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HomeMy WebLinkAboutTR-9078A Michael J. Domino,President ��®f S011A, Town Hall Annex John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith G % � p Telephone(631) 765-1892 A.Nicholas KrupskiyC4UfdTY, O Fax(631) 765-6641 � �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1412C Date: November 13, 2017 THIS CERTIFIES that a One (1) Year Maintenance Permit to remove invasive weeds and plants; and for pruningofselected plants for improved root health; At 12400 New Suffolk Avenue, Cutchogue Suffolk County Tax Map #1000-116-6-12.1 & 12.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 23, 2017 pursuant to which Trustees Administrative Permit#9078A Dated September 20, 2017, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the a One(II Year Maintenance Permit to remove invasive weeds and plants; and for pruning of selected plants for improved root health. The certificate is issued to TODD FREED &EDITH WEBSTER-FREED owners of the aforesaid property: _ e o Authorized Signature *pE SO(/r�, Michael J.Domino,President �o� ®�® Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders CA Southold, New York 11971 Glenn Goldsmith a� Telephone(631) 765-1892 A.Nicholas Krupski l//Cot IN T1 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: °14/`1 C-'- Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction / '/2 constructed V Project complete, compliance inspection. INSPECTED BY: IV,ygUoy, COMMENTS: cft, Y'v C '�11.�1 CJ �f' �� �""t G aCV•,3 CERTIFICATE OF COMPLIANCE: �pF SO(/p�, Michael J.Domino,President �0� Ol0 Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Charles J.Sanders CA Southold,New York 11971 Glenn Goldsmith ® �� Telephone(631) 765-1892 A. Nicholas Krupski �'�&Uff � Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: D� .2-3 `1-at 7 4/ Ch. 275 Ch. 111 INSPECTION SCHEDULE / Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: - COMMENT: -z � a i CERTIFICATE OF COMPLIANCE: �pE (!j Michael J.Domino, President SO � yQIO 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 ® a0 Telephone(631) 765-1892 A. Nicholas Krupski Oif' Fax(631) 765-6641 J l �OUNT`l,� 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 ef-eonstr=#&n C 1�1�Pc.7"toAl . Y2 constructed Project complete, compliance inspection Michael J.Domino,President *o� SD�ly Town Hall Anne John M.Bredemeyer III,Vice-President � Ol0 54375 Route 25 P.O. Box 1179 Charles J. Sanders Southold,New York 11971 Glenn Goldsmith ® Q Telephone(631) 765-1892 A. Nicholas Krupski cDUNT`I, _Fax(631) 765-6641 �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9078A Date of Receipt of Application: August 23, 2017 Applicant: Todd Freed & Edith Webster-Freed SCTM#: 1000-116-6-12.1 & 12.2 Project Location: 12400 New Suffolk Avenue, Cutchogue Date of Resolution/Issuance: September 20, 2017 Date of Expiration: September 20, 2018 Reviewed by: Board of Trustees Project Description: One (1) Year Maintenance Permit to remove invasive weeds and plants; and for pruning of selected plants for improved root health. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Peconic Surveyors, P.C., last dated January 10, 2017, and stamped approved on September 20, 2017. Special Conditions: Method of clearing to be by hand, that vegetation is cut no shorter than 6' high, and that Trustees are notified during the "first" cutting. Inspections: "First" cut inspection & 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. Q 6 � Michael J. Domino, President Board of Trustees a Michael J. Domino,PresidO�QSVFFQ�/-COG S Town Hall Annex John M. Bredemeyer III, Vice-PtTsicient �� yJ, =f 54375 Route 25 r Charles J. Sanders - cz ti z P.O.Box 1179 Glenn Goldsmith % Southold,NY 11971 A.Nicholas Krupski ?, • p!