HomeMy WebLinkAboutTR-8954A Michael J.Domino,President SOUrTown Hall Annex
John M.Bredemeyer III,Vice-President ,`O� ��� 54375 Route 25
P.O.Box 1179
Glenn Goldsmith Southold,New York 11971
A.Nicholas Krupski G Telephone(631) 765-1892
Greg Williams �� �� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 1601C Date:August 7, 2019
THIS CERTIFIES that the construction activities and land disturbance within Trustees
jurisdiction for a proposed swimming pool and pool deck; and to construct a±14'9"x26'10"
deck connected to the seaward side of proposed pool deck with 10' wide stairs to grade, and 6'
wide stairs that lead down to pool equipment storage area under the deck; install a 14'6"x15'6"
trellis on deck; and for a 3'2"x5'4" outdoor shower;
At 15919 Main Road, East Marion
Suffolk County Tax Map #1000-23-1-8.1
Conforms to the application for a Trustees Permit heretofore filed in this
office dated January 9, 2017 pursuant to which Trustees Administrative Permit#8954A
Dated February 15, 2017,was issued and conforms to all of
the requirements and conditions of the applicable provisions of law. The project
for which this certificate is being issued is
for the construction activities and land disturbance within Trustees jurisdiction for a proposed
swimming pool and pool deck; and to construct a±14'9"x26'1 0" deck connected to the seaward
side of proposed pool deck with 10' wide stairs to grade and 6' wide stairs that lead down to
pool equipment storage area under the deck; install a 14'6"x15'6"trellis on deck; and for a
3'2"x5'4" outdoor shower.
The certificate is issued to Edmond Franco owner of the
aforesaid property.
Authorized Signature
r
Michael J. Domino, President OF soyo Town Hall Annex
John M.Bredemeyer III,Vice-President �� l0 54375 Route 25
P.O. Box 1179
Glenn Goldsmith Southold, New York 11971
A.Nicholas Krupski G • Q Telephone (631) 765-1892
Greg Williams 'Ol coUNT`1Fax(631) 765-6641
y ,��
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: 7 l
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1St day of construction
% constructed
V Project complete, compliance inspection.
INSPECTED BY:
CO MENTS: ,
1A111 �
CERTIFICATE OF COMPLIANCE: 7 /
John M. Bredemeyer III,President �*OF SOUTyO Town Hall Annex
Michael J. Domino,Vice-President ,`O l0 54375 Route 25
P.O.Box 1179
Glenn Goldsmith isp Southold,New York 11971
A. Nicholas Krupski G ® Telephone(631) 765-1892
Charles J.Sanders �O Fax(631) 765-6641
COUfVN,�
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
1 st day of construction
Y2 constructed
Project complete, compliance inspection
SOF S0
Michael J.Domino,President �0� Ol0 Town Hall Annex
John M.Bredemeyer III,Vice-President 54375 Route 25
P.O.Box 1179
Charles J.Sanders v, Southold,New York 11971
Glenn Goldsmith ® ,� Telephone(631) 765-1892
A.Nicholas Krupski �yCOUN11, Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 8954A
Date of Receipt of Application: January 9, 2017
Applicant: Edmond Franco
SCTM#: 1000-23-1-8.1
Project Location: 15919 Main Road, East Marion
Date of Resolution/Issuance: February 15, 2017
Date of Expiration: February 15, 2019
Reviewed by: Board of Trustees
Project Description: Conduct construction activities and land disturbance within
Trustees jurisdiction for a proposed swimming pool and pool deck; and to
construct a ±14'9"x26'10" deck connected to the seaward side of proposed pool
deck with 10' wide stairs to grade, and 6' wide stairs that lead down to pool
equipment storage area under the deck; install a 14'6"x15'6" trellis on deck; and
for a 3'2"x5'4" outdoor shower.
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
site plan prepared by Ryall Porter Sheridan Architects, dated December 21, 2016,
and stamped approved on February 15, 2017.
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.
