HomeMy WebLinkAboutTR-8908A John M.Bredemeyer III,P; __,Hent 0���F SoujyOl ` 1 Town Hall Annex
Michael J.Domino,Vice-President '` O 54375 Route 25
g P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski �pQ Telephone(631) 765-1892
Charles J.Sanders ycoum Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 8908A
Date of Receipt of Application: October 14, 2016
Applicant: Southold Sunsets, LLC
SCTM#: 1000-54-4-3
Project Location: 4200 Kenneys Road, Southold
Date of Resolution/Issuance: November 16, 2016
Date of Expiration: November 16, 2018
Reviewed by: Michael J. Domino, Trustee
Project Description: To install a 64' long post-and-rail fence along the:south::' .
westerly side-yard property line beginning at a point adjacent to the concrete
walk seaward to the southwesterly property corner. _
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 Per%mit allows-for the operations as indicated on the
project plan prepared by Michael Kimack, received on October 14, 2016, and
stamped approved on November 16, 2016.
Special Conditions: The addition of one 12"x12" "Private Property' sign on the
fence.
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, III
President Board of Trustees
zaf S0 Town Hall Annex
John M.Bredemeyer III,President
Michael J.Domino,Vice-President �® l0 54375 Route 25
_ P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A. Nicholas Krupski ® Telephone(631) 765-1892
Charles J.SandersFax(631) 765-6641
'10ou 1,��
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/silt boom/silt curtain
1St day of construction
Y2 constructed
V Project complete, compliance inspection
MAP OF DESCRIBED PROPERTY THIS DWELLING IS SHOWN TO BE WITHIN ZONE AE BASE
AT SOUTHOLD FLOOD ELEVATION (13) WITH MODERATE WAVEACTION ON
THE FEMA NFIP FIRM MAP NO.36103CO154H REVISED 25 SEPT.
TOWN OF SOUTHOLD, 2009 FOR THE TOWN OF SOUTHOLD,NY COMMUNITY NO.360813.
CO. OF SUFFOLK, ST. OF N.Y. �O ELEVATIONS SHOWN HEREON ARE REFERENCED _
SCTM NO. 1000 - 54 - 04 - 03 ,` TO VERTICAL DATUM:NAVD88
O5.17 SG
✓
Q � sc
x 4.47
NOTES: NG %�o SCALE: - -20'
AC:ASPHALT
AP:ANGLE POINT ✓ 7.14TOE
BK:BRICK V` NG 5.21
BLD:BUILDING V 8.48 TOP
BS:BOTTOM OF STAIRO / .0PROVED BY
CB:COBBLE BRICK // may®
CD:COMPOSITE DECK V x 4.59 / ��4RD OF%7U$,Tfa
ETW:EDGE TRAVELED WAY NG SG5.13 // 747/ TOWN OF SOUTA00
EX.:EXISTING
EX.SS.LAT.:EXIST SEWER LAT. --------�4 /
All g / 1' / V�rLGtyC f�j
FF:FINISH FLOOR 0� S / 8 53 TOP/ 7.23 GB i: �TE N®
GB:GRADE BREAK 0 G� // , /// // I .12 LAT),
GL:GAS LINE x 4.56 // / // ,1 7.91 GB I 1 N 7.09 x
L.S.:LIGHT STANDARD NG p , /// //.16 // / x 7.46 GB I j
MHWM:MEAN HIGH WATER MARK 4.99 1� /
NG:NATURAL GROUND, SG / OE/
P/W:CONNECTED TO PUBLIC WATERI -
,61
SG:SEA GRASS LIMITS SG4.9 , // TOP x GB \xsl92 1 of 10.04 NG�
SRF:SPLIT RAIL FENCE / 870 O
SSMH:SEWER MANHOLE •�G ,� f ,/� �� x 7.22 "GB j �(�10. Top VIC
TBR:TO BE REMOVeD 4.45 NG ��� // // GB 7GB
.35 1
TC:TOP OF CURB o0z TOE 6.9 /
/ / //Gs 3 % x 4
/ x 8.51
TD:TOP OF DOCK �b / / 18.55 // / I OE