• Telephone(631)765-1892 �C� �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time:_�//7 31� Completed in field by: Creative Environmental Design on behalf of TODD FREED & EDITH WEBSTER-FREED requests an Administrative Permit for a Ten (10) Year Maintenance Permit to remove invasive weeds and plants; and for pruning of selected plants for improved root health. Located: 12400 New Suffolk Avenue, Cutchogue. SCTM# 1000-116.-6-12.1 & 12.2 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 NoticeofHearing Card Posted: Y / N Ch. 275 v Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 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: fia k A-,P(e ok -) ,''prole e W eed� o K TO j CeoA C ra f G l yeG✓ ��Cr . /0 Present were: Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino,Presid, o�QgUFF0440 Town Hall Annex John M. Bredemeyer III,Vice-President �� y� 54375 Route 25 r Charles J. Sanders y Z P.O.Box 1179 Glenn Goldsmith • Southold,NY 11971 A.Nicholas Krupski y p! Telephone(631)765-1892 ��� �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Creative Environmental Design on behalf of TODD FREED & EDITH WEBSTER-FREED requests an Administrative Permit for a Ten (10) Year Maintenance Permit to remove invasive weeds and plants; and for pruning of selected plants for improved root health. Located: 12400 New Suffolk Avenue, Cutchogue. SCTM# 1000-116.-6-12.1 & 12.2 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 Tjown: 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: i Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 i STREET ADDRESS: 12400 NEW SUFFOLK AVENUE SCDHS = RIO-14-0019 SURVEY OF PROPERTY AT C TCHOG UE TEST HOLE DATA TOWN OF SOUTHOLD BY McDONALD GEOSCIENCE ptse rG G 47N SUFFOLK COUNTY N; y DD F C E � V �[ 6/11/13 R) 1000 1.16-08 12.1 & 12.2 F L. 6.5" tDKrNG SCALE.- 1'=30'1 111 AUG 2 3 "J DARK GROWN LOAM OL pUBUC WA7;;� JULY 2. 6, do 2012 O. H) ZO�� BROWN CLAYEY SAND SC Q SEPTEMBER 6, 2013 (REVISIONS) Southold lawn SEPTEMBER 1C, 2 o 13 (LOC. VEGETATION) o t d.loon s I 3' ''`'` Ytccur�r�o NOVEMBER 22, 2013 (SETBACK LINES & LOC. TREES) c to n8 Zi PALE BROWN FINE SAND SP DECEMBER 3. 2013 (EDGE Of 8EA4`N hi.A6'S) ? FEBRUARY 5, 201+4 (PROPOSED HOUSE) EL 1.4' ATE 5.1' tpA �yACANr} �BAPRRL 24. 2014 (REVISIONS)Y 11, 2014 (SEPTIC YSTEM} un, +11rp �r'UBLiC A! MAY 20. 2014 REVISIONS WATER IN PALE BROWN FINE SAND SP ~---�__-_ S]s• Wa Zd" R rN SIRE£ ~~ JULY 2. 2014 (REVISIONS) (ADDITIEI, ONS) ) 1 A� JULY 29, 2014 (REVISIONS) a r r -t-_� JANUARY 15. 2015 (FOUNDATION LOCATION)12' �. 1 r - MAY 13, 2016 (FINAL) Alirm --_- MAY 31. 2016 (REVISIONS) r NOVEMBER 7. 2016 c;' f" r ` __ '`,,- `� NOVEMBER 17. 216 (REVISIONS) DRAINAGE CALCULATIONS + ;,4 DECEMBER 20. 2016 (REVISIONS) r r+ 1 00 DECEMBER 29, 2016 (REVISIONS) r � - SMALL MASONRY TERRACE 1K.,�r? � F z.' !� r $ �-� JANUARY 09. 2017 (REVISIONS) ? 4 ?. JANUARY 10, 2017 (REVISIONS) 150 sq.ft. x 2 X 1 - 25 cu.ft 4?l'� .t _4 ?hJ I ? CCCS1 USE POOL. DISCHARGE DRY WELL io r G 8*0 x 4' DEEP = 201 C.F. to � LARGE MASONRY TERRACE ADJACENT TO HOUSE f(Y1 It 1 J 's r Z j L-' tl 464 sq.ft. ( ( f 464 sq.ft. x 2'x 1 = 77.5 c.f. f 4 jp) r1 CI USE 8'0 x 2' DEEP 84.4 C.F. 11 r 3r r + I x r � + SMALL MASONRY TERRACE ADJACENT TO POOL `` s r it r�5I 374 sq-ft• kr tin f - d 374 sq.ft. x 2"x 1 - 62.5 c.f. 8'0 x 2' DEEP = 84.4 C.F. tP _ J 10 �- ,. sr i o w' M =>-- a r ;'?? -- `� --- ; ,'; « NYDEC ADJACENT AREA TABLE - s - -� ?1 r zw r1 +_-- DESCRIPTION AREA LOT COVERAGE I _ r fl AREA WITHIN 300' OF WETLANDS 45,122 sq.ft. _ DR' �. F EXISTING HOUSE & PORCHES 4,550 sq_fL 10.1% VrWA _ �i( g �'� + PROPOSED MASONRY TERRACES 9$8 sq. 2.2% ON GRADE ix STOjv r PROPOSED POOL 675 sq.ft. 1.9% -~- i i J �\ ; ,� ; (� EXISTING BRICK WALK 240 sq.ft. 0.5% DRIVE " EXISTING APRON 248 sq.ft. 0.6% WAY EXISTING CELLAR ENTRANCE Lry„ 3� 63 sq.ft. 0.1% EXIST. B.S. PART OF DRIVEWAY 1404 sq.ft. 3.17 PROP. LOOSE SLATE WALKS 392 sq.ft. 0.996 _ TOTAL 8560 sq.ft. 19% -. ftci ot] � sp _ 2 STgR es �� ...�_.._... F-RAME r�r i z pRB•fiCT 8s x 4�+gRgF F?N.- I-/0 S UW °p4' 'O' �DWL R. FL �7 U � ! P W RF1{�y %0 SAL?- ? 