HomeMy WebLinkAboutTR-8856A John M.Bredemeyer III,President �°�o� So(/�'�� Town Hali Annex
Michael J.Domino,Vice-President �o l0 54375 Route 25
� � �. � P.O. Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski � • yOQ Telephone(631) 765-1892
Charles J. Sanders �if'COU���,3� F�(631) 765-6641
,
BOAR,D OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 8856A
Date of Receipt of Application: July 13, 2016
Applicant: New Suffolk Waterfront Fund
S CTM#: 1000-117-8-18.1
Project Location: 650 First Street, New Suffolk
Date of Resolution/lssuance: August 17, 2016
Date of Expiration: August 17, 2018
Reviewed by: A. Nicholas Krupski, Trustee .
Project Description: To install approximately 183' long and up to 6' high
security fencing along landward side of revetment.
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 Pat Mclntyre, received on July 13, 2016, and stamped
approved on August 17, 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 111, President
Board of Trustees
,l
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�'s� ��" '
'-'zS1�F S'�l J�1^�
John M. Bredemeyer Iil, President :=�"o�-o co�'; Town Hali Annex
Michael J. Domino, Vice-President �~ �;� - y�'; 54375 Route 25
Glenn Goldsmith ii� �'� ;.� ,z `?' P.O. Box 1179
A. Nicholas Krupski � � � �� ��� Southold, NY 11971
Charles J Sanders ��;�o� � �,��-;� Telephone (631) 765-1892
'`��{L:�-;-�'�' Fax (63') ?E5-654?
BOARD OF TOWN TRUSTEES
- TOWN OF SOUTHOLD
YOIJ ARE REQUIF�ED �"O CONT/�CT THE OFFICE OF THE �OARD Ql� TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPO�NT[IltEt�T FOR A PRE-CONS�'RUCTION INS�EC�i�'ION. �AILURE TO DJ SO
SHALL BE CONS(DERED A V[OLAT(ON Ai�ID POSSIBLE REVOCATION OF THE
PERMIT.
INSPECTION SCHEDULE
,
Pre-construction, hay ba(e line
_ 1St day of construction
'/Z constructed
Project complete, comp(iance inspection
L.ECaEND
WALL
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OH OVERHEAD WIRES
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� BOARD OF (�ZUSTEES
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S7AKE CONC. PAD I O n
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POLE x �
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� / x s., s.8 S 83'43'00' E NOTE3:
\� O p 18.38
� 1. THIS SURVEY WAS PREPARED FOR A SPECIFIC PURPOSE. AND IS NOT
1., PROPOSED NY5 OPRHP INTENDED TO BE USED FOR A TRANSFER OF T1TLE OR ANY FiNANC1AL
�AR EASEMENT AREA E s.s2 S 00'��7� E PURPOSE. '
FOUND S •� 5J WOOD BULKHMAD 5 OZ`�1•••S� � -
`� \�� x WALKM�AY Z�OZ�'� E Y 4�•19 � S 0272''S4" E 2. THIS SURVEY WAS PREPARED WITHOUT BENEFlT OF A T1TLE REPORT AND
�t• I woo° . ' E Y W � 5.32' THEREFORE, THE EXISTENCE OF ANY COVENANTS, RESTRICTIONS.
?�e�'�+ ��O-b,y 597 M E 5 p3��. 0 28'� s EASEMENTS AND/OR RIGHTS OF WAY OF RECORD. IF ANY, ARE NOT
S• !y �q�. .c�r'44 Z �. � SHOWN OR ADDRESSED.
\ti. I 5 00 . • �y o
s� ���� 32'� S 0 1''•3 0'2 9" W �V�• 0 3.PROPERTY CORNER M ONUM E N T S W E R E N O T P L A C E D A S P A R T O F T H I S
� �\��, � 25.20' � � 3 SURVEY.
�J- �~� �P�'��P + � �/1 4.SUBSURFACE AND ENVIRONMENTAL CONDITIONS WERE N07 EXAMINED OR
�• � o� �,P��i CONSIDERED AS PART OF THIS SURVEY.
� � 'i'� ���`� 9 ' �
� �� � -�-r•�a o°0 0ya1� 5. THE OFFSETS OR DIMENSIONS SHOVIM FROM THE STRUCTURES TO THE
3 O � . , y CUTC�OGU� �AR�OR PROPERTY LINES ARE FOR A SPECIFlC PURPOSE AND USE AND
�e�• a ��?�5 � THEREFORE ARE NOT INTENDED TO GUIDE IN THE ERECT10N OF FENCES,
'�'� RETAINING WALLS. POOLS, PATIOS. PLANTING AREAS. ADDITIONS TO
3 �y l Sr�°`�`� .' :':3;8? S 32'15'S4` E BUILDINGS OR ANY OTHER CONSTRUCTION.
