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HomeMy WebLinkAboutTR-8927A .. pFSOU ` LL John M.Bredeme er T1 ident o�� T of 1 Town Hall Annex Michael J. Domino,Vice-President O 54375 Route 25 P.O.Box 11 Glenn Goldsmith l Southold,New York 11971 A. Nicholas Krupski ® Q Telephone(631) 765-1892 Charles J.SandersCOUNTY, Fax(631) 765-6641 I� �� 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 Project complete, compliance inspection o� John M.Bredemeyer III, ,sident SOU�� ljflTown Hall AnnexO Michael J.Domino,Vice-President �� �� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Charles J.Sanders 'O ® Fax(631) 765-6641 UN% BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8927A Date of Receipt of Application: November 18, 2016 Applicant: Cameron Dowe SCTM#: 1000-90-1-5 Project Location: 975 Cedar Point Drive West, Southold _ Date of Resolution/Issuance: December 14, 2016 Date of Expiration: December 14, 2018 Reviewed by:, Board of Trustees t Project Description: To install a 4' wide by 78' long wood walkway from the.. shed to the dock. 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 survey prepared by John-C. Ehlers,1 nd'Surveyor;received on November 18, 2016, and stamped approved on,December 14,;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, III President Board of Trustees rxX'rr� n. John M. Bredemeyer III, PresidE a�Og�FFOtk�o Town Hall�Annex Michael J. Domino, Vice-Preside"nt ° ti;��� ��� _ ' 54375 Route 25 Glenn Goldsmitho 5 P.O. Box 1179 A.-Nicholas Krupski o = Southold, NY 11971 Charles J. Sanders 4,- �o� r Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES �n TOWN OF SOUTHOLD Date/Time: x-mac (,�. fes `/ ® ��/ Completed in field by: - Shawn M. Barron, M.S. on behalf of CAMERON,DOWE requests an Administrative Permit to install a 4' wide by 78' long wood walkway from the shed to the dock. Located: 975 Cedar Point Drive West, Southold. SCTM# 1000-90-1-5 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: r Present were: V✓ J. Bredemeyer �M. Domino G. Goldsmith - /N. Krupski . Sanders Other Page 1 of 2 John M Bredemeyer III, PresidEt1fF0(k�o Town Hall Annex Michael J. Domino, Vice-President , tido Gy�q 54375 Route 25 Glenn Goldsmith. y P.O. Box 1179 A Nicholas Krupski uo Southold, NY 11971 Charles J. Sanders �`yy �a��y;N Telephone (631) 765-1892 urf Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Shawn M. Barron, M.S. on behalf of CAMERON DOWE requests an Administrative Permit to install a 4' wide by 78' long wood walkway from the shed to the dock. Located: 975 Cedar Point Drive West, Southold. -SCTM# 1000-90-1-5 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 o_ r 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: Dates Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E._ Cantrell D. Di Salvo Other Page 2 of 2 SURVEY Of LOT 137 N AS SHOWN ON A CERTAIN SUBDIVISION MAP ENTITLED"SUBDIVISION MAP OF CEDAR BEACH PARK' FILED IN THE OFFICE OF THE CLERK OF THE COUNTY OF SUFFOLK ON 12-/20/27 AS MAP NO 90 SITUATE: BAYVIEW W E TOWN : SOUTHOLD SUFFOLK COUNTY, NY SURVEYED 0 1-08-201 G S PROP05ED ACTIONS 01-2G-201 G SUFFOLK COUNTY TAX# 1000 - 90 - 1 - 5 CERTIFIED TO: CAMERON DOWE MEGAN STRECKER t If ��{J { NOV 1 8 2016 i S�g ` Southold Town n F �� � �� •9' °Otic ,' �� RELOCATE d EXIST.FENCE S�2y c y,N�w cF' _ ALONG P/L i ,cep TO � S CD _ O �/ °Fc,���� A oRr d q c UsF s 0 O �oNrRr. 3• 3O�. 1 \ �Cl/. ^ � PROPOSED 8'FENCE i lr0 O V - - DOCK, RAMP_ = - - -- FLOAT - - �G O o 0) 10 O yy� •s I -_ , rrj 33G'TO OPPOSITE iN 'cP a c 51DE OF IAFt © _ v RAM gP &L ALK 0 A N p FLOAT 0x20' l Q» RAMP 32',.l 2' O 6 WALK 4'x 5' (8)8"PAPS P� 0 VIA 0Q z P ?op 2 vV s OP1 10 > la l N O :� N r� vv co N W b UI A N s .APPROVED`8y s Nr A r80ARD OF TRUSTEES s DOC RAMP j / FLOATW`N OF SOUTHOLD DATE q-, n, NOTES- "Unauthorized alteration or addition to a survey pi0 mop bearing o licensed land surveyors seal is a ® MONUMENT FOUND JOHN C. E H LE RS LAND SURVEYOR �� ®� BICE '�+ violation of section York subt division 2, of the �Y � New York State Education Low" 5PUT RAIL FENCE 0� "Only copses from the original of this survey —X—X— WIRE FENCE , �� , marked with from original o!fthethe land surveyor's (P mped seal shall be considered to be valid true P' copies' G EAST MAIN STREET N.Y.5. LIC. NO. 50202 Carl.ficotions indicated hereon signify(hot this survey was prepared in accordance with the ex— Area = 20,895 5a. Ft. RIVERHEAD N.Y. 1 1901 3G9-8288 Fax 3G9-8287 .sting Code of Practice for Land Surveys adopted t�j Q. by the New York Stale Association of Professional Area = 0.4797 Acres (� c O Land Surveyors Said certifications shall run only GRAPHIC SCALE I"= 30' longlelandlandsurveyor.com `��,s 502 ��� to the person for whom the survey is prepared, and on his behalf to the title company, herernmen— F sal agency and lending institution listed hereon,and LAND SV to the assignees of the lending institution. Certifica— I G-109 tions are not transferable to additional institutions �1ip ,� •. t Awy INV. t. i it 4 nwd 410. -yam � I � I ,@ - -- -- - r- 1 -1I---I-iI __� _ I pgy� ���aa5aaaa�eaaa� 12,/ 1 . 