5?;- o pU$ wNG Wr 28` N +' Pow+u� , t `�` �'` I WA W rH ;� +� TOWN OF SOUTHOLD BUILDABLE LAND lo c� -- -� GOEO_ o �I �+�` DESCRIPTION AREA LOT COVERAGE PR ;fey " STONERS �`� ` I;w;�' v' _ 57,181 sq.ft. ' "`;rw --�0 _ `"'`-A i `-y' � �; = n� EXISTING HOUSE & PORCHES 4,550 sq-ft- Z, 7.97 - _WCE ` r moots= -_' �'t_ :.:'- 2 �' Q; �a fAEQrj� dVY- ' -* '~r� �° " _ -`� k PROPOSED POOL 675 s .ft. r „ r.��4 aw '� 7++_c L-r r ,1 r r _.. crpy `� -� '4 �� l `� ; TOTAL 5225 sq.ft. •. f NY 1 { syr 1r� f .•1�-k i:q` w_p _� ItCC r fti (aur ro V;s�"� h r? ��- }, pa, _s `?--__ FLOOD ZONE FROM FLOOD INSURANCE RATE MAP k� - c r r c r,' f' ;��`'• s__- - - '`` 'J"' MAP NUMBER 36103CO501 H SEPTEMBER 25, 2009 �4 rb Truar ROrp 1{k , lei C t c� f_ i�� WW toGe� �r; fined"'*q► �•� _ >�� ELEVATIONS & CONTOURLINES REFERENCED TO N_A.V.D. 198$ PROP. op f•, ock IUJ Pte,,,_ LA.I,� X $ f i f • i y { -y_ + "- ` �Rq +tn o MD . ` " PARCEL 1 AREA-50,510 SO. Fr. TO TIE LIME PARCH 2 AREA-14,748 80. I'. TO T UNEyPR DE +LM Du �. °a''e' rti +,� %. (r 'c�,cn ,s+tr; -•� �µ � - ��._�! h_ `, �ws z / ,. _.•.,, �­ --j ,11 SG?. FC TOME LIME EDUL , �. jr..._' %/ , �. TOTAL AREA-65,2W 4• Q or 1A98 Acres Aft or stir ry 201 4ss ff /,, {{f y ,�rr � �j F �C / / .` w , / //, CUs' PEQUE5TING : REMOVAL OF . INVA5IVE WEED, PLANTS. Al PRUNING OF 5ELECTED FLANT5 FOR IMPROVED ROOT WEALTH OF-ACKKEY .117 f 1 ` = HEDGES ' � _Cf 6'W,°ct�""a;4 �q�i, ii CERTIFIED T0: ■ =MONUMENT MSN yrLD �s842. `-� 1'c + TODD FREED ray w s e pr .� � ll EDITH WEBSTER FREED =SPOT ELEVATION '�°s'� r,s� ADVOCATES ABS'T'RACT INC #ADA2455--s APPROVED BY c , n� , ,� Ir STEWART TITLE INSURANCE COMPANY srr� �'ro ` `r' BOARD OF 1RUSTEES TREE TO BE REMOVED ,qV& f1+ TOWN OF SOUTHOLD = TREE TO BE TRANSPLANTED OR REPLACED A ,� rs DATE �c 4&.4k .•6'��iL 20 201 'r. = TREE TO REMAIN `��" ky t - PROPOSED DRYWELL EXISTING DRYWELL 1 am familiar with the STANDARDS FOR APPROVAL - AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES N.Y.S LIC NO. 49618 ANY AL7ERAT7ON OR ADOr7tON 7D THIS SURV>rY ISA VrOtATiQN and will abide by the conditions set forth therein pnd on the OF SEC770M 7209OF THE NEW YORK STATE EDUCA77ON LAW. permit to construct. PECONIC SURVEYORS, P.C. EXCEPT AS PER SEC77ON 7209--SUBDII?SIDN 2. ALL CER77RCA770NS (631) 765--5020 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MRP AND COPIE'S THEREOF ONLY IF SAID APAP OR COPIES REAR THE IMPRESSED SEAL OF THE SURIrt=YOR The location of wells and cesspools shown hereon are P.O. BOX 909 WHOSE SIGNA77JRE APPEARS HEREON. from Field observations and or from data obtained from others. 1230 TRAVELER STREET -f r _24o SOUTHOLD, N.Y. 11971 �G STREET ADDRESS: 12400 NEW SUFFOLK AVENUE SCDHS # = 810-14-0019 SURVEY OF PROPERTY A T CUTCHOG UE TEST HOLE DATA (DIWLUIV TOWN OF SOUTHOLD BY McDONALD/G30SCIENCE Pusuc � SUFFOLK COUNTY,, .� Y ��_ w� R 1000-116-06-12.1 & 12.2 -n i� EL. 6.5` D r A SEPTEMBER 6, 2012 nFi! DARK BROWN LOAM OL PU G� JULY 2. 2013 (TOPO & B.O.H) AUG 2 3 20117 SEPTEMBER BRAWN CLAYEY SAND SC SEPTEMBER 10.6 .62�3 (OC. VEGETEMSIONSATION) i NOVEMBER 22 2013 SETBACK LINES do LOC. TREES Yl OP r017 DECEM5ER 3. 2013 EDGE OF SEACH I'LA6� i) q PALE BROWN FINE SAND SP FEBRUARY 5, 2014 (PROPOSED HOUSE) " EL. 1.4' ATE 5.1` p ' ~t ��'�C,q;y �BAPRIL 24. 2014 (SEPTIC S } 1TY ARUARY RE (PuaLtC MAY 20. 2014 (REVISIONS) WATER IN PALE BROWN FINE SAND SP S76`5820„E WA 71•p J,V �_ MAY 29, 2014 (REVISIONS) E J'JLY 2 2014 ADDITIONS VALkr Via, a ET) � (ADDITIONS) r JULY 29, 2014 (REVISIONS) 12' ., __ _ uwhr JANUARY 15. 2015 (FOUNDATION LOCATION) Yr ~ d,arti� -}. j¢�_ MAY 13, 2016 (FINAL) --- ;c=Ey�- _______ X75 MAY 31, 2016 (REVISIONS) ? kr � NOVEMBER 7. 2016 DRAINAGE CALCULATIONS J 14 t ,?� ------ -` ~~-~-�~I, ~ '"t4t+rix_ NOVEMBER 17. 2016 (REVISIONS) DECEMBER 20. 2016 (REVISIONS) p0" ~� DECEMBER 29.-� SMALL MASONRY TERRACE F; ;; r-_ j q JANUARY�� tots (REVISIONS) 59, 2017 / ,'� ? iso JANUARY 10. 