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TR-8758A
. , „rrrcr,,t, John M. Bredemeyer Ill, Presidentro�OS�fFo(,Y�oG,^ Town Hall Annex Michael J. Domino, Vice-President q4=� f' §. .M 54375 Route 25 Glenn Goldsmith :mss ;' l P.O. Box 1179 A. Nicholas Krupski two ® eft Southold, NY 11971 Charles J. Sanders ':r�ol ,4 �� i�V Telephone (631) 765-1892 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, hay bale line 1st day of construction '/2 constructed V Project complete, compliance inspection ,, ca SOUS o - John M.Bredemeyer III,President 0 y Town Hall Annex Michael J. Domino,Vice-President 1 ~ :l 54375 Route 25 J�[ P.O. Box 1179 Glenn Goldsmith ; Southold,New York 11971 A. Nicholas Krupski � =_ ��1� Telephone(631) 765-1892 Charles J. Sanders ••-( • U Fax Fax(631) 765-6641 NT COI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8758A Date of Receipt of Application: March 25, 2016 Applicant: LISTA M. CANNON & KATHRYN CAMPBELL SCTM#: 1000-56-2-17 Project Location: 475 Arshamomaque Avenue, Southold Date of Resolution/Issuance: April 20, 2016 Date of Expiration: April 20, 2018 Reviewed by: Trustee Michael J. Domino Project Description: To install a 4' high, approximately 270' long split rail fence along the northerly property line. 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 Nathan Taft Corwin, Ill, Land Surveyor, last dated February 26, 2016, and stamped approved on April 20, 2016. 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 SURVEY OF 0� : APPROVED BY I LOT 8 MAP OF ��6) _ ' ` WARD OF 1RUSTEES- u_- BEIXEDOl� ESTATES �, e /� c��fit_ YJ Ca, g� •` "fJ .,'- OF �,/Vi FILE No. 147 HLED MARCH 16, 1946 : ' �` SITUATED AT ME- ,-PRiL 2o-20!(0 - - SOUTHOLD CONC MON TOW OF THOLD SWITHECAP S 3'40" w W�/ / ! >/ SUFFOLK NCOUNTY,U NEW YORK 7zz I .�: 23.17' / r; _ S.C. TAX No. 1000-56-02-17 ' SCALE 1"=30' oi HOUSE 7 9' JANUARY 9, 2007 • • 3 27 MARCH 28, 2007 MONUMENT PROPERTY CORNERS LO0111T 1 ' •!..:.) FEBRUARY NOBER 2016 11, 2014 UPDATE LOCATE WETLAND FLAGS ,_. \A V ' �, , FLAG FEBRUARY 26, 2016 ADD PROPOSED FENCE —a DECK - / a 1, dll. - r , _ `, t i -CONC MON__ T^ — S� I� END OF PENGE 3 AREA = 23,949.12 sq. ft. (TO TIE LINE) 0.550 ac. Y o N 83°20 0 BELGIAN BLOCK CURB ---"'_" EDGE OF CLEARING y FLAG111 a \� E. STONE DRIVEWAY cr'( 111, •., 0� W - LIN• E • o co GE ALONG PROPERTY " Ca d AiaIIIIINIIIII y SPLIT RAIL PEN z all, M ��N FLAG S — ° CO• V ��FI t'�;r 4' HIGH / PROPOSED ?� all. 3 p CD F� T d ��W OF p��li `` o N all. v, __ -. - LOT O ; �� ckFLAG • ' _ r fii--::\:,:i.....,,..... ....9E4R C I, ,; � 1, 1j 1 yhiltI, ,111, }, 02 L,J o WOODED 1 FLA WATER 11' MAR 2 5 20161--- :I t�6 w ONG 1,, ^ ' FLAG / S\E UNE \ NIGH 06 w o APPPRE N GB', 2+� O e w FLAG / 111, MPR>�7°09' ; O - S LONG. ,111. _\ L . 1 •20 c tt; la ,, , , N EDGE OF LANDSCAPING 280.1 3' FLAG p t •.. I�,fTr 5 6.'" p LANDSCAPED p E -WALL 1 2'N. 252.30' 1v F •G 1 n 0 ° ,,,..5.-,,„\-c 0 B WOOD Ti, WALL ,/ COO O�•VO Q1 N vo 0- � Z ° "° T e a- ELGIAN BLOCK CURB N� v Y L_ 0' 1 O" °, �_ASPHALT DRIVEWAY°--' �° QQ° e ° �� �� p S 83°2 v ° e ° ° 4 ° FLAG PREPARED IN ACCORDANCE WITH THE MINIMUM G \ STANDARDS FOR TITLE SURVEYS AS ESTABLISHED /Y .. .11(yBY THE LI.A-l.S AND VEB°�M1sAOOPTED D Z ° ' ° ^ tcc LOT 9 1- - TITLE ASSOCIAFOR SUCH E B ....%e. �O{R�K, I -ii ' \ ' _ '., NOTES: C 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM �tl N 'SxLic No 50467 UNAUTHORIZED ALTERATION OR ADDITION ... o..1g7 EXISTING CONTOUR LINES ARE SHOWN THUS: — — — —10-- — — — TO THIS SURVEY ISA VIOLATION OF ` -.,�,,.m.- . SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW Nathan 1o___L in III COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR Land Surveyor CERTIFIED TO TO BBE ADVALID TRUE COPY SEAL SHALL NOT BE CONSIDERED LISTA MAKIMSON CANNON CERTIFICATIONS INDICATED HEREON SHALL RUN KATHRYN ANN CAMPBELL SNLY TO THE PREPARED,ANDS ON HIS BEHALF ON FOR WHOM TTO THEE A Successor To. Stanley J Isoksen, Jr. LS FIDELITY NATIONAL TITLE INSURANCE COMPANY TITLE COMPANY, GOVERNMENTAL AGENCY AND Joseph A Ingegno LS. LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTI- Title Surveys - Subdivisions - Site Plans - Construction Layout • TUITON CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF OFFICES LOCATED AT MAILING ADDRESS ANY, NOT SHOWN ARE NOT GUARANTEED. 