1 a
Michael J. Domino,
President Board of Trustees
Michael J. Domino,Presida '^ �oOSu�F�1XC0 Town Hall Annex
John M. Bredemeyer III,Vice-Pr�'sraent 54375 Route 25
Charles J. Sanders P.O.Box 1179
co
Glenn Goldsmith Southold,NY 11971
A.Nicholas Krupski ?� o! ! Telephone(631)765-1892
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time:f�i, Completed in field by:
Patricia C. Moore, Esq. on behalf of EDMOND FRANCO requests an Administrative Permit to
conduct construction activities and land disturbance within Trustees jurisdiction for a proposed
swimming pool and pool deck; and to construct a ±14'9"x26'10" deck connected to the seaward side
of proposed pool deck with 10' wide stairs to grade, and 6' wide stairs that lead down to pool
equipment storage area under the deck; install a 14'6"x15'6" trellis on deck; and for a 3'2"x5'4"
outdoor shower. Located: 15919 Main Road, East Marion. SCTM# 1000-23-1-8:1
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. SanitaryLeaching 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:
r
Present were: . Bredemeyer M. Domino �/ G. Goldsmith N. Krupski
C. Sanders Other
Page 1 of 2
Michael J. Domino,Preside ��pS '�C® Town Hall Annex
John M. Bredemeyer III,Vice-President 4��® ��� _ 54375 Route 25
Charles J. Sanders t ro � P.O.Box 1179
Glenn Goldsmith Southold,NY 11971
A.Nicholas Krupski p! Telephone(631)765-1892
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Completed in Work Session by:
Patricia C. Moore, Esq. on behalf of EDMOND FRANCO requests an Administrative Permit to
conduct construction activities and land disturbance within Trustees jurisdiction for a proposed
swimming pool and pool deck; and to construct a ±14'9"x26'10" deck connected to the seaward side
of proposed pool deck with 10' wide stairs to grade, and 6' wide stairs that lead down to pool
equipment storage area under the deck; install a 14'6"x15'6" trellis on deck; and for a 3'2"x5'4"
outdoor shower. Located: 15919 Main Road, East Marion. SCTM# 1000-23-1-8.1
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. :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
STEEL OR WOOD FENCE POST STEEL OR WOOD FENCE POST FRANCO
@ 10' MAX SPACING W/WIRE @ 10' MAX SPACING W/WIREF IR m in
SUPPORT, 36"MAX HEIGHT SUPPORT, 36" MAX HEIGHT H %J %JSL
GEOTEXTILE FILTER FABRIC GEOTEXTILE FILTER FABRIC 15919 Main Road
SECURED TO UPSTREAM SIDE SECURED TO UPSTREAM SIDE
East Marion, NY 11939
OF POST/TOWARDS EARTH OF POST/TOWARDS EARTH
PROPOSED AREAS:
DISRUPTION DISRUPTION
Pool (incl.copings 805 ft2 REVISION DATE
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Deck: 1,050 ft2
_- New Garaae: 715 ft2
Area within silt fence: 23,600 ft2
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COASTAL EROSION HAZARD AREA MAP
NOTE: � - -___�__-_ �.._-_.._.___ -_-_ ---___.- 12
PHOTO NO. 47-647-83 SHEET 17 OF 49 aw ,d .' r - _--
1. SILT FENCE SHALL BE PLACED ON SCLOPE CONTOURS TO MAXIMIZE PONDING EFFICIENCY. ,i J' r%1 j I /,� �- "`` _ - - - ------ _...... --------- - -----
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OFFICE LOCATION: � S® �® MAILING ADDRESS:
Town Hall Annex �® �® P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor.Main Rd. &Youngs Ave.) Telephone; 631 765-1938
Southold, NY 11971- ® �® P
® Fax: 631765-3136
COU
LOCAL WATERFRONT REVITALIZATION PROGRAM ,
TOWN OF SOUTHOLD
MEMORANDUM
To: Michael Domino, President
Town of Southold Board of Trustees
From: Mark Terry, LWRP Coordinator
Date: February 8, 2017
Re: LWRP Coastal Consistency Review for EDMOND FRANCO
SCTM# 1000-23-1-8.1
Patricia C. Moore, Esq. on behalf of EDMOND FRANCO requests an Administrative Permit to
conduct construction activities and land disturbance within Trustees jurisdiction for a proposed
swimming pool and pool deck; and to construct a ±14'9"x26'10" deck connected to the seaward
side of proposed pool deck with 10' wide stairs to grade, and 6' wide stairs that lead down to pool
equipment storage area under the deck; install a 14'6"x15'6" trellis on deck; and for a 3'2"x5'4"
outdoor shower. Located: 15919 Main Road, East Marion. SCTM# 1000-23-1-8.1
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 the LWRP provided that:
1. The Board establishes a non-disturbance, vegetated buffer landward of the wetlands to the north
and west excluding a walking path to the Long Island Sound.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency of the proposed action.