,
�>°� � � :�: 9•16 � K � 8.LOT AREA = 93.588 SQUARE FEET OR 2.148 ACRES.
ry, � � �•���� � � U 9.ELEVATIONS SHOWN HEREON REFER TO NAVD, 1988.
��, i -�`� �, S 22'1414 E TAX LOT 22 & 23 0
� ,:;G��'' 11.26'
,� '.�'��"�� � �tr N 89�5��08� E LAND NOW OR FORMERLY OF 3 10. BUILDING OFFSETS ARE SHOWN TO FOUNDAT10N.
Q � 14•84' TOWN OF SOUTHOLD
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� r � �`� � Certi(ica�ions indicntcd hereon signi(y Ihat this plof
Q � a o of the propery depich.d hereon was made(n PR PE RTY
� � aoc«aance Wilh the eXisting code d Pr�tice r« O
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� y Association of Professional land$urveyurs. This S�A�
,o a certification is only for Ihe Iands depicAed hereon
,�,� O Q and is rwl certi(ication of fide,zoning a(reedom
:, O oI encumbronces. Said certifications shall run �� S U F�O��
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� QO «iy to the persons and/«enNties hsred herea,
N O Q O and are not honsferable to additional persons, TOWN OF SOUTHOLD SUFF�I.1�C�UI V 1 1 N.1.
� enlities w subsequent rs. /
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� is a violation oi Seclion 7209 of New York
� Sra�e Educotion Law
3 ���
� Copies of this survey map not bearing Ihe land
osurveyor's embossed sea�and signoture sholl
�� rror be cauidered ro be a rn,e and wlid copy cQ 2016 BBV PC
N UA: FlNAL
Date Scale Project No. S t No. j
q fEBRUARY 2,2016 1" - 30' A120278A � �1 �
VIEW: FlNAL
0
Y
i�'�- lX�=r�i� r''_
John M. Bredemeyer III, President ��S�1FF0(,��,o s� r`� Town Hall Annex
Michael J Domino, Vice-President� �,��� �y�� - --- � 54375 Route 25
Glenn Goldsmith �o =` P.O. Box 1179
A. Nicholas Krupski �o � ��� Southold, NY 11971
Charles J. Sanders �y�j p�,�� Telephone (631) 765-1892
, �����'a'�� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
__ TOWN OF SOUTHOLD (
/ �
DatefTime:_,�15/�`� I�-=v� Completed in field by: /U< �����-�
NEW SUFFOLK WATERFRONT FUND requests an Administrative Permit to install temporary+/-183'
long and up to 6' high security fencing along landward side of revetment. Located: 650 First Street,
New Suffolk. SCTM# 1000-117-8-18.1
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet t
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
l 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: � -
,� ,�2� Glo�fe',��T�W C� �IONS � �C�. :.
- �.�,v���7
� �w '�N+�+ FOJIe l� �N��D�"d�I�� j'
Present were: J. Bredemeyer M. Domino G. Goldsmith c/ N. Krupski
C. Sanders Other
Page 1 of 2
John M. Bredemeyer III, Presideni�_j o��g11fF0(��,oG ��, .s' Town Hall Annex
Michael J Domino, Vice-Presideni � f�� y 54375 Route 25
' Glenn Goldsmith n `� P.O. Box 1179
A. Nicholas Krupski o �� Southold, NY 11971
Charles J. San'ders '� � o��'� Telephone (631) 765-1892
, �'�.��r1-���� FaX (631) 765-6641 .
� BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD �
Date/Time: Completed in Work Session by:
NEW SUFFOLK WATERFRONT FUND requests an Administrative Permit to install temporary+/-183'
long and up to 6' high security fencing along landward�side of revetment. Located: 650 First Street,
New Suffolk. SCTM# 1000-117-8-18.1 �
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
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E ���� _�_ ��N (21) �� �� � �� p o NOTICE �oir.� COUNN OF SUFFOLK O E � SOUTHOLD SECTION NO
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___ �� A raittxo 1000
n�N�l _— -- -- n Ersrv• n xcr P s PROPERTYMAP
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_ - " _ - . - < . _ . -_ — - -._ __ , ___�.-.....,,..