1586 Main Road P 0 Box 16 Jamesport, New York 11947 Jamesport, New York 11947 :-14-2:17A , d? Biu 1. c r= -• John M. Bredemeyer III, President ,IpS11FFU(Kc Town Hall Annex Michael J. Domino, Vice-President ox' 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Charles J. Sanders '!,fj o� Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time '" /'./) Completed in field by: 744-/ En-Consultants on behalf of LISTA M. CANNON & KATHRYN CAMPBELL request an Administrative Permit to install a 4' high, approximately 270' long split rail fence along the northerly property line. Located: 475 Arshamomaque Avenue, Southold. SCTM# 1000-56-2-17 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=J Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line • Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1of2 John M. Bredemeyer Ill, President ,''pS�fFU(tco Town Hall Annex Michael J. Domino, Vice-President ,'�o Gym 54375 Route 25 Glenn Goldsmith i o , P O. Box 1179 A. Nicholas Krupski o' Southold, NY 11971 fi Charles J. Sanders . yftao�A Telephone (631) 765-1892 14 1, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: En-Consultants on behalf of LISTA M. CANNON & KATHRYN CAMPBELL request an Administrative Permit to install a 4' high, approximately 270' long split rail fence along the northerly property line. Located: 475 Arshamomaque Avenue, Southold. SCTM# 1000-56-2-17 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* r A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. <_25% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: • Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 KATHRYN CAMPBELL&LISTA CANNON,475 ARSHAMOMAQUE AVE.,SOUTHOLD t �� . Vis' ,r, 0 f . I, k i ii, :• �m s `11 1 `` 14 Ire's,'° ' ids, , J it ,i, ,41,. ., , ,.‘ ,, , � `, 4 • !yf i.4 ! 1 las.: ry. ;kr„S` l ' 'f ` 4 �% i�� �.. �, yam, 'At- 1 L1 I-•• .' , i / ;: ).a is \ `�. 1 ' r . . 1 z� • 3 ' is lbw"� ,.A*ei�l4�`• �.-,'.�.�_ �� 1.r-6°' ::74.....166 J� -. ii '4.:14i?' a k t •� wK r:%.' f,, ,rte 4£-vs','Sr - ._ -, "� 'it:t' d4"c§w S,,r '� '7 r,. �. I t .` _ _ - -000, " se` \ .' ,,,r t-- Z -. '` 4 . • "..1�r.- _ --'Mir - - .C.. • ry ( . .. ,-' Figure 1. Looking east from Arshamomaque Avenue at subject parcel and proposed fence location along northerly property line. N ,'�CEd'f' '�� '�iS°+' `�'• �r4�... i ' • F a 4,,. r\sIt ILO . 5 r 't • ftig 0,4V, ‘;lift,'-5 4 Avt ,.,,,-. :,ik a, 40 ., i �._ _ J � 4 1 1 .s; 4 .«� w . t iY ib,rc,'1.. y11 t,4 ' i . .44 `7711 . = r a. ' I.`, / -. “'lith,! 4, 3 -�a , • ' f Ate.. 54...4 �f \� ,� t{ h.. � ;. \ ���•£ 1. Figure 2. Looking west along northerly property line of subject parcel and location of proposed fence. KATHRYN CAMPBELL&LISTA CANNON,475 ARSHAMOMAQUE AVE.,SOUTHOLD i • 0_1 .. 'e i.,..,,it, iit..:**k V.:C'' • '14.1/11LAi i; , ' '..'"t• .4t1 ' “,'if ..1.'-' *... . ilBa ila IL •,, - ,4 „.. ,, , , 0,,,, , ,,,_,,,._, .....„, „)„ ,, ,.... ,,, „ ,, Edhl T'1--'-'41( • -../1 ., te,,,:,dais ,„ 4 . , ow.. . , ..., ,.. .:ii,col Iliirti„..,itiiii‘l)•• , 0.... p,....., Id , -14' '4,7::k. ••;."7.-"-e-/- •;•":'*4 ,!Ajf; ' ' -, et.:..,•. li, NI i Ft t,,, tr,,Vsf . .V7 ,iret 4 ,....., 'of . 4 ''t/ •. .,...... ,,,:. • li 1 f' p 4 v' - ••.‘ '. irjp, ,.,, 1, ..., ., . . •• .rti• : :-. *X , .7 . ‘"" ' kA i '..,,it. ',• /19.4 4;024,k4,1i i/ p'' f *4.41V; ' •.• pl A Olt 9 : -4 \ 1 .,r.r .., . _ •-• - ••._ _ .S.,4 , a , -, j---"--7: -; • • •' ' a *et . • .%r •tni ' tt - ' libilligig.....,45,0,4; 4 .':4- • ' - _640 , ,s .n, ',•47",..-7 *".4,--016: 43 . 