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HomeMy WebLinkAboutTR-9332A Glenn Goldsmith, President �QF s�(/�y Town Hall Annex Michael J.Domino,Vice-President ,`Q Ol0 54375 Route 25 P.O.Box 1179 Y John M.Bredeme III er k J� J� Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 co --------------=------�----------�---�-- ------BOARD-OF--T-OW�V T�UST�ES----------------------�------ TOWN OF SOUTHOLD DATE OF INSPECTION: `? 9 1'7 '�•,>:,:,, �.;C1i �275:��.^��:�s��iT Ch. 111 lO [a ,2-0 INSPECTION SCHEDULE tvi r* Cava Ol% Q �T P Pre-coristr�tcSYori.::11ebake'?linefsiltli: oti 1st clay.of construction '/ constructed Project complete, compliance inspection CQMMENT.,S-' - :.. _..... ,... .. ;<i J CU^^ am.Q aCCc,�a!) azia . <<: ow`o�SY e '' . . . .. IV Gj Gras CERTIFICATE OF COMPLIANCE: Michael J. Domino, President yo�oS�FFO(��,G Town Hall Annex John M. Bredemeyer, III, Vice-President '�o� yam' , 54375 Route 25 Glenn Goldsmith t N z P.O. Box 1179 A Nicholas Krupski 4��y • !�'y Southold, NY 11971 Greg Williams �l , c ��� � Telephone (631) 765-1892 �'uzr 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, call for compliance When pjp inspection;p O�aUT,�,ol Michael J.Domino,President QF SOTown Hall Annex 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 `,0UN11 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9332A Date of Receipt of Application: September 26, 2018 Applicant: Henry & Mary Pat Mulholland SCTM#: 1000-26-1-17.1 Project Location: 2440 Village Lane, Orient Date of Resolution/Issuance: November 14, 2018 Date of Expiration: November 14, 2020 Reviewed by: Board of Trustees Project Description: Remove overgrown plantings between seaward side of dwelling and seawall and replace with new plantings; remove large weeds on beach side of seawall and restore area with indigenous plantings to match neighboring properties. 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 Natural Landscape Accents LLC dated September 26, 2018 and stamped approved on November 14, 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. " r " Michael J. Domino, President Board of Trustees #018.05-13 N/F JOHN B HENRY REVOCABLE TRUST F' ��� LOT 1F5.1 LJ 4 � E - ' N °02'00"E �� I 67 �ry SEP 2 6 2018 ,1�1, 65. 00' �Q FENCE M FENCE Southold Town SE3C2' W 6.1' N S 1.5' h_v Boar of TnI'stco° n _ 6' LATTICE o E 6.9' or ' WOODi"' LOG I �x FENCE ul DECK ti RACK E 7.1' u') 5.0' 24.4' O� I GRAVEL 9.1' i6 42j § DRIVEGARAGEDECK C) E 1.4'N #2440o 2 STORY N o</ FRAME tO a a OVERHANG o p ^ DECK 0 0 3 3 E 2.0' ORIENT HARBOR19.8'i IE65E EW W LOT 17.1 CD i 4.0� � // z S ° (PARCEL 0 l�` STEPVINYLS � I � � 5 STEPS _ CHIMNEY � o 0 z 9 I W Q FRAME M W 27.0' _ SHED 1 Ln I S6750 0 I < oi I � - - 75.0 ' SII J67°!0' 00"1N67700' c I J 73.00' 1 FENCE 2. 0 0' 5.8' W I N28°18'00"W aGATE o 6 6. 2 0 (PARCEL 11) E 3.4' in x� WOOD DOCK O ,��- GATE (IQ E 2.7' FENCE �� S 0.9' 1 FENCE FENCE WALL v x S 0.1' E 0.3' �S 0.9 v 3 41 00`W 3.3' 3 D i S82° FENCE M ��/ S 1.5' FENCE ♦�. 00 gkVW 1.2' / N 1.0' / / / E 0.1' WF BREDEMEYER j LOT 18 61 N I I I I I NOTES: 1 1. PROPERTY INFORMATION SHOWN IS OF EXISTING CONDITIONS AS OF 5/24/18. KING STREET 2. THIS ITO CERTIFY THAT THERE ARE NO (50� RO� STREAMSS OR NATURAL WATERCOURSES IN THE PROPERTY AS SHOWN ON THIS SURVEY. 3. THERE ARE NO UNDERGROUND OR OVERHEAD UTILITIES SHOWN ON THIS MAP. CERTIFIED TO: 4. THE DIMENSIONS SHOWN HEREON ARE FOR A SPECIFIC PURPOSE AND MAY NOT BE USED TO FIRST AMERICAN TITLE INSURANCE COMPANY GUIDE IN THE ERECTION OF STRUCTURES OR FENCES. MAXIMUS TITLE AGENCY,LLC HENRY MULHOLLAND and MARY PAT MULHOLLAND JAMES J.MCGUIRE,PC DIST. 1000 SECT. 26 BLOCK 1 LOT 17.1 "JU Fm' t2 TITLE SURVEY ��®�NER �® at �� ILLRR 2440 VILLAGE LANE ' "ONLY COPIES FROM THE ORIGINAL OF 'THIS SURVEY MARKED, WITH AN ORIGINAL ` + ltv k+ ORIENT EMBOSSED OF THE, �SEALSSHOBE CONSIDERED - 0 ; LS INKED OR TOWN OF SOUTHOLD To BE A TRUE VALID COPY" ' 409 LAKE AVENUE COUNTY OF SUFFOLK "UNAUTHORIZED ALTERATIONS OR ADDITIONS To A LAND SAINT JAMES, NY 1 1760 STATE OF NEW YORK 11957 LI SURVEYING DRAWING BEARING A LISURVEYING PROFESSIONAL LAND TEL: 631 .672.248 1 SURVEYOR'S SEAL IS A VIOLATION OF p ww FX' 631 .71 6.776❑ ARTICLE 145, SECTION 7209, PARAGRAPH 2 OF THE NEW YORK STATE EDUCATION TRUEPOINTSURVEYQ@C.MAIL.COM LAW" ANDRE K. MILLER NEW YORK LIC. N0. 