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Home My WebLink AboutTR-9049A Michael J. Domino, President *of S®U��®l® � Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Charles J.Sanders Southold, New York 11971 Glenn Goldsmith ® �O Telephone(631) 765-1892 A. Nicholas Krupski IOroIV 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 1 st day of construction '/2 constructed Project complete, compliance inspection 1 SOF SOUj�, Town Hall Annex Michael J.Domino,President John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders Southold,New York 11971 Glenn Goldsmith ® �O Telephone(631) 765-1892 A.Nicholas Krupski ��C®UNTY Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9049A Date of Receipt of Application: May 26, 2017 Applicant: Muriel ,Peabody Loomis Trust SCTM#: 1000-49-1-18 Project Location: 125 Cove Circle, Greenport Date of Resolution/Issuance: July 19, 2017 Date of Expiration: July 19, 2019 Reviewed by: Board of Trustees Project Description: To armor landward terminus of bulkhead return with 6'- yards of 5001b.-6001b. boulders within the eroded area; all work to be limited,to the subject property. 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 Ian Crowley, dated June 30, 2017, and stamped approved on July 19, 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. Michael J. Domino, President Board of Trustees -= TOWN-OF SOUTHOLD DATE ltd cF ruic °4 f:ynyr,nuq 20 1 f�u�. RcNCA! ��s�rr�u� log' ��cks� �� &R'vk l""'p �'�� iA ry�ft�r[l� �il8tt�e- E�GC'Iaa1 �f SOZA7 o) r3t�}r� 'f r c�ks �F k'kss�l►iii( f �ft , t ��►�► � TbS)iyXZ-r eK_Ty. 1-so I� JUN 3 0 2017 aro Til &gcct Southold Town Board of TmWs Michael J. Domino, Presid, li„ o�p Uf¢0jC®G Town Hall Annex John M. Bredemeyer III,Vice-Presiaent �Z �� 54375 Route 25 Charles J. Sanders ° P.O.Box 1179 co Glenn Goldsmith o Southold,NY 11971 A.Nicholas Krupski �, pl Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: r I = Completed in field by: �f/d -V MURIEL PEABODY LOOMIS TRUST requests an Administrative Permit to armor landward terminus of bulkhead return with 6 yards of 5001b.-6001b. boulders within the eroded area; all work to be limited to the subject property. Located: 125 Cove Circle, Greenport. SCTM# 1000-49-1-18 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice 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: Present were: J. Bredeme er V/M. Domino �/ G. Goldsmith �' N. Kru ski Y p C. Sanders, Other Page 1 of 2 � Michael J. Domino, Presid. 1 �O CC' Town Hall Annex John M. Bredemeyer III,Vice-Pres dent rho G�j 54375 Route 25 Charles J. SandersN P.O.Box 1179 Glenn Goldsmith � Southold,NY 11971 A.Nicholas Krupski '1' p! Telephone(631)765-1892 HCl Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: MURIEL PEABODY LOOMIS TRUST requests an Administrative Permit to armor landward terminus of bulkhead return with 6 yards of 5001b.-6001b. boulders within the eroded area; all work to be limited to the subject property. Located: 125 Cove Circle, Greenport. SCTM# 1000-49-1-18 Ch. 275-12 - STANDARDS FORISSUANCE 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 orComment=* 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 .:`:,•yes' � � +�► W, � !� + r -_'".'•+yrs" -. w •' � rt _ � :• il r• � r �1�,�„'= .fir-3,,, 4 � �y � -_�__ - •_ _ 4 • ' ♦ 111 �' ' •'sem c Tit _ 4fs' Alb ir 17 Ir •. i ` 11 � DiSalvo, Diane From: DiSalvo, Diane Sent: Friday, April 28, 2017 9:40 AM To: Ian Crowley Subject: RE: Loomis return Ian: Just showed Mike Domino your photos,the permit and what you propose to do at 125 Cove Circle,Greenport-SCTM#: 49-1-18. He said you would need to do an Administrative application for the work. The next meeting you could get this on would be June 21,2017. The deadline for an Administrative application is Friday, May 26, 2017. The fee is$100.00. Diane Di Salvo Southold Town Trustees Town Hall Annex/First Floor 54375 Route 25 P.O. Box 1179 Southold, NY 11971-0959 (631)765-1892 Fax: (631)765-6641 -----Original Message----- From: Ian Crowley [mailto:icrowlev@optonline.net] Sent:Thursday,April 27, 2017 1:36 PM To: DiSalvo, Diane Subject: Loomis return Diane, Thanks for you help with this,we are looking to add 6 yards of 500-600 Ib boulders to protect this return. Please let me know what the trustees may require 1 r OWAMEAW- lp 4 r aj d5l.., w Aw ib y •_�$�1� l7.�y � �• L 'r � 'gyp�y• �. �.Rte. ■ J■-=fiJ �y y 40 jo 10 i R i • +' y iX e r r.+ 4 t y Al mom ti k A till +* _ ® ' � �\�.� •\urs SECTION BULKHEAD .i;00NSTRU.CT(ON SCALE 17, 3rXG CLAMP LENGTH OF BULKHEAD PROP -GRADEy -zt.C.Y;QFCL= AN -SAND "FROM,Asir UPLAND ,SOURCE 'Ep'R BACKFILL ; 4 ' p5 � m 2TO ALW � < J La w,n &ACH `N Lp w ; �0 0 >< 4 f a. x - ,o Lu ?r - 5 n ~ti ` "�. �.- r nom;� .�;< r -; •.�--��i~��°`^"' �"f � ��r.. _.-� •••,.;:. Zip J% :WR 'j�i'."F C{A c'.L^ •, p Y` Y ��,v�� 'A -�� i.., _•..;� i�fx_ �K vll:: "`�a�.'! ._, iii .�.�`,`' � -.�(R cl •�v *�� .� ��' ,� Agin Board -Of Southold Town Trustees: SOUTHOLD, NEW YORK '' J. PERMIT NO. . DATE: A-0-126195 . r Tei ;ISSUED-,TO _.......DR....ERL...�:....