HomeMy WebLinkAboutTR-8871A John M.Bredemeyer III,President Of SO(/TyO Town Hall Annex
Michael J.Domino,Vice-President hO l0 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski G
� ® Telephone(631) 765-1892
Charles J.SandersO Fax(631) 765-6641
�yCOWN,�
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 8871A
Date of Receipt of Application: August 16, 2016
Applicant: Gioia Turitto & Nabil EI-Sherif
SCTM#: 1000-70-10-61.1 & 62.1
Project Location: 1800 Park Way and 40 Beachwood Lane, Southold
Date of Resolution/Issuance: September 21, 2016
Date of Expiration: September 21, 2018
Reviewed by: Board of Trustees
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 along the entire seaside area of Lot 61.1, and along the south-
westerly side of the dock on Lot 62.1.
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
two (2) project plans submitted by Michael Kimack, (Lot 62.1 & Lot 61.1) received
August 16, 2016, and stamped approved on September 21, 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
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 's not a determination from any other agency.
97
John M. Bredemeyer III, President
Board of Trustees
John M Bredemeyer III, Presidentoo� Town Hall Annex
Michael J. Domino, Vice-President °� z: �� 54375 Route 25
Glenn Goldsmith ` P.O. Box 1 179
` Y
A. Nicholas Krupski Southold, NY 11971 y ®. � � �_;r
Telephone 631 765-1892
Charles J. Sanders �"=��1 ,� �� =' P ( )
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
INSPECTION SCHEDULE
Pre-construction, hay bale line
1St day of construction
Y2 constructed
Project complete, compliance inspection
NE.
ROAD
PINE SURVEY OF PROPERTY
�ry�abR S'I T UA TED A T
P�'RovED BY PINE NECK
TOWN OF SOUTHOLD
BOARD OHRUSTEES SUFFOLK COUNTY, NEW YORK
TOWN OF SOUTHOLD
' S.C. TAX No. 1000-70- 10- 61 . 1
DATE :i��i�R- Z��Zqr� s SCALE 1 "=20'
a
OCTOBER 21 , 1997
FEBRUARY 21 , 1997 REVISED GRADING PLAN & ADDED LOT COVERAGE
MARCH 4, 1998 SET LATH FOR D.E.C.
MAY 17, 1999 ADDED ADJACENT WELL & CESSPOOL LOCATIONS
SEPTEMBER 9, 1999 ADDED ADJACENT WELL LOCATION
DECEMBER 15, 1999 REVISED AS PER S.C.D.H.S. NOTICE
MAY 23, 2000 REVISED PROPOSED SEPTIC SYSTEM & ADDED WELL RELOCATIONS
PROPERTY LINE JULY 18, 2013 UPDATE SURVEY
MAY 20, 2015 UPDATE SURVEY
TOTAL AREA = 19,770 sq. ft.
(TO TIE LINE) 0,454 ac.
UPLAND AREA = 13,315 sq. ft.
WETLANDS AREA = 6,455 sq. ft.
(TO TIE LINE)
TEST HOLE DATA
(TEST HOLE DUG BY McDONALD GEOSCIENCE ON SEPTEMBER 22, 1997 AT 3:54 PM)
EL 6.0' 0•
BROWN SANDY LOAM OL
2'
BROWN LOAMY SILT ML
a i
3'
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C • PALE BROWN FINE SW NOTES:
° c TO COURSE SAND
1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM
EXISTING ELEVATIONS ARE SHOWN THUS:1.0
EL. —1.6' 11 2. LOT NUMBERS SHOWN THUS: LOT REFER TO
76 "MAP OF SOUTHWOOD"
w FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY
3/ ON NOVEMBER 24, 1953 AS FILE No. 2141
WATER IN PALE BROWN SW O p
FINE TO COURSE SAND ,� 3. ZONING USE DISTRICT: R-40
N�/ 0 4. FLOOD ZONE INFORMATION TAKEN FROM:
Z FLOOD INSURANCE RATE MAP No. 36103CO166H
v . • ZONE AE: BASE FLOOD ELEVATIONS DETERMINED
to 0 / 6-3
mo ZONE X°: AREAS OF 0.27. ANNUAL CHANCE FLOOD; AREAS OF 1% ANNUAL
55 CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT
o OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE;
^ ¢,� AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD.