50921 TITLE #: ' MT041718011 FA DATE: 5-28-2018 SCALE: 1"=30' APPROVED BY, Orient Harbor E 7 E BOARD OF 1 tRUSTEES --TaWN-OF-SOLtRiOLD I �� f� SEP 2 6 2018 1 DATE ave —_--- N M ! , 211 --------------- Beach I Boar of Trustees ———— I I I I I I Area 1 --Remove tall unwanted weeds and i restore with BeachI Grass. Concrete Wall I I Area 2—Remove overgrown shrubs and I replace with native I Shed seashore plants and grasses. j I I Deck-Wood Deck Stone` I I I I I CD Residence I ' Henry and MaryPatMullholland Plan By Natural LandscapeAccents LLC 2440 Village Lane 32900 C.R. 48 Orient N.Y. 11957 Peconic N.Y. 11958 9/26/2018 631-765-4329 Michael J. Domin �esident o�QS�FFO(KC- - Town Hall Annex John M. Bredemeyer III, vice-President �� `��,t 54375 Route 25 Glenn Goldsmith I ' N P.O.Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams Telephone(631)765-1892 - �Ol Fax'(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 0- - Completed in field by: Natural Landscape Accents on behalf of HENRY & MARY PAT MULHOLLAND request an Administrative Permit to remove overgrown plantings-between seaward side of dwelling and seawall and,replace with new plantings; remove large weeds on beach side of seawall and restore area with indigenous plantings to match neighboring properties. Located: 2440 Village Lane, Orient. SCTM# 1000-26-1-17.1 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 of Hearing Card Posted: Y. / N -Ch. 275 d/ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standard I � I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski O't-G. Williams Other ',:i�.. - .. �. '� t � - e.Kl:x :.r=`..�z�=•* ;'lC;.rizr'fz�;z'.'�.'Ya:"t,,,"•'S,*-�'�`'.` ,�a;.. '%, ,{', a?r'r�' '� ,�.«.''g �' ... . _' _.. .�.,w`. cw. _•'..�.".i:'M i':_:..#'-. ;:,M.:, <>v",sz"".,., .: y,.+ y e t-t� ,aw. 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Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 Q Telephone: 631765-1938 • �O Cou�m,��' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: November 9, 2018 Re: Local Waterfront Coastal Consistency Review for HENRY& MARY PAT MULHOLLAND SCTM# 1000-26-1-17.1 Natural Landscape Accents on behalf of HENRY & MARY PAT MULHOLLAND request an Administrative Permit to remove overgrown plantings between seaward side of dwelling and seawall and replace with new plantings; remove large weeds on beach side of seawall and restore area with indigenous plantings to match neighboring properties. Located: 2440 Village Lane, Orient. SCTM# 1000-26-1-17.1 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 INCONSISTENT with the Policy Standards (Policy 6.3) and therefore is INCONSISTENT with LWRP. 6.3 Protect and restore tidal and freshwater wetlands. E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided.- Not voided.Not enough information has been submitted to adequately assess the action. The plants to be removed have not been identified (species). A planting plan with proposed species of plants has not been provided. 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 Sep 18 18 01:27p Natural I lscape Accents 6317654329 p.3 ]Michael J.Domino,President �o� SOU���lO Town Hall Annex John M.BredemP.O. Route 25 eyer III,Vice-President P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® �p� Telephone(631) 765-1892 Greg Williams �ljY Fax(631)766-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application ::/Wetland Permit Application Administrative Permit 6AAImendment/Transfer/EXtenl'lon� �g Received Application: 44f Received Fee: $ 100,0 Completed Application: ' Incomplete: / SEQRA Classification: Type I Type I1 u Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: C oordination:(date sent): 2.1 r; p V onsistency Assessme t Form Sent:AReferral Sent: fl� iate of Inspection: u SEP 2 6 2018 Receipt of CAC Report: Technical