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HomeMy WebLinkAboutTR-7838A James F.King,President �QF SO!/T Town Hall Annex Bob Ghosio,Jr.,Vice-President hQ� O 1 54375 Main Road P.O.Box 1179 Dave Bergen l Southold,New York 11971-0959 John Bredemeyer Michael.J.Domino • O� Telephone(631) 765-1892 O�y COU Fax(631) 765-6641 NTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7838A Date of Receipt of Application: May 30, 2012 Applicant: John Boyle SCTM#: 18-2-34 Project Location: 24435 Route 25, Orient Date of Resolution/Issuance: June 20, 2012 Date of Expiration: June 20, 2014 Reviewed by: Board of.Trustees Project Description: Provide access to a right-of-way by removing trees and planting grass and a 4' wide path through the 50' non-disturbance buffer. 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 application received on May 30, 2012. Conditions: The last 50' of the right-of-way is left undisturbed. 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. 0 James . King, Preside Board of Trustees +f f7 CL oe • � ff ti rfw..a dc ow !'. /' •jp� t o �•�`.�+�1�. cH.-MOT • .�-. ere I. ?ti OUR ENT t , ..�.•.y.�Aigvrl�I, a •c cowavrvm* LL LJ ..' • .� ru m• - - O ��'i Q C�sna�Mid✓!f �•r• • tl!•'•�^�--■+.1F; . . _ .� ��„� i: .i i 1 .•...��.... .......:..�._ i fit,.; .. .r...S.....•.w•�... . ..•.�..,..•.r �..�,A..• — m- •. moA.f Mr.�r�as �I by r' :• •' • , j• r'■ • • i •� • �' Ik _ i, _ - v• - � � .� �•,:ram+. sw f,• yip•!„ - ;' `=:`1 sw•rrd�d�.MsB�xa tiv 147' + Jparnlsarl Tfbt Arfisf+r�K Gsfta LL AW Rlt' ru -'••^�w�w4�+��.ia 3 _ iLir' .i .�,�..... .r.w..ter•.. ,-�r�R"-• - .- r,..i��.•�.w. ..�.. ..r_..-► �.r...�-•..�p�. m.t. ► is+- • •... - - � a, _ '`--- - • ', ,i ..5�+'.+ 7 .• ' -rrr.�"� gu>rFo��r James F.King,President " G V C4 P.O.Box 1179 Bob Ghosio,Jr.,Vice-President � y Southold,NY 11971 Dave Bergen ti ? Telephone(631 765-1892 John Bredemeyer WO Fax(631)765-6641 Michael J.Domino y�ol 0 Southold Town Board of Trustees Field InspectionlWorksess.ion Report Date/Time: JOHN BOYLE requests an Administrative Permit to provide access to a right-of-way by removing trees and planting grass. Located: 24435 Route 25, Orient. SCTM#18-2-34 Type of area to be impacted:. �<aItwater Wetland ✓Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland �'O� Ae Part of Town Code proposed work falls under: _Chapt.275 . Chapt. 111 other Type of Application: Wetland _Coastal Erosion _Amendment —Ad ministrative_E merge ncy Pre-Submission Violation Info needed: Modifications: Conditions: �uf� S� ! � v� sAvr 1 c yl I I Present Were: J.Kinq B. Ghosio D. Bergen, I -"J--Bredemeyer Michael Domino D. Dzenkowski other Form filled out in th fiel by } Mailed/Faxed to: Date: l f II John Boyle 1 24435 Route 25,Orient 0 < SCTM#18-2-34 6/13/2012 ^t 40 Owl Ik in L 'J , �.S T l ��r,. 1', ��•y� � � �� �t ..'��+t _y.��'�u'"t4� y��.l���,j�4 _3>- ��s di^16•'F.S��:.rs '' P'i �',�.rt''+++..,...:r=s t�'Mi".� ~.: �1•`"�iw 'o�I�4 '`a �r. s .� '� .f'. i. a John Boyle 24435 Route 25,Orient SCTM# 18-2-34 6/13/2012 4. 