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3 \ UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
I� JfTO \ SECTION 7209 OF THE NEW YORK STATE
`III FoSP } EDUCATION LAW.
All. COPIES OF THIS SURVEY MAP NOT BEARING
�7�` THE LAND SURVEYOR'S INKED SEAL OR
Z I 1 FSG s o \ [� EMBOSSED SEAL SHALL NOT BE CONSIDERED
v TO BE A VALID TRUE COPY.
tV II all Fpc ` �F S/yF0 f CERTIFICATIONS INDICATED HEREON SHALL RUN
• I ° \�{ v �� ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
O �Q+ A` TITLE COMPANY, GOVERNMENTAL AGENCY AND
FUC LENDING INSTITUTION LISTED HEPEON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
O II II I zi TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
THE EXISTENCE OF RIGHT OF WAYS
Sys 1 AND/OR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
Sl �U, y y s FASF �2
PREPARED IN ACCORDANCE WITH THE MINIMUM
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
BY THE L.I.A.L.S. AND APPROVED AND ADOPTED
Q
9� v FOR SUCH USE BY THE NEW YORK STATE LAND
c^p Cy 1 ct TITLE ASSOCIATION.
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1O 'dI' II" 1 m N.Y.S. Lic. No. 50467
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T-3� Fac v D e Nathan Taft Corwin III
o AUG 1 6 2016 Land Surveyor
•
III. o Southold Town Successor To: Stanley J. Isaksen, Jr. L.S.
A' \ Joseph A. Ingegno L.S.
ssM
If Title Surveys — Subdivisions — Site Plans — Construction Layout
A0 Std, ,uz PHONE (631)727-2090 Fax (631)727-1727
•S(� 06,, OFFICES LOCATED AT MAILING ADDRESS
1586 Main Road P.O. Box 16
Jamesport, New York 11947 Jomesport, New York 11947
APPROVED BY
BOARD OF 1 RUSTEES
TOWN OF SOUTHOLD
DATE 2►g 20!(0
,S7R887 ADDR.855 40 13.88 CH W OOD L ANS
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° AUG 16 2016
outho!d Town
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� SURVEY OF PROPERTY
y A T SOUTHOLD
TOWN OF SOUTHOLD
'- SUFFOLK COUNTY, N. Y.
SH 1000-70 10-62.1
8.2 N 's SCALE: 1'20'
} r ^ p SEPTEMBER 27, 2007
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• 8 0.1 • £ 45.56T v,y LOT NUMBERS REFER TO "MAP OF SOUTHWOOD"
FILED IN THE SUFFOLK COUNTY CLERKS OFFICE
000. , ON NOVEMBER 24, 1953 AS FILE NO. 2141.
AREA=23,284 SO. FT.
TO TIE LINES N. YS. LIC. NO. 49618
ANY ALTERATION OR ADDI77ON TO THIS SURVEY IS A VIOLATION CONIC YORS, P.C.
OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. 631) 765-5020 FAX (631) 765-1797
EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER77FICATIONS P.O. BOX 909
a2 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
ELEVATIONS REFERENCED TO N.G.VD. SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET nn_�O�
A =WEILAND FLAG WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y 11971 CY
John M. Bredemeyer III, Preside' _pSUFF04 Town Hall Annex
Michael J. Domino, Vice-Presid=111r°' �s'�' C�Gy� = �' 54375 Route 25
Glenn Goldsmith o ` P.O. Box 1179
A. Nicholas Krupski o Southold, NY 11971
Charles J. Sanders dj, o� Telephone (631) 765-1892
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: �v `� Completed in field by: _ 7�
Michael Kimack on behalf of GIOIA TURITTO & NABIL EL-SHERIF requests an Administrative
Permit 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 along the entire seaside area of Lot 61.1,
and along the south-westerly side of the dock on Lot 62.1. Located: 1800 Park Way and 40
Beachwood Lane, Southold. SCTM# 1000-70-10-61.1 & 62.1
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=q 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: 1 II Unlisted Action
Type of Application: Pre-Submission Administrative Amendment Wetland
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line
'Additional information/suggested modifications/conditions/need for outside
review/consultant/application completeness/comments/standards:
Present were: /J. Bredeme er M. Domino G. Goldsmith �N.'Kru ski
Y � p
C. Sanders Other
Page 1 of 2
John M. Bredemeyer III, Presidei, i oS�FFO(�� Town Hall Annex
Michael J. Domino, Vice-President 54375 Route 25
Glenn Goldsmith o ` P.O. Box 1179
A. Nicholas Krupski o Southold, NY 11971
Charles J. Sanders ,4, foo Telephone (631) 765-1.892
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Completed in Work Session by:
Michael Kimack on behalf of GIOIA TURITTO & NABIL EL-SHERIF requests an Administrative
Permit 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 along the entire seaside area of Lot 61.1,
and along the south-westerly side of the dock on Lot 62.1. Located: 1800 Park Way and 40.
Beachwood Lane, Southold. SCTM# 1000-70-10-61.1 & 62.1
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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OFFICE LOCATION: ® MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor.Main Rd. &Youngs Ave.) cos ,e
Southold,NY 11971 Telephone: 631 765-1938
O Fax: 631765-3136
lyc®UNTY,�
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: John Bredemeyer, President
Town of Southold Board of Trustees
From: Mark Terry, LWRP Coordinator
Date: September 19, 2016
Re: LWRP Coastal Consistency Review for GIOIA TURITTO & NABIL EL-SHERIF
SCTM# 1000-70-10-61.1 & 62.1
Michael Kimack on behalf of GIOIA TURITTO & NABIL EL-SHERIF requests an Administrative
Permit 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 along the entire seaside area of Lot
61.1, and along the south-westerly side of the dock on Lot 62.1. Located: 1800 Park Way and 40
Beachwood Lane, Southold. SCTM# 1000-70-10-61.1 & 62.1
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 department, as well as the records available to me, it is my recommendation that
the action is CONSISTENT with the below listed Policy Standards and therefore is CONSISTENT
with LWRP provided:
1. Native vegetation is not disturbed or removed from the area.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
John M. Bredemeyer III,President O�*QF SQ�TyOI Town Hall Annex
Michael J.Domino,Vice-President 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski ® �Q Telephone(631) 765-1892
Charles J.Sanders ol�CoUN1V,� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Applicati
_Wetland Permit Application Administrative Permit
AmendmentJTran �gnsion
Received Application: f (pp
Received Fee:a 1®Di�
Completed Application
_Incomplete
_SEQRA Classification: D
Type I Type II Unlisted
Coordination:(date sent) C�i
LWRP Consistency Assessme t Form U% AVG 16 2016
CAC Referral Sent: $�-3l c l�
Date of Inspection: ,I
_Receipt of CAC Report: outhold Town
_Lead Agency Determination:
Technical Review: q
Public Hearing Held: —Il�l(O
Resolution:
Name of Property Owner(s) G/0/AZ'UP�,TL �N•�B>L �L J'.�>.�,(�/�
Address /6 Q �, ���-"'��.J'T. �}�T �6 i1/�GU jV,OAe IV. 0 d 6 jr
Phone Number:( ) 9/74,5— 6.5'�z
Suffolk County Tax Map Number: 1000- 'f 6—/Q — 61, / /x
Property Location:!4Q ���C111"apL�/f!�z7 t*_/0— 'd
(provide LILCO Pole#, distance to cross streets, and ocation)
AGENT: /CA/
Art/- A At /' C/G
(If applicable)
Address: Q. �� �7 f 0 ,�_ . Y.01
Phone: 6 ���j e5-407
`)ard of Trustees Applicata
GENERAL DATA
Land Area(in square feet): 4 _0,5�74 (,Foz;v
Area Zoning: R— 4 Q
Previous use of property: 92 f' moo)/rjoVV Q us, l6? VA 0441 - 4 6 7-
/,7
Intended use of property: ,fA/�`//S7�
Covenants and Restrictions on property? Yes No
If"Yes",please provide a copy.
