Loading...
HomeMy WebLinkAboutTR-9031A Michael J. Domino'President �OF SQUTyo Town Hall Annex h0 l0 54375 Route 25 John M.Bredemeyer III,Vice-President .FAL P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A. Nicholas Krupski ®�i�COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection Michael J.Domino,President ®� Q� Town Hall Annex John M.Bredemeyer III,Vice-President O 54375 Route 25 P.O.Box 1179 Charles J.SandersCA Southold,New York 11971 Glenn GoldsmithG �® Telephone(631) 765-1892 A.Nicholas Krupski ��C®U N Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9031A Date of Receipt of Application: May 4, 2017 Applicant: Marilyn & Charles Southard SCTM#: 1000-56-5-22 Project Location: 435 Bay Home Road, Southold Date of Resolution/Issuance: June 21, 2017 Date of Expiration: June 21, 2019 Reviewed by: Board of Trustees Project Description: Ten (10) Year Maintenance Permit to hand cut the common reed (Phragmites australis) to not less than 12" in height on an as needed basis; 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 Charles W. Southard, Jr. Architect , dated May 4, 2017, and stamped approved on June 21, 2017. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar(Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder(Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 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. A Michael J. Domino, President Board of Trustees MAP OF WILLOW POINT SUBDIVISION °� sc File a 4652 Filed,June 16,14166 °�y ,��� \ry��U Conal Flood t0 S 5 Pond Situated At e� ��° P c+ � -�q � � Udd'� ARSHAMOMAQUE ° Q� ° W -4.8Town of Southold 4 $ -42 Suffolk County, New York W ' dock - 9 - 1 50TM# 1000-56-05-22 ° 0 ?1 ♦ vC -I. Qo Area = 15,854.65 sq. ft. or .518 acres T 't" ' • �, ab NOTES: Al. 1. Elevations are referenced to N.6.V.D. 14188 Datum 2. This property is in Flood Zone AE Elevation 6 10 ��. left t X as shown on flood Insurance 4 a° 4 Rate Map # 56105CO158H Zone AE: o g, �,0 °'• SUM flood determined .0 g 5. All information taken from survey + so -D"t + v Nltcation DAor +98 — by Nathan Taft Corwin III Land Sur v y l0 9' wst dated April 41, 20041, modified ,sA 0 4 January 14, 2014 4'1 +4 INIM Ob , Non-Fertillsatlon Wfor �• OdC 6 \ry0 ZONE q E CO ZOE...X . .................... ..... ..................... TC -0. ............................ e ti�N� ...... ................. ..... ..... T6+100 ' •••• •••• ••• T6+8DO Td,+1A0 Q w,0 T6 ADO T6+6.00 "all T6 w,00 '�- Ta+101W a hood Dock (j T6+10,00 MI ,g• TD+1489 l6 . �.�• Zl � � $ 6ARACIE ere�e'r TOS+E 4 T +a 4' Ing TA r � pp O q n Too of Find Yiofl N O T6 .00 TG+8 w � 4, -- - - - - Tg+100 Tg d0 +1.0 a Q Tg '� €9 N _ +D w Tg sif 1 ILI tat holy � Tg WA' O. O 8 gravel '� Ka Tg 46,w TG+8A B mstw D' N3'Td 14' 50" w +' + �31 EDGE OF PAVE MEN 455 45A I.D OF PA T .x.44 CvA5-PAW r BAY HOME ROAD AA WA MAIN + s '� S TOWN 01= SOUTHOLD GODS S I 7E FLAN_ scale 1" = 20.0' chapter 275 Wetionds and Shoreline 275-II construction and operation standards [2] Within creeks and other narrow waterways, no dock length shall exceed 1/3 the total width of the water body. Determination of the length of the dock must include the dimensions of the vessel. r [b] If any part of a residential dock structure Includes a float or floating dock, the float Y 'p or floating dock portion shall be designed so that, with the exception of the pilings: [i] It is no larger than six feet wide and 20 feet long except on Fishers Island if the need is =; = demonstrated; or of equal square footage as determined by the Trustees; i' MAY - 8 2017 [ii] No part of the floating dock will contact the bottomlond during a normal low tide. [c] In determining the permitted length of a proposed residential dock, the Trustees shall seek to maintain lengths consistent with the other docks (i.e., pier line) in the waterway which meet the requirements of this chapter. [d] Pilings shall not project more than threce of a dock or catwalk unless a ^� need for greater height is demon tr-ated;._ v �•' ``LL�� DD i] Charles K Southard Jr. : TQWN OF SOU THQ�Iint nonce Gutting of Phragmites R G I T G T ' for Southard Residence = I DATE TviF 2( 20 455 i3ay Home RoadI 17 435 Bay Home Road Southold, New York 114171 Southold, New York 114171 Phone (651) 4-11-5228 cwsarchitec ` May. 4, 2017 I Michael J. Domino Presi Town Hall Annex John M. Bredemeyer III,Vice-President ,`� y� , J 54375 Route 25 Charles J. Sanders cm z P.O.Box 1179 Glenn Goldsmith g Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD C� Date/Time: I.