14 16 w ♦ ! \ . `7�. ��: • �.;,��'" 'tali• p }`i�'� "� � , °t�►� '*�► - �t .. air: r,. s r+•1 r • • y s v ! Town of Southold A- 1881 Suffolk County, NY The People of the State of New York vs. i LAST ME E DAN FIRST NAME M ODLE 11 NITIAL ,Ins_ i STRE�ESS APT.NO. Yf-/l 37� STATE ZIP Ch lT//yy OAJ LICENSE OR R ATION NUMBER - - STATE TYPE OF UCENSE DATE EXPIRES ISEXI DATE OF BIRTH OPERATOR MO H Y OWNS VEHICLE OYES ONO ` - THE OPERATOR OR REGISTERED OWNER OP VEHICLE DESCRIBED BELOW PLATE NO. i DATE EXPIRES STATE PLATETYPE _... .. ❑N.Y. ❑N.J. ❑N.Y. ❑N.J. ❑ ❑PASS ❑COMM ❑ VEHICLE MAKE ❑ DODGE ❑ BUICK ❑ CHEV ❑ C ❑ -PONTIAC ❑ FORD ❑ OLDS PLYM ❑ TOYOTA ❑ VOLKS ❑ 1 BODY ❑ 2 DR ❑ 4 DR ❑ •BUS ❑ MCY ❑ S.W. TYPE ❑ LICK ❑ TRAILER ❑ VAN ❑ ' THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS PLACE OF OCCURRENCE R ,d 129 ^ A DATE p F OFFENSE AM TIME PM TY,TOWN,VILLAGE OR HAM SUFFOLK COUNT/NY IT 2r3l Z ❑yam ��.?V. IN VIOLATION OF SECTION SUBO. OF THE O VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK ❑OTHER(SPEC TIF�p ❑O.S. ❑COM ❑BUS ❑HAZ Y DEF VEH MAT ❑ SPEEDING OTHER OFFENSE MPH IN A MPH ZONE NO / MISDEMEANOR ❑ FACTUAL PART(NOT FOR TVB) THE ABOVE NyMED DEFENDANT DID ON THE STATED DATE,TIME AND PLACE/ OG/ Zeez. ' The Fotegoing's wed an(personal knowledge)and/or( '�rca being the attached s om deposition(a)of ap „laaMFAnn A �T dated ' PARKING SCHEDULED FINE$ CONTACT COURT❑ THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT " SOUTHOLD TOWN JUSTICE COURT,530g5 ROUTE 25,SOUTHOLD,NY 11971 OATS OF✓APPU CE(NOTFORTVS) ' ON ,` 2 AT /Ad At'I,�l � FALSE STATEMENTS HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE P.LN.Y.S. COMPLAINANT /' BADGIE__# COURT COPY `.� Ar • ..R�f1.f '. R • •S 41 ..,.. •-t+" .mil '. �j = .,', '.q'. �t"� �, •� i r , Y •� + to i lk It , }'� Southold Town Police Report 10/01/2011 16:38 Incident Report Case Number 01-11-009063 . 1 Case Number Report Occurred On/From . Occurred To Report Type N 01-11-009063 110/01/2011 16:38 10/01/201116:38 Original C Incident Type Case Status Case Status Date Cleared I POLICE INFORMATION CLOSED-NO ARREST(ADMI 10/01/2011 D I/L Common Name E LAPORTA JEANNE-1995 DIEDRICKS RD ORIENT, NY 11957(SUFFOL'County) N Day of Week:SATURDAY I alcohol Related :NO T Map Reference:ORIENTWEST rug Related: NO Location Type:YARD +.al Damaged Property Value:$0.00 Sector:4 804 it Stolen Property Value: $0.00 Alcohol Related :NO iI Recovered Property Value:$0.00 P Person Type Business/Person Name Business Phone E COMPLAINANT(CO) ALFRED LAPORTA Sr 631-_ R Home Phone Person Address Map Reference S (914)271-9332 1995 DIEDRICKS RD Orient, NY 11957,SUFFOLK County 0 Cell Phone Employer Address Map Reference .N (914)393-4810 Race Sex SSN DL Exp.Date DL Number WHITE Male Birth Date Birth City 06/05/1933 Age:78 Body Marks: Adult/Juvenile:ADULT P Person Type Business/Person Name Business Phone E PERSON INTERVIEWED John BOYLE 631- E Home Phone Person Address Map Reference g (631)323-3926 24275 SR 25 Orient, NY 11957,SUFFOLK County 0 Cell Phone Employer Address Map Reference N (917)991-5687 Race Sex SSN DL Exp.Date DL Number WHITE Male Birth Date Birth City 06/04/1935 Age:76 Body Marks: Adult/Juvenile:ADULT N Topic Original A R Laporta reports that Boyle is clearing trees behind his property listed above and may not have the R necessary permits. A Undersigned interviewed Boyle at his residence. T Boyle stated that he was not aware he needed permits to clear trees on his property. I Boyle states that he will go to Southold Town. Hall on Monday October 3rd, 2011 to ascertain any v permits necessary to clear the trees on his property. ECD p rY p p Y Reporting Officer Department Report Status: s PO RICHARD J BUONAIUTO (1000) SOUTHOLD TOWN POLICE Approved Officer Name Date/Time i Verifying Officer Department Date/Time o SGT