Will this project require a Building Permit as per Town Code? 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 >e—No
Does the structure(s) on property have a valid Certificate of Occupancy?__ Yes No
Prior permits/approvals for site improvements:
Agency Date
ZRV��- 6 96 6 zo0e
6 — Z 0A
6� Z /2r�2 0,1g,
r,�vrr�s 61) ( J7e Z&16S
Y2 /0./ 2006
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): C OZ: 12
.A6 M( 05AZAMI Z 0 GeV 27
innoV cur_ 1Ga�� yE�
mrd of Trustees Applicata,' ;
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: /AV
C .e ZAZN
Area of wetlands on lot: /2 O 04' square feet
Percent coverage of lot: 29 %
Closest distance between nearest existing structure and upland
edge of wetlands: (0 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: gig feet 162.E f- l
Does the project involve excavation or filling?
No Yes
If yes,how much material will be excavated? N 0Al,6 cubic yards
How much material will be filled? IV OV,,5 cubic yards
Depth of which material will be removed or deposited: /V QW4 feet
Proposed slope throughout the area of operations: JV&Y r' eeTCl,,1 7DWARW GlJ�TZi2
Manner in which material will be removed or deposited: MIA
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):
ON
NN-DS iLIAIti 729W CV r AS T Y161PAI-,Y
I
61Z20
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:
oz
Project Location(describe,and attach a location map):
Wo C cU oo ,a dQZV oI-r2
Brief Description of Proposed Action: D !Z 1i W61V A L'ON
/_
,1'�® �Ua» /A/ e�,�jr �iY L 0 CA T!Mol s' �3�Y,O
�1I6N > Y.
7A1/v c07_W ,F1&� �,e-
Name of Applicant or Sponsor: rE_Melephone: ,ffZ 6S- _ 6 A17
C a L '4• gll'7 L *AMM.CAC- Z V" 2 A.M. J
Address:
City/PO: State: Zip Code:
dU�i1B� l/ 7/
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
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: I,t2•I ❑
3.a.Total acreage of the site of the proposed action? 0. 9 1V acres
b.Total acreage to be physically disturbed? Z acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? MWacres
4. Check all land uses that occur on,adjoining and near the proposed action.
Urban ❑Rural(non-agriculture) [—]Industrial ❑Commercial 'OResidential(suburban)
❑Forest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Pagel of 4
5. Is the proposed action, N
YES N/A
a. A permitted use under the zoning regulations? ® ❑
b.Consistent with the adopted comprehensive plan? ❑ L9 ❑
6. is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑ Pul
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: M ❑
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
LrX F-1
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 f�r and technologies: ® ❑
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water: /1/4b M ❑
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: %V,11 ❑
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? . � i( ❑
b.Is the proposed action located in an archeological sensitive area? LJ ❑
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? F-1-
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:
gShoreline El Forest ❑Agri cultural/grasslands El Early mid-successional
N Wetland ❑Urban Dd 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? ONO DYES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: F-1 NO DYES
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: ❑
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?