2/2/2017 Workspace Webmail::Print
Print I Close Window
5
Subject: Re: Franco-Surveyor
From: Will Robinette<will@ryallporter.com>
Date: Thu,Feb 02,2017 6:04 pm
To: Betsy<betsy@mooreattys.com>
Cc: Moore Patricia<pcmoore@mooreattys.com>
Attach: A100.pdf
Hi Betsy,
Sorry,I was out of the office all day.
revised A100 to clarify those dimensions,see attached.
I'm not sure what the first dimension they're looking for is,but
The stairs that lead towards the sea are 10'-0"wide and project 7'-7".
The stairs that lead down to the storage area are 6'-0"wide. �r
The trellis is 14'-6"x 15'-6"in plan and 10'-0"high off of the deck. D E '(��`--E al E
The shower is 3'-2"x 5'-4".
FEB - 3 2017
Southold Town
Will Robinette Board of Trutees
Ryall Porter Sheridan Architects
45 West 21 Street 4FI,New York,NY 10010
p>2122541175
f >212 254 1755
htto://www.[yalloorter.com
On Thu,Feb 2,2017 at 11:53 AM,Betsy<betsy(d)mooreattvs.com>wrote:
hi Will,
Trustees clerk just called.
needs dimensions of the deck that bumps out seaward
width of the stairs
dimensions of the trellis and outdoor shower
if you can get them to me right away,we can stay on the Feb.meeting calendar.
thanks.
Betsy Perkins LA
Moore Law Offices
William D. Moore, Esq.
631.765.4663
Patricia C. Moore, Esq.
631.765 4330
mailing & physical address:
51020 Main Road
Southold NY 11971
fax number for both
https://emai112.godaddy.com/view_print multi.php?uidArray=766571INBOX&aEmiPart=0 1/2
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'�-•.,� c PROPOSED POOL
&DECK PLAN
1 POOL EQUIP AREA(UNDER DECK) �,1 SWIMMING POOL&DECK PLAN Z
,? „4•.,Q A100
John M Bredemeycr Ill, President �`av' - �'/yO town Hall Annex
U l 54375 Main Road
Michael J. Domino, Vice-Preside ` P O Box 1179
James F. King, Trustee _``5
outhold, New York 11971-0959
Dave Bergen, Trustee G
Charles J. Sanders, Trustee 'Ql Telephon,6e;3(631)765-18892
BOARD OF TOWN TRUSTEES JAN 10 2017
TOWN OF SOUTHOLD
To: Southold.Tow_ h Building Department $UMDINGDEPT.
TOWN OF$OUTHOLD
Re: Verification of Building Department Permit Requirements
SCTMff: 3— g•
Property Owner Name: ` FkAyeoj F-Pao/yp
Date Sent to Bldg- Dept-: �' ��
The Office of the Board of Trustees is forwarding the above referenced application for
verification of the Building Departfnent's permitting requirements stated below:
YES NO
ill the proposed project require a Building Permit?
VV
the proposed project require a variance determination from
e Zoning Board of Appeals?
Will any part of this application be considered as Demolition as
described under Town Code?
COMMENTS:
gnature of Revi r Date
k Sa(/JJ� Town Hall Annex
John M.Bredemeyer III,President p Q` iti,
•; .` ,�. D 54375 Main Road
Michael J.Domino,Vice-President � .
P.O.Box 1179
James F.King,Trustee + Southold,New York 11971-0959
G.
Dave Bergen,Trustee
Telephone(631)765-1892
Charles J.Sanders,Trustee " '.
� �'aU� s� 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/Extension
V Received Application:- 1,Ri 1'
Received Fee:$ 100,n , � -i�i1 [E
Completed Application: < < K,.,- Lam, !; V 1i
Incomplete:. _ Pr_; C� I
_SEQRA Clssification: I
Type I Type II Unlisted
Coordination:(date sent): JAN e 9 2017
y;LWRP Consistency Assessment Form: Z'
C.A: 'Referral Sent: ' Southold Town
Date of Inspection: ' 2.-M'7 __Bciarc�gf Trus ep
_Receipt of CAC Report: ~,
_Lead Agency Determination:
Technical Review:
Z jublic Hearing Held: -15t t
Resolution:
Name of Applicant: Zifnon -_- +1--ralw-
Mailing Address: mast` CS�YLP / ff Q
10003 Phone Number:
7y
Suffolk County Tax Map Number: 1000-
Property
000-Property Location: - J J .9 1 _9 - Ka"'
__
(provide LILCO Pole#, distance to cross streets, and location)
AGENT: . Cell c Gt.CcI
(If applicable)
Address: MCA 1 n .._LQad (
1 `�I
Phone: (-_� ` L' -3—"s-D
l
Edmond Franco Project Description
1000-23-01-8.1
Within Jurisdiction of Trustees(adjacent Pond):
part of deck and stairs to deck will be 92' 11" from edge of Pond.