THEODORE O BEEBE,JR. (5140) SOUTHOLD TOWN POLICE 10/01/2011 20:28 0 0 1 of 1 w Town of Southold Town of Southold A 410 3 Suffolk County, NY A ^ 410 2 Suffolk County, NY The People of the state of New York vs. The People of the State of New York vs. LAST NAME(DEF E;DA�Nn r RSTME MIDDLE INITIAL LAST AME(DEFENDANT)�7 j� aw ttv1 � ANT) FIRST NAME �MIDDLE INITIAL STFIEETADDRESS APT.NO. STREETADDRESS j �/ G '•�r `, 7� � �L:_.li L&—T APT.NO. CI STATE ZIP ) 00 CITY ✓ STATE ZIP � _ O taw MB iriof = C-1-�r N y firth LICENSE OR REGISTRATION NUMBER , LICENSE OR REGISTRATION NUMBER STATE TYPE OF CENSE DATE EXPIRES SEXI DATE OF BIRTH OPERATOR I?(Li { T— STATE TYPE OF LICENSE DATE EXPIRES SEX DATE OF BIRTH OPERATOR +` MQN�Fi DAY„ ON VEHICLE M Ayt A OWNS VEHICLE L%�r L>'�' j ❑YES ❑NO I IFS :� D "' r IZ ❑YES ❑NO THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BELOW ��! Q THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BELOW PLATE NO. DATE EXPIRES !( PLATE NO. DATE EXPIRES t STATE PLATE TYPE I _- -- STATE PLATE TYPE ❑N.Y. ❑N.J. ❑N.Y. ❑N.J. ❑ ❑PASS ❑COMM ❑ 'N,-` --`` _ .❑N.Y. ❑N.J. ❑N.Y. ❑N.J. ❑ ❑PASS ❑COMM ❑ VEHICLE MAKE ❑ DODGE ❑ DODGE —"'VEHICLE MAKE ❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC ❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC ❑ FORD ❑ OLDS ❑ PLYM ❑ FORD ❑ OLDS ❑ PLYM C ❑ TOYOTA ❑ VOLKS ❑ ❑ TOYOTA ❑ VOLKS ❑ \V�\ BODY ❑ 2 DR ❑ 4 DR ❑ BUS ❑ MCY ❑ S.W. BODY ❑ 2 DR ❑ 4 DR ❑ BUS ❑ MCY ❑ S.W. TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑ TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑ VIN NUMBER VIN NUMBER THE PERSON,DESCRIBED ABOVE IS CHARGED AS FOLLOWS THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS PLACE OF OCCURRENCE PCT PLACE OF OCCURRENCE n PCT 2tt)C1 Z000 11,00!2 .5 Kq • fQ'e—tC—A'T ,c'.v DATE OF OFFENSE V I AM TIME PM CI ,TOWN,VILLAGE,OR HAMLET SUFFOLK COUNN NY DATE OF OFFENSE AM TIME PM CITY TOWN,VILLAGE,OR HAMLET SUFFOLK COUNTY NY L'��'•-�11' '8'1 C''� ° d 0 T f`JEfC)L-1� IN VIOLATION OF SECTION BUBO. OF THE❑VEHICLE AND TRAFFIC UAW OF THE STATE OF NEW YORK IN VIOLATION OF SECTION SUED. OF THE❑VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK OOTHER(SPECIFY)��' L � ❑O.S. ❑COM ❑ 90THER(SPECIFY.� ❑OS. ❑COM -Up ❑HAZ DEF VEH M� ,5 . MAT dc� ❑ SPEEDING OTHER OFFENSE, y ❑ SPEEDING OTHER OFFENSE tJ MPH IN A MPH ZONE r„J<7 f'��f ,.r(.- MISDEMEANOR❑ MPH IN A MPH ZONE Na e. f -, ,MISDEMEANOR ❑ FACTUAL PART(NOT FOR TVB) FACTUAL PART(NOT FOR TVB) T THE ABOVE N MED DEFENDANT DID ON THH D DATE,TIME ��AND ,,,PLACE y THE ABOVE NAME DEFENDANT DID ON THE STATED DATE,TIME AND PLACE C51164 r LIU c /da d��t L� �L C T`e C)c'tcY y^ /i` 24, �— The ��Foregoing is based+on(po..... n�aW4y�}ee/ibF(information&belieQ,the source being the attached sworn deposition(s)of The ��Foregoing is fbased on(} d"&R0 f7r(information&belief),the source being the attachedd morn deposttion(s)of 1LY4?:..6 %aJ{a�'Ljre> dated 0i L— 17--0 s)C i Yl�STV)NL� dated ��!