2017 (REVISIIONS) 150 sq.ft. x 2 X 1 - 25 cu.ft Q ri USE POOL DISCHARGE DRY WELL zo I 8'0 x 4' BEEP = 201 C.F. (0 LARGE MASONRY TERRACE ADJACENT TO HOUSE Q J ? N 4 � x LEGEND 464sq.ft. u.t ? r '� 1 3j1 464 sgAt. x 2"x 1 = 77.5 c.f. USE 8'0 x 2' DEEP 84.4 C.F. ��; E oEaaaan oR Evozc,Rm.,8110' ( }?,r r r F r7,•�'.'�'yt f' fArf�7F?ap 'hj Z- rV SMALL MASONRY TERRACE ADJACENT TO POOL � $ r ??r?:.,r (6 It ? {""%L5" ;� `s:;.. rn I J d r ftt.� fry �' � 374 sq-ft. 374 sq.ft. x 2"x 1 - 62.5 c.f. �- $'0 x 2' DEEP = 84.4 C.F. i '_ `� ,f ,.'�;-`P';-',�fo•r•--'-,, f kPNYDEC ADJACENT AREA TABLE Lj, . U ;? :ter ,_�= `• �-~_ '`' -"~=t DESCRIPTION AREA L07 COVERAGE ]. ?? r"►'" $•$ AREA WITHIN 300' OF WETLANDS 45.122 sq.ft. pRr w EXISTING HOUSE & PORCHES 4,550 sq.fL 10.1% r. AY ' A.& "GJa4V �// 4l PROPOSED MASONRY TERRACES 988 sq.ft. 2.2% ON GRADE ix StOHE. � ? PROPOSED POOL 675 sq.ft. 1.9% - � EXISTING !3RlCIC WALK 244 sQ.ft. 0.5% o ~`AF��• ^-_ ttr r�, DRJ WAY EXIS11NG APRON 248 sq.ft. 0.6% �_s EXISTING CELLAR ENTRANCE 6113 sq.ft. 0_t%; y H - EXIST. B.B_ PART 4f DRIVEWAY 1404 sq-ft. 3.1% PROP. LOOSE SATE wA4-KSqr 392 sq.ft_ 0.9% aka ° r TOTAL 8560 sq.ft. 19% __ 2 Srpp F A ME fttX pR Crso m n - F7N , ty D J/OUST f r O ► r ?d. 8 r¢ pBr u,� t • ``'; rE�j ; " , r f TOWN OF SOUTHOLD BUILDABLE LAND WCE 4$0M* s2s. ti 1 to ----- t p ,1 r '--_ C� o ,`�' ► y.`' DESCRIPTION AREA LOT COVERAGE ARa'o ' _STO EOI✓'RE X18�. 70NC } 57,181 sq.ft. EXISTING HOUSE & PORCHES 4,550 sq_ft_ 7.9� PIS _ . :�_ Q Fkr ^r '' �-r- ' � r r �' _ PROPOSED POOL 675 s .ft. 1.2 arc o �'°�v _.. r TOTAL 5225 sq.ft. 9.1 CRY r-' �ti--._ ':� . �•';`���� ' ' =� ""-�._"' 7-- -. r Tj s '== ! FLOOD ZONE FROM FLOOD INSURANCE RATE MAP z�A )exOler ro?jm �' ?,?; � --j''d zs _ -y�-�'�``' =' r MAP NUMBER 36103CO501 H SEPTEMBER 25 2009 -ro LIM OV kr NEWt ° 'rr � ?ter _ � - ,s�% ELEVATIONS & CONTOURLINES REFERENCED TO N.A.V.D. 1988 TROP a OCAnOA;) � �` r Z ; L 0�!! f P&P, L� PARICE... 1 AREA-50,51{} SO. 1�=r". TO TIE LINE �. w ;"^rav Q� ' `�+�:• -��` akort ,�h`�; _ PARS 2 AREA-14,748 80. FT. TO 11E LINE 'IIENrAL'u��y zags *� (^J �+lo +1 '� `' •. $LXTIM Nvc� ]! t_ TOTAL AREA,-65,258 SO. FT. TO TIE LINE A14 or 1A98 Acres or ZAW E or CN CC , ti ?;, �`,_`^! - , ASR *• 4 � .ice•, ��• � ,t���h� f � �a'2N��'�L Y �T tjAt IV Y ^'+yrs ° - E_.: °F I�r'� tea+ "0HEDGES Cf's rte'a° +q�t t CERTIFIED TO: A z" / TODD FREED a =MONUMENTpos 842 p1 �� fjr EDITH WEBSTER FREED ( =SPOT ELEVATION 4�°+?r 1 Cl) ADVOCATES ABSTRACT INC #ADA2455 S Csy° ter ,, n� ;I" #/ STEWART TITLE INSURANCE COMPANY K~ - COQ , ro TREE TO BE REMOVED �'� a f r TREE TO BE TRANSPLANTED OR REPLACED A s TREE TO REMAIN `�•�' t` = PROPOSED DRYWELL EXISTING DRYWELL I am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SY57FMS FOR SINGLE FAMILY RESIDENCES N.YS, LIC. NO. 49618 ANY ALTERATION OR ADD1770M TO THIS SURWY IS A %40LAT70N and will abide by the conditions set forth therein and on the OF SEC770H 720.90F THE NEW YORK STATE EDUCA77ON LAW. permit to construct. PECONIC SURVEYORS, P.C. EXCEPT AS PER SEC77ON 7209--SUBDIVISION 2. ALL CER77F7CA77ONS (631) 765-5020 FAX (631) 765-7797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF The location of wells and cesspools shown hereon ars P.D. BOX 909 SAID MAP OR COPIES BE THE IMPRESSED SEAL OF THE SURVEYOR p WHOSE SIGNATURE APPEARS HEREON from field observations and or from data obtained from others. 1230 TRAVELER STREET a�_��� SOUTNOLD, N.Y. 11971 1 'I I I 1 E 1 1 1 / Nr 1 4 ,r , A i ' i d` /It I,• *�jr`.t_. # `Ya-� ..• F Y ' I , l i '"rs, gip. -r �."" `�, i l �. � �,^, ,r-` 'i ,�•..,.,� _ ?�J *► -' r* •'A'a�? �i f� +l_Yi 'dL , ,v �� •1 1 ��`f ��'W: 1 ; : `�:i- ,tia�' � �" J r� t I_ r . '' • , .,!'�.. ,y� � i .rte \ � 7�'AI r '% ., 7 n r� � ) :►+e �. � � >< 1' �;� �� ° 1•T'rl' e fir AIA , (/k� i � � � s(f' n«�. .� •r '� �f .�M4 P!' � y�'L d'L �� 1 �' 1��� "� �s � • 1 •ii~' '� :yl' \'� A .