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OFFICE LOCATION: 0��0� SOU�yO� MAILING ADDRESS:
Town Hall Annex � � P.O.Box 1179
54375 State Route 25 � � Southold, NY 11971
(cor. Main Rd. &Youngs Ave.) N �r
Southold, NY 11971 � � �p� Telephone: 631 765-1938
�`ycoUNT`I,��
- LOCAL WATERFRONT REVITALIZATTON PROGR,AM
TOWN OF SOUTHOLD
� MEMORANDUM
To: John Bredemeyer, President
Town of Southold Board of Trustees
From: Mark T�rry, LWRP Coordinator
' Date: August 10, 2016
Re: Local Waterfront Revitalization Program Coastal Consistency Review for NEW SUFFOLK
WATERFRONT FUND
SCTM# 1000-117-8-18.1
NEW SUFFOLK WATERFRONT FUND requests an Administrative Permit to install temporary+/-
183' long and up to 6' high security fencing along landward side of revetment. Located: 650 First
Street, New Suffolk. SCTM# 1000-117-8-18.1
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 ciepartment, as well as the records available to me, it is�my recommendation that
the proposed action furthers the policy to the extent practicable and therefore is CONSISTENT with
the LWRP.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action. -
� T
'�� , �
, �
John M.Bredemeyer III,President O��o� So(/�yQl Town Hall Annex
Michael J.Domino,Vice-President � O 54375 Route 25
P.O.Box 1179
Glenn Goldsmith � � Southold, New York 11971
A.Nicholas Krupski � � �� Telephone(631) 765-1892
Charles J. Sanders ���COUN�,�� F�(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Applicatior�/
Wetland Permit Application i/ Administrative Permit
F/ Amendment/'Transfer/E tension
Y/ ReceivedApplication: �•�����
�ReceivedFee:$ ioO,,Q(,
�Completed Application � �r , � � � j�� �j p// �L i f���
_Incomplete _ - l� Il V �
_SEQR.A Classification: �� ��
Type I Type II Unlisted L�
Coordination:(date sent) ��.`� � ���, � 3 �016 i
�LWRP Consistency As�s�essment Form ` ,
CAC Referral Sent: as ?J'�� ;
�Date of Inspection: • � (r� Southold Town
Receipt of CAC Report: r f r �
Lead Agency Determination: -
Technical Review: '
�Public Hearing Held: << • ' �
Resolution: �
— ,,- _ -
Name of Property Owner(s) �Q,(,() Su�C(G �,�Qf'CV �Uvlt Fu Vtl�
Address � f� ��OX (�� , �euJ �c�l�R9C�G , /� � (I Q S(n � ' '
Phone Number:( ) Q17— �7 3— b D O�
Suffolk County Tax Map Number: 1000 - �I � � �g — I �r �
Property Location: (p 5 O Fi rs f Sfi�ee{- �EQ Sf� �� I s�- S�'r�e t'� f�o r172 c� so c��
kiil�c,
(provide LILCO Pole#, distance to cross streets, and location)
� � AGENT: �Ct,f �.,�V1�'V ►�G ^
� (If applicable)
r
Address: � (?� �D� I y�
�ew Sk� C(�, I� �( I( qSG Pnone: (v31- `�3�( —�S(oro3
' •; -_
: , ,�oard of Trustees Applicat�-_.��z
GENERAI,DATA
Land Area(in square feet): Q� , 30 �j
-�
Area Zoning: M(t
Previous use of property: �17�N1 VY)Pj�,C(u.�
Intended use of property: ���ry�,�,u{-(�
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 X 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 �No
Does the structure(s) on property have a valid Certificate of Occupancy? � Yes No
Prior permits/approvals for site improvements:
Agency Date
NYs D� c 5�/��l�o�o
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):
1 A. �� � G��m�ar �eef �G �- d�.cqh.
�t e� ' L n k �S � S�.�c-ft, b r�e C�e.cc�c'd� �u r r�e s� �s �
TKe✓r���.��c e S S �a P�fre r�1+�t 4 Cl��o u s ►"e ye t ry� e vtr.
; � �� . ,
, �oard of Trustees Applicat__=n
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: �v �0 MAf___,�cf �B �fJUbl�c �-roM �'Lt� G�QnC'er
�
�h 1� c�S�rou�cd cL„cQ S(,�nerr. �r�v�f'm�e,�'
Area of wetlands on lot: U square feet
Percent coverage of lot: l7 %
Closest distance between nearest existing structure and upland
edge of wetlands: q -feet
Closest distance between nearest proposed structure and upland �
edge of wetlands: /�//q feet
Does the project involve excavation or filling?
