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HomeMy WebLinkAboutTR-8848A John M.Bredemeyer III,President � S® �® Town Hall Annex Michael J.Domino,Vice-President ~o l0 54375 Route 25 Glenn GoldsmithP.O.Box 1179 Southold,New York 11971 A. Nicholas Krupski a� Telephone(631) 765-1892 Charles J. Sanders ol/r00mv Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1251C Date: August 11, 2016 THIS CERTIFIES that the as-built landscaping_surrounding_the dwelling; to revegetate an area on the seaward side of dwelling using indigenous plant material (30) 5 gallon Bayberry and(20) 5 gallon Beach Plum; and to install a 4' wide pearf avel path in order to provide beach access with the condition'-that in the Fall removal of blue grass sod in area over sanitary system and reseed with a low fertilizing type of grass seed, i.e. fescue; At 1725 North Sea Drive, Southold Suffolk County Tax Map#1000-54-4-19 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 17, 2016 pursuant to which Trustees Administrative Permit#8848A 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 the as-built landscaping surrounding the dwelling; to revegetate an area on the seaward side of dwelling using indigenous plant material (30)5gallon Bayberry and(20) 5 gallon Beach Plum; and to install a 4' wide pea gravel ath in order to provide beach access with the condition that in the Fall removal of blue grass sod in area over sanitary system and reseed with a low fertilizing type of grass seed, i.e. fescue. The certificate is issued to ROBERT G. BOMBARA owner of the aforesaid property. Authorized Signature gUfFO(� John M. Bredemeyer III, President Yd�o coG�:<< Town Hall Annex Michael J. Domino, Vice-President : � tib'=, 54375 Route 25 Glenn Goldsmithii N P.O. Box 1179 A. Nicholas Krupski y ® off` Southold, NY 11971 Charles J. SandersT elephone (631) 765-1892 _0=9 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: r r 4 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction / '/ constructed 1/ Project complete, compliance inspection. INSPECTED BY: COM=TS: CERTIFICATE OF COMPLIANCE: } OS�FrOLk�--_ Town Hall Annex John M. Bredemeyer III, President Michael J. Domino, Vice-President z �< 54375 Route 25 Glenn Goldsmith o s;1 . ,? ' P.O. Box 1179 o Southold, NY 11971 A. Nicholas Krupski Charles J Sanders '=: 1101 , �� Telephone (631) 765-1892 Fax (6311 765-6541 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 VProject complete, compliance inspection John M.Bredemeyer III, President o��Qf S® �® Town Hall Annex Ice Michael J.Domino,Vice-President ~ ® 54375 Route 25 �g P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski ® app Telephone(631) 765-1892 Charles J. Sanders Fax(631) 765-6641 f�COU ,�`6tl BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8848A Date of Receipt of Application: June 17, 2016 Applicant: Robert G. Bombara SCTM#: 1000-54-4-13 Project Location: 1725 North Sea Drive, Southold Date of Resolution/Issuance: July 20, 2016 Date of Expiration: July 20, 2018 Reviewed by: Board of Trustees Project Description: For the as-built landscaping surrounding the dwelling; to revegetate an area on the seaward side of dwelling using indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon Beach Plum; and to install a 4' wide pea gravel path in order to provide beach access. 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 TFLC, Inc., dated March 30, 2016, and stamped approved on July 20, 2016. Special Conditions: In the Fall remove blue grass sod in area over sanitary system and reseed with a low fertilizing type of grass seed, i.e. fescue. 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. mj� John M. Bredemeyer, III President Board of Trustees John M. Bredemeyer III, President ' ; , ��gUFFOIK Town Hall Annex Michael J. Domino, Vice-President �4� 54375 Route 25 s Glenn Goldsmith y = P O. Box 1179 A. Nicholas Krupski ,o Southold, NY 11971 Charles J Sanders y�j�f o� Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed infield by: �n�1V �L_s ��,�9deys Twin Fork Landscape Contracting, Inc. on behalf of ROBERT G. BOMBARA requests an Administrative Permit for the as-built landscaping surrounding the dwelling; to revegetate an area on the seaward side of dwelling using indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon Beach Plum; and to install a,4' wide pea gravel path in order to provide beach access. Located: 1725 North Sea Drive, Southold. SCTM# 1000-54-4-19 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 Z' Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 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: �n r � - �� �- S�� r7 ��� ® �G'� �,✓ ��' cave. I Present were: Bredemeyer M. Domino C/ G. Goldsmith rupski C. Sanders Cher Page 1 of 2 John M. Bredeme III, President er SUFFO( � Y Town Hall Annex Y Michael J. Domino, Vice-President ��o 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski o ^* Southold, NY 11971 Charles J. Sanders �jp �ao� ` Telephone (631) 765-1892 , r} Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Twin Fork Landscape Contracting, Inc. on behalf of ROBERT G. BOMBARA requests an Administrative Permit for the as-built landscaping surrounding the dwelling; to revegetate an area on the seaward side of dwelling using indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon Beach Plum; and to install a 4' wide pea gravel path in order to provide beach access., Located: 1725 North Sea Drive, Southold. SCTM# 1000-54-4-19 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 EX. Rosa Ra osa EX. Rosa Ra osa g g EX. Rosa Ragosa + /m , EX. EX.EX* f EX. EX. Beach Plum EXFj f EX41 :f EX EX. •'4'•••f•• tad3 _3 EX* EX EX. a + F illillillillillllllllIIIIIIIIIIIIIIIIIIIIII1111111111111111111000� } • ron tRe ,,,Vegetaterat o _ 30 - 5Gal. Bayberry + / 1 5 fc ( 20) m5Gal � Ex q� . roposed4 ' Y � :•itiiii i. } e a- rave Beach EX E FilPath I EX EX . . . .. . ... .. illilillljlllllllllllIljlllll '00 i .ti• " EX. tr tie+ ' ••ti..•..•.1.•.•. Yirk { :j lac. EX*W, Ef + / M5 f 8405Cox Lane Bayberry EX♦ Cutchogue NY 1 1 9 3 5 EX, . . . . . twinforklc@optonline.neti631-734-6643 _ Pea Grave - .... ........ r4. Creeping Rose �° emit Ornamental Grass _ e `� Y Bayberry of . Crushed ravel _ ()o � -- , - a�, 0() Access . #: : • - v . . _ ;+, . - . # .-. - . �... //// —I'' W„_. 4',a e'i .* •pee y .wF a .„ { 'C • - +• ''+`h `, 1 Spirea ., ._ _... ;� C o lumn ari s ., ��.. �. � Yip � .. . _ �-. Juniper ,y Spirea Bayberry , . ' —use 2-3 op"ng•takeM es Root 110111 raft - Shredded wood mutt•Sat t Inct"s thick after willing Q•rdly Peck 6adAln:xQttor r �^ Form ridge of t+olt to kno wolf to!silts t o11 around mala , water puddled over roots. - v Limit Troe ��� Columnaris - Diagram Juniper Gravel ..;. JL.. . . A _ '� : . rr .. +Ys I°. �°. r'1 }- � of 9 I' I'r I'r i r -y'♦ I''r /j�� �Irr rjr T" E • t r.r i Perennials - Ornamental Grass Perennials TravertineNatural ' .,. _ Step Stones Crape Myrtle Stone • Vat y � p Y Drivewa „ �- APPROVED BY _l Turf BOARD OF 'f RUSTEES N J+� � � _ s .-TOWN OF SO , . itex Cotoneaster �� Zo, �,,� SHRUB � � - - l -A 1� ' JUN 17 2016 w it . Honey Locust ) ;A Carex Linden Ornamental Grass Microbiota CreepingRoseDwarf Buddleia + t Knockout Roses T) 0111 erantsi ence *� �....a Bayberry Bayberry — � 1725 O e__ _ __ ___ _ _ , - -•- - �, � . r - ., _ _ rte_ �_._. -- c �.. ___ ___ � ______ _-..___. Southold11971 .......... 0 V P& VYole VY ermea e Pave March30, 2016 Northern Dropseed AreaScale= - rQ'� a � 1 5 Northern Dro V� pseed , „ NOTES Young & Young > N �� AREA = 24,S7ci SQ. FT. 400 Ostrander Avenue, Riverhead, New York 11901 $"Ir / • VERTICAL DATUM = N.A.V. DATUM (Ig88) 631-727-2303 �� • 5EE FLOOD INSURANCE RATE PANEL NUMBER Land Surveyor Howard W. Young, y g 56108COI54 H LAST DATED SEPT. 25, 2008 Thomas C. Wolpert, Professional Engineer F" dv04q 7" � Douglas E. Adams, Professional Engineer o'✓�� /,y kY°�P • ZONING USE DISTRICT = 'R-40' WxEs W E / ® �� K' p*< Oh\° Robert C. Tast, Architect J,Q�Y�\4�ii per' \X// HEALTH DEPARTMENT USE � DK rx ` P6, 0. 44 0 'A�0' p ? �H6 ��� ' . 360 / 9'y o� v �Qi, 8 41I.UZ`Q" �iic� / �[12 /`A ' poi lgr �,0c s/ / ac Uo� z p�"� °� SPU •'` �he'y `�p� „ QA� =a a t'P�,,, / /, ,� Q9 m=E Y 'S RV ORCERTIFICATION =EM'� �pZ vpU /06, / sr. > ® i' `'�. ��tp`�� * WE HEREBY CERTIFY TO R O B E RT G. B O M BA RA THAT FN THIS SURVEY WAS PREPARED IN AGGORDANGJ•-TFd E �D g OF PRACTICE FOR LAND 5URVEY5 ADOPTS ji� l ,�., i p!\ O / YORK 5TATE A55OCIATION OF PROFF-551 +j:.A i'� ®o ' 0'®.