3 3 �` 71����„ ��� {. - `� �i -? +t' -sem� _ � • i "'!. �. '' - �_ - _ ti:. ?' `Ric+y�• r �'�• '�♦ " SHAWN M. BARRON, M.S. 124 Pleasure Drive,Flanders,NY 11901 631.786.6672 888.371.1833(fax) Shawn@barronenvironmental.com v I Photograph of the location of the shed with stakes indicating where the wood walkway will terminate. 11/11/16. The view is to the west-southwest. M Y ` 7 :a• 1 L } 2 L� �� i'J,�q� �F 1 Sf � • •i Q � C o.4 1.� M1 _ - c': S .,t. t �'tio •. ,.. ;fie, r ° M� ��;.... ... ��.j./H'3_ tie,�k.tr,A4. '.,., �nl _�:�Y.�. ... View of the path of the proposed catwalk from the bulkhead to the northeast,towards the proposed shed. 11/11/16. SHAWN M. BARRON, M.S. 124 Pleasure Drive, Flanders,NY 11901 631.786.6672 888.371.1833(fax) shawn@baffonenvironmental.com 6t,', Photograph of the location of the shed with stakes indicating where the wood walkway will terminate. 11/11/16. The view is to the west-southwest. { cry iPl•pf!nu�InlnLi 611_- _ x df r l +'Z r�i Lr ter �f�U�rl N r w�wi� :. 3;M �w iw � �1� �',f..,,.:i � ,"loaf iit •H... n�9��� C,y�1 r\�p ',ry��t��i�c`+1 jw,.�,+� pr �{iw I1t` �II� r zl..r R! 'R� .F ,F',�9';d'Sak.�.#7'5�o-_ae.. .. :ii►. .: .�.,'4' ..'.A W:L View of the path of the proposed catwalk from the bulkhead to the northeast,towards the proposed shed. 11/11/16. I SA(,) Op 16 O 22 is TO 'OF ft s as 83 04 2 2.3A(c) c 2 4 2 4 12 ------------ CeDAr? S., 0 PO1Ar-r 1 IA 14 W.OFSOUTHOLD 7 ZOA(.) Is 11 4 5A(c) (SO)26 Is islep 01 WEST LAKE 16nm R 41 is 2,1TOM is SOUTHOLD 141 E- 261 M) zm IS 21 25 IS M 1 20 ZD Iglr 19 19 :12A(.) TL 91 Zi ; I I IA(cy HOG NECK BAY T 7 OUTHOLID COUNTY OF SUFFOLK 0 SECTION N Realm A -x Se Q-40 - -- . 090 ONE!' Irr M I VMAW OFFICE LOCATION: ®� S® y®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 ® �� Telephone: 631765-1938 ® Fax: 631765-3136 l�c®UiVT`I,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President flD E E I V-E Town of Southold Board of Trustees D EC e 8 2016 From: Mark Terry, LWRP Coordinator Southold Town Date: December 8, 2016 Board of T Re: LWRP Coastal Consistency Review for CAMERON DOWE SCTM# 1000-90-1-5 Shawn M. Barron, M.S. on behalf of CAMERON DOWE requests an Administrative Permit to install a 4' wide by 78' long wood walkway from the shed to the dock. Located: 975 Cedar Point Drive West, Southold. SCTM# 1000-90-1-5 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 Policy Standards and therefore is CONSISTENT with the LWRP provided that: 1. The Board establishes a non-turf vegetated buffer landward of the bulkhead. Require that the buffer be shown on a survey. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. ..1 John M. Bredemeyer III,President �v`'\a ouff,�`T;: Town Hall Annex Michael J.Domino,Vice-President f+' ';' , . . � 54375 Main Road P.O.Box 1179 James F.King,Trustee , 711 t3 Southold,New York 11971-0959 Dave Bergen,Trustee ; C Telephone(631) 765-1592 Charles J.Sanders,Trustee CQ� IJ} Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application ,,,Wetland Permit Application Administrative Permit Amendment/Transfer/Ex eension Received Applic tion: �I�«�� (�Received Fee:$L00, _ �� � ' E Completed Application: � �� t- j Incom Tete: _SEQRAClassificati L� NOV Type I Type II 11 Unlisted 1 8 2016 Coordination:(date sent): V/'-LWr RP Consistency Assessment Form. 12.2, � CAC Referral Sent: Southold Town �1 Date of Inspection: Z'&,1b_ , Board f Tr s'ee,� _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: --121 1411b Resolution: Name of Applicant: Cameron Dowe MailingAddress: 975 Cedar Point Drive West,Southold,NY 11971 Phone Number: 917 218 1262 5 Suffolk County Tax Map Number: 1000- 90-1-/ Property Location:975 Cedar Point Dnve West,Southold +/-404 feet east of Little Peconic Bay Lane (provide LILCO Pole#, distance to cross streets, and location) AGENT: Shawn M Barron,M S (If applicable) Address: 124 Pleasure Drive, Flanders, NY 11901 Phone: 631 786 6672 Board of Trustees Applicatzvn GENERAL DATA Land Area(in square feet): 20,895 Area Zoning: R-4 0 Previous use of property: Single family dwelling Intended use of property: Sante 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? X 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 X No Does the structure(s)on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date Trustees-Dock October 19,2016 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): At grade wood walk from shed to dock assembly Ifw , t Hoard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: Provide stable platform to traverse the distance from the shed to the docking assembly. Area of wetlands on lot: +[ 550 square ft square feet Percent coverage of lot: 2.6 % Closest distance between nearest existing structure and upland edge of wetlands: 90 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0' feet Does the project involve excavation or filling? XNo Yes If yes,how much material will be excavated? 