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Looking west and upslope from tidal wetlands toward location of proposed fence. .w.o...u. -,-- o.R.,. - MAP »a ` '"^" PROPERTY xw.n ,V . ,w 0.2 - 000000 osz man nAro..i. _-_f_._._ - -__-_- -_.._ -` _._ __ 0.ro.rot �, 05200„ -z IINE n 0,00,.. 2])A \ a . 44 O EniSn:Nry •r\ H e Y 1 a t25 a e • Pace �O 28.201c) 9 . iiiiii s'p a „] 2.MT) Al +TA TOWN OF "h5e� S . ,/ 'V tt 15 50UTHOLo • .r 4 � \ Z08A d. 1!111 , PiOawEnrwONi 51 w ^` U \ Q. 4. 0. 73 w u4 x. `\ - 201 4 / , , .- .9L rCOUNTY OF SUFFOLK m ,; O ', ] j1P) , M°t "-� `0.3 pA l^ t d, tww ^` \` SO ,?w\ I MAIN -111ITHIL ��. .7AIqd' Ot"'N �p, t10 1 2))Ai �d11" `p -bA.y.s. O'l_p \3Wq` ,111A.: .... ,, an ` ,,SIPS' so TOWN ...d,J� ° � d as /vp 1 0 • ` 1T \'ti DEVEELiOPME iRPFITn)sr- * `,d"°` an' ` d, Qp[�'+� 17 20(0 \` :r^""'' ti9e a0 - ,opt. -- ,1` ,mad+ L' E-: `" ' . ,04's a'P� SN • ,,,,,,,096 ,...0.` a ,a e.`�Li\ O Fop • �' r.Q. se v+ 1L 0• ?p � vEwoPNENr. ... ititir• , 1 W0 e• � \`w`�•. .L . O n 15 1' •14 • " I110.') ,A 1,..: F�' QpN�t asA \\ i vi„ 0 (COUNT V OF nuswu w w , ; A 11H0 l / - aONrp 112 d �`. �� !. � 2.30121 1] . . ,y /% 0r, ' . © TOWNOSOTNOLD/ 10 / 43 y-- �l' ilit. ( Budd' j t.A1 Fo. 8 ep \O / Pond ,50(0 5� 7 c5 rsyF%% _ - . .. ow../s/A . ti� c. op , 1/4 ili. So „*. . ��to0 . .1.,,ox 4- -. 4,, �` • .9 2 s2°Aa, fl 47 101 e .4, 1 104 *4111 S .# 1] *Alli,4011r. " % . 4+ ., pe40�'. $ N .,9: faxe FOR PCL NO SEE SEG 5 / OBB OlOtS. .MTCN � � UNE,- SEE SEC NO 058 K 7 • aep0]am ,1 A'r r L .�.,.. ....r..► w ...w.... O - ••-a•-,•- --�°'-- �•+'-"• --^-- NOTICE COUNTY OF SUFFOLK © K NA ..... SOUTS+m E c.444... —�— u.. w. (21) _ i SECTION NO _____ _ R , Real Property Tax Service Agency r o� uu. -, ard.... w....,. —_ ro..u. --r-= w CountyConmw.eme,a.Nlttw, M '° ox .a VILLAGE OF 56 rr.iwn h m , r >m no p as — at NOwt,. -- " nE,N PBOPE^ry 1Ax 53030 Nxucr r,Ty> i r_^ P f 0005100 ,050 nr.r 1ztNq ,�� ��,� --.-- �^ PROPERTY MAP COONFREDON WE F.22 20,2 +q 5- . <, a2_.�/ 1 „>,,, "'«sib w +.cF a ...�•_...- L.1st. .m» .:::;:.-.-x»o- �,,.:.ve ws. .� - aLs `" ,'5... .,..,-3 ro 'g ..ry„,me,•,„,.„..,_.__. OFFICE LOCATION: �0 °l4 S®��*0 �� MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 1111111Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) ua ar Southold,NY 11971 = � � Telephone: 631 765-1938 irCOUNIC°." 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: April 12, 2016 Re: Local Waterfront Revitalization Program Coastal Consistency Review for LISTA M. CANNON & KATHRYN CAMPBELL SCTM# 1000-56-2-17. En-Consultants on behalf of LISTA M. CANNON & KATHRYN CAMPBELL request an Administrative Permit to install a 4' high, approximately 270' long split rail fence along the northerly property line. Located: 475 Arshamomaque Avenue, Southold. SCTM# 1000-56-2-17. 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 action is EXEMPT from LWRP review pursuant to: • § 268-3. Definitions. MINOR ACTIONS items "Z" which states: • Z. Split rail fences or fences used to control nuisance wildlife that do not interfere with the public's rights of passage along the foreshore; Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. ®ofFote John M.Bredemeyer III, President `'• b1. +"day~AtTown Hall Annex Michael J.Domino,Vice-President 54375 Main Road t ti P.O.Box 1179 James F.King,Trusteeerr+i Southold,New York 11971-0959 Dave Bergen,Trustee �Q� alb?/1 Telephone(631)765-1892 Charles J. Sanders, Trustee ,►'' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicatioy Wetland Permit Application V Administrative Permit / Amendment/Transfer/Extension V Received Application: 3'26•)(O Received Fee: lOOt 00 Completed Application 3.29<«O Incomplete "I , < SEQRA Classification: )°` ` ------~------ -=-- '. Type I Type II Unlisted Coordination: (date sent) gili, ,`t MAR 2 5 2016 1' V LWRP Consistency Assessment Form CAC Referral Sent: { 7—Date of Inspection: 13a'/C _Receipt of CAC Report: Lead Agency Determination: _ _ _ Technical Review: it Public Hearing Held: it 2-0i/4, Resolution: Name of Applicant Lista M Cannon&Kathryn Campbell c/o Jennifer