TW:TOP OF WALL �1�,/ / \ TOP, ,%� //x10.531
WP:WOOD PLANTER ,/ / 7.48 GB 0 � '3 �i � GB
WV. WATER VALVE �' // % CP2X2 ��
TOE 6.74 / Q i� / 9.20 FD2X2HT
x4.59NG � SG 5.97// ETW 6.73 / x785 �� 0.28 t� x8,43
0 / TOEAP 6.84 x /// 7.88 GB Ge
o ,/ ,NX\ /'8.39 TOPAP // x9.41 / x9.12
0�� 'o���,// � /'� � � x772 /// /'/ GB x1o.o� GB
1► , TOE 6.71( / 1.37 GB / / / GB
TOPAP 7.91 ETW G� // ,/ 1/ NG743x
SG 5.38 5.61NG //// / TOE 784 \ // /// ��� x10.41 / O�►
GB
/ /// x9.28TOP1 / NG 9.75 �� x8.21 GB
--,GB777x / �kg�/ x11.06 GB / GB x x
8.47'/ � Eby _9 i �Q`A/ RSG/V� 8.45. ` / 9.66 x8.40 NG
TOE 6.36 TOP / �' CDA
�� � �® �ETW 8.09 �' t.�c� e ,,,Q.95
,6L�ANKAP 8.94 4� AP
i x 8.01 NCS GLS `X10.12 GB ry��
5.42SG �� - `- _ -PLANKAP 8:87 i' -- - 9 --
.5�'�AIG- - o
PLANKAP 8.9 1114 0 6 8.86 19MNKAP x x9.92 GB
x8.08 PCCAP8.76 .93 i� X9.70
8 71 7i GB RA a 8.55 DAP x 7.8 A(G GB 9.27x 5 x 9.20
TOP NG �;� � w? 845 x7.85 NG 783l+►Cz NG /
8.30�0 54LpTN 1BCDAP PLAN P G t
TOE / GB �O rccara Gp�G. p'�/�3�OQ' S�veZ 39 8H AP12.2X8.3 lb
PCCA 9.11 �o �6� ��' 0� 0 ��' T�% x9.29 CP2X2 0� /
18-16
�P PCCWDA CQ 11.41BLDAP 5,(0 cP- .05SHEDAI� x9.56
PERGA 7
`yam VlWv • 5 / -7 NG
NG �G Q
PCCEC 8.68 CC '>; y��10 /P.� G �� TEST HOLE / G��Q�
NDAP 8. 11 "10'byON 46. rv, X8.91
ENDWF 8.5/g h 10 TOE ,.•x9.04 NG
/ PCCAP 748 GUYS �� 01 J�V // x8'7 TOPTOEDL Pale brown fine to coarse sand SW
EP 6X6WFP 772 PCCAP 7. 5 ACSWAP G �' 10.58TOP
EP 6X6WFP 7.52 . i"••` • .31 ACSWAPN�5 iG�i 8.11
" NG 746 i Water M pale brown rine SW
EPWF 757,f• :;" ,• ;WDPLN END 8.1 11,75 FD.51P to coarse sand
EuEIVM LI-,`` • / x 51T0 11.50 NG
J P ,AIL;720 7 99S)tgN�Va�
Comments:Water encountered 8.1 below surface.
nI
OCT 14 2016 :vI s.90 • �� �o�x .38 lip, DATE OF TEST HOLE: 12 AUG, 2014
7 2s :WV 9.62 ,x s.os o BY:McDONALD GEOSCIENCE
POS o
Southold Town CNAI x7.05 , \ 6.58
Board fT a AC: -' ^' �'• A
ALL LOTS WITHIN 150 OF SCTM LOT 3
ARE CONNECTED TO PUBLIC WATER. f1''
6.88, :.,• V� ?', :,`•
SURVEYED:29 SEPT 2014 Ac z'
REVISION:02 APRIL 2015;HWM, PW CONNECTIONS 6.04
• AP 6.64
THE OFFSETS OR DIMENSIONS SHOWN HERON FROM THE PROPERTY LINES TO ONLINE
THE STRUCTURES ARE FOR A SPECIFIC PURPOSE&USE THEREFORE,THEYARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION
OFFENCES,ADDITIONAL STRUCTURES OR ANY OTHER IMPROVEMENT " A���788
UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THIS SURVEY IS A VIOLATION OF 5.81 OrX A lA*V SftRP0.V.7N0�7N40
SECTION 7209 SUBDIVISON 20 OF THE NEW YORK STATE EDUCATION LAW. COPIES ACAP
OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED SEAL OR PETER A. GROBEN
EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BEA VALID TRUE COPY. LAND SURVEYOR NY LIC. 50869
CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM OWNER(S) SOUTHOLD SUNSETS,LLC
THE SURVEY IS PREPARED, AND ON THEIR BEHALF TO THE TITLE COMPANY,GOV- P.O. BOX 704 RIDGE, NY 11961
ERNMENTAGENCY AND LENDING INSTITUTION LISTED HERE ON. CERTIFICATIONS LOT AREA 13,828 SF=.32 ACRES 631.849.4750
ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS.
