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HomeMy WebLinkAboutTR-9029A 1 *QF SO UTy Michael J.Domino, President Town Hall Annex�O� Ol0 John M.Bredemeyer III,Vice-President 54375 Route 25 ! [ P.O.Box 1179 Charles J.SandersCIO Southold, New York 11971 Glenn Goldsmith �l ® Y� Telephone(631) 765-1892 A.Nicholas Krupski �'C+oU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE /kP.�A Tev -r v' Cy7-4AcTvi2 Mse�r 779 /K4kK 130vtPM-S Pre-construction, hey bale Igne/at beeff4aNt-cuftafm 1St day of construction / % constructed V Project complete, compliance inspection *pF SO(�ly Michael J.Domino,President ��� Ol0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders C Southold,New York 11971 Glenn Goldsmith ® �Q Telephone(631) 765-1892 A. Nicholas Krupskil�c®Uffm Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9029A Date of Receipt of Application: May 22, 2017 Applicant: Carol &Joseph Kane SCTM#: 1000-33-1-3 Project Location: 3100 Sound Drive, Greenport Date of Resolution/Issuance: June 21, 2017 Date of Expiration: June 21, 2019 Reviewed by: Board of Trustees Project Description: To relocate existing large rocks at the bottom of the beach steps over to the west in order to gain beach and water access. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Carol Kane, received on May 22, 2017, and stamped approved on June 21, 2017. Special Conditions: Area Trustee to meet with Contractor prior to work starting in order to mark the specific boulders which are to be relocated and to specify no machine activity in order to ensure minimum disturbance. 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. � .� Michael J. Domino, President Board of Trustees 1c. 1 f � / a . a L)4,)>7 w S� APPROVED BY BOARD OF nUSTEES TOWN OF SOUTHOLD DATE :r*e Z( (20i7 �f MAY 2 2 2017 ' 1 Ob MAY 2 2 2017 Michael J.Domino,Preside E._. OHO C'®G Town Hall Annex John M. Bredemeyer III,Vice-President �� yj, 54375 Route 25 Charles J. Sanders P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski � �ap� Telephone(631)765-1892, �., Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD c'3Z17— Completed in field by: 0o•�'�Date/Time: � . _l CAROL & JOSEPH KANE request an Administrative Permit to relocate existing large rocks at the bottom of the beach steps over to the west in order to gain beach and water access. Located: 3100 Sound Drive, Greenport. SCTM# 1000-33-1-8 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: 10.0 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: Dr , 4t> /,R�-5:.gA 0--V� Present were: J. Bredemeyer XM. Domino G. Goldsmith V/"N. Krupski C. Sanders Other Page 1 of 2 .tea •, Michael J.'Domino,Presid, r��OSCOG Town Hall Annex John M. Bredemeyer II1,Vice President Z54375 Route 25 Charles J. Sanders P.O.Box 1179 Glenn Goldsmith r Southold,NY 11971 A.Nicholas Krupski 4,, ap�r�% Telephone(631)765-1892 1 Fax(631)765-6641 �''•'�xxr�xx`L" BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: CAROL & JOSEPH KANE request an Administrative Permit to relocate existing large rocks at the bottom of the beach steps over to the west in order to gain beach and water access. Located: 3100 Sound Drive, Greenport. SCTM# 1000-33-1-8 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 SURVEY OF pUND ✓{� MAKK LOT 109 L A Nr '� ORpIN�FI�Ep MhPtE 'EASTERN SHORES SECTION FOUR' ONG IS A5 PER FILED MAR. 7, 1966 FILE NO. 4586 Nao 00 pO..E 11E LINE 10 at OREENPOI�T ——— IOM BANK MI-M�vt TOWN OF SO UTHOLD ep-( SUFFOLK COUNTY, N. Y B NK h epJN�t 1000-33-01-08 �N� o STAIRSLANp�NG P� SCALE.- 1'=40' AS MODIFIED S APRIL 29, 1996 NW, MA Y 23, 1996 (FOUNDA 77ON LOCA 770N) �� JAN. 18, 2010 (FINAL) Q TOP OF BALK \' AUG. 31, 2010 (ADDI77ONS) YAGCARINODEC. 8, 2010 (RETAINING WALL) 02-08-2017 W AIN& WALL FE ° FE. GMF WE. DEC. 28, 2010 (ADDI77ONS) 0- Q�e� j JULY 18, 2016 (STAIRS AND LANDING) \1 FEBRUARY 7, 2017 9 -9 y'� SSONE y PPT 10 \may \'Ocp 5 G� 02� �2\So k �� o � wAQO09 U O@ — `� .s MAY 2 2 2017 - TO COLLUM ... "t • PIPE 115.29 FE, UTILITY FENCE P057 ® STAKE \2E eCOLE FPEO PICKET FE,O/L E PICKET FE. ® WATER C a' cri t ■ MOUNT EDGE PA 4 2 5. VALVE OF VE7 R.•r cy,Y a R� PAINT ON 60ULDER 58`f44'00"W 100.00' WITTH�MAI eo Es ANY ALTERATION OR ADDITION TO THIS SURVEY 15 A SOUND DRIVE:e i�� ,' y VIOLATION OF 5ECTION 72090E THE NEW YORK STATE ;u N. Y.S LIC. EDUCATION LAW. EXCEPT A5 PER 5ECTION EC EYORS, P.C. 7209-5U250105/0N 2. ALL CERTIFICATION5 HEREON ARE 631) 765-5020 FAX (631) , VALID FOR TH15 MAP AND COPIE5 THEREOF ONLY IF 5A10 P.O. BOX 909 MAP OR —OPIE5 BEAR THE IMPRE55ED SEAL OF THE , 5URVEYOR WH05E 5I0NATURE APPEARS HEREON. AREA = 30,984 SQ. F T. 1230 TRAVELER STREET A,� 3100 Sound Drive, Greenport, NYE 0 E C V E SCTM# 10QO-33-01-08 M AY 2 2 2011 Southold Town rVBoard Trustees— L) r r�i Ll f"�� ✓ .. _,+�`:,_ ♦ .p; awe ,G�� 4w���� a��� �/� � '• a' � � ti�sA FC oAN�s ry imp01. ' e T 77 — —74 3 9 � NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY @ Stony Brook,50 Circle Road,Stony Brook,NY 11790 P (631)444-03651 F.