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TR-8842A
- *.-•of f OL,i- John M Bredemeyer Ill, President -.. Town Hall Annex • Michael J Domino, Vice-President f �' �' 54375 Route 25 Glenn Goldsmith o - 5.4 j: - z ` P.O. Box 1179 A. Nicholas Krupski ,^� ' Southold, NY 11971 Telephone (631) 765-1892 Charles J. Sanders ==�07 ,� ��;:' P 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 % constructed kProject complete, compliance inspection I 1 . j ,�l' soy •John M.Bredemeyer III,President os' ; 41® Town Hall Annex Michael J.Domino,Vice President - �� 54375 Route 25 �Z = 41 P.O.Box 1179 Glenn Goldsmith �° Q ; Southold,New York 11971 A.Nicholas Krupski � � ® '� Telephone(631) 765-1892 Charles J.Sanders Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8842A Date of Receipt of Application: June 29, 2016 Applicant: Castelforte LLC SCTM#: 1000-78-2-38 Project Location: 2100 Glenn Road, Southold Date of Resolution/Issuance: July 20, 2016 Date of Expiration: July 20, 2018 Reviewed by: Michael J. Domino, Vice-President Project Description: For the existing 144' of 3' high split-rail fencing along the side yard lot line; and to install an additional 56' of same fencing off of the seaward end of existing. 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 project plan prepared by Maggie Sparagna, received June 29, 2016, and stamped approved on July 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, Ill President Board of Trustees SURVEY OF PROPERTY AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NY. 1000-78-02-38 SCALE: 1'= 30' w% a JUNE 15, 2016 : APPROVED,BY, ' N ROAD 1 . GLENN P,..0 { OI�RD'OF TRUSTEES ,00-p0'A _ tV OF SOMAL :- EDS vA p C 11 .F 1474.00 D°"E D . . 20zo1� , - - , .- , _ .._.., s /� r //J��.X785.00' N n- IA cn 4-4'fi. . , _s.- • G =•. �J; p tO "" It.1). 21 PI _ ;y_ Ip–I, : 4 STAKE STOTE/LP'K• '+ SET iI ��� - E j� I�� 225 �4� 3 DIQASURE 111 ii ,\I ,', ,2Y- ',is- { _ 2 STORY ,T2)Ain (.J FRAMED �C i �) - ' HOUSE I CAW & GARAGE STAXE ` , MI SET o r7 4' 92 �V l� 2ao'Ce MI\''' LCT -- t • ,�IAKE uric i`n --- -LIC 1, ^-} S,,3" ARE" .57WS T or STEPPE aErAwrlOJx T ', � LpT•Zai ^� ,'-TAKE �r4� STAKE SEP77C LOCATIONS P r 1 1. z� oi' �' w A B SET'I 4 'MI N i sr 1. 17' 18' vh0 i_4 i' i! i , SA1 E ` LP 49' 31' t��f %V' PE FIND STAKE I y �, r �. 10'6 fee1.4 t) e+^' (Lb 1 s1 I i _- 103- R.� — ,U1 , S?IXE �, or DA—.„ '' END t cERnc ST n�ORTE LLC ( � - -00 - $E-9-. , FIDELITY NATIONAL TITLE INSURANCE sER CEs LW STS TM J W `opn voa ' sr ,� S68 D10 _ & to C -1 aoEEg 05 N i =SPIKE __ CI c co• =PIPE ' ,, iv+ 2 - A = STAKE SET - - - ca co O }'. CI FLOOD ZONE FROM FIRM 36103C0166H i/ '` N , ' 1,1,� 1 9 1 LOT NUMBERS RcrtN TO MAP OF WEST CREEK ESTATES" { c FILED IN THE SUFFOLK COUNTY CLERKS OFFICE + , ON AUGUST 19, 1953 AS MAP NO 3848 \\c-7".„:,.-;* t;\ - - AREA= 23,252 SQ. FT. \\-, `' to. LIC NO 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLAnCN PECONIC SURVEYORS P.0 OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW EXCEPT AS PER SECTION 7209-SUB (631) 765-5020 FAX (631} 765-1797 DIVISION 2. ALL CERTIFICATIONS (3 BOX6 909 HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N Y 11971 09-169 lin M. Bredemeyer Ill, President 1t SUFFO(,t O " i Town Hall Annex chael J. Domino, Vice-President s.,/ r�o� • �,�Gy� 7- 7-4-- 54375 Route 25 Glenn Goldsmith `' P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Charles J Sandersk\#449 01 Telephone (631) 765-1892 -r .`Yµr Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: d Completed in field by: 914 pASTELFORTE L C requests an Administrative Permit for the existing 144' of 3' high split-rail fencing along the side yard lot line; and to install an additional 56' of same fencing off of the seaward lend of existing. Located: 2100 Glenn Road, Southold. SCTM# 1000-78-2-38 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=-Ni Setback Waiver Required 1. Residence: 100 feet o- . 