Loading...
HomeMy WebLinkAboutTR-9331A J/ 4 _Ny<i�=r.ClJ} D Michael J. Domino, President c�o a Town Hall Annex John M. Bredemeyer, III, Vice-President ��� y<;", 54375 Route 25 Glenn Goldsmith P.O. Box 1179 A Nicholas Krupski S �y • o��' Southold, NY 11971 Greg Williams ' �l �. �'' 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 When project complete, call for compliance inspection; �o�*Of S®Ujy��O Town Hall Annex Michael J.Domino,President John M.Bredemeyer III,Vice-President 54375 Route 25 .iL P.O.Box 1179 Glenn Goldsmith T Southold,New York 11971 A. Nicholas Krupski �� Telephone(631) 765-1892 Greg Williams Iy00M) Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9331A Date of Receipt of Application: August 2, 2018 Applicant: Oliver Frankel SCTM#: 1000-13-2-8.21 Project Location: 975 Hillcrest Drive North, Orient Date of Resolution/Issuance: November 14, 2018 Date of Expiration: November 14, 2020 Reviewed by: Board of Trustees Project Description: Ten (10) Year Maintenance Permit to hand-prune the vegetation located landward of the top of bluff; and to top-off trees by hand. 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 Oliver Frankel received on October 31, 2018 and stamped approved on November 14, 2018. Special Conditions: No bluff vegetation is to be cut below 4' in height. 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. j r Michael J. Domino, President Board of Trustees Michael J. Domino,Pr ntO�QSVFFD(�-COG Town Hall Annex John M.Bredemeyer III,Vice; V_rresident �� if 54375 Route 25 Glenn Goldsmith o P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �too Completed in field by: OLIVER FRANKEL requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-prune the vegetation located landward of the top of bluff; and to top-off trees by hand. Located: 975 Hillcrest Drive North, Orient. SCTM# 1000-13-2-8.21 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: J-� 6Ws, 1,e J 5-,5 I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: . a emeyer M. Domino' G. Goldsmith ~ N. Krupski G. Williams Other Michael J.Domino,PresO��Sl1FF0(�-C A Town Hall Annex John M. Bredemey Vice-rresident er III - 54375 Route 25 -a y�,R Glenn Goldsmith yP.O.Box 1179 A.Nicholas Krupski V Southold,NY 11971 Greg Williams ?� ® p! Telephone(631)765-1892 wo1 �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: C Completed in field by: OLIVER FRANKEL requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-prune the vegetation located landward of the top of bluff; and to top-off trees by hand. Located: 975 Hillcrest Drive North, Orient. SCTM# 1000-13-2-8.21 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� 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 eo Ch. 275 �" Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: fe- 0')Jn 9) Qq e CEJi°C,� CJ -e-Aa'l . I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski -G. Williams Other fir'= �4 i. f� - +ri - zF f c �►'.a: °" P ,r-.. _ v 't �� i ♦a ��t � r. - - �� i s re'. ..1 i> `�:. �"-�a• +f ..Y r �' �S/' -. t •.�'�-�• �. E...:rt1 `T'�+�xi�� :fit.• '�'�:.As�SE� '.�i�l� s•� Mor) 10 Frye_ _ '�; `a°� b to•,,C- ` °: _pl. ;��w"'Y'„ -.i+'srs•-�XeV••." Y �`3R t,. _"'_ � ��.' oc ,L •� .I�:.3a - d y v (;Aar' ' '° ,'' + yl. �• �t t<,.- Rw'...' +r f .n ;�ca 4 .t,�A' -1,. - Qa Fw' �..": _ t �' Yr "� � �•'T;�, �y��� `�"i� �yi i i4 ii '�,,,r �_�4 ,10 i1 1 � ,,�y ''1 f.�"^ "+'� '!��^• �L� l .s� _ .f.r�t'ie� �y ,' J '�ur.�a,1�`R�r fs.?!}'�}'* ^':�k �." ;1M� M' 1�,.�:� fence;- ,..Vy.��.lk'. '1���i• Cyt.. •�: ��+Li�•f � � r �' tR' 1r �'^ *� _ . - .;%, 1 ` 1 , �, • , : (. ,ta. fw � S _,,a ;'L}.^ ` .:t,*�, .#', '""aC� ;+l�'KSt •'� 'cam£" ~"^�_� 44 -'.irS' f�14��. f'�'.'•�� � J,. ..r - r v"�_tt_aa 2 w.t�.• qZ�_ .,.ry w� 7 ��� rt�M. "�y r��� ,.:3�" ,. ' -•-� �p �'� �'�^ lr b .. r• � .._,: ray _ - � � '�� r - _. �� < : c•1��. � / w � ! J � i � y ... •�it,� }�• - -.. �.. - •• � `'�. 1f� - ' •..:3M,�,"= tee+: ''r�. ^ .- *��. ti� ���< ''"^°;. w'.' - +.