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HomeMy WebLinkAboutTR-9269A OF SU[/T Michael J.Domino,President �o�� y�lTown Hall Annex O John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski Yp� Telephone(631) 765-1892 Greg Williams �COUFax(631) 765-6641�a BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1493C Date: July 30, 2018 THIS CERTIFIES that the as-built residential horticultural irri atg ion system installed landward of the 30' non-turf buffer area; At 4145 Wells Road, Peconic Suffolk County Tax Map#1000-86-2-12.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated May 29, 2018 pursuant to which Trustees Administrative Permit#9269A Dated July 18, 2018,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 as-built residential horticultural irrigation system installed landward of the 30' non-turf buffer area; The certificate is issued to Charles &Brenda Grimes owners of the aforesaid property. Authoriz6d Signature g ' Michael J. Domino,President *OF SO(/JyO Town Hall Annex 54375 Route 25 John M. Bredemeyer III,Vice-President �� lQ P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski • Telephone (631) 765-1892 Greg WilliamsyOOUM`l, O Fax(631) 765-6641 l �c� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION:, 712�I 2�1� Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: el CERTIFICATE OF COMPLIANCE: Michael J. Domino, President ��o��S�FFU(,t�oGy� Town Hall Annex John M. Bredemeyer, III, Vice-President = 54375 Route 25 Glenn Goldsmith N P.O. Box 1179 A Nicholas Krupski y • �� Southold, NY 11971 Greg Williams 'y49 , dao Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/ constructed Project complete, compliance inspection; i Michael J.Domino,President �Of SyOlO Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �pQ Telephone(631) 765-1892 Greg Williams �y`, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9269A Date of Receipt of Application: May 29, 2018 Applicant: Charles & Brenda Grimes SCTM#: 1000-86-2-12.6 Project Location: 4145 Wells Road, Peconic Date of Resolution/Issuance: July 18, 2018 Date of Expiration: July 18, 2020 Reviewed by: Board of Trustees Project Description: For the as-built residential horticultural irrigation system installed landward of the 30' non-turf buffer area. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by and submitted by Brenda Grimes, received on May 29, 2018 and stamped approved on July 18, 2018. 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 USE BWLDc CLEANour oErAIL s� Foro / SURVEY OF PROPERTY ' fe g I1WNBIR /NexrEHsav/cavNECTrow N �o�%� r'40 TO., / TOr�� LINE AT PECONIC OF TOWN -OF SOUTHOLD ---AREA�. NTY N Y. O=10,298 sq lL , /101' OVEE��BY �oo�e z B sm Pur / 3 J74 4124 29 77-13 2 X SCAt/+G. 0' \/7� qCA�O [ /T �[PPe�e�4 ' p JANUARY'l 2015 sreseos a�' 4 Qa (y / 1.DCJARE 0`11 1 RUS 1 E 16, 2016 IE PLAN) APRIL 7, 2016 REWOSIONS) TOWN OF SOUTFI(XD4, 2016 RE�1sIDNs, 7EsrLD OLE DvATA ` ¢ej �iS a• VC N4 ;_ ) JUNE 9, 2016 SONS f0�7a/16 o�FJO ��9 I c0 9¢S`�O /N S�O '-ai–A73•E J NOV 04, 2016 RENSIONS) a�P ��'1�1 9 ��\ 4L44.` a h' F�j� V "'rC-� FEBRUARY 7, 201 (RENSIONS) 4vAE aoxx�rYL 5�y O"��P `pw v'g, mak ^ – { MARCH 6, 20 (R(ENS/ONSSI PAIS L7RDIM/tar Ta LYDTuv s+nm LJ J Ac rI MARCH 116%,201 (REN57ON5) a., CH-28, 201 (RENS/ONS) gave _ 8(FINAL) W1TDR IN PAI'HROAII tLVf!O YEDAIY 5110¢ of tY1 �� FFD C9R ' ® _•. 1 METER Ag MDTE WATER ENCddTTBPED QC(aloW AA'fAE£ 9 v `9f 'gfJ 1 OWf J96 y� LANDWARD LAUT OF TIDAL W£iLANOS AS DETERMINED W _ 'B' BY SUFFOLK ENMRONMENTAL CONSULTAIr INC 'p �, Hy,,N��OO� ON SEPTEMBER 24.2015?..�qyT O6 \ +4iE,N,Sg'�(( v r„Q 4' 62' ""''kms' \_-_ \ �9,�, 6.4r /•4 5,eo N07F \ \ y sr 20.5' 59.5' A 4 FOOT ACCESS PATH PERMITTED THROV4W - y WE 30 FOO OFMON-TuRr BUFFER FOR SHORELINE ACCESS PURPoSES� •\ I ,(��a01 26' 46' n 1,, _ \�,F �,QpY 04' 35' 50' 22 ---- -� / PTA 2?IV 2P Jp. _ U ts� AV Y. X q y� Y C� ok- ■ -MTONUMENT N74226r TtLft V AKE 4 W m TEST HOLE CER70E0 TO =BtT LANDS FLAG �, u,W BRENDA SGRIMESMES ,W Q WFG NAAONAL 777LE INSURANCE COMPANY IIEYATIOVS AND CONTOUR LINES ARE REFER£NCFD FROM NAVD 88 \\\� \\\\- `lG, ��1 Th.I ZONES FROM FIRM 36f03C -d c Th./JWdr of tknblk Wates f „nd<,Ob&b df—A th o e tT£tlBLE SUPPORT RIND SEP77C SY47EM DETAIL 1 8e/d obsrnvUms m+d a�hom doto o6toMad!