NO RESPONSIBILITY IS ASSUMED BY THE UNDERSIGNED FOR ANY SURFACE, SUB- USE EXISTING SINGLE FAMILY DWELLING
SURFACE, AERIAL EASEMENTS,SUBSURFACE UTILITIES AND/ OR STRUCTURES
IN OR OUT OF EASEMENTS IF SO PROVIDED.
SCTM 1000-54-04-03
John M Bredemeyer III, Presi �d�o%UFF01,��0� Town Hall Annex
Michael J Domino, Vice-Pres'iaent v`��o Gy. j 54375 Route 25
Glenn Goldsmith o P.O. Box 1179
A Nicholas Krupski
y s Southold NY 11971
o -tea, ,
Charles J. Sanders ��o Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: . L /� �= Completed in field by:W
Michael Kimack on behalf of SOUTHOLD SUNSETS, LLC requests an Administrative Permit to
install a 64' long post-and-rail fence along the south-westerly side-yard property line beginning at a
point adjacent to the concrete walk seaward to the southwesterly property corner. Located: 4200
Kenneys Road, Southold. SCTM# 1000-54-4-3
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action
Type of Application: Pre-Submission 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:
o
Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski
C. Sanders Other
Page 1 of 2
John M Bredemeyer III, PresiOcufFO(K`, Town Hall Annex
Michael J Domino, Vice-Pres'i6en1 �� �Gy 54375 Route 25
Glenn Goldsmith o P O. Box 1179
A Nicholas Krupski o ® ? Southold, NY 11971
Charles J. Sanders 4, �ap�� Telephone (631) 765-1892
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Completed in Work Session by:
Michael Kimack on behalf of SOUTHOLD SUNSETS, LLC requests an Administrative Permit to
install a 64' long post-and-rail fence along the south-westerly side-yard property line beginning at a
point adjacent to the concrete walk seaward to the southwesterly property corner. Located: 4200
Kenneys Road, Southold. SCTM# 1000-54-4-3
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
SITE DECK x 4,59 // / Ir
TRAVELED WAY NG 5.13
:EXIST SEWER LAT. /
'LOOR O�'��'Sy // /// 8,53 TOP// 7,23 GB
BREAK /// I 12 LATH
STANDARD 4.56
.6 �0 5� / //� ///� 7,91 GB I NG 7.09 x
NG
iN HIGH WATER MARK ,x4,99 // /TOE/6/ l x 7.46GB I i 1 �s00
IL GROUND SG h / / / �/ 00O,
'CTED TO PUBLIC WATER 6 // //� , j
ASS LIMITS // /� �`8,70 x�,b1 GB I 10.04 NG�
RAIL FENCE SG 4,9 , / Top / \_61.92 1 v Z
ER MANHOLE e� // //� // x 7.22 GB 11 It 10. TOP d
REMOVgD 4,45 NG �pc�// /x 7.63 GS 7. 5 1 x 8A4 �/ I
CURB
DOCK �°�// /
TOE 6.9�`/ 18,55 G
// �/ I x
WALL ��,/ / // /\ TOP,/ x7,60 011lb x7,6.3/ /// �/X10'532LANTE
GB
VALVE R ��� ' // / / CP48 2X2 GB V� � / / �
`'� -TOE 6.74 /
3 PV SG 5,97// ETW 6.73x // - x.8& �� 0.28 4`
n / TOEAP 6684 / ,/� x;88 GB /C1 i �"GB
18,39 TOPAP / /9,41
// GB / / x9,12
x7,72 / / x10,011 GB
TOE6.71,1/// 1,37 GB 7 V.64/ // /� GB/
TOPAP\ 7.91 ETW
5.611 G /// TOE 7,84 /// x 10,41
x9.28 TOP/ GB / NG 9.75 �•
�\B7.77x /����o k x11.06 GB GB 9.66x x ^�
TOE 6,36 2 TOP 01 / ' ��' CDAQ
�` I �® /ETW 8.09 l I�c , -�J.95
/ Oo ` -PL/ANKAP 8.94 Q // x 8,01 NQ Gam' 1'0.12 GB
-
� - PLANKAP 8 9 /Bo° // .5�'AIG-------- - -� -
8,08 / 8.86 1911 NKAP x x9.92 GB
GB PCCAP8,76 .93 / �6 5�
8 71 � w 8,55 DAP X9.70 x 9.20
P� P a x 7.85`A(G GB 9,27.