In order to construct pool and deck a 20' area of construction and land disturbance will be within
Trustees Jurisdiction.
Wetlands to be protected during construction by silt fence.
\) I
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): �, & (o s
Area Zoning: R- 90 _
Previous use of property:
Intended use of property: a c vourt +
Covenants and Restrictions on property? Yes V/ No
If"Yes",please provide a copy. /
Will this project require a Building Permit as per Town Code? `, Yes No
If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review
and Elevation Plans will be required. /
Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No
If"Yes",please provide copy of decision.
Will this project require any demolition as per Town Code or as determined by the Building Dept.?
Yes ✓ _ No
Does the structure(s)on property have a valid Certificate of Occupancy? ' Yes No
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approvals for site improvements. 4exc(std
Has any permittapproval ever been revoked or suspended by a governmental agency?__Z No Yes
If yes,provide explanation:
Project Description(use attachments if necessary):
www
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: / CY e GlG _ c�
Area of wetlands on lot: L_ c�yl square feet
Percent coverage of lot: C %
Closest distance between nearest existing structure and upland
edge of wetlands:__ p+ _ ' feet
Closest distance between nearest proposed structure and upland
edge of wetlands: _9 -`-It - _feet
Does the project involve excavation or filling?
X No Yes
If yes,how much material will be excavated? 1;0h!j S 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: �P1oti_
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):
-WoRk - - -
` 11
61 Z20
Appendix B
Short Environmental Assessinent 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 l 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 I'-Project and Sponsor Information
. 0;Wo,7cW
Name-of Action or Project: - -
Project Location(describe,and attach a location ma
Brief Description of Proposed Action:.
/Pao/ t' . - 0/ 1Le0
auld cvvPIC/
Name of Applicant or Sponsor: Telephone:
E-Mail:
Address: G-® E-0ST'
City/PO: A , ,/ � State: Zip Code:
��f J '7 /Doo 3
1.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
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)natne and permit or approval:
,0.
1a.Total'acreage of the site of the proposed action? �acres
b.Total acreage to be physically disturbed? acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? acres
4. Check-all land uses that occur on,adjoining and near the proposed action.
E]Urban ❑Rural(non-agriculture) ❑Industrial []CommercialResidential(suburban)
❑Forest ❑Agriculture ❑Aquatic EJ Other(specify):
❑Parkland
Page 1 of 4
5. is the proposed action, NO YES 'N/A
a.A permitted use under the zoning regulations?
❑ :❑-,
b.Consistent with the adopted comprehensive plan? ❑ ❑
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES:,
landscape? ;
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: _ _ _ i❑
8, a.Will the proposed action result in a substantial increase in traffic above present levels? NO 1 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? 171 •❑
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 technologics:p
❑•
t
10. Will the proposed action connect to an existing public/private water supply? NO_ YES
If No,describe method for providing potable water:-, _ _ _ _./VIA
� i
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? rjY ;❑,"
b.Is the proposed action located in an archeological sensitive area? IU_I ❑ ;
13.a.Does any portion'of the site of the proposed action,or lands adjoining the proposed action,contain NO iii YE
wetlands or other waterbodies regulated by a federal,state or local agency? j
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? -j '❑
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:.
/Od r GSpo? 4-z-
14.
-14. IddeAfy the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
LW Soreline El Forest ElAgricultural/grasslands El Early mid-successional
M 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'
_ _______ _ _LL
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO ESI
If Yes, I
a.Will storm water discharges flow to adjacent properties? ETNO DYES — ❑
b.Will storm water discharges be directed to established conveyance systems(rungff and storm drains)?
If Yes,briefly describe: NO YES
G
i
Page 2 of 4
` ` I
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
If Yes,explain purpose and size!
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:
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor (GAG[ _ Date-. /2 'Z3"1.