� �'�-C� Completed in field by: ��r� �1 i� J�(,-i _�►t� MARILYN & CHARLES SOUTHARD request an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis along the shoreline. Located: 435 Bay Home Road, Southold. SCTM# 1000-56-5-22 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: C� L) f C-0 k 1 _VaJ Present were: ZJBredemeyer M. Domino G. Goldsmith N. Krupski \.�/C. Sanders Other J Page 1 of 2 Michael J. Domino, Presi ��QSCD Town Hall Annex John_M. Bredemeyer III,Vice-President �$O G�j,', 54375 Route 25 Charles J. Sanders ; c P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: MARILYN & CHARLES SOUTHARD request an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis along the shoreline. Located: 435 Bay Home Road, Southold. SCTM# 1000-56-5-22 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 v+ ak^;_,�--, S`�''v.a:.a::'"�^C�t�(�{;y'w» y.'T "tA.4..:caa, '$t,,a_�,'#<'a4 """ �.:; •�]ww'^iyq�oa•s - - " i:"�.'Y�� �'�a=,La:v:M,Sw.>�,,'T,�d,+a$-i;°�K ;�;,yro't""ti'td�`.': �r �g.'s'�„�.^ �'1�� °3.T..+»a�w,c. ,C&- ±k ,as..s - "yr•• _ '..: :. ,�k� tP.-T 3 ,,qac+ .+�- "��Y ,d \• wi++. ^� a��+`r r ,t,n,.� ND %"' u ,Y' . t w Ila 2aAA(e) te?d:' ,�::`k';�'-'ri "a• ��-`Y':_i',•,n'.i.i oe:- r �} ._ Cc p'3.c`• Vit'`{"'- - ._•C` n .f.:''' .:,"x""'�"Pv nr TOWN OF e41•� 11 15 O SOU]NOLD a�P'"t C •F•%"`.• •Y'=]J,�;a- 'r r tis b` zo a+ tb 7,9 (CnNvrYpF]vLLOtX /' \e •dam PA 5 k"'abwayl- �ry��•^„t mo—C—) t Ve ,xP\ \ a • cN �p �• 4,3 COUNTY OF SUFFOLK fl yNt,) ; O f Optc) �• aP r p eOG 1� vin m` b 4 tip to , xo2 A roxNa 'e„ ° Y ,r J`.\ 15 5°u11gt0 tt 41 o°t.9 a ,� . O N1 �+ a total � •• <7A1d `` a�.n• Y3 \9 2 42 \p ,p p 70A a �e�, o"M- ''_ Q� k� e• `gip, e�sya°"' 277A MS Vie\ : tea�B PypO \3sntc\�� s ;+9 G,PFs 2+ \ g pe TO-1 � 2 * '4.+` \^ 'itis k "m" `B'�?� �,°"i ya. �:�P,g+ v � �/ `� `• �"� 17UIl :1 � �� vsi �( e,� tts a. B �,a,•a;•o�. ��®, 04 \¢W�,' �,O'¢f � �_ _ 2x5 2p Fg0"�� • V �,y�pQ�9 ,F�P�I��L�6` t •. tp� �d`",�.,p `�y't`O •D I �s � C tcovxrv°Lsuffoux S� �,°".e . t t 6p?�`t •, ,;tet t: 5O I 5 y25P fo'4 n 0 EM T Y' 4 1A(c) \ 1 0 .•.i`M'_ 1 3+ 't r •1 .o ff�2,7e `� ]�, td t`v`t`+�`;�\`` �� �1 W 0 gQONO Coll 25° 'S e„ 1o9A n1 te,` '!(2 FO yxs urcOVE°NinauFFitrnwx]s) d 9 \Q 1• t-tU a "a P F ,p 14A N 13 2'm ]� / 3.�Atc courm = 2o'en(c) )a9/ +'• ,y2t Q qy ♦ems// OF SUFFOLIq( /y © TOWN OUTHOLD .IO ,r O 4" BUMS 219 r✓•w \OT •b � .�� w // 15 MCC) « s�a�+ ap.i \ip ro tiA / rp e° IT 11 o ¢ � oc.'✓ '�yltltn � e d P p e'\e�,d• \ to / 6 0 62O s'r t5 ]`]/ � \ ,(1 a v / 1= ,, Bto n �r 2.5AIc) I z z' os 2e OBt 5a 13 o� is q r] FOR PCL NO i l 20 �p 13 W SEE SEC NO 1i :41 °55-0}015 'q xwxa s• p] ° iA rt a � a --- x]a tax R � earcH uxE is P MATCH —�—--- -----�----UNE ' 4f F.s[9ELN 055 n• m ' SEE SEC NO SEE — -- —— — "" NOTICE O� N COUNTY OF SUFFOLK o... -- ..�.•,r (2,) r O �.,.:,.� -- -- o,ww --n-- P a ew © E Tonin aF SOUTHOLD SECTION NO a�w — wdw "TExAxceAVDArax.aNaoe Real Property TaxServiceAgencyCounty Center WVFH:eaE,NYlf9al NEtAGE6 56 2] J121 NFt pFµrmpFFmY]zF wsixi°T x0 1000 PNOPERTYMAP -___ .,r�:��q...0 ^'_'.•j:�v':;^:;z.: r�s:�c"'�'.'�-+s��'-T��^.a.`,,-='''r-'>•�. :.y':,.o--'G;e�:�';w` F.:c�-;..C^"m*"^''m+•'_=�:--'-- _ _—__ __ _ _ _ _ ___ _ _ ___ _ _ :ia�::-� - - ___ _ •:Y' x'�.;.'r_?... -r. - »b'1�s'".w�:� _ %Yt^^s-... :>.+."«."... "':N5•'^^s../...��''��� _ _ +�_. _ u'y--+ .t;+,'.;,x G YYu:Ba�'r5�S•ry`ct••,�,^4 Y�"`._'nSuw •i•+.u'^'.^ar+1]'+-v%in.'.`.".�.'.F`�s'�.