/om oNna. CONNECTOR AT PYC/OL,XNNi I AM FAMILIAR MTH THE STANDARDS FOR APPROVAL AND FF Q fl O' NOT TO SCALE CYWSTRUC770N OF SUBSURFACE SEWAGE DISPOSAL S15TEMS FOR (LEAN WT SINGLE FAMILY RESIDENCES AND PALL ASIDE BY THE CONDITIONS RNISNEL 017ADE SET FORTH 7HERWN AND ON THE PERMIT TO CONSTRUCT ET..8' £L B' 24 NASDNARY p1/MNE15 MYISONARY CHIMNEY INVIL 6MM f MIN LOT�a REFER TO'MINOR SUBDIMMON PLAT KNOWN AS RICHMOND CREEK FARMS' r.:� - O^"F'T --- .. �yyyp„ 12 Y MAX TO S A PORTION OF THE PREMISES CONY£TED TO ME GRANTOR ,T- (T=tel �'• r ' i &5 B f0 HEREIN BY DEED DATED NOVEMBER 24 1997•RECORDED IN THE SUFFOLK COUNTY •�.. 1 i H IN ®®®®@ CLERK'S OFFICE ON DECEMBER 9,1997 IN LIBER 11866 OP 747 1�� ;� ,i_� , 'tea 1%B'PE� DOT 6 f(/4 FOOT INV am ®m 30MUMPI MWIMUM POUT S6• ® ¢ I ®ANYALTERATION OR ADDITION TO TMS SURVEYIS A WOL.A770M MLTI4'O/A.PIPE + WN 4'DNA PIPE A`• PECONIC SURVEYORS, P.C.OF SECTION 72090'THE NEW YORK STATE EDUCATION LAW + 2• "` 2 (s)2 bet eeov genies (831) 765-5020 FAX(631) 765-1797 IXCFPT AS PER SECTION 7209-SUBDlNS/ON 2 ALL cmnFTCAnDNs ; / WATER EL.DYP.O. BOX 909 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IFSND MAP OR COP/ES BEAR THE IMPRESSED SEAL OF THE SURVEYOR a p. 1�� 1230 TRAVELER STREET Yd LOSE SipVA7URE APPti1R5 HEREON A .N/A SOUTHOLD, N.Y. 11971 15-225 I Mil Michael J. Domino, P; ;nt O�Q CSG Town Hall Annex John M. Bredemeyer III,Vice-rresident �� � 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams ?, ® p! Telephone(631)765-1892 ��� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ACompleted in field by: LJ114`5 CHARLES & BRENDA GRIMES request an Administrative Permit for the as-built residential horticultural irrigation system installed landward of the 30' non-turf buffer area. Located: 4145 Wells Road, Peconic. SCTM# 1000-86-2-12.6 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 e"'� Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment d 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: 's P4?r- Z­k c��J j"-seec-41110 PIC I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. redemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other ->x;lk . t. c 14. 1; s • .�,aye ., •.1 y• Y/�}� �. kA, r n s- •a f � / �,,�tt'� ;t #��.�.� r •r . � � � �,mil'; ,,, ... 1,•e �!� „� v � i. ;+hit .. ;i ', ��„ •, � .�: a[ u 17rG• .•,.',�1R`'� ;� � ,•� '`:.• •.'9 �yL. ,.l'� '�' J r, r + �1'af l f r + .a E {p •: Y K Z\ I. - �t .. . 1 fSy' .. .. .aw s, h .;3- >•r% :�a ; _ "",•. " •.rte-. .�'�`a•1>>T+1 C U r, rte, ie }�•:, +...- _ t1i 9 G�.�- d•�'" t _ tS .s �� �'' s�%.• } � tt' Sr t !•• P3s--� „��3y'`iti3��C+'��-•4+-ate_ rI' Wit. (�~✓ �eS �: C��ja� 1 ter..,. i L UjJ> ••�`—�E�^'i•, i� �"�;� 'rte'. U"'.• J7 s��-' t'''1 "^xY-"'. -• ..,1„�' W •.�i�t�`+✓ ���'� G[;.;�. '�a�_:'+�at5-:•mss 1. ;T+ <`o�y..c.- 5c7'",,;;!- ,•a--••F..`�.;y.� ���i.:, �. �• S ."��f�Y-`.� ' -f -,... 'c,` •+, f-�,1,�1>� ';lava ` .''�'tiia�^' .-'s�, `. '2L� y;.,..:s-•Gr`' -.�Y.:""i-- -' .i.^�;�,f?LY'�Y= -"i"7 ;(-,,,-'�a 3�`: 4 ���•.�3,ti,;V.. •�.F,:-S�2- r L1i' �i;:=r.`.���`,�^i"`��"�''rr,a-'=t1l4S••,, j,��....-�,,�, 1 -_ �i �• ��f ' V,,^...Sti„'l �_G• _v�_-,C - �.. sa:� •�. t= 1-"GSI"-• : 'S_�., its.:,..., '.tsj"�._;d r=''=^,'.^..,��es•:_i:.=��..>7��ii,.+-: C` s,�� .d`r7S �-{s ,r."-^z-m� - - `-':,:.:•?�w'�..:�'`•=��f:�c^'-�c='�:����:,^^,..c:.�^�.��. - - - - - ^'=�r_..r+=y,s:^,'Vz-s.,,_,�;' lO � fj;sy�(1`1 if `.� ` ,{-� �-y ;{Tey '�•OLD g� 7 TRUSTEES t� �+g; S d IN W•�fl�d k PERMIT INO. 8805 ATE: MAY18, 2016 ;, `}I S UE_D.TO­ . T?:LNT FAMILY TRUST c/o DAVW EDELS T E1bl &LIBBY PROPERTY ADDRESS: 41145 WE LLS R€3Ab,PECaNiC AUTHORIZATION H. d Pursuant to file provisions of Cha to 275 of the Torn :.ode of the Town of Southold and in f; , accordance =.