0 cubic yards How much material will be filled?0 cubic T yards Depth of which material will be removed or deposited: NA A feet Proposed slope throughout the area of operations: relatively flat Manner in which material will be removed or deposited: NA 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): It is not anticipated that the proposed at grade wooden walkway will have a negative effect on the tidal wetlands on this bulkheaded property. Board of Trustees Applica' . n AUTHORIZATION (where the applicant is not the owner) I, Cameron Dowe residing at 975 Cedar Point (print name of owner of property) (mailing address) Drive, West, Southold do hereby authorize (Agent) Shawn M. Barron to apply for permit(s)from the Southold Board own Trustees on my behalf. (Owner' signature) Board of Trustees Appl '_- ,tion AFFIDAVIT Megan Strecker BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FORT ABOVE DESCRIBED PERMIT(S) AND T14AT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISMER 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 8OARD OF'TRUS'T'EES 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. Signature of Property Owner SWORN TO BEFORE ME THIS ok -- DAYOF 20k-(p VASHU PATEL NOTARY PUBLIC-STATE OF NEW YORK NO.01PA6334587 QUALIFIED IN KINGS COUNTY My COMMISSION EXPIRES 12.21,2010 Notary Public Board of Trust6es Appl :tion AUTHORIZATION (where the applicant is not the owner) I, Megan Strecker residing at 975 Cedar Point (print name of owner of property) (mailing address) Drive, West, Southold do hereby authorize - (Agent) Slhawn . Barron _ __ to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANTIAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM (it' piciv-.1-i-in flic 11,111 t'l fk,,Vi)offtt:CrN aIII !111,;fill I]I is[I-)plovietc I I)I-0[T11,16'7I V0116 C-al I-.11M d Ir lown I i,:(",of III it to Take neces YOUR DAME- StTe cker,---- Megan (Last name,first name,tuiddle initial,unless you are coplying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity Do you personally(or through your company,spouse,sibi-ing,parent,or chilli it,l.ifi,m hip with any officer or employee of the Town of Southold'! "Relationship"includes by blood,Marriage,or bu.m(-.:. --i it iness interest"means a business; including a partfferShip,in which the town officer of employee has even a pais ril.•55 it,-i Jiij-tIj it yr employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES 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 cifthat petson Describe the relationship between yourself(the ipplicaiit/,igent/representative)and the town officer or employee.Eitlief check the appropi iate line A)through D)and/or describe in the space pr&ided. The town officer of employee or his or her spouse,sibling,parent,or child is(check all that apply)--. the,owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); I—C)an officer,director,partner,or employee of the applicant;Or the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this —day of 200 Signature PrintName 1, Form TS I Board of Trustees Application i AFFIDAVIT Cameron Dowe 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 OFA Y WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOA"F TRUSTEES DURING THE TERM OF THE PERMIT. SiAe&e of Property Owner SWORN TO BEFORE ME THIS DAY OF ,20 t� C' V Notary Public CHERYL WALLACE Notary Public, State of New York No 01 WA5008792 Qualified in Kings County Commission Expires March 1, 204 � S Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I Cameron Dowe residing at 975 Cedar Point (print name of owner of property) (mailing address) Drive, West, Southold do hereby authorize (Agent) Shawn M. Barron to apply for permit(s)from the Southold Board own Trustees on my behalf. (Owner' signature) i APPLICA.NVAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Town of Southold's Code of Ethics Dmhibits conflicts of interest on the Dart of town afticers and emalovees.The Du_mose of this farm'is to Xrovide infarinatioitwhieh can alert the town of possible conflicts of interest•and allow it to take whatever action is necessary to avoid same. J YOUR NAME' C^ (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 I(' 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 day of 200— Signature Print Name Form TS l � 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 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- Dowe - at grade wood walkway. Project Location(describe,and attach a location map): 975 Cedar Point Drive West, Southold, NY Brief Description of Proposed Action:4' x 78' at grade wood walkway from shed to docking assembly. Name of Applicant or Sponsor: Telephone:631 786 6672 T Shawn M. Barron, M.S. E-Mail:shawn@barronenvironmental.com Address: 124 Pleasure Drive City/PO: State: Zip Code: Riverhead _ _ �NY 111901 f.