/2—f ' PARKING SCHEDULED FINE$ CONTACCTT COURT❑ PARKING SCHEDULED FINE$ CONTACT COURT❑ VVV THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT 6LIK-- THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT - acw SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 t L q SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 2 77"� ON OAATTTr.1AAPPEARANCE(N0TFORTVB) n 2 ,` A[)ATEEEOFF AAPPGg,AeN�CE(NOTFORTVB) J•+vC"_7J AT t�, 7i �n M ON O `:^ L..O lJ AT y 3U M G �f ` � FALSE STATEMENTS HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE RI-N.Y.S. FALSE STATEMENTS HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE P.LN.Y.S. COMPLAINANT DATE COMPLAINANT DATE 4ka 33 ,ff-od C~ BADGE# AZ'4�— k�' . BADGE# rnrmm nnpv rnTTPrP rnpv Town of Southold 54375 Main Rd. P.O. Box 1179 Southold, NY 11971 Board Office(631)765-1892 Fax(631)765-6641 Fax To: Don Dzenkowski From: Lauren Fax: 765-2715 Pages: It Phone: Date: 1/18/2008 Re: Complaint CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: A complaint was referred to our department from the Building Dept. concerning the clearing of a right-of-way possibly within 100' of a freshwater pond and within 100' from tidal wetlands. Please inspect and provide us with a copy of your written determination. Please let us know you need any further information. ev slons 08-19-96 0 1. 6-9 SEE SEC.NO.013 0 5-18-9 a SEE SEC.NO.013 LIKE 12- 1-97 MATCH LINE MATCH S FFOLK COUNTY 0,-1 _96 H 3Q.200 WATER AUTHORITYO 0 .20-9 09-10-90 It 1 0 -YO 60 Q 7.1 01 2 -1 00 1.3A 1 03 05 0 % 01 8-10. 6.18 05_02 01 6.8 2.8A 30.4 I 1 07.0ll 1.3A 12.7A(c) 0 22 02 D5 10 0 hl 6.7 1.3 6 5 2.2A 16..1 3_0`1 6.19 (PECMC AN TRUST) 7.5 FOR PCL.NO. To 1 1-05 • 1\OS.4A CONSERvA N EASEMEN C 7.4 C� SEE SEC.NO. \ ox 5-26-05 901 .`ip 3.2 23.1 019-01-001.4 03- -06 6.20 3.10A 4 22.1 T Di-10-06 1.4A 10-26-06 24 11-21-06 QD 2.3A 'nO 21.7 3.1 2.3A( 3.3 d P• 6.13 8.7A(13 o EL 27 J.6A 2 d S 5 12 GA(d 1. JILk 21.8 0 13A 3 18 20 11.8A(d 2.3A(c) r f-I 9.9 17 J.TA(C) 21.9 1 3 2 9 11 SUFFOLK 00A 4 2 A(d COUNTY L,:, (DEVELOPMENT RIGHTS) 1.2A(c) 17.5 1.5 A I STATE IF .YORK 2B NEW YO­ 2' 2.1A(d Z. 19.3 4.OA 37.1 27.7A( 21 1.1A 26 2 3A(c) 23 Is 2.3A(c) STATE OF 6 38.1 10 K.TORT( 1.4A(c) I.SA Z.JAICI 2 25 2 AIA(c) 14.6 0`16 14 2. 1.7A(c) 2.OA(d 7 11 17.3 2.3A(c) IJA(c) 26.7A(c) 13 8 16.20 15 34 13A 22.2A(c) 12.2 10 Ln 2S 18.2 . 12.1 17.2 33A(d G.1AId STATE O F 14.5 36 4.UAIC)))) STATE OF NEW PORK 4. ORK 8 14.8 35 .9A(d 4 12 33 Ot: hgAtd 14.9 62.3A(c) 16.5 32 TOWN OF SOUTHOLD q J.DA(c) 24 DEVELOPMENT RIGHT I uA 1.9A(c) sac 23.1 STATE OF S 12.9A(c) NEW YORK 42 &28 1 A(c) 7. k 0. LU OYSTERPONDS 21 -_ UNION FREE 26 18.3 1, SCHOOL DIST. 2.5A 9 25 0 4.1 10 20.1 21. 11.5A(c) 11.12-- .1 113. 18.4 22.1 a 1.6A(.) 2.9A 2 Or 13 ORIENT < CHURCH z vO 21 ss 3.7A 18.5 3.6A 26-17 rn 2.DA 10 13.6 23 27 0 12 4.4A(c) 2.1A 4 ORIENT FIRE DISTRICT 8.OA(d FOR PC'NO 18.1 .19 SEE EC:rM 9.2 10, 13.7 027-02-007 2.2A(c) .6 z ZZ % MATCH LINE MATCH z xsa MATCH Z LINE SEE SEC.NO.027 SEE SEC.NO.027 SEE SEC.NO.027 SECTION NO shmOI1t1k1 t� SCH *I*mt OI,fi­k,t Lim --H-- UNLESS W1 DRAWN OTHERWISE, ALL PROPERTIES NOTICE COUNTY OF SUFFOLK (1). K TOWN 11: SOUTHOLD L DDmvlslon Lot No naBbik Llint ARE THIN THE FOLLOWING DISTRICTS. Real Property Tax Service Agency E VILLAGE OF Nm F- m --R-- SCHOOL 2 SEWER "0 MAINTENANCE,ALTERATION,SALE OR y E D.-m c...ii- -Z� (21) B.k N. FIRE 25 HYDRANT_ DISTRIBUTION OF ANY PORTION OF THE 018 1.fir W- tw-01-10 Um HST-- ED County Center Riverhead; Y 11901 M G ------ LION WATER� SUFFOLK COUNTY TAX MAP 15 PROHIBIT SCALE IN FEET: LDmvklm L.1 Um -A-- PART go WATER .2S ii�, E stream I smm S:&W Dlimml. G­t'U` Light Owrim Lim L- k�,DIsfirle U" K REFUS E-ATER WITHOUT WRITTEN PERMISSION OF THE 2 400 A DISTRCT NO 1000 PROPERTY N P-1 W 23 Dmd k. 12.1 A(d) or 12.1A T­Lim P��Dl,lrkt 11, P- ue,WN,Ol.tlkt Lim - AMBULANCE REAL PROPERTY TAX SERVICE AGENCY. P D CdWated