+ittz the I2:solution of the Board of Trustees adoflted at tie meeting held on Mav 18:2016t and in C 2- f' 1c ,l consideration of application fee in the sum oC25U.OQ paid by E G. Steal Family Trust c/o David Edelstein& ?e,, * 1 Ubby Goldstein aed subject to ttie Terms and Condition;as stated in the Resolution the Southold Town Board ?° 1 of Trustees autliorizes andpermits the following: ' iM J , 1 r - ' a Wetland i'e'rit to construct�t 37 x50 1 850s ft. t�vo-story€1a�etiiu with a ( 9 q� )-- g fir• �� 24'�24'(576sq..tJ attached gaiAge-and a 12'x6Z'(895sq,ft.) attached deck: hni tall a �m-N�septic system OR landward side of dwellingconnect to Public-waterinstall a i,890sq.ft. £�� x,s �' � ; granl drives`ay., and inst`ll a.sysienz of-dry velIs io,contain storms rater runoff;.With ' the condition toestablish and perpetually�zzaintam* a 30,'wide iian-turf buffer aloes the �'�'"` � i la�ad�� rd edge of vietlands wi�rz a 4' wic�a access Aatlz through same;or shoreline access;any ac-tiiiity to remove_iAvasive-speciesin said buffer area Twill require the = ;tet., �...;-•��l issuance of a permit;and as depicted on the survey prepared,by Peconic Sun eyors, P.C.,last dated June 9 X016 ands stamped approved on July S,2016, ��•'S`'��q� rid,AgTNBSS;A�R-EOF the said-Board of Trustees hereby causes its Corporate Seal to be affixed, �E = _ 4 and-these presents to be,subscribed by a majority of tine said Board s Df this date. '�''' R� to��� } f �^•�-�✓ t� � ` `C�•.,���� r � cE'L a. SS'-�5�;:��b^=�'<tru-.'�"�`',�:,-;j=am ,�4•r f,-,��Ca�'.?;,:C rY�"(';; ::''••'�:r` _'":r.��� `C--..-.-q-�7�4 y..-- kl-�-k� S .�..n...^y 4 �e •y=�='�s' ..�`9�, fir..-„y'�:5^c-..r;,Sj�� :.-5� �. �::.:-,�r7� �=- 3�r-. - ��..�:r_`'/�•� � „�Kj�'- - •:<�T :�,��- ;•9� jy ` Js,�'•, .�^,rc�y�+,�p P \��.�.__� F1y,:. _.,..,=.;,% j�' � r l�d �`' - jti' - - • iI •i { t 'e'''¢fir'-a!{ :i";i' "•-';cTt.lt; - Yom: o tr�: t+•,�� s'- iTtii� --`=ir,�4? 2s” - i'=�.!� r .4 ti �i t •;`�;•`Vc.�' f�y`';- .'`'„�.,,�:J;o� f 'S•rt�iti�'r-`:;;:r'.'�..77I �''�N.•.., � ' � �p ' , OFFICE LOCATION: ®��OF SO(/jy®l SLING ADDRESS: Town Hall Annex ® P.O. Box 1179 - 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) S � � �Q Telephone: 631 765-1938 Southold, NY 11971 O Fax: 631 765-3136 C®UNTI,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: July 16, 2018 Re: Local Waterfront Coastal Consistency Review for CHARLES & BRENDA GRIMES SCTM# 1000-86-2-12.6 CHARLES & BRENDA GRIMES request an Administrative Permit for the as-built residential horticultural irrigation system installed landward of the 30' non-turf buffer area. Located: 4145 Wells Road, Peconic. SCTM# 10007-86-2-12.6 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. The following is recommended: 1. Water conservation irrigation practices should be discussed to further Policy 5. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney ivl'i6ael J.Domino, President Town Hall Annex John M. Bredemeyer III,Vice-President54375 Route 25 P.O.Box 1179 "Miarles J.Sanders VS Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 Nicholas Kru,pski 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 ADp lication: rQ, _ Received Fee: $ 0,00 Completed Application: __R_0_0.1 M AY 2=9 2�018 _incomplete: SEQRA Classification: Type I Type Il Unlisted Lead Agency Deteftnination: sou" T101d low Coordination:(date sent)- (I Trustees A LWRP Consistency Assessment Form Sent: CAC Referral Sent:. Date of Inspection: Receipt of CAC Report: Technical Review: 7—Public Hearing Held: It IT,I Resolution: Legal Name of Property Owner(s): Charles & Brenda Grimes Mailing Address:-. 