Review: Public Hearing Held. Southold Town Resolution: Board of Trustees O-vvner(s) Legal Name of Property (as sho-wn on Deed): Mailing Address: I Uo Phone Number: Suffolk County Tax Map Number: 1000- Property 000-Property Location: v o A (If necessary, provide LILCO Pole 4, distance to cross streets,and location) Co. e— kcc-efVk AGENT (If applicable): �{ Mailing Address: P. o • dJ C' � 3 � � ��G�mi 1 GXF Off° Phone Number: Sep 1818 01:28p Natural t lscape Accents 6317654329 p.4 Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: S` ��°�" Intended use of property: S� 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 ✓ 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 v No If"Yes",please provide copy of decision. Will this project requ��io demolition as per Town Code or as determined by the Building Dept.? Yes Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V INo Yes If yes,provide explanation: Project Description (use attachments if necessary): OIMVJ�J AQ-(JVtAc� 6AJee,1,J k�C-L oe" kou�� aius aced iw o K N I � � k�C,6 � � 10- J�el 451r-0A -p t P Sep 18 18 01:28p Natural L scape Accents 6317654329 p.5 Board of Trustees Appl�.Qetion NVETLANDITRUSTEE LANDS APPLICATION DATA Pu proposed p Purpose of the ro osed o erations: ���°"� d�� s 4\m- aNA c eo-wcLA or-,,A �-e4`0'J`d Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? �_cubic.-cubic yards Depth of which material will be removed or deposited: d 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): 00 Lic G Sep 18 18 01:29p Natural' --dscape Accents 6317654329 p.6 617.20 Appendix B Short Environmental Assessment For,rc Instructions for ComptetinjZ Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses became 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 oruseful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information 'lame of Action or P sect: c-4�N a, � �— H.v ll, ((_a I Project Location(describe,and attach a location map): a-,A L�0 \/;tto_� " , 0 Brief Description of Proposed Action: 1 ��-^-'�"�S 1D-e-��-� ��-'c-(�- 0 C— aN g-ea. l b-e_ ne Zaa�J wti`s a V- L���� 4 � S Ste^S S j Q-A, ry-&roe I.r� tin a.`�.eNu�Se � 'Name of Applicant or Sponsor- ( Telephone. S L PC � i E-Mail: C" Address: 10 ) City/P0_ State: Zip Code: �� c� 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordir nce, 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 govemrnental .Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ 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- F-1 Urban [:3 Rural(non-agriculture) ❑Industrial ❑Commercial Residential (suburban) ❑Forest ❑Agriculture Ei quatic ❑Other(specify): ]Parkland Page 1 of 4 Sep 18 18 01:29p Natural'---dscape Accents 6317654329 p.7 5. Is the proposed action, \O YES NIA a.A permitted use under the zoning regulations? ❑ i ❑ b. Consistent with the adopted comprehensive plan? ❑ '; F1 6. is the proposed action consistent with the predominant character of the existing built or natural N O g landscape? Is the site of the proposed action I Ited in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: dot- g.AJC1LJ T�_ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO I YES 0 F11 b.Are public transportation service(s)available at or near the site of the proposed action? Fj ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? LL__JJ ❑ 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 publiciprivate water supply? NO YES If No,describe method for providing potable water: 11.«rill the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 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 TNO 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. Id tify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply- shoreline ❑Forest VsIburban gElricultural/grasslands ❑Early mid-successional [Wetland urban 15.Doesthe site ofthe proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, —0,TJ a.Will storm water discharges flow to adjacent properties9 ❑NO DYES b.Will storm water dischargcs be directed to established conve}ante systems(runoff and storm drains)? If Yes,briefly describe: El No DYES Paae 2 of 4 Sep 1818 01:29p Natural -Iscape Accents 6317664329 p.8 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? if Yes,explain purpose and size.