A lNe S­DMIld Li.r CONVERSION DATE: A.9.19,1936 All OFFICE LOCATION: OF SO(/ryO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 G Q Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM DEcE WE To: Jim King, President J U N 18 2012 Town of Southold Board of Trustees From: Mark Terry, Principal Planner southhold Town LWRP Coordinator Board of Trustees Date: June 19, 2012 Re: Proposed Wetland Permit for JOHN BOYLE SCTM#1000-18-2-3 . JOHN BOYLE requests an Administrative Permit to provide access to a right-of-way by removing trees and planting grass. Located: 24435 Route 25, Orient. SCTM#18-2-34 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the Policy Standards and therefore is INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The action was conducted without the benefit of a permit. 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: Lori Hulse, Assistant Town Attorney A fit.,• .. -• James F.King,President �QF Soot Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O Ol0 54375 Main Road Dave Ber en P.O.Box 1179 g Southold,New York 11971-0959 John Bredemeyer G pQ Telephone(631) 765-1892 Michael.J.Domino '� � Fax(631) 765-6641 �yC4UM'`I � BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application it � ry., _Wetland Permit Application L Administrative Permit CIa ��fl r�cS' �� W Amendment/Transfer/Extension ,,ekeceived Application: 2 _Received Fee:$ _- _�Completed Application _Incomplete ,I _SEQRA Classification: Type I Type II Unlisted �012 _Co ordination:(date sent) MAY 3 0 .t�RP Consistency Assessment Form CAC Referral Sent: �cut�cici Tc,vn ,45ate of Inspection: gear c( Trusi es ) _Receipt of CAC Report: ------..-.. _Lead Agency Determination: Technical Review: %.,-,rublic Hearing Held: Resolution: Name of Applicant Address 4 S I u f }� Phone Number:(L.) 1 9 Q I I Z) i Suffolk County Tax Map Number: 1000 - }- Property Location: n (pro ide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: f i Bob,*-!_ of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Intended use of property: 1 C, I J Y�),A4 l� Covenants and Restrictions: Yes No If"Yes",please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes '�<, -No 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? No Yes If yes, provide explanation: Project Description(use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: P Guess, Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands:15,�--> — 171 S feet Closest distance between nearest proposed structure and upland edge of wetlands: feet rJ Q S au ct Q, -e J I� ��f 9 �J•'� Does the project involve excavation or filling? U No Yes ��- If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): f�l�, r\J E PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.AP P 1CANT/SPONSOR 2.PROJECT NAME 3.PROJECT LOCATION: rr Municipality County r c) 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 5.IS PROPOSED ACTION: 2 New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: IA 6 e,(f Y/ Ce 7.AMOUNT OF LAND AFFECTED: Initially,%2 acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑�Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ©Residential ❑Industrial ❑Commercial NAgriculture ❑Park/Forest/Open Space ❑Other (describe) 10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑Yes ❑No If yes, list agency name and permit / approval: A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes &No I CERTIFY THAT THE INFORMATION PROVI D ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signaturell�i a 20( If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment l PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ElYes ❑✓ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes ❑✓ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species. Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: F-- C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts includin2 changes in use of either quantit or tyge of energy? Ex lain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If yes,explain briefly: ❑ Yes ✓0 No E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: ❑ Yes ❑✓ No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance mustevaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur.Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees p Name of Lead Agency Date President p Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) aosulFQ4. Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM 0 2 PROPERTY LocanoN: s.c.T.M.p: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A y01 3j ' n)o 19 "9, 3 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN bTstrTt— 1ecttioonn —UocTc— Tot— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within Will this Project Retain Al Inch Rainfall o Run-Off / the Scope of Work for Proposed Construction) Generated by i Two(all Inch Rainfall on Site? (S.F./Acres) (This item will include all run-off created by site b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed r Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F./Aces) � 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and — Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities ® — Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction — General DEC SWPPP Requirements: or Within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be,Site preparation on Existing Grade Slopes are part of larger common plan that will ultimately disturb one more acres land; which Exceed Fifteen(15)feet of Vertical Rise to M — including Coo nstruction activities involving soil disturbances of lesss a than one(1)acre where the DEC has determined that a SPDES permit is required for storm water discharges. One Hundred(100')of Horizontal Distance? (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the NOI.The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, / required,post-construction storm water management practices that will be used and/or Removal Of Vegetation and/or the Construction of any El — constructed to reduce the pollutants in stone water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(This Item will NOT include the Installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of stone water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Stone-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that Is knowledgeable in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building PermiL (NOTE: 'A Check Mark(4)and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, COUNTY OF.........................................� SS .. That I,......... .. ...being duly sworn,deposes and says tha he she is the applicant for Permit, H.............. ............................. (Name of individual signing Document) And that@she is the n !.. - .. V )..A.��.