9 6 ' OP 8,3000 54 TNNG G�y o/ r.reoonr /a 5 x7.85 NG 7.8b Nq NG
LA P / •!� PLAN P Q \1
GB accnne •� 39 6H AP12,2X8,3CP
j� C ,q 9,11 O '�6' �.(F O pb�'�� o O� f�// x9.29 CP2X2 y0�
l� t�-TOPO 11,41BLDAP 0 �1 5SHEDA
`
OCT 1 4 2016 PER 7
outhold own T H• /
f PC EC 8.68 O��''!` D�JOPP // 0 TEST HOLE
Boaa 1�5 �.��GQ�C�
NDAP 4 5 `JE 03 a6� x 8.Q-.1
ENDWF8,58 '8,7 TOE_ .x9.04
/ TOPTOEDL
PCCAP 7.48 G(JBY� �• 9` p� / x �r' Pale brown fine to cos -
EP 6X6WFP 7.72 PCCAP 7, \ GW /
5 ACSWAP
EP 6XGWFP 7,52 .31ACSWAP /G♦♦� 10.58TOP 8.
1'
NG�5 2lAP
'.
WPAP8,
NG 7.46 `(/ ♦ // Water/n pale brown f
EPWF 7.57x . -WDPLN END 8.1 11,75 FD,51P to coarse sand
•,; `�>...;•''� ':; ..'•:.;,;:•; //�/� 61T0 11,50 NG
CPCNAIL••7.20 .
Comments:Water encountered 8.1'below sura
,. :wvs.so �:: ,� \ �O\x 38 DATE OF TEST HOLE: 12 AUG, 20'
:;; ;' : �\ \ \ T qtr
x728 wiis:s2,• \� '9.09 'o BY:MCDONALD GEOSC/ENCE
CNAIL 7,05 ;'r' \��
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(3)Southold Sunsets LLC
Taken Oct.13,2016
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(4)Southold Sunsets LLC
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�U
James F.King,President i� Town Hell Annex r/y� 54375 Main Road
Bob Ghosio,Jr.,Vice-President �� +: P.O.Box 1179
Dave Bergen 1 1 Southold,Now York 11971-0959
John Bredemeyer Telephone(631)765-1892
Michael J.Domino Fax(631)766.6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 7880A
Date of Receipt of Application: June 21, 2012
Applicant:Vito&Dina Moles
SCTM#: 54-4-3
Project Location:4200 Kenny's Road,Southold
Date of Resolutionlissuance: August 22, 2012
Date of Expiration:August 22,2014
Reviewed by: Board of Trustees
Project Description: To;install a post and rail fence along the west side of the
property from the concrete walkway seaward,to be no more than 52' seaward of
the northwest corner of the existing deck-
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
application prepared by Vito& Dina Moles, received on June 21,2012, and
stamped approved on August 22,2012.
Special Conditions:None
Inspections: Final Inspection.
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chaplet 275 of the Southold Town Code,a
Wetland Permit will be required.
This is not a determination from any other agency.
Ames F. King,IPSVIdontr
Board of Trustees
00
J. 4ORMFn RX,
BOARD OF TRUSTEES 0+-J87
' TOWN OF SOUTHOLD
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'. ', ' .. NEW YORK. 11792
' igROLD,F.TRJINGHON JR. PENN Ax.
