ Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200 Signature Print Name • Form TS 1 r Town of Southold • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of-Southold agencies,Y-shall complete this CCAF__for proposed actions that are subject to the Town of Southold Waterfforit 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# i-Re - t7 - -- - - -- - - -- - PROJECT NAME CO ;(111 i V\ CO'-i V .V1 I AVVii@ 5 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 anAl extent rui :764 60)_VP_Ctr Irty&ti6451.14(Z,- kaVa---Cd COu w cel $1 . wu - 5At);daitriDVICE V ;54161111 I (,%/1 ti)AdiCr00 etIn C Sfo0_= r e Location of action: 11.‘"<" �'`� ✓� it A Site acreage: r 01 or' e. Present land use: few ;;';$ ' Present zoning classification: festa„,:„„ lGY,� 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: (b) Mailing address: 7Qde ` I' 1�5 i4T , v c-f ( (c) Telephone number: Area Code( ) ("DO 05q (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes No. 1( 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-r-equir-e-that-the-form-be-r-etur-ned for completion.--- — --- -- DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. - Yes No -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—Poli ies Pages 3 through 6 for evaluation criteria Yes 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 n No R7Not 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 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 throw h 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 Apt- [ble ' Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes No RC/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. r Yes fl No 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. YeJ No 13 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIF`_F_. 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 I VI 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 F- 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 NA Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P.ges 65 through 68 for evaluation criteria. Yes No 11 Not Applicable PREPARED BYTITLE DATE LC)/2-0/b