� I war �. `� 1 4 Y Todd Freed&Edith Webster-Freed 12400 New Suffolk Avenue,Cutchogue SCTM#: 1000-1 16-6-12.1 & 12.2 9/12/17 s: a�rrw «-+_isMe a 'erg �H14 ♦S''x i - �..., if r =r a M L r w� n I LIC Y-4 t, c AS I� / ' � •� __ — yr a. � c _i —.. �, ,., _. . .,, y _ _ _ _. �. -- ;.,- _ ,�, i ,- ./ c ,,�� `�o � � � 1t'e �- � _ �1 - \=..- y� MATCH Z EELM NO We UNE ........... LINE z--------- ........Z _Z_ Z FOR PCL NO FOR PCL NO un 3 SEESM NO SEE SEC NO 10903009 10804008 3 10 33 ZIA(,) TOWN 0,Ft-OwID 0 51(,A 83 TO—OF SOUTHOLO 4M(c) 60A is PEMNIC LAND TRUST 4W.) 5 TC-1 OF 12 I SCUTI,Om 39A(I)g 7 9e I IT GAI.) 10 38M 1 1 s� 12 G.5A(Q 141. ECONIC LAND TRUST 32A(cl 02 J, C—Im—Nn 19 30A(.) j ZINC) Mm CASE RDx PAST BO 2 em 02 I IA(C) 12- &ZA(.)� 0 92 3 4 kmw 'A Lk IWO 5 TOWN or,=UOw 4 2 SA(C) M",/-, 32 AV1 61 f2A U7 ,Z\ 2 �,Wc)- 12 9 (1 S102 13 14 41 5 1 IA(c) 1I14A(l) "A(c) I3 FI 4 2 3A(.) p 15 1, 1171 3 NSUFFOK T 7A(.) FARKOISTRICT 5 7A(c) 0 I2A 114 O,� 11 1. 2A(c) If 3 I IA(.) OUTNO AM IA(,, Tom1Bac1 12 So 1. To 0 SA(C) Tor PECONIC ZA(C) t91 A s 1713L.D45 F lea 91 I> — SEESEC NO 134 Pr)go 241 I IA(.) % NOTICE A4DTpw COUNTY OF SUFFOLK G K 1w1mff SOUTHOLD SECTION NO E Real Property Tax Service Agency Y 116 A P PROPERTYMAP OFFICE LOCATION: ®��®f S®Ury®� MAILING ADDRESS: Town Hall Annex ® P.O. Box'1179 54375 State Route 25 Southold, NY 11971 (cor.'Main Rd. &Youngs Ave.) u' Southold;NY 11971 ® �®� Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: September 18, 2017 Re: LWRP Coastal Consistency Review for TODD FREED & EDITH WEBSTER-FREED SCTM# 1000-116.-6-12.1 & 12.2 Creative Environmental Design on behalf of TODD FREED & EDITH WEBSTER-FREED requests an Administrative Permit for a Ten (10) Year Maintenance Permit to remove invasive weeds and plants; and for pruning of selected plants for improved root health. Located: 12400 New Suffolk Avenue, Cutchogue. SCTM# 1000-116.-6-12.1 & 12.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department,,as well as the records available to me, it is my recommendation that the action INCONSISTENT with policy 6.3. Protect and restore tidal and freshwater wetlands and therefore INCONSISTENT with the LWRP. 1. Photos show a healthy, predominately American beach grass (Ammophila b.) community. 2. The invasive species have not been identified. 3. The method of clearing has not been identified. 4. The species to be replanted have not been identified. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. SOFT Town Hall Annex Michael J.Domino,President �q �® 54375 Route 25 John M.Bredemeyer 1II,Vice-President , i P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631)765-1892 A.Nicholas Krupski �l/�C® 4R, Pax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOI.D This Section For Office Use Only Coastal Erosion Permit Application eetland Permit Application - Administrative Permit Amendment/TransferlExtension Received Application: $`x3'17 D V E .Received Pee:$ 100,6V Completed Application: Incomplete..,-,..- AUG 2 3 SEQRA Classification: Type I_ Type II_ Unlisted r _Lead Agency Determination: �Coordination:(date sent): Southold Town LWRP Consistency Assessment Form Sent: �`S`11 ru _CAC Referral Sent:, Date of Inspection: I�� Receipt of CAC Report: . Technical Review. Public Hearing Held: Resolution: - Legal Name of Property Owner(s): 1 r) meA-1 • r—_ �A - Mailing Address: k1 ,\6D ,'- �v� � �� o l c� yC)I` V1 c�©©a --- Plione Number: C1X —q�cDh Suffolk County Tax Map Number: 1000- Property Location: ti yDD �1 �b4UL� Gln (If necessary,provide LILCO Pole#,distance to cross streets,and location) AGENT(If applicable): L YlaD<4ULL-7 �i�' W6 8i*&Onmental Design Mailing Address: 0 P@Wfik,NY 1195E Phone Number:, 6"b —13 H--7 a3 • Board of Trustees Application GENERAL DA`g'.A, Land Area(in square feet): 5 12, 10 � . Area Zoning: 4k-40 Previous use of property: K-140 Intended use of property: 4,0 Covenants and Restrictions on property? Yes _L-"No If"Yes",please provide a copy. Will this project require a Building Pernut as per Town Code? Yes eXW0 If"Yes",be advised this application M11 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. yVilI this project require ay 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? Cu' Yes No Prior permits/approvals for site improvements: Agency Date _. 