If Yes,describe: Pul ❑
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE 1S TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: C L C Date: ®4�2OV 6
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
1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land? ❑
3. Will the proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the ❑
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or �jj ❑
affect existing infrastructure for mass transit,biking or walkway? u
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? IZI
7. Will the proposed action impact existing: ❑
a.public/private water supplies? I
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 ❑
problems?
11. Will the proposed action create a hazard to environmental resources or human health? ❑
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
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 i pacts.
Town of Southold-Board of Trustees 1;2--14
Name of Lead Agency t Date
President
Print or Ty ame of ReSIP
ible Of icer in ead Agency Title of Responsible Officer
Si ture of Respo le fficer in Led Agency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
';ard of Trustees Applicata l
AFFIDAVIT
XM46b— BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE 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.
d
Signa operty Owner
SWORN TO BEFORE ME THIS /47�ti DAY OF (>&OV17- —, 20/ 6
Notary Public
MICHAEL A.KIMACK
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.02KIS056823
Qualified in Nassau County
Commission Expires March 11,2019
and of Trustees Applicati;,
AUTHORIZATION
(where the applicant is not the owner)
G/O/A MR/TTO X
I,NVYl1 �L. Jam/F residing at /,6 o �,r,U,T 6 S"�h-tl /Q�r 2 6 C
(print name of owner of property) (mailing address)
A46W y We ,vy /0 0,6 Sr do hereby authorize
(Agent)
WA','r�,f1 i(Cl"N C/C to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(Owner's signatur
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE,FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose_of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: �IM�CIC /`// r
(Last name,first name,.piddle 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 �C
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other,name the activity.)
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or business interest"Business interest"means a business,
including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation
in which the town officer or employee owns more than 5%of the shares.
YES NO /`
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this /9 day of 1' 20//-
Signature
3 Print Name 1 f/ C,d/.-W .tlt
Form TS I
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for permits* including Town of Southold agencies, shall complete ,this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area(which includes all of Southold Town).
3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. Thus, each answer must be explained in detail, listing both supporting and non-
supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions,it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
PROJECT NAME / E�,(��,�U�Q/77d = C Ute' _ph//e (j
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:
Ler—.12aGU/V �iy/Z LzT/`?/ �A4 ON Z Al
Location of action: 4® B, (,y�/o�� e, /K'/1aP--1UO t! gW tZINY
.S'O Ur."V CLO
Site acreage: 99Y
Present land use: kzf>�� Z'
Present zoning classification: Z�/1 W44
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: G/o/�[� 1.Z 17"2 AN0 -"OjF L EL .I'� Wle,
(b) Mailing address:— 16 a 64,r6,� Jr- APy" 2 d C
(c) Telephone number: Area Code( } ?,ZZ— ,5���— 6-4-44
(d) Application number, if any: 05--1 CIO/ 4906
Will the action be directly undertaken,require funding, or approval by a state or federal agency?
Yes ❑ No X 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 LWIZP Section III—Policies; Page 2 for evaluation
criteria.
mYes ❑ No ❑ Not Applicable
Y Cy7yW6 MF de&R—W6 6&.1 Zo—FS a o COA1- i7- 9M-',/44-
4b,rO1NJ41& 4047!x: Ax
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III-Policies Pages 3 through 6 for evaluation criteria
❑ Yes ❑ No 9 Not Applicable
11
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
72E/21--' cU V-rlN AWP4 6- h e,TE S
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III—Policies Pages 8 through 16 for evaluation criteria
❑ Yes ❑ No X 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
rf� 6014 x No .��'�t�cr &,A/ "425�e t rY
Y CO MM6 �M?,g!5 , %W6171 ZEE
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 Ar,,,-_ _;able
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 jW-_j' 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.
❑ Ye�] No Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICII',-,
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria.
❑ Yes ❑ No Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes ❑ No X 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 ❑ NoX 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 0 Not Applicable
PREPARED BY—a"WZ ��TITLE.— �G�jY�� BATE / �o/9