�00MIS.,... Pursuant to the provisions -of Chapter 615 of'the Laws of the Sta'te of New York, -1893; and`Chipter 404 of the Laws of the I State of New York 1952; and the Southold'Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS F, tiJ. � .•f. IN ,AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM. I ; = LANDS 'UNDER TOWN -WATERS;"-and in accordance with the Resolution of The Board adopted at a meeting held on .1.0/2619.5.. r 19 .95..., and in consideration•of the sum of $..15p,00 paid by € J.M.Q... Consulting. for.DR..EARL -A_LOOMIS.. k r °; of QroenpQrt.. ...... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and 'permits the following: A_n Wetland Permit to constr. approx. 101' of timber blkkhd. a 2011 f y' return and backfill with approx. 20 c.y. of clean sand truck. inrl� Sti ,4 from upland source, a 201 non turf, non=fertil. buffer• landward 41, blk d.�aaidL aritrris� a�d op blklead. r a in acc ance 4446 e ai ed s ec1 tca ions as presented in J_,; the originating application. i•µ c� IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to l' be subscribed by a majority of the said Board as of this date. ,`•��; 's) '� �=,4 ��77 +f / ip�--,� is •• ' } � ' #.��I � • � --- - Vit+ •�- ICY Trus..es ys� �z _.z��'r�.r:,��.is`ux•-,v�.s`_..a�,a��>��.a:,tet',%.'''• ' •,.1..�,7itL',:=��si:„�_r.�:s�vz�-.��=:`s",-yam�:,r: �rfi?yT"s;,+'�'"rd-��Y' '-�,'•'•, y• - �:t. f d• $�� -�.., `�' ��/<'-+�•�� :,SA^.�'� '�i11-:r` /--ate r l• -- •� rtt':lri• (t' ri. ' y ;,5H•�aAb=•• ? 'hd.��s U, iJ'Si\ti' + 'y ��\ ,��`\ ~~ ��+�,J• 'i'si 5'�j�. µ.Vi{�=u YY ',•Y_ rw- �p� <.. :;X _ � .z ?• ��`-p- ^�A tr�. .rl� �'.i- .�+,+J�'J�i,.�'�✓' Y .a•' .,�n�J` `Q' +iii`\y;. `•- fry :a°,A`� r+..i•'1• 4: 'A $ VON 09-1- ItE 7 6 0 e PjW pL Z 47 m15 14 21 4 SD r, ' n llxc) I OA(c) 23 - io I GNO '24 IA(.) 13 to li ICn 3 so 0 _ 0, 'T My 26 is I G) 2 U) (n 0 q � 2 ,o C: m -0 192 00 C. c� Cotz co NOTICE UNTYOFSUFFOLK K T—I OF SOUTHOLD SECTION NO L C E E (21) n4, ,, Real Tax Service Agency y Re. ...... 049 EA N 1. loss D P —PROPERTYMAP OFFICE LOCATION: ®��®f S® �®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 ® �� Telephone: 631 765-1938 c®UNT`1,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Mike Domino, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 14,2017 Re: Local Waterfront Revitalization Program Coastal Consistency Review MURIEL PEABODY LOOMIS TRUST SCTM# 1000-49-1-18 `MURIEL PEABODY LOOMIS TRUST requests an Administrative Permit to armor landward terminus of bulkhead return with 6 yards of 5001b.-6001b. boulders within the eroded area; all work to be limited to the subject property. Located: 125 Cove Circle, Greenport. SCTM# 1000-49-1-18 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 provided: 1. The Board requires clear cross sectional plans showing design of the action, including the top elevation of the boulders. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cantrell, Elizabeth From: Amy Loomis <awloomis1@gmail.com> Sent: Friday,June 30, 2017 9:44 AM To: Cantrell, Elizabeth Cc: ian crowley;Janet Markarian Subject: Re: Permission to submit revised proposal Attachments: Scan.pdf Hi Elizabeth, I just got off the phone with Ian and he will be down around lunch time to touch base with you. I've attached the updated map for the work below and give him permission to make any amendments needed to the project description that confirm this is work to be done within property boundaries. Please let me know how things go and if there are any additional questions or concerns that need to be addressed within today's deadline. Best, Amy Amy W. Loomis On Fri, Jun 30, 2017 at 9:29 AM, Amy Loomis <awloomis I ggmail.com>wrote: Elizabeth, Thank you for all your help this morning. As discussed, I am authorizing Ian Crowley to submit a revised proposal for work on 125 Cove circle to backfill our eroded land behind the bulkhead return. Please let us know if there are any other requirements on my end or his besides the updated drawings and project description. If you need to reach me for any reason, you can today at 617-320-4266. Please confirm when you've received all materials needed and thank you again! Best, Amy Amy W. Loomis i %0f SO(/r�, Michael J.Domino,President � Ol0 Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith � Telephone(631) 765-1892 A.Nicholas Krupski COU N 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 �• u l A 1 r Amendment/Transfer/Extension Received Application: Received Fee: $ Completed Application: MAY 2 6 2017 Incomplete: t SEQRA Classification: Type I_ Type II Unlisted Lead Agency Determination: Sauthoid Tav�n Coordination-(date sent): �LWRP b'�17 Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: 6-13 Receipt of CAC Report: Technical Review: Public Hearing Held: •Z Resolution: Legal Name of Property Owner(s): Mailing Address: C f 0 3(o Q.WSA �L6kL60m.,r 1,4 A 06('0_0 Phone Number: LL+ —T10 Zd "q 1_6(P Suffolk County Tax Map Number: 1000 - 41 9 -- Property Location: 611242 l (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Vr' Mailing Address: Phone Number: l �� -3 711 Board of Trustees Applicatxun GENERAL DATA. Land Area(in square feet): Area Zoning: Ras P�� Previous use of property: �o Ibh-lhndL Intended use of property: Ibra1T/A- - 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 '5e, No Does the structure(s) on property have a valid Certificate of Occupancy? _Yes No Prior permits/approvals for site improvements: Agency Date p �3 i J k' No'prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agericy?