^.i _ _ _ _ _ '_ OFFICE LOCATION: �O S® y® MAILING ADDRESS: Town Hall Annex '`® �® P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) ess �e Southold, NY 11971 ® �� Telephone: 631 765-1938 ®l�C®UNN,�� 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 MARILYN & CHARLES SOUTHARD SCTM# 1000-56-5-22 MARILYN & CHARLES SOUTHARD request an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis along the shoreline. Located: 435 Bay Home Road, Southold. SCTM# 1000-56-5-22 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 CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. II,VTI Town Hall Annex Michael J.Domino, "' r President 54375 Route 25 John M.Bredemeyer III,Vice-President k P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A.Nicholas Krupski 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 Amendment/Transfer/Extension Received Application: -5,*17 17—Received Fee; 100,06- 54- V7 Application: - 4 ___2Completcd MAY 2017 Incomplete: SEQRA Classification: Type I' Type 11 Unlisted Lead Agency Determination: rr _15—ut h U I—d"-0,G) Coordination:(date sent): �LWRP Consistency Assessment Form Sent- CAC Referral Sent: ( Date of Inspection: _&.t 3-t-7 —Receipt of CAC Report: Technical Review: �A —Public Hearing Hefd- Resolution: Legal Name of Property Owner(s): Marilyn &Charles Southard Mailing Address: 435,Bay Home Road, Southold, New York 11971 Phone Number: 631.553-2340 '41 Suffolk County Tax Map Number: 1000- 56-05-22 Property Location: East Side of Bay Home ,435'south of Route 25 (If necessary,provide LILCO Pole distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Board of Trustees Application GENERAL DATA Land Area(in square feet): 13,834.65 Area Zoning: R-40 Previous use of property: 1 family residence Intended use of property: 1 family residence Covenants and Restrictions on property? X 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 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?__X_Yes No Prior permits/approvals for site improvements: Agency Date Town of Southold 2015 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): 10 maintenance permit to cut phraamit_es_ __ 1 I Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: Cut phragmites Area of wetlands on lot: 250 square feet Percent coverage of lot: 1.8 % Closest distance between nearest existing structure and upland edge of wetlands: 75 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: NA 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): None } Short Environmental Assessment Form Part I -Project Information Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: Catwalk&Floating dock for Southard Residence Project Location(describe,and attach a location map): Intersection of Route 25,East Side of Bay Home,125 South of Budd's Pond Rd on Canal off Budd's Pond Brief Description of Proposed Action: To obtain a maintenance permit to cut phragmites. Name of Applicant or Sponsor: Telephone: (631)772-7070 Charles W.Southard Jr E-Mail: cwsarchitect@optonline.net Address: 436 Bay Home Road, City/PO: State: Zip Code: 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)name and permit or approval: Town of Southold Trustees 3.a.Total acreage of the site of the proposed action? .318 acres b.Total acreage to be physically disturbed? .25 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? .318 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ®Rurgl(non-agriculture) ❑Industrial ❑Commercial 21 Residential(suburban) ❑Forest OAgriculture ©Aquatic ❑Other(specify): ❑Parkland Page 1 of 3 1 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ 21 ❑ b.Consistent with the adopted comprehensive plan? ❑ RI ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ RI 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? lv� ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: RI ❑ None 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? ❑ a b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ R If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: Canal off