�•. ,..:} 3'^ _r �ir,. �b'r o._, -"�� Vit' - i'i�,s,��JJ/ �,i "' l y� '�1 �;,�•' r �.'a ^ kyr :} - � vt. �ti _ �_- Ifs '' - jj E •�� �� 'ti' i��- r _ 14 Ja �,L,yS � � .1.' NFA •. ���� 1 �. - • )f. J }.' . t Ari'�:�i :' , •.r- � � �.- �f� r'i'm -'.� .}+•.- K �t i f. CII .as,:�q,,. A, i• �'. -Z'�i, i'��'y�y _ ` ly _..r y19 is`t:.i �j1 r, � 1r�•F^£!� _ ,_�1I CT3 '� ,Y ':s �' 'any .ii'" •J, �, r�f� • `�> - t ^7A' ; All !'r ',} - 4- t ,' =S '- 115�-Q�cy�� "U _ n- :4'L Vii ^ 'i• 1, �v � �. r -.� i'yX_�" f�s#''�►' s•_ - .,� � ` ��,y _ G.. - ,y. i t.. ,.} ,•w 1', i '�� r+ `•! r' ..:` \� � rr�,. •a%fes, -+,�to 'Fr �R� - �"r• •y. Ms, ';4.-• �� - ... �, /�' - /t t,ir � s.ri J "'j,c��- 'r.. - has ]r ,!► 1!�t.} �•rr 9�x,. _.. Iw ;si, :� ��'4�"'- _ .., r �i�,,' �.cm1- �," ,� _,�r. � �,y; t1; .` �. `3' Y �jj,� '�,M1'+,-•_ a ��.'� �„_ )• t. ' �' � - .i,'a - ; ��� Y.` '�� ::�'�WY,..f .�'-�+7i�:ty- T�' Vt�• iy -•tet. .- • rx 1• i yr.ra _ t''. "'a`. ''C'' - '•�' - '`�. - v .;-' ��►'� .aa.`"s�':": r' «fi` gp ('ti�a•,:.s+'S!" �r•;.` -,�;� '-� �=� y - -1.94+,"': --L_�,';� 'y�r" , -- , . __ Y� a •� _ pr .�.� '-�q�! ' _mss r ,�. .� E r - .. y _j=am"'• - � ` � _ ': � ?', �. �,- � �-� r__ �(� _ - �•: �:- •,: f-tea /- ,�` z d *r • , i I. 1 t: l - 1 iY tt�- �. .�+'-,97 O t _ ' v ^6� t :l`K ♦ " M1i - a:i.. "'�!..r:.'. 'Y .0•a"+If. �i �..• • �a- is •� 1 .t - SA �, - gist�'��y"'`�,�' '"� x- �_ � �' ,�` f : `�. . ,'� �� 'J�►" •�- I 1 � � � ,> �' fgyw:�'? �` • S •y J_.}1�.'•4��"'C�`.ir��9�_/' tFr .1 _ -�'r. � �-�_J- d��t ,� �' �.� � ��'•.� 'f l; � " � .w-. "'x' �J•�'c� -- ��� -- �.'T^� -;ev � - �.r."�'f•� :,.*, ";E�''i:� ,qv,� fir.- � i, �:..�; ` .��q�`- S ; ` ^�t` a• -- - _- •.��G.0 ^'f -!fir :. ✓ y�� � 1` �'k�'i y .';� ���_ � 5 h -• - �iSV.� ^J. }. r��"_,e$, ren. ��, ,�, .rte_ -- 'ti, :s-''"ti�,i� o.�s�S��,svi " �7 v•'` a•"'�» v— •.�.'.-' ::� y'� c_. r�i1�C a a. -.i;r � ,.� �{ ..�;' �.: �+. .n� ..�� -� <•+•a f/���a fi�� `*_•s. I `- � pia \p ,,_ '-3, a�_� f� 6����iY"A••/' L�Ki /��i� ., _ .,� �,��t. ••��� ti sa�•.�` E , � Pti�'.� /i. `!K}`0. .�. �'-� •<' fi+ �''.�'r. � � f�7�: :� Imo' tam ��\�� �' E�l' �. > f =d t" r'Y' t+ *'�w�iy.L L-` eif`•�}: �. `j .✓t"�__-./1 •{.;•ice. :':; •�^' .�ti-.. + . +t�{� .__'� ,• .s �,� �i. � `3�A w .���.si�;�' '_� .,�^rf�_,�'..y{,}lei.;,v��\ '� 4�: _ .+��/r�s►� ��; �i►w::.. ^" .; t .r ,,�'F -, �.1."'tr.. - ! '•' >. ��. T' �^�,jl ',•�ir7•`V� "'ti.^`Y� '' 0, 1 .�+.�,� r _-. '� � C� �,�. a .qty .� {• .,� ��'• �'` �, �,2 l�hr"�G�1� 1� _'�� ���` -�%y�R Y�• .Y f 5►' + ,� 'ice'• .A 6, . ��- �:Sa,'"' "'s-�i .r.•.:'.- .'� s�k* F•- -r- r s}� 3 �3/�,� �. :�}:.._� •�n�J .t` 4., •"L- ;Y� •` :.� •• - 55.0 50.0 45.0 40.0 LONG ISLAND SOUND 31 NIDE TIMBER sTAI RNANr S 7824'35" E N 48.48 LANDING #-r S 84'34'01 E N 87'48'59" E 4'x4' 92.23' LANDING #6 - — -- -3 4 — _ __ 4'x4' TIE LINE ALONG APPROX.--- 6.7 ----__ HIGH WATER MARK LANDING #5 WITH BENCH e ----_ BLF s ---_--_-__-- -_-___--__---__ r � �_.� �♦ �. r ,.� �• .`C 1, `�yji .!� « �i �' . Ale ML Ak We 411 or t . •ift_ ` No « r:'+ y Y� it IL .. ` � .`t•.r' _�:�b1., ,�. 'r JIB.. r: � �•_ jw V,. YY _ �'�.•� i t _ a: ��� � may:. Y :��' i. rA _ - F , I ,. I� • .�/;.� war- . s-�. _ {+ �•w- _�- ! �, •� -. _ .r _, `�_ r - ".sir -- _ low dk w iIS� Aoll ~' +� 14 kf Oft NAIL a _ ,� l �I _ � 'Y tom, e• �..:fir. � � K fes♦ • .3-- ''+ �� •�.. �... Y.„ � Aw No Ff i�� _ _ �• T ''t 14 r�.�+!^,,•_�"$aa' �. 'ri`"� �, , •mss ►1� - . � ` ' •. �- •� � r 10 T rj1 � Y •y - � � '`�,- - � ..,, {i^ � , , ,� � },{tip � a�� - T+ +� ti. i yf s-ilky • ��� � � � , � -� "' 1 `!� �i . .-. �, .'� 3► .�- + s}�L} � � _ fir. � _ � . OPT Ko A �� ', • 4 ,,, _ ' E ' 1,.11+ay-b _:' 'meq - ; MWT77-71= 4 r N a0 Pp 65 MD aorta ]s ]m y SOJ�O / zeA�c1 valla `_fto � G e31 N ]13 LO � ^ ezo 16A aorta '" at9 i]A / ry 9.te / 1]A N w as m" ^° 17A O� =IA(C) 9 eza O aC I 7A OA(C) 17A 13Ma Si L• '9Mc1 M' e.z x x an a� OAA a]1 x 1. a A' 1.zya n.a w eye valla 101 102 °^ 810 S 1 M 1 a fir° y wo_z, ']Mclz w s e e.s w e.za sa aa� e9 - za ze O' FOR PCL.NO a" FOR PCL NO SEE E9"W q0]]O BA eS w rv' p OP 1.MJ�` SEESEC NO � a WS-0e-09a,3 , e , ,¢` ]1 d y b a] AMTLH ---�.