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Home My WebLink AboutTR-8845A John M.Bredemeyer III,President O� SO1 Town Hall Annex Michael J. Domino,Vice-President ® 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G � � Telephone (631) 765-1892 Charles J.Sanders `e®U � 3 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1257C Date: August 22, 2016 TRIS CERTIFIES that a Ten(10)Year Maintenance Permit to hand-cut Common Reed(Phr pmites australis)to not less than 12"in height by hand on an as needed basis within a 160 sq. ft. area; At 545 Reeve Avenue, Mattituck Suffolk County Tax Map #1000-114-9-9 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 14, 2016 pursuant to which Trustees Administrative Permit#8845A Dated July 20, 2016,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 10)Year Maintenance Permit to hand-cut Common Reed(Phragmites australis)to not less than 12"in height by hand, on an as needed basis within a 160 sq. ft. area. The certificate is issued to JEFF TYZIK owner of the aforesaid property. _� Authorized Signature r t John M. Bredemeyer III, President S�FFO(K�0 `c Town Hall Annex Michael J. Domino, Vice-President r�= ti� 54375 Route 25 Glenn Goldsmith h� P.O. Box 1179 A. Nicholas Krupski 'vs"Z� ® �` Southold, NY 11971 Charles J. Sanders `y�Ol/ T eiephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 18"A 6 y Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/z constructed k V Project complete, compliance inspection. INSPECTED BY: G2 Co IJGr i 11� COM=MENTS: ii Qccoclooca %,,,,,'A parrn►T OK CERTIFICATE OF COMPLIANCE: John M. Bredemeyer III, President w.tio�� o�`:. Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 Glenn Goldsmith o z ` P.O Box 1179 A. Nicholas Krupski ® Southold, NY 11971 Charles J. Sanders ;� �� , ��? Telephone (631) 765-1892 Fax (631) 165-6641 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 1" day of construction Y2 constructed 7 Project complete, compliance inspection John M. Bredemeyer III,President O��®F S0 01 Town Hall Annex Michael J.Domino,Vice-President ~ ® 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® �O� Telephone (631) 765-1892 Charles J. SandersC®UNTI, l Fax(631) 765-6641 � �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8845A Date of Receipt of Application: June 14, 2016 Applicant: Jeff Tyzik SCTM#: 1000-114-9-9 Project Location: 545 Reeve Avenue, Mattituck Date of Resolution/Issuance: July 20, 2016 Date of Expiration: July 20, 2018 Reviewed by: Trustee Glenn Goldsmith Project Description: Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis within a 160 sq. ft. area. 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 submitted by Jeff Tyzik, received June 14, 2016, and stamped approved on July 20, 2016. § 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 ti 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. Jo M. Bredemeyer III, P esident Board of Trustees PLAT MAP Borrower:JEFFREY TYZlK File No: AC672 PropertyAddress:545 REEVE AVENUE Case No CV:MATrITUCK State:W Zip:11952 Lender Wells Fro Bank,N.AJRels 1 0 I- ,j xr 7�r ly 01mos, At" giAnvu 0- Ift 9102 V I Nnr I 1A j tit or B-495/12525 John M. Bredemeyer III, President �f`�g�FFO(kc ., _ E ---_ Town Hall Annex Michael J. Domino, Vice-President {��e°� °yam �' 54375 Route 25 Glenn Goldsmith y P.O. Box 1179 A. Nicholas Krupski v Southold, NY 11971 Charles J. Sanders y o�` Telephone (631) 765-1892 ( :r Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �� Y,30Completed in field by: C'. X01 �,� vA JEFF TYZIK requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, on an as needed basis within a 160sq.ft. area. Located: 545 Reeve Avenue, Mattituck., SCTM# 1000-114-9-9 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 ,l 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: ST�ca.:��zTyoqrlo_/OXId %j Y �V cs o'�� r� ��n�5 �P r�g'e n'� w�►c I, w� I'1 �e ��G'��f Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer III, President ,�� "� Town Hall Annex Michael J. Domino, Vice-President �o Gym 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas KrupskiSouthold, NY 11971 Charles J. Sanders Telephone (631) 765-1892 I ; Fax (631) 765-6641 ZZ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: JEFF TYZIK requests an,Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, on an as needed basis within a 160sq.ft. area. Located: 545 Reeve Avenue, Mattituck. SCTM# 1000-114-9-9 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. :525% 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 ..%a... I t ..ley; � - � �r - i• _ Ow IF {' ,1 xJ (.b 1 < 'L_. � F^S�'bf nCt�y jYC.P� �. ,•� ' 'q �; I �,{.. f'' 'n,' ;�}� Fey., U •� - - � ,..Ste' ' c n � .!-�� +,.. 