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 theproposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway? El
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing:
a.public/private water supplies?
b.public/private wastewater treatment utilities? El
8. Will the proposed action impair the character orqualityof 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)?
I
Page 3 of 4
t
i No,or Moderate j
small to large
impact impact
i
i may may
occur occur
j 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage a
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 siipporting 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 environmepa s
ntal i .
Town of Southold-Board of Trustees : b
Name of Lead Agency Date
President
Print or Type Na of Res oris` le OffiLead Agency Title of Responsible Officer
'Signature of Resp4hsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
SS
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r
Board of Trustees Application
County of Suffolk
State of New York
EDMOND FRANCO,BEING DULY SWORN DEPOSES AND AFFIRMS THAT
HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND
THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF
HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN
THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED
BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES
TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMIS CONJUNC N WI VIEW OF THIS APPLICATION.
t
N RAN O
3 ,
f
1
Sworn tbrefore me this
day of nCef4j be , 2016
4
1
Notary Public
E
S A. DUTAN
, State of New York#01DU6348630
Queens CountV
xpires Oct.3,2
2o20 ;
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Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
EDMOND FRANCO, as owner of premises 159Q9 e4 d Onebt NY (sctm:
1000-23-1-8.1)residing at d SMee`,Apt. 1 ew York NY 10003 do
hereby authorize my attorney, Patricia C.Moore,to apply for permit(s) and
appear before the Southold Board of Town Trustees on my behalf.
` !!: �(Owner's signature)
EDMOND FRANCO
i-
APPLICANT
TRANSACTIONAL DISCLOSURE FORM
(FOR SUBMISSION BY OWNER and OWNER'S AGENT)
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: FRANCO,EDMOND AND MOORE,PATRICIA C.
(Last name,first name,middle initial,unless you are applying in the name
of someone else or other entity,such as a company. If so,indicate the
other person or company name.)
NATURE OF APPLICATION.(Check all that apply)
Tax Grievance
Variance
Special Exception
If"Other",
name the activity:
Change of Zone
Approval of Plat
Exemption from Plat
or Official Map
Other Trustees X
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_X
Complete the balance of this form and date and sign below where indicated.
i
Name of person employed by the Town of Southold:
Title or position of that person:
Describe that relationship between yourself(the applicant) and the Town officer or employee. Either check the
appropriate line A through D(below)and/or describe the relationship 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 intei est 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 �n�,, "- /
Submitted this PO d of&,[-- ��Io
Signature:_
EDMOND F NCO
atricia C.Moore
- I
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
L 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 arid'adverse�effects upon,tlie coastal',drea fwlricli incl`udes�all of`Soutlrold_'Fown).•
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. Thur , 'bach:AhsWer iriust:be.ezpl hued iri';tletail,:listin bnth•sdonorting and-non--
sunporting 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# .-..�__
PROJECT NAME, 1 /g(?,49
The Application has been submitted to(check appropriate response):
Town Board ❑ PlanningBoard❑ Building Dept.
❑ Board of Trustees :--
I. 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) 0
(b) Financial assistance(e.g.grant,loan,subsidy)
(c) Permit,approval,license,certification:
Nature and extent of action:
1
Location of action:
Site acreage:. O�
Present land use: OyW
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: L drnorr/ 1 Gfi1�LC U
(b) Mailing address:_
n4 y• , l��° / adv� - --- - _
(c) Telephone number:Area Code O _ l� �� �o��' 3 75—
(d) Application number,if any: __Will the action be directly undertaken,require funding,or approval by a state or federal agency?
Yes ta, N61-10; 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.
Q Yes ❑ No ❑ Not Applicable ` 1 ` L
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III—PoIic' s 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 ;
Q YesE] No Q Not Applicable ;
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III—Policies Pages 8 through 16 for evaluation criteria
Elf Yes No Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
—Policies Pages 16throu 21 for evaluation criteria
0 Yes 0 No Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the'quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22
through 32 for evaluation criteria.
F1 'o
Yes No of 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.
E] 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. ee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
EJ Yes 0' 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.
YXI No Not Applicable
Attach additional sheets if necessary
� r
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.
0t
:Yes 0: 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 watNot Applicableers. See LWRP Section III—Policies;'Pages 57 through 62 for evaluation criteria.
1:11 Yes 0: No u ,
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 evalu ion criteria.
Yes ,0 No Not Applicable
Attach additional sheets ifnecessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pam 65 through 68 for evaluation criteria.
0 Yes :0 No Not Applicable
PREPARED BY_-.. ._,T C�./S!�Gffit' �iG��DGr P TITLE DATE z -