No Yes
If yes,liow much material wi'll 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):
"7lohe �ho��n
. � _\ �
� \
617.20
Appendix B
Sho�t L�i1Vli'OilifleilEl[I fli�SeSSYilei4t FOYii1
Instructions for Comnletin�
Part l -Project Information. The appiicant 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
ec� u o�M �er o �
Name of Action or Project:
-ea1 -�'M�e �t' e e
Project Location(describe,and attach a focation map): ��Sf c�Isr 5t-� o. 0�1')lqi►t�'t•� So � i►�91'-
S Fr t e�JS'u k � i4 �a� k d. a � -
Brief Description of roposed Action_ '
, '�o �IQc� a-Fenee-(� pre�e�+ �eo�i� {Y'omCro�'Sin �e�.�fyre.�nevehS��s�ebars
.F
et�neQ.91 ass o,�7�rQ v 2fin a t�'• �'+iS c1 re�e. is 2+��f�v'�rn�e..(c� �P�o u S �1S� ro cdcs etr�
4�� S I�p�o t�4 a n� �r�t�t�e� • Fu�'lh,e.t' 1'7�t e �e de-h�rt�e n�-�s ir'ehA ra.titdl -rJ'(c�S S
��en q-� rvGks.
J
Name of Applicant or Sponsor: Telephone:�,� �37 ,��d '�f
]�P.l.��u���(['(�et�2fFUanfi Pafr� � � r� E-MaiL• CWSu -o �1'14� •C
Address:
Q�•�$oX �`�(o
City/PO: State: Zip Code:
rl¢w Su.FF'r�(k I f C4 1 QSG
1.Does the proposed act�on 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:
� �,��s�th NVS D�G "1YIarmCa. rn.ainfehcG '�ervr�f'('°': 1-�F����1=ofooS 000it � �
, _
3.a.Total acreage of the site of the proposed action? acres
b.Total acreage to be physically disturbed? �acres
c.Tota(acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? /U a acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural (non-agriculture) ❑Industrial [�Commercial �Residential(suburban)
❑�'orest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Page 1 of 4
� ' \ �
` i
5. Is the proposed action, NO YES N/A
a. A permitted use under the zoning regulations? ❑ ❑ �
b.Consistent with the adopted comprehensive plan? � �
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑ �
7. 1s 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? � �
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:
❑ ❑
]0. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: � ❑
1 l.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: � �
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 archeologicat 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? � �
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 ❑Forest ❑Agricultura]/grasslands ❑Early mid-successiona]
❑ Wetland ❑Urban ❑Suburban
I5.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
1f Yes, � ❑
a.Will storm water discharges flow to adjacent properties? ❑NO �YES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
lf Yes,briefly describe: ❑NO QYES
Page 2 of 4
�� ' �\ I
� � ^ �
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: ^ �
I�I
�p_i
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: � ❑
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
IfYes,describe: aBp'j � .Zo O g ❑ �
C��mecCca.fii.o� �oe�Fc�-rc��A �o�¢cehf S�f� �i� .�o�o when Pcca�►rc, ��.av+c�
ed r
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
ApplicanUsponsor na : � �" � C!, � (2 Date: J f�l,�(A (�� � ��
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
]. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑
3. Will the proposed action impair the character or quality of the existing community? � �
4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ ❑
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑
affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing: ❑ ❑
a.public/private water supplies?
b.public/private wastewater treatment utilities? � �
8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
.`
. • _�
. ,� �
. `
No,or Moderate
small to large
impaet impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ �
problems?
1]. 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.
� Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
� Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
Town of Southold-Board of Trustees
Name of Lead Agency Date
President
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
,' � r--. ',
• '��_��oard of Trustees Applicatrvn
AFFIDA�IT
. .
Q.'� l C'(Cf, C.Lf1 f' 1�2� BEING DULY SWORN
DEPOSES AND AFFIRM TI3AT HE/SI3E 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 TI3E SOUTHOLD TOWN BOARD OF TRUSTEES.
'I'�E APPI.ICANT AGatEES 'I'O HOILD 'I'HE'd'OWN OF SOU'T�IQ]LD E1ND'I'IiE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES
AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF
GI2AN'I'ED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE
TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE
C01�1SER�IA�'ION��ISORY COUNCIL, a0 EN'l�"Eit ONTO 1VIY PROPER'I'4'TO
INSPECT THE PREMISES IN CONJUNCTION WITI3 THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FURTI3ER AUTHORIZE THE.BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIAI�TCE WITH A1�tY CONDI-'�YON O�ANY�VETLANI➢ OR CO�iSTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF TI3E PERMIT.
.
� C
Signature of Property Owner
SWORN TO BEFORE ME THIS ��J`� DAY OF ��� , 20�
�, � � �►�� � ,
Notary Public -
�OMNlE D. BUMCH
iVotary Public,State of New York
f�o.01 BU6185050
Oualified in Suffolk County
Commissfon Expires April 14,2��� .