1�) 65'C_ 3X-1 [17 No prior permits/approvals for site improvements. ,� / Has any permit/approval ever been revoked or suspended by a governmental agency? 'v No Yes If yes,provide explanation: Project Description(use attachments if necessary): W-41�Gv4 � 1A9& kr-4 • , �- -� 1. r ` Board of Trustees Application WETLANDPI RUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: V-0 ma h'xV Area of wetlands on lot: square feet Percent coverage of lot:� _ % Closest distance between earest existing structure and upland edge of wetlands: feet Closest distance betwe n n arest proposed structure and upland edge of wetlands: feet Does the pro' ct 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): � a 617.20 Appendix B Short Environmental Assessment Form 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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: t eo w& Project Location(describe,and attach a location map): Ib-i�-ia_L4-1a.�_ Brief Description of Proposed Action: cM�eI(�� h�e� �� e4— �c ti © ���- �cSS- �d►�cov - Name of Applicant or Sponsor: Telephone: 63f-73Z(- ate E-Mail: Address: Creative Environmental Desip P®Box 160 City/PO: Peconic,NY 11958 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 Rr R 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: Er ❑ 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. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial [—]Commercial EXesidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 r � • 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? El 10 ❑ 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: 9 ❑ 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? ❑ 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: B ❑ 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? ❑ ET 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. Ideptify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest ❑Agricultural/grasslands ❑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? O 16.Is the project site located in the 100 year flood plain? P YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, r--1/ ❑ a.Will storm water discharges flow to adjacent properties? ❑NO OYES �]�] b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ONO OYES 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: [d ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Appli ant/spons ame- Date: IT— 6- 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 I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the F-1establishment of a Critical Environmental Area(CEA)? MI 5. Will the proposed action result in an adverse change in the existing level of traffic or E]affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? EJ 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, Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? M� El 11. Will the proposed action create a hazard to environmental resources or human health? 10 1 11 Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmentalimp ts. Town of Southold-Board of Trustees /(? Na e of Lead Age �, ate I d � a ��M.� " —" President Print or Ty e Name Respo sible Offr in Lead Agency Title of Responsible Officer Signature of Responsible icer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Appli.6 - on AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000- in the town of New York,hereby authorizes Creative Environmental Design PO Box 160 �cfvrcA r,,�'� u� C- Peconic,NY 11955 I to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. 4��di Property Owner's Signature roperty Owner's Signa SWORN TO BEFORE ME THIS 20 \—I MELISSA R DEBOER NOTARY PUBLIC STATE OF NEW YORK Notary Public SUFFOLK COUNTY LIC.