B.Gould,Esq.,P.O.A. Address P.O.Box 988,Southold,NY 11971 Phone Number: (631) 765-8036 Suffolk County Tax Map Number: 1000 - 56-2-17 Property Location: 475 Arshamomaque Avenue,Southold (provide LILCO Pole #, distance to cross streets, and location) AGENT: En-Consultants (If applicable) Address: 1319 North Sea Road, Southampton,NY 11968 Phone:631-283-6360 >ard of Trustees Applicati GENERAL DATA Land Area(in square feet): +/-23,949 Area Zoning: R-40 Previous use of property: Vacant residential land Intended use of property: No change at this time except for installation of fence. Covenants and Restrictions: Yes X No If"Yes", please provide copy. Will this project require a Building Permit as per Town Code? Yes X No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals Yes X No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by Building Dept. Yes X No Does the structure(s)on property have a valid Certificate of Occupancy n/a Yes No Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): Install 4'high,approximately 270'long,spilt rail fence along northerly property line,as depicted on the site plan prepared by Nathan Taft Corwin III Land Surveyor,last dated February 26,2016. Bo' 1 of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Installation of fencing along northerly property line to demarcate perimeter of property. Area of wetlands on lot: +/-1,790 square feet Percent coverage of lot: +1-7.5 Bio Closest distance between nearest existing structure and upland edge of wetlands: N/A feet Closest distance between nearest proposed structure and upland edge of wetlands: +/-20 feet (fence) Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated?N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A 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): The project consists only of the installation of a split rail fence,which will be located landward of the 10'elevation contour,outside the NYS DEC's Tidal Wetlands jurisdiction,and at least 20 feet from the wetlands boundary. The fence will demarcate the northerly property line without any effect on the adjacent wetlands or tidal waters. 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 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 I-Project and Sponsor Information Name of Action or Project: Cannon Campbell Fence Project Location(describe, and attach a location map): 455 Arshamomaque Avenue,Town of Southold,Suffolk County,NY, SCTM# 1000-56-2-17;property is located on east side of Arshamomaque Avenue, +/-459'south of Main Road,location map attached. Brief Description of Proposed Action: Install 4'high,approximately 270'long,spilt rail fence along northerly property line,as depicted on the site plan prepared by Nathan Taft Corwin III Land Surveyor,last dated February 26,2016. Name of Applicant or Sponsor: Telephone: 631-765-8036 Lista M. Cannon E-Mail: lista.cannon@nortonrosefulbright.com Address:do Jennifer B.Gould,Esq.,P.O.A. P.O.Box 988 City/PO: State: Zip Code: Southold NY 11971 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 may be affected in the municipality and proceed to Part 2. If no,continue to question 2. X 2.Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: X 3.a.Total acreage of the site of the proposed action? +1-23,949 sf acres b. Total acreage to be physically disturbed? >300 sf acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? +1-23,949 sf acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban 0 Rural(non-agriculture) 0 Industrial 0 Commercial ,-, Residential(suburban) ❑Forest 0 Agriculture Aquatic 0 Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b.Consistent with the adopted comprehensive plan? X 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? X 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: Name: Peconic Bay and Environs,Reason:Protect public health,water,vegetation& scenic beauty,Agency: Suffolk County,Date: 7-12-88 X 8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 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: X 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: N/A 11.Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment: N/A 12.a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? X b.Is the proposed action located in an archeological sensitive area? X 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? X b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X 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. ® Shoreline 0 Forest 0 Agricultural/grasslands 0 Early mid-successional ® Wetland 0 Urban e 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? X 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? CD YES If Yes, a. Will storm water discharges flow to adjacent properties? ❑NO 0 YES b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: 0 NO 0 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: X 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: X 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: X I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Cobert E.Herrmann,Coastal Mgmt. Specialist Date: March 17,2016 r Signature: :a 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 I 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? 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 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 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage n occur problems? ,J 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 I 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, hat 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 i pact". < r3r14421"( /(Lic)-ter LI /7 A Name of Lead Agenc > 1 ate J v4Peat ' — lr ' Print or Type Nale of Responsi., : ficer i ead Agency Title of Responsible Officer Sign. .r, o Resp Responsibl : icer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Lista M. Cannon residing at do Norton Rose Fuibright LLP (print owner of property) (mailing address) 3 More Lond Riverside London, SE1 2AQ, United Kingdom do hereby authorize (Agent) En-Consultants to apply for permits)from the Southold Board of Town Trustees on my behalf. C� l , 1/ i if F' ��� _ % 2 4, (Owner's signature), Lista M. 'Ciro/ Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) 1, Kathryn Campbell residing at c/o Sullivan &Cromwell LLP (print owner of property) (mailing address) 1 New Fetter Lane London. EC4A IAN. United Kingdom do hereby authorize (Agent) En-Consultants to apply for permits)from the Southold Board of Town Trustees on my behalf. (Owners signature) , Kathryn Campbell _ I Board of Trustees Application County of Suffolk State of New York Lista M. Cannon BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN 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(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. atit' ecc /OA l/Lnau G UM a6e0li Signature, Lista M. Cannon SWORN TO BEFORE ME THIS O1 DAY OF (hptrch ,20 ROBIN HOLZ -11";MY\ 0)kVf Notary Public - State of New York Notary PublicN0. 01H06239198 Qualified in Suffolk Count My Commission Expires • Board of Trustees Application County of Suffolk State of New York Kathryn Campbell BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN 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(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. / Signature , Kathryn Campbell SWORN TO BEFORE ME THIS 0?9 DAY OF fie4e0 4 y ,20 //6 LOIS A.BILOTfl / Hut<uy Pubiio,State of New York No.015161869A5 QuO 1 ed In Nom York County Cert,`-9COta Fi od in a;tip+York County Comm oion Expires Mey 12,0,019 No ublic - 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: Cannon, Lista M. (Last name,first name,middle 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 X 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 Ifyou 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 311016 Submitted this day of Mar(/4-, zo Signature opi/1Q n,( ii�l,p,c Print Name Lista M. Cannon C Form TS 1 