: J• � `� , .
_,�;oard of Trustees Application
AU'I'�IORI�ATIOle1 '
(where the applicant is not the owner)
- -- ---- -, ,_ - -- - -- � - - - �
�. �-- • „
, —.� -�� ,-- ,
I, !�_Y-� ____ -- " - - -residing at
(print name oi�'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)
. I'�` -- - ' t '� } ----
A������r�i���r�����s�r���aav�
TRANSACTIONAL DISCLOSURE F(�RM
The Town of Southold's Code of Ethicsprohibits conflicts of interest on the nart of town officers and emplovees.The vuroose of
this form is to,provide inforination which can alert the town of possible conflicts of interest and allow�t to take whatever action is
necessar�to avoid same.
YOURNAME: �U@W SUF�a��C (AJll.fQl(�d►'l't ��
(Last name,first name,�iddle initial,unless you are applying in the name of
someone else or other entity,such as a company.If so,indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.) ,
" Tax grievance Building
Variance Trustee X
Change 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,�arriage,or business iqterest"Business interesY'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 ans�i�ered"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 applicanUagent/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]egal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an o�cer,director,partner,or employee of the applicant;or
D)the actuat applicant.
DESCRIPTION OP RELATIONSHIP
7 Submitted this_�_day of U� 20�(�
Signature - �" f'Y�`
Print Name c �
Form TS 1 f ,
' - • / `i
. � ; --- �
Town of Southold '-'
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIOIrtS
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 in,formation 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 Loca1
Waterfront Revitalization Program. A proposed action will be evaluated as to its si�nificant
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, listin� both sunportin� and non-
supportin�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, a11 ,
locallibraries and the Town Clerk's office.
B. DESCRIP�'ION OF SIT�AND PROPOSED ACTION
SCTM# 11'1 -�_- .� �f
P�20JECT NAME �eJe�t'om�nfi �en e�.
The Application has been submitted to (check appropriate response):
Town Board ❑ I'lanning 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: '
�nstQ�� �,= �'e»�or_�+��- f��"3 �inear �ee+ �— b��-• h�ah�Qnce asCc.
�e� Rf�e Gac��'lan �ur vose (S�o �r�✓e nt �ccess�a e�c�reme l.0
ncP_r�u,s 1"e �et�v�rrt+. ,
� , � � � }t
, / + �
I ,� _
Locationofaction: �Q�,tJ �'U,�r.o(k I�aFe�' dnt �ZeJ.�t'n��n�'
Site acreage: '�, 1y.Z
Present land use: 7'har►rtct, ► S'iarace _ t'es�-a u�a.�� b cufo(c�.�
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: f vQ(,� Su�rjL[� �Q.�"�r-t�/DYI�' �U.hG�
(b) Mailing address: �D. �Qx l�flc , j�Qa,J �'GtF�O�� � l�{S�v
(c) Telephone number: Area Code( ) (�3 I� 073 4� s(�6 3 �r ��I-s�(�' D g0(e
(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 co�pletion.
I)EVELOPED 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
nninimizes adverse effect� of develop�ent. See LWRP Seet�o� III-Polieies; Page 2 for evaluation
criteria.
��es � No � Not Applicable
1� bro'recf l,�r11 AmvrelG ct.fi�rr�ooraru bar�rer -f� an uMSa� k�e� 71�at�.c�ilf �n f�r ,
1,6.µ�P�rab r�ca-r�sfrucfion•
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeologieal 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 throtxghout the �'own 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. Manimize 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 �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 Habitat� and wetlands. See LWRP Section III—Policies; Pages 22 .
througb 32 for evaluation criteria.
❑ ❑ lL�
. ' • t, ^. ;�^j
� Yes No Not AYY'iicable
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. M1 inimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWItP Section III—Policies; Pages 34 through 38 for evaluation criteria.
❑ Yes ❑ No Q Not Applicable .
PUBLIC COAST POI,ICIES
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.
� Ye� No Q Not Ap�licable
Attach additional sheets if necessary
� • -
,, � �. � � '�
WORHING COAST POLICY��
� 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.
0 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 l�l Not Applicable `
Attach additional sheets if necessary � •
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages
62 through 65 for evaluation criteria. ,
❑ Yes ❑ No� Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
❑ Yes ❑ No � Not Applicable
PREPARED BY (�Q�"rrG�a e.�,h �e. �'ITLE��Y ��
� �{ �1�-cr)Su��olkkJaf�Pr�owtDATE 7 13 201�
- 'Fu�nd