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ATTI -W SCH DOLDISTRICT 7 6A,-- I .004 DISTRICT —,ZVI SSA ROMAN 243 CATHO 5 vs—, CHURCH 10 'N 12 13 12A(c) V -1 22.2 Is 16, 22 cc 2APIi6 141 7146 17 A,9 FOR PCL NO SEE SEC NOuf 142 —N S—) U I JAAfc) j-1A 147 2 42 I—N— 144 41 1 xl x0 FOR PCI.NO 19A to JOA E SEC NO SEE SEC 0 L MIxIi 4 1,4�5A —z- -Z—---UNE MATCH "NE 6 -aj7C—N13 6 1 7 SEE SEC N 122 UK, xm 13T 24 A(0) souTHOLD SECTION NO COUNTY OF SUFFOLK C K NOTI ww E rty Tax a I Agen 114 Real Prope y L E �7 1 OFFICE LOCATION: ®��®f S® y®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) Southold,NY 11971 �� Telephone: 631 765-1938 olyC®U ,� 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 JEFF TYZIK SCTM# 1000-114-9-9 JEFF TYZIK requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, on an as needed basis within a 160sq.ft. area. Located: 545 Reeve Avenue, Mattituck". SCTM# 1000-114-9-9 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 CONSISTENT with the LWRP policies and therefore 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. L �,®f s®�� John M.Bredemeyer III,President Town Hall Annex®� ®� Michael J. Domino,Vice-President .�® 54375 Main Road " "` P.O.Box 1179 James F.King,Trustee �G * .' .N Southold,New York 11971-0959 thc- Dave Bergen,Trustee ® O ® a Telephone (631) 765-1892 Charles J.Sanders,Trustee �`�C®U-N.N, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application __/Wetland Permit Application i/ Administrative Permit Amendment/Trans ertt nsion Received Application: �' !� - - Received Fee: $ a d®.®® r^^, f' _ 1 Completed Application: _Incomplete: _SEQRA Classificati : :- Type I Type II_V Unlisted JUN 142016 ` i Coordination-(date sent): ZEConsistency Assessment Form: CAC Referral Sent: Date of Inspection: 7a PZ� M _Receipt of CAC Report: Lead Agency Determination: Technical Review: I Public Hearing Held: 7201 Resolution: Name of Applicant: 2-t k, Mailing Address: 5 qS' /3 eg VE AyeN U E Al ATT-!(a��1 q'C 2- Phone Number: ,�B S 6 c S — 9 3 6 Suffolk County Tax Map Number: 1000 - 1 1 ,4 -e-7" Property Location: Sa tm_e lid a 6 o v-f (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: `atoard of Trustees Applicat �a GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes ,� No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes �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 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): Ss r-4• loard of 'Trustees Applicat'-5n. WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ( ,%J-r-' r�t e- i3()G V,_ e, e' f' Rel 1� t i S Area of wetlands on lot: square feet 1 J Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information ,itF(-- � _T8 Lt- -r-/-z- ko"Ie-OLLIneVrS Name of Action or Project: Project Location(describe,and attach a location map): 545 -r_-r vs Ave ��- Brief Description of Proposed Action: v�il�I G.-- 13ri6k- ® F r NVfa51 L/6 PIFA4(9-A r r C- f'L_tq,\-c rs t61D 4-r-R_6.k- Name of Applicant or Sponsor: PE-Mail: elephone: e . I t�ctt Address: �/ �• 6-1 5 City/PO: State: Zip Code: l- // �6r__ i 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. 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: Z� ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres 16fpj, _ qr-f . 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 ❑Commercial ZResidential(suburban) El Forest ❑Agriculture El 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? ❑ ❑ 4 b.Consistent with the adopted comprehensive plan? ❑ ❑ Ki 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? 6,4 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: Z El 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: r ❑ 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? Elif Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: /Co O 15(A r is&-r- 14. Idpiatify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑Agri cultural/grasslands El Early mid-successional Wetland El 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 E]YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES 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: ❑ Zf 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: Kf ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname ��i l Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? [Z ❑ 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: Ela.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, El or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage 1:1problems? [�f 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. Veck this box if you have determined,based on the information and analysis above,and any supporting documentation, t the proposed action may result in one or more potentially large or significant adverse impacts and an ironmental impact statement is required. eck 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 environmeryal inipacts. Town of Southold-Board of Trustees Name o ead 1 ency Date 5e— President Print or Type ame of R gBible fficer n Lead Agency Title of Responsible Officer Sign r of Res le Officer in LeA Agency Signature of Preparer(if different from Responsible Officer) PRINT I Page 4 of 4 ''__'oard of Trustees Applicata—Ai AFFIDAVIT 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 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. C i Signature of Property Ox6er SWORN TO BEFORE ME THIS r� DAY OF Z1W 120/4 �41 ,(1, Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 Qualified in Sutfolk County My Commission Expires April 30, 201 Board of Trustees Applica in AFFIDAVIT 2 I� BEING DULY SWORN DEPOSES AND AFFIRMS THAT ftE/SHF 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. ign7e of Pro erty Owner SWORN TO BEFORE ME THIS DAY OF Notary Public UARNA K0KKiiii0j NOfsq Public-Stat.