#01 DE6349898 COMM.EXP. ��k�A I � Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) UW., rW Fre-e.j ' owners of the property identified as SCrM#1000- in the town of New York,hereby authorizes Creative Environmental Design PO Box 160 to act as my agent and handle all Peconic,NY 11958 necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner`s Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF V Sf 20jj_ Notary Publie JOSEPH RAYMOND KOLBOW Notary Public,State of New York No.01 K06302755 Qualified in New York County My Commission Expires May 5,2018 Board of Txustees Applicj_._¢ion AFFIDAVIT 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 Property Owner Signature of Pro er �L9 SWORN TO BEFORE ME THIS DAY OF U. ,20= BOER tlkj OF NEW YORKNotary Public UNTY49898� Board of Trustees Application AFFIDAVIT ro d , BRING 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 DONEIN 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 PERNIIT(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 EROSIONPERMIT ISSUED BY THE BOARD:OF TRUSTEES;DURING THE TERM OF THE PERNIIT. r Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS O f h DAY OF Aijp5t ,20 f7 Notary Public JOSEPH RAYMOND KOLBOW Notary Public,State of New York No.01KO6302755 Qualified in New York County My Commission Expires May 5,2018 APPLICANT/AGENT/REPRESENTATNE TRANSACTIONAL DISCLOSURE FORM The Town of Soudiold's Code of Ethics prohibits conflicts of intem ton the mart of town iifficers and employees.Tha e P-1111ke of this form is to provide information which can alert the town of nnscihle conflicts of interest and alimv rt to take whatever action is necessary o avoid same. -YOUR NAME: (Last name,"First name,t/riddle initial,unless you are app yingiri 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 ofZone _ Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other,name the activity.) Do?rou 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,nlarriage,or business inter "Business interest"m ars m 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. t 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/age esentative)and the town, cer 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 appiieant (when the applicant is a corporntion); B)the legal orbeneficial owner of any interest in a non-corporate entity(whcti the - the is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this 8a of Z U� Signature Print Name Form IS 1 y i U t11.103 attl8mu a -� amleAs L frOZ -.,of Jo Cep sigi poWpgnS . dlx MOIIV- x M MOUd U�Saa juv lIdda 113mB Out(a .io,!Iuw!ldde agl3o aatioldwa io yauped'.iolaagp'=glo im(0 . -. XuoiWpdioa u;ou sl lnttogdde ' tagn�). nuaalutad�oo-uau v m pw*lu!sue3o.r6mo tetoljauagao pzSai ago(S ;(uogeaadxpa u sl Itumildde Ogl WJgx►) ju itIdde agt3o Tools ale O&W Ogl3o mqs agljo/.sww moeaIo nude aql(d :(/Cidde lgqtlis*aqo)st pllgo to�do-md lutlq!s tsnods laq io stq ao wf&idwo jo sastgo tm c4 aU .. -pap*wd aaeds oqo ui agUasap ioipue(Q tiZa iql(YOUR aleudwdde a* *alp MwE •aa�toiduta iolmiwo a u►o1 GID pug(Oklmuasaldaihua9e/�ueandds agi)3I oS uaannlaq cltgsuopelaz aig aq, saa uosiod;ugt jo uonlsod jo Olid, piogpioS3o umol aqi tq paAoldwa udsiad jo awuri . -palx&nput=qm n2!s pue aoep pus uuo;s.Mjo aauuleq otp a)aldwoa;SaA„par h%m IkOk�l •• ON SSA •sauegs agl. o QAS ill=m'sumo a goldum m=Wo UMOI aql gonia%in . uorla�odloa u(,tgluawAoldum io)to dl)lstau�►o ptgit#d uaAa sari ldwo ao 4aay�o wi+oi agl,gotq&ul'ditImuMd a iujpnloul '�autsnq asueow plsuolw ssoinsng„gsaia3iy ssouisnq�o'a�ut�siu'poolq dq sapnlaut�dttisttotlela�I;, dptQ�uoS 3o.uxoy agl3° - aa&ldtuO 30=gig fm g1174C dtgsuoilelai s onuq(pittp jo'luamd%ujigls °ods'gitgdwoo most g9noallo tD)AIleuosiad no.