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: 1 Aajlon,...e.e. tI .: .. ..ate/ • /14.41 / Present were: J. Bredemeyer I</ M. Domino G. Goldsmith . N. Krupski C. Sanders Other Page 1 of 2 Vlohn M. Bredemeyer III, President Town Hall Annex ichael J. Domino, Vice-President Nso _Gy�,� 54375 Route 25 Glenn Goldsmith o ` P.O. Box 1179 A. Nicholas Krupski �.> Southold, NY 11971 Charles J. Sanders 4- 4'0ao? Telephone (631) 765-1892 2� "� Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: CASTELFORTE LLC requests an Administrative Permit for the existing 144' of 3' high split-rail fencing along the side yard lot line; and to install an additional 56' of same fencing off of the seaward end of existing. Located: 2100 Glenn Road, Southold. SCTM# 1000-78-2-38 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* 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 SURVEY OF PROPERTY AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y 1000-78-02-38 SCALE: 1'= 30' Te, JUNE 15, 2016 / // A D d 06-16-WO 06-16-2016 GLENN r EDGE oFP i oo•O°PE EDGE OF pA QdT 174•DO,OO"E 0 I CAF r 0 131 A C:4 785.00' N ��s cn O O 4 STAKE SET (N O • • O rri pv, SET ORro \PROPANE TANK • ' 3. IN ENCLOSURE 26.5' [ III; t� 12.3 STORY V FRAMED2) a/cs HOUSE Z =q CHIM. 14' & GARAGE ' STAKE 17.4 �+ 2 I p 20.0' O ------- LOT 2 STAKE LATTICE n - SET FENCE ��3'x3' i AREA DECK STEP - • OF SEPTIC \'., RETAINING :_ LOT g %:-:-:-:-:::52.74;OT 2� L STAKE STAKE SET o ' SET E ZONE LINEON—_ SEPTIC LOCATIONSZ j N% A B % w � ST 17' 18' / DNE SPIKE LP 49' 31' fx-C1 FND. STAKE ZONE{ee t O 103 0 Of BANK . il . - CER77FlED TO: FN�SPIKE le O 13 • CASTELFORTE, LLC vl►1i p1 • D E I V E FIDELITY NATIONAL 71TZE INSURANCES SERVICES, LLC STAKE MN f c ANG DOCK SET ��E w o* f,OA J om, 56a o8'10 �� JUN 2 9 20% �M OSE • = SPIKE 00 gEEK outhold Town B gni g T.gm • = PIPE Q... A = STAKE SET _.. ()F Net. FLOOD ZONE FROM FIRM 36103C0166H � � �' ' 1 * ' .], 45,,y. . LOT NUMBERS REFER TO MAP OF WEST CREEK ESTATES ; 11; ;�, FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE Vi==e. Q ON AUGUST 19, 1963 AS MAP NO. 3848 < •:"," ' s1 AREA= 23,252 SQ. FT. ‘F°j,_s. 0.:: �. y -------------- -- -- -- - - "' �'J•. LIC. NO. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION PECONIC SURVEYORS, P.C. OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW. 631 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTION 7209—SUBD1V/SION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 09-169 1111111/11111111111 IiLtIll lln -1 ii We are extending fence to F-' the poll with the flag additional 56' it will leave 44.54' from high _"_ f -_ .. '' water mark with out fence. ri in.. • ,`.-... tib. . ; r. 1w. - • . an.uy�` A. �Y*'. .nom V' 4M-. , 40 vabit - . ' H. . - **, Photo No.2 shows beginning of the 456H. - fence 144' fence already in place 16111110 Ilt, .;,',...e.Air , — azdfirm.' .' ": .Vii:%; .-. 0.1. 41110. 11111r. ....' 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NOTICE ., ,-`7..1COUNTY OF SUFFOLK © °"°' SOUTHOLD SECTION N, 14i (2g ...... 0 ................,..... it Real Property Tax Sennce Agency y r,n, - -- .T.HAT NUR.OG Dr R..... 0 M ROW OCRIF N FUR 200 403 A ....ow NOHOW!1nROIEN PERRIS..0 rn, 1\'..TW:;': ra REAL PROPERTY TM SERVICE AGENCY "4.1., I — .i 11 I I I I P DISTRICT NO 1000 PROPERTY A CONVERSION WE Ray fl 2015 : - —'----.=.....,,,,.77,=,%7+7..-'ro.:•es..71.7=== =-•.'ffefnEm.:..-:7:..., - ".-:.^.^' '..- -.,.......-.... .,.. _ ........,_.,........... --,..,...,.... 