----l1NE '0Ma y1 __-Z________UNE t 19MU 10.1 AMTCH '• t z • a e.T O0. ♦ 5 ` a148 u x r•NRO V _ __ NOTICE COUNTY OF SUFFOLK © K souTNan sEcnoN No v�a'� m ,� A RealPropertyTaxSemceAgency i 1$ .s.. vim. w Ns,aeuno oFw«~�.��re y � .Y. r. �"t^ F,p a Gau^ty fSznW RI.ezMee,NYlleet M e,e u.ir zu w n..[ _ eufcatrvc rvry rax rrrru. r wrr�w.ru�--w.-- run¢ .rnerwrtv wrrocrua ncv a[aussox or mE uvExrt[r m o m uo err.. rww.. .rte __-- r�e...u. --.-- ro.n m xE,u rwoccvry ru ecmncEwcEvcr '� p a,e oto tnr,ncr x0 IMa PROPERTY AMP '. OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex ~� l0 P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) • COQ Telephone: 631765-1938 Southold, NY 11971 O Fax: 631 765-3136 �ypitUNV LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Assistant Town Planning Director Date: September 13, 2018 Re: Local Waterfront Coastal Consistency Review for OLIVER FRANKEL SCTM# 1000-13-2-8.21 OLIVER FRANKEL requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-prune the vegetation located landward of the top of bluff; and to top-off trees by hand. Located: 975 Hillcrest Drive North, Orient. SCTM# 1000-13-2-8.21 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 and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold's ecosystem. 1: The submitted materials lack specific details on the area(s) that would be pruned. 2. Will pruning occur in the Coastal Erosion Hazard Area? It is not recommended. 3. What assurances will'the Board have that severe pruning of vegetation (to the ground) will not occur within areas. 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 Michael J.Domino,President Town Hall Annex��' e��! ' John M.Bredemeyer III,Vice-President �' 54375 Route 25 [ S P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A. Nicholas Krupski � C Fax(631) 765-6641 �UN_s BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only { Coastal Erosion Permit Application Wetland Permit Application ZAdministrative Permit Amendment/Transfer/Extension / rp Received Application: `` Received Fee: $ ���, �� n 11 Completed Application: - _ lirE — 2 201$ Incomplete:, / AUG SEQRA Classification: Type I_ Type II V Unlisted ; Lead Agency Determination: So+!f{old Town Coordination:(date sent): /� Board of Tniste°s LWRP Consistency Assessment Form Sent. / CAC Referral Sent:, Date of inspection: Receipt of CAC Report: _ Technical Review: Public Hearing Held: Resolution:, Legal Name of Property Owner(s):� Mailing Address: I q 3 �'f• �N, ��C Phone Number: q1q "01 1 ^ 3a� Suffolk County Tax Map Number: 1000- Property Location: q f)�, - N I k V-S I M03\ Ngal (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Board of Trustees Application GENERAL DATA Land Area(in square feet): Q�j\�(;�(1 1�Q ' �Q(�y q q Area Zoning: Previous use of property: 'ns Lc - tiAV ckW Q,1,kl� Intended use of property: ��Q Q, c\�l �q d-W���1�10 - --- - 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 Y 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. r Does this project require a variance from the Zoning Board of Appeals? Yes Y No If"Yes",please provide copy of decision. i Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _N0 i Does the structure(s)on property have a valid Certificate of Occupancy? _Yes No t Prior permits/approvals for site improvements: Agency Date 6( 1a lbws No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_ No Yes If yes,provide explanation: Project Description(use attachments if necessary):,: cif -I-hQ o o+ b Lu-4.9 ar'cl to _�� 04_i121 r � Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: R(Ird 0 0—tt" VOKAMIM W M Ao V f Area of wetlands on lot:- square feet Percent coverage of lot: % # t i Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: ��feet 3 i Does the project involve excavation or filling? 5 No Yes If yes,how much material will be excavated? ���cubic yards i How much material will be filled?