- _ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or 110 YES completed)for hazardous waste? if Yes,describe: 4 ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF rV1Y KNOWLEDGE Applicant/sponsor n e. �-�eri ��(ul(,ol�.r Date: `r 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 I 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 Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ry t 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 ❑ establishment of Critical Environmental Area(CEA)? E 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 ❑ reasonab[y available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a-public/private hater 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? U 9. Will the proposed action result in an adverse change to natural resources (e.g.,wetlands, � waterbodies,groundwater,air quality;flora and fauna)? Pagc 3 of 4 Sep181801:30p Natural'---,IscapeAccents _ 6317654329 p.9 No,or Moderate small to large impact impact may may occur occur 14. Wilt the proposed action result in an increase in the potential for erosion,flooding or drainage F] problems? 1 I. Will the proposed action create a hazard to environmental resources or human health? 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 considerthe 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 environmental i pacts./ Town of Southold-Board of Trustees Name of Lead Agency baLe Michael J„ D iD m I rn President Print or Type Name f R onsible Officer in Lead Agency Title of Responsible Officer Signature of Respo ible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Sep 2618 41:56p Natural I. ' Iscape Accents 6317654329 p.2 Board of Trustees App!'�,�..ation AFFIDAVIT 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 TRUS'T'EES. 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 I%n-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. Si e o Property Owner SignaturdVof Property Owner SWORN TO BEFORE ME THIS � DAY OF �17s`t�t ,20 C I CAROL A RACCARTNSY Notary Public Notary Public-State of New York No.01 MC6178979 Qualified in Nassau County My Commission Expires Dec.17,2019 Sep 2618 01:56p Natural I Iscape Accents 6317654329 p.3 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, a.—� . 0—� -- ( 1 owners of the property identified as SCTM# 1000- in the town of New York, hereby authorizes 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. a4/�a Pz p y wner's Signature Prope y Owner's Signature SW(?RIV TO BEFORE ME THIS 6157 DAY OF 2 201 ! + CAROL A MCCARTNEY Notazy Public Notary Public-State of New York No.01 MC6178979 ®uallfled In Nassau County My Commission Expires Dec.17,2019 Sep 2618 01:57p Natural L. scape Accents 6317654329 p.4 r'. r - - - AFFLJ-A1�i-/AGFNx'/kE'PRESENTATIVE TRANSACTIONAL DISCLOSURF.F01M The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees-The pumose of this form is to provide information which can,alert the town of ossible conflicts of interest and allow it to take whatever action is riecessary to avoid YOUR NAME• � ^'� SIJ l l• (Last name,first name-puddle' tial, unless you are applying in th.e name of someone else or other ontity,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 Trustee Variance Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"OtheC,"Othername 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,r4arriage,or business Interesk.