_,X_No Yes If yes, provide explanation: f; Project Description (use,attachments if necessary): -F vo- &a 4b M 11t� D �lIUN 8 �'b LL EFf I S 4 Board of, Trustees Application WE'T'LAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: T&AIME GE tgr gem1 lS �Ua m -iD Scow ow► -W EWW ,&C7W IW WdSIosl DY -`/W l4JWAEV Area of wetlands on lot: ® square feet Percent coverage of lot: % Closest distance betwee nearest existing structure and upland edge of wetlands: feet Closest distance betwee nearest proposed structure and upland edge of wetlands: A/ feet Does the project involve excavation or filling? No ►/ Yes If yes,how much material will be excavated? S cubic yards How much material will be filled? SSG cubic yards Depth of which material will be removed or deposited: 'r'� feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: s E 1 { Statement of the effect, if any,on the wetlands and tidal waters of the town that may result by r reason of such proposed operations (use attachments if appropriate): QJ, Q PIZAtU- /00 y �r ;L• 617.20 Appendix B Short'Environn:ental Assessment Forrn 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 publk 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 Nam of Action or Project: lS Revito &-mw- AmaL Project Location(describe,and attach a location map): // Brief Description of Proposed Action: Waal e7lv'A ¢cL. Name of Applicant or Sponsor: Telephone: E-Mail: Address: j City/P0: Slate: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? y If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that rZ;l ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. E 2. Does the proposed action require a permit,approval-or funding from any other governmental Agency? NO YES a If Yes,list agency(s)name and permit or approval: t 3.a.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? 4. Check all land uses that occur on,adjoining and near the proposed action. F-1 Urban El Rural(non-agriculture) ❑Industrial ❑Commercial 2 Residential(suburban) z' i ❑Forest' ❑Agriculture 171 Aquatic ❑Other(specify): ❑Parkland ; Page 1 of 4 . ,R 3,3 5. Is the proposed action, ,'O YES N/A a.A permitted use under the zoning regulations? ril❑ ❑ b.Consistent with the adopted comprehensive plan? F] El 6. Is-the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? IM❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO I YES If Yes,identify: 01 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation services)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? [i 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: ❑ 2( 10. Will:the proposed action connect to an existing public/private,water supply? NO YES If No,describe method for providing potable water: (�j ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:_ / lig- A 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 YE 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? El If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: j r i 14. N�Idd tify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: sphoreline ❑Forest ❑Agri cultural/grasslands ❑Earlymid-successional ❑ Wetland ❑Urban OSuburban t 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 I OOyear flood plain? NO y 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, f a.Will storm water discharges flow to adjacent properties? [?rNO DYES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: FKNO ❑YES r. 1 t,. Page 2 of 4 F: 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: [0 ❑ 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? � F-1lfYes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDG Applicant/spons name: Lc`rvvt+Q M PL , rl7— Date: ZZb 1--7— 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 LJregulations? El/2. Will the proposed action result in a change in the use or intensity of use of land? EY ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the 1:1establishment of a Critical Environmental Area(CEA)? EX 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate j� reasonably available energy conservation or renewable energy opportunities? EA- i0 7. Will the proposed action impact existing: E]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, n architectural or aesthetic resources? L—J 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 - t - No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Dead 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 ofoccurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. FJCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, 1 that the proposed action may result in one or more potentially large or significant adverse impacts and an x 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 impacts- Town mpa ts_Town of