6-e4,14 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: Campbell, Kathryn (Last name,first name,middle 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 X 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 t i 7 day of 2044 Signature il' - Print Name Kathryn Campbell Form TS 1 'Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. A 11 applicants for perm its* including Town of Southold agencies, shall cam plete this CCAF for proposed actions that are subject to the Town of Southold W aterfront Consistency Review Law . This assessor ent is intended to supplem ent other inform ation used by a Town of Southold agency in m a k i n g a d e t e r m illation 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). 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# 56 - 2 _ 17 PROJECT NAME Lista M.Cannon&Kathryn Campbell The Application has been submitted to (check appropriate response): Town Board Planning Board Building Dept. Board of Trustees1 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 and extent of action: Install 4'high,approximately 270'long,spilt rail fence along northerly property line,as depicted on the site plan prepared by Nathan Taft Corwin III Land Surveyor, last dated February 26,2016. All policies have been checked"Not Applicable"because it is our understanding pursuant to Town Code§268-5("Review of Actions") and the corresponding defmitions of"action"and"minor action"by§286-3 ("Defmitions")that the project meets the following definition of a minor action and is thus not subject to waterfront consistency review pursuant to chapter 268: Location of action: 475 Arshamomaque Avenue,Southold Site acreage: +/-23,949 sf Present land use: Residential,vacant land. Present zoning classification:R-40 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: Lista M.Cannon&Kathryn Campbell (b) Mailing address: do Jennifer B.Gould,Esq.,P.O.A. P.O.Box 988,Southold,NY 11971 (c) Telephone number: Area Code 631-765-8036 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III- Policies Pages 3 through 6 for evaluation criteria Yes El No 1 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 n No [><I Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria Yes No IN Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No ® Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. Yes No M 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 ® 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. Yes No M Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES t � Policy 10. Protect Southold's water-uependent uses and promote siting oY new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. Yes No 1>4 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 IX Not Applicable PREPARED BY TITLE Coastal Mgmt.Specialist DATE 03/17/16 Robert E.Herrmann Amended on 8/1/05 11111 r _'•� `:lam EN-CONSULTANTS ;, ` ,„ MAR 2 5 2016 S t • + ! March 17,2016 REQITE,ST FOR AN ADMINISTRATIVE WETLANDS PERMIT Town of Southold Board of Trustees 54375 Main Road Post Office Box 1179 Southold,New York 11971 Re: Lista M. Cannon&Kathryn Campbell 475 Arshamomaque Avenue, Southold SCTM#1000-56-2-17 Dear Board of Trustees: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Four (4) Wetland Permit Applications including: a) Short Environmental Assessment Form; b) Authorization&Disclosure Forms; 2. Survey/site plan prepared by Nathan Taft Corwin III Land Surveyor, last dated February 26, 2016. 3. One(1)set of site photographs. 4. Application fee of$100.00. 5. Three(3)LWRP Consistency Assessment Forms including: a) Survey/site plan(as referenced above). I trust this information shall allow you to process our permit request. Should any additional information be required,please do not hesitate to contact our office. Sine; •ly, /%Pit Robe .Herrmann Coastal Management Specialist /khs Enc. 1319 North Sea Road I Southampton,New York 11968 I p 631.283.6360 I f 631.283.6136 www.enconsultants.com environmental consulting