®f�e�r York No.®IK06191941 Qualifiedin Suff®iia County. My COMMission ExPfret Aug.25,2®96 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 o this form is to provide information which can alert the town of Wssible conflicts of interest and allow it to take whatever action is /\ necessary to avoid same. YOURNAME: Ir (Last name,first name,�qiudle initial,uhless you are applying in the name of someone else mother entity,such asucompany.uso,indicate the other person's orcompany's ommvJ NAME OF APPLICATION: (Check all that mpy|yj Tax grievance ______------ Building l/miuucn Trustee Change oyZone � ComstalBomiuu Approval ofplat &oodo& Exemption from plat orofficial map Planning 0de, (If^`Othe,-,name the mzb,ityj Doyou personally(or through your company,spouse,sibling,parent,o,child)have urelationship with any officer oremployee of the Town ofSouthold? "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)ucorporation inwhich the town officer oremployee owns more than 5Y6ofthe shares. YES 00 ~71— If you answered"YES",complete the balance of this form and date and sign where indicated. Name oyperson employed by the Town ofSouthold Title orposition o[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 iothe space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): the owner ofgreater than 5%o[the shares ofthe corporate stock of the applicant (when the applicant iouooqmruhon); _____�B)the legal o,beneficial owner ofany interest iounon-corporate entity(when the applicant isnot uoo,porabvo); _____C)uoofficer,director,partner,oremployee ofthe applicant,o, _____,])the actual applicant. DESCRIPTION 0yRELATIONSHIP 4 � / uuvom/ueu / �� Sian Form 7Sl APPLICANT/AGENT/REPRESENTATIVL 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. �f YOUR NAME: �y ZI k (Laste,first n e,.;niddle initial,unle s 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 z� /� (If"Other',name the activity.) lnn ✓✓-0'J� d fC-91.9�(M 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 -C 200 E Signature Print Name vc Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. 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 sig?ificant 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# - - PROJECT NAME T—v/2- 1 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: a Ci.& 4b 12-'t I' fa 5;4 i Location of action: Site acreage: Present land use: Present zoning classification: 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: (c) Telephone number:Area Code( ) (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No VT 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 0/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—Polic'es Pages 3 through 6 Yes 1:1 Nfor evaluation criteria ❑ o 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 Pa s 8 through 16 for evaluation criteria ❑ Yes 11No 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 16throu 21 for evaluation criteria Yes 1:1No 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. r Yes No Not)-, licable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ZNot 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. �� ❑ YeLl No ZNot Applicable Attach additional sheets if necessary t t • WORKING COAST POLIC%___,5 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 2Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat rs. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ElYes 1:1 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 evalu tion criteria. ❑ Yes ❑ NoNot 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. F-1YesElNo Not Applicable PREPARED BY DATE-&hy � I , I ' 6/14/16 To Whom It May Concern The invasive phragmites plants have completely obscured the view of Maratooka Pond we had when we purchased our home at 545 Reeve Avenue 5 years ago. Every year there is further encroachment onto our property by this nuisance vegetation. There was also a wet area near the pond where waterfowl would congregate and now the phragmites have'overtaken and drained that area. We respectfully ask for a 10-year permit to cut this invasive plant to restore our view and hopefully the original wet area. ff and Jill Tyzik 54 Reeve Avenue attituck, NY 11952 (585) 615-8367 V�P� 4r Jefftyzikl@gmail.com � _ o