® , / SURVEYORS. �F Grp W. Y �� o EX I + P Cfid . I S Z �_._ 399 9 / \ =tit �� z—o _ff g � `U 8 0 / �'° 0 / HOWARD W. YOUNG, N.Y.S. L.S. NO 45883om 4' e ; Q / s � ° SURVEY � ? Q �' y` o ,9 �`�ori ®8g �� y �' '' ./ ,�" R101PERT G. 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Main Rd. &Youngs Ave.) N Southold, NY 11971 ® a� Telephone: 631765-1938 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: LWRP Coastal Consistency Review for ROBERT G. BOMBARA SCTM# 1000-54-4-19 Twin Fork Landscape Contracting, Inc. on behalf of ROBERT G. BOMBARA requests an Administrative Permit for the as-built landscaping surrounding the dwelling; to revegetate an area on the seaward side of,dwelling using indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon Beach Plum; and to install a 4' wide pea gravel path providing beach access. Located: 1725 North Sea Drive, Southold. SCTM# 1000-54-4-19 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 INCONSISTENT with LWRP Policy 6, specifically 6.3 (below) and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. Landscaping and clearing on site does not comply with Wetland Permit 7919 and Coastal Erosion Hazard permit 7919C. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. So John M.]3redemeyer III, President ��`' yQl Town Hall Annex Michael J:Domino,Vice-President O 54375 Route 25 P.O., Box 1179 Glenn Goldsmith Southold,New York 11971 CA A.Nicholas Kru ski G p �. ® �O Telephone(631) 765-1892 Charles J. Sanders Q�ycoUNly Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application Wetland Permit Application �Administrative Permit /Rec�iy:ed Amendment/Tran�r/xtension Application: 1 Received Fee:$ , QHS �Cornpleted Application Zz-I& _Incomplete _SEQRA Classification: Type I Type II Unlisted �ti• i4 t� �Coordination:(date sent) 7�g��(o JUN 1 7 2016 LWRP Consistency Assessment Form CAC Referral Sent: ' v Date of Inspection: _71 I2Q - q ' Receipt of CAC Report: t zSouthcic�(a{en _Lead Agency Determination: Technical Review: _ Public Hearing Held: Resolution: Name of Property Owner(s) Rog �� &' V WL Address 172.6 N OOM e5F� UWE d Q" g771 qS-I(o :0lr3rd 3y'7 2j5e5 E-9- Phone Number:( ) NY 111 Suffolk County Tax Map Number: 1000- Property Location: 972.6 NG�GI'I'I SV Idt. 0 �11 lta-+i (provide LILCO Pole#, distance to cross streets, and location) AGENT: W- &&Qd 5,TWl N FMIL (,l IQNZAPF (If applicable) P.Q• V q �0y Laj"e Address: - ��q?j J� (''� � Phone: (J - U 4oard of Trustees Applicato GENERAL DATA Land Area(in square feet): Area Zoning: Rte'—0 () Previous use of property: ,5� Intended use of property: 1!%51 DVNn A-L.- 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 any demolition as per Town Code or as determined by the Building Dept.? Yes —A—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): The purpose of the proposed application is to obtain Trustee's permit for an as built landscape. Per S, the Trustee's we are to re-vegetate the area. Attached provides the intended planting plan. We will re-vegetate with indigenous plant material, (30)5 gallon Bayberry and (20) 5 gallon beach plum. Also creating as illustrated on plan,the construction of a 4'wide path providing beach access.The path will consist of pea gravel as per the Trustee's direction 40oard of Trustees Applicator WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: The purpose of the proposed application is to obtain Trustee's permit for an as built landscape. Per the Trustee's we are to re-vegetate the area. Attached provides the intended planting plan. We will re-vegetate with indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon beach plum. - Also creating as illustrated on plan,the construction of a 4'wide path providing beach access.The path will consist of pea gravel as per the Trustee's direction --Area of wetlands on lot: 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: 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? 