(631)444-Q360 www dec ny gov July 8, 2016 Ms. Carol Kane 3100 Sound 4= Greenport, NY 11944 RE: Permit No.: 1-4738-01259/00005 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with'any conditions please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. Please note, the permit sign and Notice of Commencement/ Completion of Construction form are sent to either the permittee or the facility application contact, not both. Sin a ely, Susan V. Ackerman Permit Administrator SVA/Is NEWYORK Department of OPPONiUNITV Environmental Conservation NEW YORK STATE DEPART,_ __,INT OF ENVIRONMENTAL CONSERVAi iON i Facility DEC ID 1-4738-01259 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: CAROL KANE KANE PROPERTY 3100 SOUND DR 3100 Sound Dr GREENPORT,NY 11944 Greenport,NY 11944 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Greenport Facility Principal Reference Point: NYTM-E: 719.87169954789 NYTM-N: 4554.79997880289 Latitude: 41°06'53.1" Longitude: 72°22'52.4" Project Location: 3100 Sound Drive Authorized Activity: Maintain beach access by moving 20' of existing natural beach rocks. Rocks will be scattered on the western portion of the beach property above mean high water. No structure shall be built on the beach using the rocks. All authorized activities must be in strict conformance with the attached plans stamped NYSDEC approved on July 8, 2016. Permit Authorizations Tidal Wetlands -Under Article 25 Permit ID 1-4738-01259/00005 New Permit Effective Date: 7/12/2016 Expiration Date: 7/11/2026 Water Quality Certification-Under Section 401 -Clean Water Act Permit ID 1-4738-01259/00006 New Permit Effective Date: 7/12/2016 Expiration Date: 7/11/2026 Excavation &Fill in Navigable Waters -Under Article 15,Title 5 Permit ID 1-4738-01259/00007 New Permit Effective Date: 7/12/2016 Expiration Date: 7/11/2026 NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict- compliance trictcompliance with the ECL, all applicable regulations,and all conditions included as part of this permit. Permit Administrator: SUSAN ACKERMAN, Deputy Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ St ny B 0ok150 Circle Rd Stony BroolA NY 1 90 -3409 Authori7eci NEW YORK STATE DEPART-_,_ NT OF ENVIRONMENTAL CQNSERVA'rIQN gammi Facility DEC ID 1-4738-01259 Distribution List "Habitat-TW SUSAN ACKERMAN Permit Components NATURAL RESOURCE PERMIT CONDITIONS WATER QUALITY CERTIFICATION SPECIFIC CONDITION GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS; WATER QUALITY CERTIFICATION; EXCAVATION &L FILL IN NAVIGABLE WATERS I. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work. 2. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 3. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 4. Storage of Equipment,Materials The storage of construction equipment and materials shall be confined to the upland area landward of the bulkhead or on a barge. 5. No Equipment below Apparent High Water Equipment operation below(seaward) apparent high water is strictly prohibited. 6. Rock Placement No rock shall be moved or placed seaward of Mean High Water. Rocks shall not be arranged in such a way that travel along the shoreline between Mean High Water and Mean Low Water is inhibited. 7. No Interference With Navigation There shall be no unreasonable interference with navigation by the work herein authorized. Page 2 of 5 a � NEW YORK STATE DEPAW, ;NT OF ENVIRONMENTAL CONSERVJ►t-10N v Facility DEC ID 1-4738-01259 8. State May Qrder Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 9. State May Require Site Restoration If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require, remove all or any portion of the uncompleted structure or fill-and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 1Q. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 11. Conformance With Plans All activities authorized by this permit must be in strict conformance with the,approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Carol Kane. 12. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. WATER QUALITY CERTIFICATION SPECIFIC CQ"ITIQNS 1. Water Quality Certification The authorized project, as conditioned pursuant to the Certificate, complies with Section 301, 302, 303, 306, and 307 of the Federal Water Pollution Control Act, as amended and as implemented by the limitations, standards, and criteria of state statutory and regulatory requirements set forth in 6 NYCRR Section 608.9(a). The authorized project, as conditioned, will also' comply with applicable New York State water quality standards, including but not limited to effluent limitations, best usages and thermal discharge criteria, as applicable, as set forth in 6 NYCRR Parts 701, 7Q2, 703, and 704. Page 3 of 5 Ask NEW YORK STATE QEPAR'+, 1rNT OF ENVIRONMENTAL ppNSERV—".aJN Facility QEC,In 1-4738-01259 GENERAL CONDITIONS - Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal,modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal, modification or transfer are to be submitted to: Regional Permit Administrator NYSDF,C Region 1 Headquarters SUNY(0 Stony 13rookl50 Circle Rd Stony Brook,NY11790 -3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Excavation& Fill in Navigable Waters, Tidal Wetlands, Water Quality Certification. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification,-suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; Page 4 of 5 y AM NEW YORK STATE DEPART ,'',NT OF ENVIRONMENTAL CONSERV;__�` taboo )N Facility DEC ID 1-4738-01259 d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically.prohibited by statute, regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. NOTIFICATION OF OTHCR PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Page 5 of 5 , / � \ ` ` ) l ) � / / ~ 41) OFFICE LOCATION: �®r S®���®l 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 ®l�C®U ,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: June 12, 2017 Re. LWRP Coastal Consistency Review for CAROL&JOSEPH KANE SCTM# 1000-33-1-8 CAROL &JOSEPH KANE request an Administrative Permit to relocate existing large rocks at the bottom of the beach steps over to the west in order to gain beach and water access Located: 3100 Sound Drive, Greenport. SCTM# 1000-33-1-8 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 proposed action is INCONSISTENT with LWRP Policy 6, specifically 6.3 (below) and therefore, INCONSISTENT with the LWRP. 4.2 Protect and restore natural protective features. Natural protective geologic features provide valuable protection and should be protected, restored and enhanced. Destruction or degradation of these features should be discouraged or prohibited. B. Maximize the protective capabilities of natural protective features by. 1. avoiding alteration or interference with shorelines in a natural condition The shoreline appears to be in a natural condition. The large rocks provide important erosion protection to the toe of the bluff which is evident in Figure 1 below showing receding shorelines on either side of the location where the rocks occur. a t a � _ Y. -Nil C) Dr - -- ,r 0 2097 Google Earth 1994 v "�� Michael J.Domino,President SOUTy® Town Hall Annex h0 l0 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith 0 ® �� Telephone(631) 765-1892 A.Nicholas Krupski ly�OUNT`l Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit r Amendment/Transfer/Extension ! ' Received Application. S, `17 100 MAY 2 2 2017 Received Fee: $ +0 Completed Application: Incomplete: eau};ri1�5ofsn� SEQRA Classification: Type I_ Type II Unlisted �- Aoard of;r��_:eek-�_,•___ _ J Lead Agency Determination: Coordination:(date sent): 6. �LWRP Consistency Assessment Form Sent: , CAC Referral Sent: Date of Inspection: •13.I Receipt of CAC Report: Technical Review: Public Hearing Held: bill-,17 Resolution: Legal Name of Property Owner (s): C41PI vz)s Mailing Address: Phone Number: Suffolk County Tax Map Number: 1000 - Y-13 t6 ? 3 ,-3- - 1 -9 Property Location: (If necessary, provide LILCO Pole#, distancd to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: 3oard of Trustees Applica 'n GENERAL DATA Land Area(in square feet): 3 a J D 0 Area Zoning: Previous use of property:' 4Z— 0 w L!6-a- — 4 S Intended use of property: Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes X 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? 'Y Yes No Prior permits/approvals for site improvements: Agency Date /din v, s;✓V�fvz,4 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): -Board of Trustees Applica' `>n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 6-ao er,,2NJ �(�� !} I�'.�L® u e� � rt)c�� �1_ --�D 0 t- Or- OVA �-�4� ��' rD)G 0 ,0') r Uj1 ' ' tv 11 LM er gf Al Area of wetlands on lot: © square feet Percent coverage of lot: O % Closest distance between nearest existing structure and upland edge of wetlands: feet le?/.61- Closest distance between nearest proposed structure and upland edge of wetlands: feet A/*E Does the project involve excavation or filling? No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I -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 1 -Project and Sponsor Information Name of Action or Project: `m uol- b-P-4&A Project Location(describe,and attach a location map): Brief Description of Proposed Action: 91 vi- v15 +4 Name of Applicant or Sponsor: Telephone: -7 a rto 0 L �n �441� E-Mail: C KtaY1 3 I f1'9 C rl !L 6�j Address: / 3f (� 4Vv" n� � . City/PO: State: Zip Code: 'e'S 1^--a 0 11 I) 5LI 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 -�g ❑ 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: 11 FXI . '_b- 2', C . --- hoc 44 P�Ak P7 III i_ V J-_vud 91i4 3.a.Total acreage of the site of the proposed action? 3 Z)L b nacres to 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? 