No. 117-E, 631-929-4699
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OFFICE LOCATION: � S®�ryO MAILING ADDRESS:
Town Hall Annex '`® l® P.O.Box 1179
54375 State Route 25 Southold, NY 11971
(cor.Main Rd. &Youngs Ave.) en sr
� ® �O Telephone: 631 765-1938
Southold,NY 11971
® Fax: 631 765-3136
c®UNTI,�c�'
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: John Bredemeyer, President
Town of Southold Board of Trustees
From: Mark Terry, LWRP Coordinator
Date: November 14, 2016
Re: , LWRP Coastal Consistency Review for SOUTHOLD SUNSETS, LLC
SCTM# 1000-54-4-3
Michael Kimack on behalf of SOUTHOLD SUNSETS, LLC requests an Administrative Permit to
install a 64' long post-and-rail fence along the south-westerly side-yard property line beginning at a
point adjacent to the concrete walk seaward to the southwesterly property corner. Located: 4200
Kenneys Road, Southold. SCTM# 1000-54-4-3
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 the LWRP provided that:
1. The Board determines that the fence does not impede or hinder public access along the
foreshore.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
Lown Hall Annex
John M. Bredemeyer III,President 54375 Main Road
Michael J. Domino,Vice-President P.O. Box 1179
James F. King,Trustee N: t Southold,New York 11971-0959
t
Dave Bergen,Trustee ' '' ,{�� Telephone (631) 765-1892
Charles J.Sanders,Trustee ='Y `r�'� � g4' Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Application Dpi
Aetland Permit Application --
dministrative Permit
-_ Amendment/Transfer! xtension OCT
Received Application: T 4 2016
Received Fee:
Completed Application:j P I + Southold Town
f Tr
SEQRA Classificat' n:
Type 1_.__ Type II Unlisted-----
Coordination:(dat
nlisted_-_-_Coordination:(date sent): !,/6/LWRP Consistency Assessment Form: 'tz
CAC Referral Sent:
Date of Inspection: 1
_Receipt of CAG Report: .
_Lead Agency Determination:'Z
Technical Review: -��
Public Hearing Held
Resolution:
Name of Applicant: zz C
Mailing Address: ,._.___...
/ /I GU Ya,��� //�3 5�� Phone Number: - /—V-
Suffolk
V_
Suffolk County Tax Map Number: 1000-
Property Location: r �O Yi' /f�/�
AF MAI 47Y-
(provide LILCO Pole#, distance to cross streets, and location)
AGENT:
(If applicable)
Address: • a 4&0' /0 47 . _ 0(,f I 27�
Phone:
,_hoard of Trustees Applical n
GENERAL DATA
Land Area(in square feet): A✓, i'2 7
Area Zoning: 1e- 4
Previous use of property: A � 1 �
Intended use of property: ��f'/,��/S✓ // L
Covenants and Restrictions on property? Yes X_No
If"Yes",please provide a copy.
Will this project require a Building Permit as per Town Code? Yes _ )e_ 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 - No
Does the structure(s) on property have a valid Certificate of Occupancy? Yes No
Prior permits/approvals for site improvements:
Agency Date
ego ..
A d/
Z
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency? X' No Yes
If yes,provide explanation:
Project Description(use attachments if necessary): �J�T�_. —/? ,ST
roB
3oard of Trustees Applicai n
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: (J square feet
Percent coverage of lot: 0 —%
Closest distance between nearest existing structure and upland
edge of wetlands: 6 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? Q cubic yards
How much material will be filled? �_cubic yards
Depth of which material will be removed or deposited: O ., feet
Proposed slope throughout the area of operations: oCL,4 7
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing;
Part 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 I 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 Pail 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:
X0 117-a
Project Location(describe,and attach a location map):
4'Z00 0 eAL-W /,6Y5_-AF9 _,C01Jr1-1060 , iii
Brief Description of Proposed Action: 1410 Al& fdtJTAI
7-0 COWC, Gr��L,L GUr�y r��GvA/Z/� d d iv d1V AUY 16V
C OkAl4e 0 6� fir- /AI
Name of Applicant or Sponsor: Telephone:
_"_ _ACe2 (a
Address:
0 Ux
City/PO: State: Zip Code:
I.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:
3.a.Total acreage of the site of the proposed action? _ W ` acres
b.Total acreage to be physically disturbed? 0. A70acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? , acres
4. Check al land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) ❑industrial Q Commercial WResidential(suburban)
❑Forest ❑Agriculture El Aquatic ❑Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action, NU 1'ES !\'/A
a. A permitted use under the zoning regulations? 1.4kJ
b.Consistent with the adopted comprehensive plan? ❑ '2R`J' El
6, Is the proposed action consistent with the predominant character of the existing built or natural _ NO _YES
landscape? Ll VJ_.
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO (YES
b.Are public transportation service(s)available at or near the site of the proposed action?
c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? lel L�J
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies:
10. Will the proposed action connect to an existing public/private water supply? >> _ NO YES
If No,describe method for providing potable water:
11.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 archeological sensitive arca? -
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`? 1:1 LK
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: A
Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional
29 Wetland El Urban Cgfsuburban
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, I—`7
a. Will storm water discharges(low to adjacent properties' �NO ❑YES l..W....l
b. Will storm water discharges be directed to established conveyance systems(ruiloff and storm drains)?