3501 Bonita Bay Blvd, Bonita Springs, Florida 34134 Phone Number: 239-777-4185 Suffolk County Tax Map Number: 1000- 86-02-12.61 Property Location: 4145 Wells_Ropd, Peconic, New York 11958 (If necessary,-provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable):, N/A Mailing Address: Phone Number:, Proiect Plan "As is" residential horticultural irrigation system landward of the 30' non-turf buffer. Board of Trustees Application GENERAL DATA. Land Area(in square feet): 38,595 Sq Ft/ .89 Acres Area Zoning: z Previous use of property: s -�iitended use of property: Residential Covenants and Restrictions on property? X Yes No If"Yes",please provide a copy. see attachment A adjacent to this page Will this project require a Building Permit as per Town Code? _ __ _ _Yes X No $f"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. r Will this project require any demolition as per Town Code or as determined by the Building Dept.? 'des X No € Does the structure(s)on property have a valid Certificate of Occupancy? Yes X No 'Prior permits/approvals for site improvements: a Agency Date Southold Board of Trustees 5/16 ammended 4/17 Adminstrative permit 5//16 Southold Building Dept 7/17 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? NoX Yes ar"yes,provide explanation: `. stop work order was erroneodsly issued by the Southold Town and Trustees. Work has subsequently resumed. Project Description(use attachments if necessary):- See attached project plan for further detains As is permit for residential horticultural irrigation system installed landward of the 30 ft non turf buftr Board of Trustees application WETLAND/TRUSTEE LANDS APPLICATION DATA;. Purpose of the proposed operations: --As is permit for ins all .d residential hard . ilt ural irrigation system landward of fn= 30 ft non turf buffer. M i r i Area of wetlands on lot: 10,298 square feet Percent coverage of lot: 27 % 'Mosest distance between nearest existing structure and upland edge of wetlands: 75ft feet Closest distance between nearest proposed structure and upland edge of wetlands: N/A feet Does the project involve excavation or filling? X No Yes If yes,how much material will be excavated? _ cubic yards x 6 How much material will be filled?._ _ _ __ .cubic yards g 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): Positive effect by maintaining healthy ground cover for erosion control and residential vegitation horticulture. 617.26- Appenrlix B Short Environmental Assessment Form _mg tk fmdd 6ns'foi :,C6'ifipIgtina Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part I. Responses become part of the application for approval or funding,are subject to public review,and may be subiect to further verification„,- r Complete Part 1 based on information currently available. If additional research or investigation would be needed to fusty 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. E Part l -Project and Sponsor Information - ^— Name of Action or Project: - - -- Residential Irrigation system Project Location(describe,and attach a location map): 4145 Wells Road, Peconic New York, 119.58 Brief Description of Proposed Action: As is installed residential irrigation system landward of the 30ft non turf buffer. f 3 Name of Applicant or Sponsor: Telephone: 239-777e185 Charles and Brenda Grimes E-Mail: bgrimes@gandb.com Address:. 3501 Bonita Bay Blvd _ City/PO: State: Zip Code: Bonita Springs Florida 34134 1.Does the proposed actiononly 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: ❑ 3.a.Total acreage of the site of the proposed action? 3g,5Sq ft- -89 as b.Total acreage to be physically disturbed? 12 Acres acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 38,595 sq ft.89 acreaies 4. Check all land uses that occur on-,--adjoining and near the proposed action.- ❑Urban ❑Rural(non-agriculture) ❑industrial ❑Commercial [X_]Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, - - N® YES N/A a. A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? �• L_J F 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES > landscape? }. I§the site of the Droposed action located-in,or does it adjoin,a state listed Critical Environmental Areal NO 'YES If Yes,identify: M, T� 8. a.Will the proposed action result in a substantial-increase in traffic above.present levels? NO YES oa ` 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? F `a 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: N/AF-1 T1 10. Will the proposed action connect to an existing public/private water supply? NO YES_ If No,describe method for providing potable water: f' 11.Will the proposed action connect to existing wastewater utilities? NO -YES i If No,describe method for providing wastewater treatment: F- (� I I a.Does the site contain a structure that is listed on either the State or National Register of Historic NO� YES Places? X ❑ 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? F1 El 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: _ ® El 14. Identify 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 Q Wetland ❑Urban ❑Suburban 15.Does the site of the-proposed action contain-any species of-an im al,or associated habitats,listed -' NO YES by the State or Federal government as threatened or endangered? 16.1s the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create stone water discharge,either from point or non-point sources? -NO YES If Yes, � 54a.Will storm water discharges flow to adjacent properties. ONO ❑YES 17 b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: O NO OYES Page 2 of 4 18: Does tfi`e proposed action include con'struc'tion 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; ,3 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; Mx El - - - - I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spons n in . G-���+fC� E ��-_ 0 20 f Signature:_ - k Part 2-Impact Assessment. The d 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 action9" a -- - No,or Moderate small to large impact impact ? may may occur occur 1. Will the-proposed action create a material conflict with an adopted land use plan or zoning ❑' regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? EJ - - -_ 4. Will the proposed action have an impact on the environmental characteristics that caused the ® ❑ - establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ 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 a 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? 8. Will the proposed action impair the character or quality of important historic,archaeological, ®' ❑t architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? V1, Page 3 of 4 No,or Moderate small to large ' impact impact may may occur occur IJ. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? ,� ❑• r 11. Will the proposed action create a hazard to environmental resources or human health? f 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. r a fi i S c h t�J Check this box if you have determined,based on the information and analysis above,and any supporting documentation, n 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, y that the proposed action will not result in any significant adverse environmental imp S. ±, Town of Southold-Board of Trustees _ Name of Lead Agency Date ���'�© President Print or Type Name of Respons► le icer in1'ec]'Agency Title of Responsible Officer Signature of Respon ble Officer in—lead-Agericy Signature of Preparer(if different from Responsible Officer) F, PRINT Page 4 of 4 Board of Trustees Applicatiot AFFIDAVIT fi ! R_L G I U.a °BEING DULY SWORN ?DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE 'ESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ,UL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION D 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 3 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 WE AND O COASTAL EROSION PERMIT ISSUED BY THE BO OFT ST.'E 'H ERM OF THE PERMIT. 