Southold-Board of Trustees 117 110 f 7 Marne of Lead ency -ate ( {'/ Ti (�ywlll� President Print or Ty e Nam of Responsibl Officer in Lead Agency Title of Responsible Officer i Signature of Respo ble Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) } 4l ly PRINT Page 4 of 4 kffj t: i� Board of Trustees Application AUTHOPJZATION (where the applicant is not the owner) I, L&CIOLy 0+0 64�KA residing at 3(p (print name of owner of property) (mailing address) `tk P"� Luvhk-�,T LUAT- LA,W-utw,I IAA JH 6 D do hereby authorize `Y�9-,VE% (Agent) Q to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) I , l 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.Thepurnose 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. YOURNAME: m W Kftj AIJ `T�� i (Last name,first name,giiddle 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 (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 V 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/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this , day f 2041 Signature—C�� Print Name7P M A i�-KA_-W Form TS 1 Y APPLICANT/AGENT/RIJPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest an the part of town officers and employees.The pgrpase of its form is to rimvide 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 name,griddle init ill.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 ofplat Mooring Exemption from plat or official map Planning Other (lf"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,to 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 500 of the shares. V ES _ NO Ir)ou ans%%cred"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),ourself(the applicant/agenUrepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. 's The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply)- i 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 i Submitted this �. day of -201'}^ Signature �—'• _ Print Name -. tma y ,L9b =� Form TS 1 Scanned by CamScanner Board of Trustees Application AFFIDAVIT A M j �-0® M t j 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. L(A , Si afore of Property O er � SWORN TO BEFORE ME THIS DAY OF-SA AQMh,- 20� Notary Public SUSAN C. PEW Notary Public COMMONWEALTH OF MASSACHUSETTS My Commission Expires December 14, 2023 I+ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question.in Section 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 e 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#10 D o PROJECT NAME L+MDOf &7OW cS r A lm. The Application has been submitted to (check appropriate response): i i 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) ❑ x (b) Financial assistance(e.g.grant,loan, subsidy) i (c) Permit, approval, license,certification: d f3 Nature and extent of action: MM Vg M w z. rJ r t Ole _ I §290` /b &L,02�U IT /'vtr'7OA-M vft 1rw1D rrved Location of action: IZC COW 6zW C-1R _►U�� ((qc(c/ Site acreage: Present land use: Present zoning classification: PSSObWft. 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: (b) Mailing address: (c) Telephone number:Area Code( ) (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes LJ No❑ If yes,which state or federal agency? 44i40*6ut 'TD AAjj/a,�j /i/'�/51 t 7- 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 E 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-LMW Section III—Policies; Page 2 for evaluation criteria: 1 x ❑Yes ❑ No pl Not Applicable Attach additional sheets if necessary • r, Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies.Pages 3 through 6 for evaluation criteria ` ❑ Yes ❑ No Not Applicable f Attach additional sheets if necessary Policy 3. ]Enhance visual quality anti' protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No iNot 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 Pa es 8 through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary s 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 s El Yes ❑ No Not Applicable 4 4 r� u t J Ott' Attach additional sheets if necessary r� h. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems includings Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluata n 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[Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LVVRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable s I i i PUBLIC COAST POLICIES s s Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public 4 resources of the Town of Southold. See LVW Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeFJ No Not Applicable E, }}f' t" p� �i 3 F r,. Attach additional sheets if necessary t ip. 1"' t WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of,new water-dependent uses in suitable locations. S e LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes [:1 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 aters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. 1:1Yes ElNo 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 1:4 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 Pages 65 through 68 for evaluation criteria. ❑ Yes F1 No ❑ Not Applicable PREPARED BY 40�ct TITLE l�rt_.� • DATE R-7-o 2 f