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that V F1 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: ❑ NYSDEC (submitted) 3.a.Total acreage of the site of the proposed action? <0 5 acres b.Total acreage to be physically disturbed? <0 05 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? _____acres 4. Check all land uses that occur on,adjoining and near the proposed action. E3 Urban E3 Rural(non-agriculture) [-]Industrial ❑Commercial V°Residential(suburban) ❑Forest ❑Agriculture Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 S.V Is the proposed action, NO _YES N/A a.A permitted use under the zoning regulations? E b.Consistent with the adopted comprehensive plan? ❑ W ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7.MIs 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? ® F-1— c. c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 0 El 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: Li 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Not-applicable _. _.___---- W 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Not applicable © ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � ❑ b. Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ IBJ 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 ❑Agricultural/grasslands El Early mid-successional ❑ Wetland ❑Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ® ❑ 16.Is the project site located in the 100 year flood plain? NO YES .21 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ® Ela.Will storm water discharges flow to adjacent properties? V1 NO [:]YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: VINO [_]YES 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 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:_____________,.�. _ _ tv� ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURA E TO THE BEST OF MY KNOWLEDGE ��/� (�_ 1 � /11 � Applicant/sponsor me:S AV" 1� ` (�CCA/� ._. Date: l` 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 Pant 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 Targe 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)? S. 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: T I� a.public/private water supplies? I—I b.public/private wastewater treatment utilities? EJ 1-1 8. Will the proposed action impair the character or quality of important historic,archaeological, Elarchitectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ I�l waterbodies,groundwater,air quality,flora and fauna)? �J 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? El 11. Will the proposed action create a hazard to environmental resources or human health? El F 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. EICheck 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 —��- Dates�_.__. 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 t 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 si cant beneficial and adverse effects upon the coastal area which includes all of Southold Town). 1 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 exl)lrined iii detail, listing both suQ)nortina and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000-90-1-5 - PROJECT NAME Dowe 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: 4' x 78' at grade wood walkway. Location of action:975 Cedar Point Drive West, Southold,NY Site acreage:20,638 square feet Present land use:Single family dwelling Present zoning classification:Residential 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:Shawn M. Barron, M.S. (b) Mailing address: 124 Pleasure Drive, Riverhead, NY (c) Telephone number: Area Code( )631 786 6672 (d) Application number,if Duly: Will the action be directly undertaken,require fielding,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 Rest 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 propose wood walkway is consistent in that it makes beneficial use of a coastal location and will be permitted so as to minimize adverse effects. 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 ❑✓ 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 [—I No ❑ Not Applicable In Mat the wooden walkway I beat grade,the floating dock will not have an adverse impact(s)on visual quality. 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 0 Yes ❑ No 1:1 Not Applicable The wooden walkway will be constructed-in a manner consistent with state and local building code regulations. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of$outhold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ❑✓ loot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Z Yes ❑ No W]Not Applicable 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 ❑Nowl 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. nYes ❑ No ❑✓ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye.-0 No Z 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 ❑ No a 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. W1 Yes ❑ No F 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 a 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 Shawn M.Barron . TITLE Agent DATE 10-30-15