5 2 Signature o o Owner ' t e SWORN TO BEFORE ME THIS DAY OF otary Public FNOTARY G�CHWt�MW0RN UBLIC,STATE OF NEW YORK ation No.OIGA6274028 ified in Su R&County sion Expires Dec.24,20 � Board of Trustees kpplicatiQ:1- AUTHORIZATION -(where the applicant is not the owner) a Charles and Brenda Grimes residing at (print name of owner of property) _ (mailing address) .:mo=b herebv authorize N/A 15 --- - .Agent) to ; `s to apply for permit(s)from the Southold]Board of Town Trustees on my behalf. y 3 Y (Owner's signature) ` s .APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE ,ORM The Town of Southold's Code of Fthics.pmhibits conflicts of interest on"the part of town officers nn&cmplovees.The numose of form is to Drovide inform-ntion which enn alert the town orpossible conflicts of interest and allow-it io'take whatever action is, iiecessar�t�ivoid saroo. - � YOUR NAME: Charles and Brenda Grimes_ ' -(Last nartie;first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other --crson's or company's name.) NAME OF APPLICATION: (Check all that apply.) - aax grievance Building -�*iance Trustee _ X - Change ofZone f Coastal Erosion i Approval of plat ; Mooring Exemption from plat or official map Planning Other 3 :9"{)thef%name the activity.) D o you p"ers6nzilly(or ilirough•your company,sponge,sibling„parent,,or child)haven rcl'ationshipavitlrairy_olTcer or employee of the Town of Southold? "Rel'utionship"includes by blood,rgarriage,or business-interest:."Business interest"monis a business, ineluding;a partnership,in which the towrrofficer-or,cntplayee has oven a partial-0yrietship of(dr'eiiiplayntent by)g,coWpration in which thc.tbivn officer or.,cmhl6yee owns,morcahan 5%,of the shares; YES NO X if you answered"YES",complete the balance of this form and date and sign where indicated. r •- 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 the appropriate line A)through D)and/or describe in the space provided. nt e 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 applicgnt ?when the applicant is a corporation); a)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 u Submitte t t' Za of 20Q prj Brenda Grimes 'fl� W , "orm TS I Town of Southold L-WRP_CONSISTENCY ASSESSMENT--FORM = A. INSTRUCTIONS ' L, All applicants for permits* including Town of Southold agencies, shall complete this CCAF for F 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 E making a determination of consistency. *Except minor exempt actions including Building Permits ' .end other ministerial Permits not located within the Coastal Erosion Hazard Area. 5 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 x Waterfront Revitalization Program. A proposed action will:-be-4evaluated-.--as;=to,_'ifs,,-si Lilficant lierieficiaLFiiici adyersc affects upon°tlie coastal:areawliicli'iiclndes,<all of,Soutloll Town. _ k 3„ If anv question in Section C on this form is answered "yes" or "no", then the proposed action will erect the achievement of the LWRP policy standards and conditions.contained'in the consistency z review law. Thus,._each'aansiver.�must�'be exl lained'';.iia-dstaif,,"&siing botli-supporting and'_n_on= ortie _faetg If an action cannot be certified as consistent with the LWRP policy standards and conditions,'It`slialtriot-be-iuidert-aken. t copy of the LWRP is available in the following places: online at the Town of Southold's Y 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 L d SCTM#.�as = oz 124 -,PROJECT NAME Residential irrigation system_ The Application has been submitted to(check-appropriate response): Town Board ❑ Planning Board❑ Building Dept. Board of Trusteesx. ❑y h L. Category of Town of Southold agency action(check appropriate response)- (a) Action undertaken directly by Town agency a 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: As is installed residential irrigation system landward of the 30ft non turf buffer. x Location of action; Landward of the 30 ft non turf buffer at 4145 Wells road Peconic Site acreage:._ 38,595_square feet .89 Acres , Present land use: residential----- Present esidential_--Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant:, Charles and Brenda Grimes (b) Mailing address: 3501 Bonita Bay Blvd Bonita Springs Florida 34134 3 (c) Telephone number: Area Code( ) 239-777-4185_ _ (d) Application number,if any; Will the action be directly undertaken,require funding, or approval by a state or federal agency? = S 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. S 5 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 LWIIP Section III—Policies; Page 2 for evaluation criteria. 