0 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): No" U 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 Name of Action or Project: Project Location(describe,and attach a location map): ,f 112,7r:.:5M0 t Brief Description of Proposed Action: The purpose of the proposed_application is to obtain Trustee's permit for an as built landscape. Per the Trustee's we are to re-vegetate the area. Attached provides the intended planting plan. We will re-vegetate with indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon beach plum. Also creating as illustrated on plan,the construction of a 4'wide path providing beach access.The path will consist of pea gravel as per the Trustee's direction Name of Applicant or Sponsor: �y �� / Telephone: 1--7a✓ ,�&& Ade Address: ! LA*+�AVf. E-Mail:�'IM T�► lC_e►� t ft Address: �®� Cor vme ®1-66Y /_a City/PO: ���� A Q/ !/ State: Zip Code: I" ' l 03ir 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO I YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that F] 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 El Rural (non-agriculture) ❑Industrial ❑Commercial residential (suburban) ❑ ❑ ❑Forest Agriculture Aquatic ❑Other(specify ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ RJ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ISP 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: F1 El 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? ❑ ❑ 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: I ❑ ❑ 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: ri ❑ 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? El ❑ 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 El Forest ❑Agricultural/grasslands ❑Early mid-successional Wetland ❑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? IN O YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO VES If Yes, Ela.Will storm water discharges flow to adjacent properties? ❑NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe. ❑NO DYES Page 2 of 4 U 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: P� ❑ 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: r$ ❑ 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 /��l -- Applicant/sponsor name: Date: Z 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? n ❑ 3. Will the proposed action impair the character or quality of the existing community? LNZ I ❑ 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? El 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9_ Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F] 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 a viro mental impacts. Town of Southold-Board of Trustees 9//6 , w,Name of Lead Agency Date 0 President Print or Type Name of es ible Of icer in Lead Agency Titl o W-1c er Sign at of Respo i fficer in Lead(Agency Signature of Preparer different from Responsible Officer) PRINT Page 4 of 4 - -- i Board of Trustees Applicaen AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS HAT 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 HARNILESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES-IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner SWORN TO BEFORE ME THIS / / DAY OF 20Ag' Notary Public MICHAEL F. KANZER f Notary Public, State of New York No. 24-4980123 Qualified in Kings•County Commission Expires: 04/15/20 I U Board of Trustees Applicaan i tt- Y. AFFIDAVIT BEING DULY SWORN DEP SES 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. eignaturto Property Owner SWORN TO BEFORE ME THIS DAY OF 20 /Gr' Notary Public MICHAEL F. KANZER ' Notary Public, State of New York No. 24-4980123 Qualified in Kings.County Commission Expires: 04/15/20 U — - - ?, O&oard of Trustees Applicata AUTHORIATION (where the applicant is not the owner) residing at -/� (print name of owner of property) (mailing address) do hereby authorize_ (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) j n . i -7 U -- ftoard of Trustees Applicatik ' dt' t 1 vr AUTHORISATION (where the applicant is not the owner) residing at (print name of owner of property) (mailing addr ss) Gd ���� - � do hereby authorize (Agent) "TW)rV RN L.WWD05 PCC �t l Aj& Nc to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ature) i U APPLICANT/AGENTIREPRESENTATI V E TRANSACTIONAL DISCLOSURE.FORM The Town of Soutbold's Code of Ethics prohibits conflicts of interest on the part of town oPFicers 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. YOURNAME: AMA 90�/--ff ,(East darne,first Wame,qilddli 