If Yes,briefly describe: NO OYES
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,darn)?
If Yes,explain purpose and sizer
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: _ _. ._....._...__- — _.-- _ L]
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 D /
Applicant/sponsor name: 6yV44 ,� f/�_�f� Date:
Signature:
Part 2-Impact Assessment. The bead Agency is responsible for the completion of Part 2. Answer all of the,following
questions in Part 2 using the information contained in Part I 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 Inrge
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations? IT] El_
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)? LLJJ
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? I_I
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 resutt 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 oroccurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and
cumulative impacts.
0(�'""� Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
EE��11 that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
HCheck 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 environment Iim qacts.
Town of Southold-Board of Trustees _
Namcof Lea Age>cy � ate
P President
Print or Type Na e�of Re�spon, e�Officer n ead Agency Title of Responsible Officer
Signature ponsibl nicer in Lead gency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
Board of Trustees Application
AFFIDAVIT
1'0 VoW olid P(Wro4TS 1104PIA164 LL C.
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 BOA OF TRUSTEES DURING THE TERM
OF THE PERMIT,
Signature of Property Owner
SWORN TO BEFORE ME THIS DAY OF 20 �5
Notary Public
Darlene Pozarycki
Notary Public State of New York
No: 011`05041596
Qualified in Queens County ��Woks
Commission Expires
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
GM's r-R,, IMM9residing at 12
(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)
`
. .
.
TRANSACTIONAL DISCLOSUU FORM
necossa!y to avoid sa
YOUR NAME:
(Last name,first name,qii ie 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 0yAPPLICATION: (Check all that opply.)
Tax grievance ___--____- Building _____
Tmx�� +�____'
Variance - _---- -
Change oyZone
Couuo�Dmxino
______,___
Approval o[plat Mooring
Exemption from plat urofficial mxpYluoulog
0dmr
(if°Othor-'numothe ucbvityj__ _________________
Do you personally(or through your company,spouse,sibling,parent,orchild)hmeun:\atiomhiywith any otOormemployee
of the Town of Southold? "Relationship"includes by blood,njarriage,or bu4iricss interest."Business interest"means a business,
including upartnership,inwhich tile town officer oremployee has even upartial'uvoor,s/iymr(uremployment by)ucorporation
iowhich the town officer nremployee owns more than 5%o[the shares,
YES NO
If you ansNyered"YES",complete the balance of this form and date and sign where indicated.
Name oyperson employed hythe Town ofSouthold
_______
?i||ourposition o[that person
_______________
Describe the relationship between yourself(tile iomiVhgpuViupmxnoxivo)and the town officer oremployee.Either check
the appropriate line A)through D)and/or describe/nthe space provided.
The town officer or employee or his or het spouse,sibling,parent,or child is(check all that apply):
tile owner of greater than j%n[the shares oythe corporate stock o[the upp|icnnx
(when the applicant iooxoqmmi ;
____B)the legal orbeneficial owner ofany interest inunon-corporate entity(when the
applicant bnot xoorpoo¢ion);
____Qooofficer,director,partner,oremployee ofthe applicant;m
the actual applicant.
DESCRIPTION OfRELATIONSHIP
.
-------------
Submitted this day ofLL&
Signaturo
Print Name
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 G 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 a plaJued in detail, listigg,both supporting and now:
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#
PROTECT NAME f'a VW12U) I'U/�/J'�,�3IJL,pIly6 S LL C
The Application has been submitted to (check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees knti
1. Category of Town of Southold agency action(check appropriate response):
(a) Action undertaken directly by Town agency(e.g. capital E
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: /AXPIA— L 1'6Jl 'AMP R4/4
ON& J' I-IM,E /?U D/�IlT
Location of action:
Site acreage: 6 .
Present land
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:y_ ,S'QC��/V DLA ,I'U �4Ld�/NG LLC .
(b) Mailing address:
(c) Telephone number: Area Code 90 DD
(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
E. Yes ❑ No,0 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 R' No R Not Applicable
IIIAW 9-r- CIA/ V ZPV-,4 Z
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 1:1 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
R YesEl No IX-5-1 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 LV*W Section III—Policies; Pages 22
through 32 for evaluation criteria.
Yes No Not Appficable
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 Do Not Applicable
Attach additional sheets if necessary
Policy S. 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 0 No 0 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.
YcX No 1-1 Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
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 ❑ NoLnj
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 rXil 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 N 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 �i� ,f� Cly TITLE DATE v ,/(