{oQ (•141egoe agl aareu'zjagl0„3l) -Mip0 2owae1d dew pplUo so field woa3 uogduma lauooyt aeld jo ptnoiddy ooisaia le;seo0 'T auoZJo a;iugg0 — OWW.L aOuuueh $w.ppng aauonays xey (Aldde M Ae3IpzgO) :NoILVDI'IdaV dO M'K (,aumu 9.kwdwoo io s�uosmd iatpo aq;bbluatpul'wjl,tuedwoo s ss gars`61gua ragoo Jo Osla auoamos 3o aweu aglpr,�uuCldde aae no t ssaldn'ieg!ul alpptdr�wuulsuJ$�mu isg't) 1aMRUnOA •1�-Qum P►ono of AJUSMOU s o ou as a ;WM of l!ntol u pue l_saraoul3o sla!lluoa glq!s.W° 3o ua ol.ogl ale uua'Piga&uopetuta3u!ap!nat sl ° s! t J°a, .. agy sod of a pue siaat o wnoi o� atp o uc3q st°!llnoa stlq,gou sa- 'I ap°O s� loglnosio uK►oy atl 1, rnr�ro mmozasxa awollaysKm �,���s�a�uJ.►��o���aizaa� 1, f APPLICANT/AGENT/REPRESENTAnW TRANSACTIONAL DISCLOSURE FORM The Town of Maold's Code of Ethics Wk1-W—s conflicts of interest on the part of Mm iifficers and employees.The nm m of this form is to provide inforination which Can alert the town of possrble conflicts of interest and allow it to take whatever action is pecessary to avoid same. YOURNAME: (Last name,first name,giiddle initial,u&ew you ane applying in the nAWUMVe EnVifonMentd DeSip someone else or other entity,such as a company.If so,indicate the other PO Box 160 person's or company's name.) P@COYl1C,1VY 1195 NAME OF APPLICATION:-(Check all that apply.) Tax grievance Building " Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption fiom 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 pattial 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 slate and sign where indicated Name of person employed by the Town of Southold Title or position of that person Desch-be the relationship between yourself(the applicanttagenttmptesentative)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 5016 of the shares of the corporate stock of the applicant - (wben 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 Submittedv is d Signature- Print Name l Form TS l y + 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 sigifficant 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 palainW in detail, listing both sunnortina 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 W& Fty✓ 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: Location of action: t AL40D CUA&1n Site acreage: 50 1510 �-r- Present land use: `-IIVVIKA Present zoning classification:__ knlb 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: `T9CU,V-7VgL ACS I Ia,S Ewe (b) Mailing address: L ti� �e ,fir v� Inq l L19 (c) Telephone number:Area Code O )f�L_q.b� 6 (d) Application number,if any: Will the action be ' ectly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No ' If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed 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 trite 'a. Yes ❑ No ❑ 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=Pol' ies Pages 3 through 6 for evaluation criteria 1:1Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ 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 LI/Yes F] 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 —PolictEl ages 16 through 21 for evaluation criteria j No ❑Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ I i Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LNRP Section III — Policies Pages 32 through 34 for evaluation criteria. /Yes ❑ No❑ Not-Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wUS-Applicable s. ee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ElYes ❑ NoNot 4 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. El Ye❑ No Not Applicable a - Attach additional sheets if necessary 4 WORKING COAST POLIUIES 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 ❑ 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 wa rs. 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 forevaluation criteria. ❑ Yes ❑ No K1 Not Applicable I Attach additional sheets if necessary ' I Policy 13. Promote appropriate use and development of energy and mineral resources. 'See LWRP Section III—Policies; -ages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE��L DATE Creative Environmental Desigrk PO Box 160 Pcconic,Nva' �11)5 8