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,nar(ie 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 br position of that person Describe the relationship between yourself(the applicantlagent/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 appliegnt (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 4ay o 206/50 Signature Print Name Form TS I r 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 inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessarytoavoid same. YOUR NAME ��j��mJ (Last nae,fust naTe,.rpiddle 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 ofZone 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): j 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 is day ✓ 20 A/V Signature Print Nam Form TS 1 } 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 puroose 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: J_ -r �! /0 �L ' (Last name,first name,-piddle initi ,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 employe,p,has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than5% 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. DES,QRIPTJON OF RELATIONSHIP - - --— - - — - AC? ),- — - Submitted this 17 day of JQ WC 20Q 6 Signature . - W, ' Print Name ffiq J W, fff0 5"r V Form TS l PAUL W ESPENSEN Notary Public•State of New York N0.01 ES5076852 Qualified in Suffolk County Commission Expires May 05 2019 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, listinIz 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# OV4 PROJECT NAME YYIbOl,1�Ct.. �471 � 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: The purpose of the proposed application is to obtain Trustee's permit for an as built landscape. Per the Trustee's we are to re-vegetate the area. Attached provides the intended planting plan. We will re-vegetate with indigenous plant material, (30)5 gallon Bayberry and (20) 5 gallon beach plum. Also creating as illustrated on plan,the construction of a 4'wide path providing beach access.The path will consist of pea gravel as per the Trustee's direction U Location of action: p �� ���1 K 1(J�� d �L`q 1 Site acreage: Present land use: eFa I M.1`I'1 At, Present zoning classification: R,-140 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: W.1ana` nf�,bb ' (b) Mailing address:470 PN JfW �U•�L ''"�,\'�`'Q' Ny !��?7�S (c) Telephone number: Area Code( ) &231 (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 El Yes 1:1No 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 ❑ NoNot 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 ❑ Tot Applicable Yes 1-1 No [ 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 1?3 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";cable 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 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. nn F] Ye�----1 No P Not Applicable Attach additional sheets if necessary 9 WORKING COAST POLIO Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locationsZNLo WRP Section III•—Policies; Pages 47 through 56 for evaluation criteria. F1 Yes [:] 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 w ters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 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 evaluation criteria. ❑ Yes ❑ No 0Not 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 rNot Applicable PREPARED BY TITLEDATE i �1 IAL Twin Fork Landscape Contracting, Inc PO BOX 460 Cutchogue, NY 11935 PH: 631-734-6643 FX: 631-734-8354 twinforklc@optonline.net To: Board of Trustee's From: Twin Fork Landscape Contracting, Inc r � ,-- E- 0 Date: 6/17/16 a UUN 1 7 2016 RE: Robert G. Bombara & Margret M. Bombara Southold Town 1725 North Sea Drive Board of.Thistm TAX Map# 1000-54-04-19 Attached provides you with a Wetland permit Application. The purpose of the proposed application is to obtain Trustee's permit for an as built landscape. Per the Trustee's we are to re-vegetate the area. Attached provides the intended planting plan. We will re-vegetate with indigenous plant material, (30) 5 gallon Bayberry and (20) 5 gallon beach plum. Also creating as illustrated on plan, the construction of a 4' wide path providing beach access. The path will consist of pea gravel as per the Trustee's direction.