'El Yes Q No Q Not Applicable Policy_ 1 is not applicable_given that the-project does not-involve -development, preservation-of open space, infastructure use of coastal location and adverse effects on development. Attach additional sheefs-if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LW1JP Section III—Policies Pages 3 through 6 for evaluation criteria ',E] Yes F0, NoEl Not Applicable Policy 2 is not applicable in that the proposed project plan does not impact any potential historic and or archaeological resources or in the surrounding areas 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:F1 No ❑ Not Applicable " 3 Yes this proposed project does enhance visual quality of the property. Specifically policy standard 3.1 b 3.1 e; yard--cover and vegitation will-be healthy due to regulated irrigation. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRF Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No F] Not Anulicable 3 a f i ne i2roiect pian-will-comply-with policy 4 in that it will improve vegitation and ground cover stabiltiy for better rrosion control measures throuah regulated watering. 4.1 There will be no loss of human life and or structures.= = 4.2.-We will be.protecting and enhancing=buffer._-4.3 no.impact on public land. 4.4 no impact on costal. 4.5 no public funds used. 4.6 no public funds used. Attach additional sheets if necessary — -- Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No 0 Not Applicable _Project is not applicable to policy 5 in that it will have no impact on the water quality supply within the -surrounding area nor the Town of Southold. - - — - — -- - Attach additional sheets if necessary- Policy ecessaryPolicy 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 hrough 32 for evaluation criteria. 0 1. I^l Yes No Not Applicable Policy number 6 isnot applicablein the project will-not'impact the'Town of.Southold's ecosystem - coastal fish and wildlife habitat and the wetlands. . a Attach additional sheets if necessary 3 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•7'No'F] Not Applicable ` The protect will.not have any impact on air quality and,therefore policy number 7 is 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. Ves No Q Not Applicable The project does not involve disposal or transportation of solid waste, hazerdous waste, toxic pollutants i ;petroieum-pro ucts etc. As such, policy number 8 is not appicable. 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 -.riteria. M Y0 No� Not Applicatote Policy 9_is not applicable. Project relates to a private residential property. Attach additional sheets if necessary WORIUNG COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III--Policies; Pages 47 through 56 for evaluation criteria. ❑.Yes 0 No [3 Not Applicable Policy 10 is not applicable as the project does not effect water dependent uses. use is regulated i - i 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. ` s 0Yes0 No - 0 Not Applicable Policy 11 is not applicable in that it does not involve any form of marine resource managment ie., commericial- ' Vis. eves. recreational is eves, aquacu ure etc. - -- s .attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LVMP Section III—Policies; Pages 62 through 65 for evaluation criteria. 0 Yes F] No 0 Not Applicable f Policy 12 is not applicable in that the project does not involve agricultureal of lands (i.e. the converson o - farmland, the establishment and/or-maintencance of new coastal agricutiural produ ion etc. Attach additional sheets ii 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. 0 Yes 0 140'-El Not Applicable Policy 13 is not applicable in that the proposal does not involve the conservation of energy resources on a - commercial level_and /or the promotion o alternative energy sources, proper maintenance ot fue-1s orage facilities ancF7 or the extraction o -mine a e rac o .-- - PREP Y _ TITLE_0 G DATE_q