3 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial J2 Residential(suburban) El Forest ❑Agriculture ❑Aquatic El 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: 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? Fclp F-1- c. c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ® ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ® ❑ 1 l.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: E� ❑ 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? ® ❑ 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: JiitShoreline ❑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 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ,[�]NO ❑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,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: Fci F] 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 name: ' Date: J� �! / 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? El 1-1 3. Will the proposed action impair the character or quality of the existing community? F71 0 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or F]affect existing infrastructure for mass transit,biking or walkway? �J 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate u reasonably available energy conservation or renewable energy opportunities? t� 7. Will the proposed action impact existing: El a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 r � , 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 I l ❑ problems? u 11. Will the proposed action create a hazard to environmental resources or human health? El 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. F] Check this box if you have determined, based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F] Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental i pac b Town of Southold-Board of Trustees (,p Name o >d Ag y Date J 6 Yh.t President Print or T e Name Respo ible fficer in Lead Agency Title of Responsible Officer Signature of Responsio Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Applicc" '<)n AFFIDAVIT B'` BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE _DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY-THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Sign re of P operty wner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 120 7� 7 r [ �1 gell Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. OID1475593 ®u011fled In Suffolk County d My Commission Expires April 30. 204 0 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. _ YOUR NAME: (Last name,first n e,.qiiddle initidl,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 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 Ifyou 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/agenttrepresentative)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 orbeneficial 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 ay of J� 200 l Signature Form TS 1 y Print Name -O �"J� —Board of Trustees Applica,,_,�Dn AFFIDAVIT 4 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner SWORN TO BEFORE ME THIS ZZtLA' DAY OF 114y , 2017 Notary Public DIANE DISALVO NOTARY PUBLIC-STATE Of NEW YORK No. OID1475593 Qualified In Suffolk County o My Commission Expires April 30, 20►_D APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. \,(� J YOUR NAME: / 4 (Last name,first Aame,ipiddle 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 Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other All M//�/S / jeA L) (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 a Zdaypf 200 Signature Print Name e41414 Form TS I 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 si flu icant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - - PROJECT NAME 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: JL. c:)- + 44t f OF L004 Location of action: " D 4 Site acreage: 3� " A ���- 3�,�`0 D S P Present land use: M 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: C4PapL- k--,'A"L (b) Mailing address: tr?) Lqy j-7 (c) Telephone number: Area Code 3,,SJ J V0-3 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No 54 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. F—]Yes ❑ NoNot 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 ❑ Yes ❑ No T Not Applicable i Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No [� Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No [Z 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. ❑ ❑ VN Yes No Not jlicable 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 IF/Vj, 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. ❑ © Not Applicable Yes 1:1 No PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. � ❑ Ye(] No p Not Applicable Attach additional sheets if necessary WORKING COAST POLIO_ �S 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 `tj 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 © Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No M Not Applicable PREPARED BY TITLE DATE/