of Budd's Pond 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Q Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional 0 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? ❑ RI 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, Z Ela.Will storm water discharges flow to adjacent properties? ❑NO ❑YES b.Will storm water discharges be directed to established conveyance systemsMO f and storm drains)? If Yes,briefly describe: ❑YES Page 2 of 3 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: W—] ❑ 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: Wl ❑ I AFFIRM THAT THEN N VIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: yjet 4, Signature: Charles W Southard Jr PRINT FORM Page 3 of 3 rte, l r Board of Trustees Application AFFIDAVIT Charles W. Southard Jr &_Marilyn A. Southard 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 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 Prop Owner Si afore ofProperty Owner SWORN TO BEFORE-ME THIS DAY OF �"T 520 17 Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 qualified In Suffolk County My Commission Expires April 30, 2011 f t r ' f APPLICANU/AGENU/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i (1 The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The Purpose of 1' this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is 11111 necessary to avoid same. 1 YOURNAME: Charles W. Southard Ainitia � (Last name,first name,.t/tidunless 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.) ' Taxg rievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring i 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,njarriage,or business interest."Business intorest"-mcans 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 f If you answered"YES",complete the balance of this form and date and sign where indicated. r 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 1 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)Ute owner of greater than 5%of the shares of the corporate stock of the applic;int (when the applicant is a corporation); i 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 rd 20 Signature bio i Print Name Form TS 1 /���,n n, oo 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 signif cant 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# 1000 - 56 - 5-22 PROJECT NAME To cut phragmites for ten years The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 0 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: Review and Approval to construct ! 1 Location of action:_ 435 Bay Home Road, Southold NY Site acreage: .318 Present land use: Single family residence Present zoning classification: R-40 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: Charles W. Southard Jr (b) Mailing address: 435 Bay Home"Road, Southold N.Y. 11971 (c) Telephone number: Area Code(6P1-772-7070 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No❑ If yes,which state or federal agency? NYS Dept of Environmental Conservation C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ❑v'Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes 0 No 0 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ 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—Policiels-Pages S through 16 for evaluation criteria ❑ Yes,❑ No u Not Applicable Attach additional sheets if necessary r 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 rNot 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. Yes No 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 ❑ No D 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. F] Yes ❑ No L3 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. ❑ YeiD No%-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 HI--Policies; Pages 47 through 56 for evaluation criteria. El Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No ❑ 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[9-j Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PREPARED �y Xrieso thar TITLE Owner DAT, Nk� J.-201-7