�W.. 1 ...... er,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this applicatio , all statements contained in this.application are true to the best of his knowledge and belief;and that the work will be pert ed in a manner set forth in the application filed herewith. Sworn to before me this; NotaryPublic: ...... ..... ........ . .!................ .. ..... ................ .................... RnRFRT 1.C°GQ•`T JR. (Signature of Applicant) FORM - 06/ 0 Id03�RY P1113 a No.4725089,Suffolk ourtty le`fn ExpirOs��aI 3��&Iz Boas-!q. of Trustees Application County of Suffolk i i State of New York J��� may'�e 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 TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICA ION. ignature . SWORN TO BEFORE ME THIS ��` ` DAY OF VkOLj ,20 otary Public ORERT I--=TT,JR. OTARY PUBLIC,State of Ky- Term Exp�$2.9s� ay31.W-4 - I APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees.The purpose of this form is to rovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. ^^rr '' YOUR NAME: 'J f QU (Last name,first name,spiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,njarriage,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 Submitted this2V�L day of 20 Signature � f Print Name :15 t ►a te ai (� Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a.determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form.should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be 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 Offce the;P}an`nirig FDe rhnent, all local libraries and the Town Clerk's office. �; ,f 9 �r �` � _ .� ��k B. DESCRIPTION OF SITE AND PROPOSED ACTION MAY 3 0 2012 SCTM# PROJECT NAME LLflQ l ✓1 C��- I W' O ICU�► °i ry��s __--_-_--- The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate-response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval,license,certification: Nature and extent of action: . P Location of action: L �S1 k=4 L Pbg �Y Z--i", Site acreage:_ I I -(b Rc-�,E Present land use: A c—iLi� 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: Lk Q (b) Mailing address: g t µ'` �- !� �s, 5�.lq I] t N {� i I O► (c) Telephone number: Area Code (C) IT 1 9 1 b�� (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No M If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No 'KNot 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 ❑ Yes ❑ No NJ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pa 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 throuah 21 for evaluation criteria El Yes ❑ No ZNot 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 evaluati n criteria. ❑ ❑ Yes No Not Appli', e 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 Auation 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 waste . See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 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. ❑ Yes[] No 2 Not Applicable Allvt VAlrie i Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Sout old's water-dependent uses and promote siting of new water-dependent uses in suitable locationsZNLo WRP Section III Policies; Pages 47 through 56 for evaluation criteria. Yes ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote stainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town w ters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes El 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 evalu on criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote ap .ropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE DATEA \ ��