- _ ftO, cubic yards 3 Depth of which material will be removed or deposited: GL feet Proposed slope throughout the area of operations: I\Wa r Manner in which material will be removed or deposited hI 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): ho inn o ot'+ +0 W 0 s-1.0 0) r Du \A dj(.S+urb0_nft r' ~. 61 Z20 Appendix B i Short Environmental Assessment Form Instructions for.Cimpleting Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part t -Project and Sponsor Information E Name of Action or Project: t IWF(MW Project Location(describe,and attach a location map); V1 ON" Brief Description of Proposed Action: 1� ccl cA-AAW4 +o F k Name of Applicant or Sponsor: I Tqo LE-Mail: 1phone: c3Q 1�� � Address: �fi. � I d e City/PO: State; Zip Code: n 08 /3 1.Does the roposed action only involve the legislative adoption of a plan,local law,ordi 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 governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: _ ® a 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? _tglacres 4. Check all land uses that occur on,adjoining and near the proposed action. EJ Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ❑Residential(suburban) ❑Forest ❑Agriculture [ ]Aquatic ❑Other(specify): ❑Park land Page 1 of 4 5. Is the proposed action, NO YES_ .N/A a.A permitted use under the zoning regulations? ❑ (�`) ❑ 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? ""� U 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? -NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? /\I L❑_l 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: �I� ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: F]1 (—`L_.11 11.Will the proposed action connect to existing wastewater utilities? NO YES I If No,describe method for providing wastewater treatment:. MOL Q ❑ 2. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? n b.Is the proposed action located in an archeological sensitive area? ` i 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? O b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? E If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 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 Wetland El Urban [RSuburban 15.Does the site of the proposed action coniain 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, a.Will storm water discharges flow to adjacent properties? ❑NO DYES � b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: No ❑YES Page 2 of 4 i 18. Does the proposed action include'construction or other-act-ivities 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: � , a 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: FT S 20.Has the site of the proposed action or an adjoining property becn the subject of remediation(ongoing or NO. YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PRO ABOVE 1S TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name;. _ / VKVof:-_r Date: Signature _ S -=J S 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 1 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 1 small to large impact impact may may i occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ! regulations? a ; 2. Will the proposed action result in a change in the use or intensity of use of land? j 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 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 actiori-cause an-increase in the use of energy and it fails to incorporate Q 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? E 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, 3-1 waterbodies,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? F- 11. 