`Business interest"means a business, includ i ng 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 thany 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person • Describe the relationship between yourself(the applicantlagWrepresentative)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 applic�nt (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 1?)the actual applicant. DESCRIPTION OF RELATIONSHIP CAROL A MCCARTNEY Submitted this : day of � 200 \� Notary Public-State of New York Signature- No.01 MC6178979 Print Nam Quailfied In Nassau County v FgnaMlsslon Expires Dec.17,2019 APP IAiCAN T/ADEN T/RE PRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. ��,C� �, r� YOUR NAME: PAf-�L ovi -S� %' k) ' (Last name,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 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 chill)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood, marriage,or business interest"Business interest"•means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP cy --20 Ile Submitted th' day of � Signature Print Name Form TS 1 Sep 1818 01:32p Natural' --Jscape Accents 6317654329 p.13 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 ir�forrnation used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerialpermits not located tivithin the Coastal Erosion Lazard 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 he explained in detail, listing both supporting and non- supgortin facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertakers. A copy of the LVVW is available in the following places: online at the Town of Southold's website (southoldtowm.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 SCTM4 PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LIQ! 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by To,�kn 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: Sep 18 18 01:32p Natural',-- Ascape Accents 6317654329 p.14 Location of action: U Site acreage: Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the follov ing information shall be provided: (a) Name of arplicant: �"'J rJ Mtw�4-"'A �_ (b) Mailing address: 100 I'�Vo At (c) Telephone number: Area Code (i (d) Application number,if any: /A Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No 9 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 LWItP Section III—Policies; Page 2 for evaluation criteria. Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Poliev 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWI2P Section III—Policies Pages 3 through 6 for evaluation criteria 12f Yes ❑ Yo ❑ Not Applicable Sep 1818 01:33p Natural', Jscape Accents - 6317654329 p.15 s 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 ZYes ❑ 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 LVVRP Sectio III—Policies Pages 8 through 16 for evaluation criteria Yes No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ ides ❑ 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 ,Sep 18'18 01:33p Natural; --,Jscape Accents 6317654329 p.16 Yes No Not Applicable Attach additional sheets ifnecessary 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 waste - See L)N RP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes 1:1No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No[ZNot Applicable Attach additional sheets if necessary Sep 18'18 01:34p Natural --Jscape Accents 6317654329 p.17 WORKING COAST POLICIES Policy 14. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LVVRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Z Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No ffNot Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L'VVRP Section III — Policies; Pages 62 through 65 for evaluation criteria. [�J/ � ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 63 for evaluation criteria. F-1Yes ElNo Nat Applicable KJ����� PREPARED BY `� TITLE DATE Natural Landscape Accents LLC P.O. Box 361 Peconic N.Y. 11958 631 765 4329 To the Southold trusties September 14 2018 Attn. Greg Williams I am the owner of Natural Landscape Accents LLC. I have a job site at 2440 Village Lane, Orient N.Y. 11957. My customer would like to remove over grown plantings between back of house and concrete sea wall, to be replaced with new plantings. Also, beyond seawall the homeowner would like to remove big weeds and restore area with indigenous beach grass to match neighboring properties. All work to be done at the appropriate time of season by hand tools only with no fill removed or added. Thank you, Darrin E. Skrezec Member � CE V E � ''r SEP 2 6 2018 Soathald Town Board of Tmstees