1 . , i • • OFFICE LOCATION: / O - MAILING ADDRESS: Town Hall Annex �� `` ® ; P.O.Box 1179 54375 State Route 25 IIISouthold,NY 11971 (cor. Main Rd. &Youngs Ave.) Co Southold,NY 11971 `` �� Telephone: 631 765-1938 `'COUNT{, ' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark'Terry, LWRP Coordinator Date: July 18, 2016 Re: Local Waterfront Revitalization Program Coastal Consistency Review for CASTELFORTE LLC SCTM# 1000-78-2-38 CASTELFORTE LLC requests an Administrative Permit for the existing 144' of 3' high split-rail fencing along the side yard lot line; and to install an additional 56' of same fencing off of the seaward end of existing. Located: 2100 Glenn Road, Southold. SCTM# 1000-78-2-38 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" and 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. o,�., John M.Bredemeyer III,President '//�i/�‘QF,S®UTy® Town$all Annex l0 54375 Route 25 Michael J. Domino,Vice-PresidentI 4143 P.O.Box 1179 Glenn Goldsmith cs, y Southold, New York 11971 A.Nicholas Kru ski _---� p ;_ �O �� Telephone(631) 765-1892 Charles J. Sanders - COUNTCW �� Fax(631) 765-6641 ,•... 0'I/ �1 • BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application./ _Wetland Permit Application V Administrative Permit / _Amendment/Transfer/Exte cion W Received Application: (ci 2.--q1/(/ Received Fee:$ 1°Ot00 Completed Application 7.5 /6, nECEIVED Incomplete SEQRA Classification: Type I Type II Unlisted - JUN 2 9 2016 /Coordination:(date sent) V LWRP Consistency Assessment Form 7 0 p '1W CAC Referral Sent: outhoid Town • Date of Inspection: 7,12,/to ' Board of Trustees • _Receipt of CAC Report: _Lead Agency Determination: - - - -- - Technical Review: Public Hearing Held: 1.2666 Resolution: Name of Property Owner(s) ( -e C. FO 1E. L� Address 25 cit B 1 DA 4-t) lLJ 2(p-cc/I ('L 1/7 7Z. Phone Number: 7 '/?g2. Suffolk County Tax Map Number: 1000 - 1 g _ O Z 3 8 Property Location: 2100 64 C' ?S3-M> 4--t ,01._.b f r cig v (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Applies. >n GENERAL DATA Land Area(in square feet): 2 5 / Z_&2_ ter' Area Zoning: Al AL Previous use of property: t.4 e-•tTi4 Intended use of property: Ls 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 )4 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 _No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes )4 No Does the structure (s) on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency • Date 7cNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V No Yes If yes, provide explanation: Project Description (use attachments if necessary): I xl .�i VkLL 06 LIT s L c Eet / -9s ?/w J91 -T' ge-i'vEs r .0Z . ' Board of Trustees Applica m • f' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: P 3 L(N Area of wetlands on lot: /IVO square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 40 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: AVA4 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): ` a 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 r L(L Name of Action or Project: 1,14G l 4a E [e-.t– Projet Location(describe,and attach a location map): Pte . t- >,e �-��� Brief Description of Proposed Action: • Name of Applicant or Sponsor: Telephone: C k1E Mail 6ti a 1C LLC.p1-4441_.c-o-04 Address: eei, r , „ - ( tom CSL t - City/PO: State: Zip Code: • [Sl av:.•v >�3 fl\ .is l i q 5k1 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• ❑ 3.a.Total acreage of the site of the proposed action? —! acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural (non-agriculture) ❑Industrial D Commercial E-Residential (suburban) ❑Forest ❑Agriculture CI 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? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7c 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: I 1 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? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? `•4 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: )1. n 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: \C>-n. C.7 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? Ni(' 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 DForest 0 Agricultural/grasslands El Early mid-successional [9-Wetland 0 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 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? ❑NO EYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: 17-NO QYES Page 2 of 4 r 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: `l 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: './(1 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: )C I AFFIRM THAT THE INFO , ATI ROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: \ Date: /2q t Signature: C Sir r Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? ~ 2. Will the proposed action result in a change in the use or intensity of use of land? I 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 ry affect existing infrastructure for mass transit,biking or walkway? �/J 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: Et a.public/private water supplies? b.public/private wastewater treatment utilities? Ei 8. Will the proposed action impair the character or quality of important historic,archaeological, �{ architectural or aesthetic resources? / I 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 f 1 ,l1' 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. • I-7 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. [T -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 environmentaympac Town of Southold-Board of Trustees 7 Name of Lead Agency Date ` a i &dQ^- President Print or Type Na 'e o Responsib e 0 icer in Lead .gency Title of Responsible Officer ir J� Si' e ref Respohsib e Officer in Le Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 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. 1. • YOUR NAME: (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 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% 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 this 19 day t7/.,f 4— 246' Signature Print Name "vote , ,/EK' /27C? Form TS 1 �/ -:oard of Trustees Applicat' a .,a AFFIDAVIT - BEING DULY SWORN DEPOS / Iaf,9i Ne-D AFFI "4 S 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 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. I� ii 7C Signa' e of P,rperty Owner SWORN TO BEFORE ME THIS O�� DAY OF v (4 I/1 C , 20 / ___ : Notary Public iodboihmawaabobiemosiftdwarsmo GIOVANNA AORAGNA Notary Public-State of New York NO.01A06302063 Qualified in Suffolk County _My Commission Expires Apr 28 2018 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# - - l PROJECT NAME 1—"A ? Li oqie-- P&kt�cs" 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 and extent of action: ( p /1 � e 1ON ® 6-6 r' ec ft-t / iTrtgCl cjo ' 1 isle v` 'Y , Location of action: 21 Lo-® 4 t >.( i 1111/1 e'` AN Site acreage: -� Present land use: b-&7.177/Ye_- Present zoning classification: •P' S I H11 I iR- 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: f Ci ( e /1– b Mailing address: 2 gieraTo ' " ?ft-4-e-L" ��/'(c _( (11 -1 (c) Telephone number: Area Code( ) — 7 30- I (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes No M 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 1 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 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 7 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes No I'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 A1\ dcable -' 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 iyi 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. YeJ NoI)-51 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE'... Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. Yes No ?Not Applicable Attach additional sheets if necessary - Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes ❑ No Not Applicable • Attach additional sheets if necessary • Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for_evaluationcriteria. - 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—PoIicies; Pages 65 through 68 for evaluation criteria. Yes No sp9 Not Applicable PREPARED BY alA z 10, �&--11j1jA— TITLE � C DATE Z4' j4.