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, z duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. i ❑ 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. FICheck 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 d Name of Lead Agency Date Michael J. Domino President Print or Type Name f Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsi Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 r \ APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM .The Tbwft of Sot old"s.Code of Etliles"r ' ' fto c n i of inferbskt► "Y art officer s,pa mWqve,,,s;Afig pwose,ot n this formjio' rov nformtiti " .w icli can al a town,ot0ossl6IicQDfljCtS,qf into ' a ' "w ffb ttikb''15'<'v `'rYcfin :is rieesssarv;��<�void'sam� YOURNAME: - (Last name,first name,.rpiddle initial,unless you are applying1n the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name,) 1 , t 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.)_ • s DO you piirsdrd ly(6etlirough your ciimpiiny,spouse,,sitiling,parent,.or child).hvg.a relsitignslilpavitlrnrzy.vl cerxir cr[tployee c f.tlic.'Town of_5outlioltl? "Relationship"includes byUIood, rria e,iirbusiricss:irite`rest`rl t iii s5.ii}tcresl 'tti ri .a atisiiies�k; includifrg,t pnrla�ersl�ij,in}Ytiieti'the town ofticc ror.Criipts% ,lais;vy4tt patisiiystierfli .off(#r }ifl5lpy,►ltpnt lxy)'a t orpr3ratinn ; iri vkiiicli did lawn of(cer of"emiloyee'owns more tlian.S°!4 tat itie shores: i YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. _ a Name of person employed by[lie Town of Southold - Title or position of that person ' Describe the relationship between yourself(the applicant/agcnt/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 .._ Sub ttec a f 200 • Signa - Print Name Form TS 1 Board of Trustees Application ,AFFIDAVIT - 3 f i 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 I EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM 4 OF THE PERMIT. of Property Owner ` r SWORN TO BEFORE ME THIS I DAY OF Notary Public LAUREN M.STANDISH Notary Public,State of New York No.01ST6164008 Cluslified in Suffolk County Commission Expires April 9.2018 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) F I, NNW f(C.X94 residing at (print name of owner of property) (mailing address) Q e- YL� do hereby authorize - — (Agent) eA-Q�6 _N to apply for permit(s)from the F Southold Board of Town Trustees on my behalf. (O ure} Town of Southold LWRP,CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS L. 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 sinificanC, beneficiate and adverse effects u on the:cdastal•area LwLbighibeludes all of Southold` oma 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, aeach'answer,must•be extilained'im detail, listing both,supporting, and Ron- 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#. _ . �. ,Olt - PROJECT NAME 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: LAJ Nature and xtent of action: rY1Ca��1,�LR0Ma 10 M I amward ol-� -Vrees d Location of action: I S R W e,\r t 2,1 Site acreage:��t Present land use: It (�'f1�QLQ SI�lQ�2 JODAYI.( (l( Ctwaui Q 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: (! F(b"V- (b) Mailing address: � 3 PUCU& ov,, o-C- - (c) Telephone number: Area Code (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes LJ No® If yes,which state or federal agency? i 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 t minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. F]Yes No [4 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria U Yes m No 1� 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 7 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 n : 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 0 Yes ❑ 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—PoIicies; Pages 22 through 32 for evaluation criteria. I] ❑ NI r Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 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. i Yes No Not Applicable i 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. Yce ] No Not Applicable Attach additional sheets if necessary E WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ,❑ No F-V-1 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑Yes No LTW' Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY, u TITLE DATE , 1