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HomeMy WebLinkAboutTR-7901A James F.King,President \\0f SO(/�yO Town Hall Annex Bob Ghosio,Jr.,Vice-President �O l0 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer G Q Telephone(631) 765-1892 Michael J.Domino OlyCOUNTV Fax(631) 765-6641 , BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 14, 2012 Mr. Emanuel Moraitis 40 The Strand East Marion, NY 11939 RE: EMANUEL MORAITIS 4965 THE LONG WAY, EAST MARION SCTM# 21-5-9 Dear Mr. Moraitis: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, November 14, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit#7901A to include the removal/cutting down of one dead cherry tree; and as depicted on the.revised project plan prepared by Emanuel Moraitis, received on October 9, 2012 and stamped approved on November 14, 2012. Any other activity within 100' of the wetland boundary requires a permit from this office.. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Ance:erely, James,F. King President, Board of Trustees JFK:amn 2t ...' - • _ r/ �.-sue � 5 « •� + ' ' - � - .�.y r:. Ir - - - . , - -.-+,�':• 'mac .gip -• e :. - - - ; i. , r � +��7/4�11Kyli�l�:•x.:y _ ,.,.+. . a�1:-+`:,+•.aunr; .e _ , -,. .. . ,- - TITLE NO. G3'43S -- VIEW: SURVEY Ce'rtiflcbtions indicated hereon signify that this plat of the hereon described property is a true and correct representotion bf a recent survey made and plotted ur4der my direction in occordonceindic the existing Code of Practice for Land Surveyors by the New York State Association of Professional Land Surveyors. SaiThis d Certifications shoonly t r the the person for whom the survey is prepared certification o on ftitle, zoning behalotofreedoml co encurnberancres.TientCertifications al agency dare lending transferron ableltoe hereon institutionsrlcarlsubsegmy for the lands as described hereon, it's not IA. I 0 � e' ��GOG Off/ C, lP, r ,. t`'�j OPEN SPACE 'E' QO4P 01% � 04 / ryo�6 r 0 t -17 J S � / \ 4*1 N 70.3 48 t tea? •.7)d,(, WOODS 1 POST' /J 4.5'S 0 4 O POST Q 1.:'E . ♦x 10 CW � o G DE 1 `' 37,5. i. c 191 �OJ 0, O 0. ,Y U • �' . LOT .. vG� 6•T OC- a ,�O w - �,X� OCR. C FtB � Q to J AUG 29 2012 ;{ter ti LOT i 139 a • �"Southold Town board of Trustee„s > IAJ w O f� 1 J C K) v• O O :7 0 N Z V , S 76'28'30" VY �0- D� 45.00' 4 •►jN THE STRAND and use, and therefore, are not intend The offsets or dimensions shown from structures to the property lines are for a specific purpose construction. Subsurfc to guide in the erection of fences, retaining walls, pools, patios, planting areas, additions to buildings and any other consttru e' and environmental conditions were not examined or considered as a part erhns survents were not placed as o port of this survey. Easements, Rights—of—Way of Rec o sown. ro UNAUTHORIZED ALTERATION C P.C. REMSIONS: ADDITION TO THIS SURVEY IS arrett, Bonacci & Van Weele, 1 C VIOLATIOhI .DE..SECTION 77_R9 CiVI].ENGINEERS/SURVEYORS/PLANNERS THE NEW YORK STATE EDUCn TION LAW. - di 175A Commerce Drive,Hauppauge,NY 11788 K a• TEL 631/435-11 H FAX 631/435-102 www.bbvpc.com LOT 139 BLK. ' MAP OF: PEBBLE BEACH FARMS SITUATED AT: EAST MARION, TOWN OF SOUTHOLD COPIES OF THIS SURVEY MAI FILED: DUNE 11, 1975. NO. 6266 CO.SUFFOLK NOT BEARING THE LAND SUr CERTIFIED T�: ®200;i B.B.V.,P.C, VEYOR'S SIGNAfIjRF_Al. AND Eta BOSSED SEAL SHAI.L. N01' BI EMANUEL A. & VASILIA MORAITIS CONSIDERED A VALID rRUE co ASTORIA FEDERAL SAVINGS & LOAN ASSOCIATION JOB NO. A030649 —Y CHICAGO TITLE INSURANCE COMPANY DATE JULY 3, 2003 GUARDIAN 'LAND ABSTRACT DR. A.V.R. CH. W.J.B. SCALE: 1" = 50' DIST. 1000 SEC. 21 BLK. 5 LOT 9 �j D LONG 15LAND ! UUND i' APPROVED BY t3 OF TRUSTEES AppRox. HGH WATER TVA OF SOUTHOLD MARK A5 LOCATED OATE11 { oN 7/3/2003 i � t { 1 I ( r ! TcE ol: 5LuFF 7/3/2003 'I - - - - - AREA TO BE i �, i -- - - - - RE-VEGETATED OCT - 9 2012 D;" ` ___ =DD- TIVE - - WITH NA SPECIES PLANTINGS _lop p EX15M VEGETATION C'n ON t�IGFW"PROPERTY �- ` — _ --_ _ — J ; b LroT OF PLANT 5PECE5 TO BE PLANTED OPEN SPACE - - - - - - -- -_ - DBEARBERply - - "� LOW Bl1��H BLUEBERRY 4� ApEAC� TO WILLOWLEAF COTONEA5TER - - - -- - --- - - - --- - - t . - - -,, ,- --- -- - - - - - MAW I)EUTZIA ,. RE VEGF - - - - - - - - - - - - - - D � I5HIVY �J JUNIPER E - - - - - �►�ft� - - - �° - - - LE"THOE �� . -- - - - - - - - - - - '. VINCA, MNOR I5TUR6ED - - - - - - - - - - - -- UND - - VEGETATION -- - - - - - - - - - - - , ____-- 100 FROM TOP — — a x 1 h z OF BLUFF LINE -- — r — ENS- 100 FROM TOP - - Y Y , OF BLUFF LINE -- EXI5TWG PRIVET i ON rUC4-11EMNG PROPERTY I i - -PROPERTY LINE I i i i i I 7r t I I ! I ! I i I I i > > > > > > 1000o--2Q . Revision #: Landstcape Plan : 8-24- 1 Date: 2 12 2 S%.Ule: Lands.f%#npe Desi n by: David C If . of 1Creative Environmen al Desi n - 2 177 ~ "5 AUG 2 9 2012 r 1 � Southold Town Enid of Trust es APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD LONG 15LAND ! UUND I t . I I 1 APPROX. HIGH WATER ' -------- - MARK AS LOCATED -- -- oN 7/3/2003 --------------------------- ,I I � I i I I - a of 5.uFF 7/3/200 1 � - - - - f 1PEA TO BE - - - - - - RE-VEGETATED -_ - - -- WITH NATIVE 5PECIE5 PLANTINGS I ; I 200�b - -- --= EM5TIN.,VEGETATON ON NEIGH qNG f RYFRTY -------------- - - LIST ff 5ffcE5 To �E ftmu EN 5PACE BEARBERRYMDGURY = _ -_ -_ LOW 1303H BLUEBERRY - - - - - _ CLEARED TO WILLOWLEAF COTONEA5TER WARF DEUTZIA _ - — — — BE RE—VEGETATED GUSH IVY I 5HORE JUNIPER - We �° -- LEUCOTHOE UNDI5TURBED - - _ __-_ -__-_ _ PACHYSANDRA VEGETATION100 FROM TOP I OF BUFF LINE 100 FROM TOP --------------- OF BLIJFF LINE I ; I � i - -- EXISTING PRIVET ON NEIG430RING I PROPERTY I PROPERTY LINE I j I I I I I I I I I I � I I � i i i i i i i i 1000"-2 "— Revision . Lansca Ian :e 8 -24- 1 8/29/2012 Date. Scale: Landscape Desi n by: David Cic han owicz 1 " = 2of Creative Environmen al Design C , p� gUf Qce .lames F.King,President �O P.O.Box 1179 Bob Ghosio,Jr.,Vice-President �`r Gy Southold,NY 11971 Dave Bergen coo -� Telephone(631 765-1892 John Bredemeyer Fax(631)765-6641 Michael.l.Domino Southold Town Board of Trustees -Field InspectionMlorksession Report Date/Time: EMANUEL MORAITIS requests an Administrative Amendment to Administrative Permit#7901A to remove or cut down one dead cherry tree. Located: 40 The Strand, East Marion. SCTM# 21-5-9 T pe of area to be impacted: _Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _Chapt.275 Chapt. 111 other ,LAType of Application: Wetland _Coastal Erosion _Amendment dministrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: 12- /as 40 Prpg-ent Were: J. King B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled Out %1119 Id Mailed/Faxed to: Date: gUFFO(�- James F.King,President �p� �'OG Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President W., P.O.Box 1179 Dave Bergen -3 Southold,NY 11971 John Bredemeyer o • Telephone(631)765-1892 Michael J.Domino °1 `a0! Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - P: YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-bonstruction, hay bale line 1 st day of construction / % constructed �/ Project complete, compliance inspection James F. King, President �QF SO(/ry Town Hall Annex 54375 Main Road Bob Ghosio,Jr.,Vice-President hO l0 P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer N G pQ Telephone(631) 765-1892 Michael J. Domino 'OlC � Fax(631) 765-6641 CoUNT`l,O BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7901A Date of Receipt of Application: August 29, 2012 Applicant: Emanuel Moraitis SCTM#: 21-5-9 Project Location: 40 The Strand, East Marion Date of Resolution/Issuance: September 19, 2012 Date of Expiration: September 19, 2014 Reviewed by: Board of Trustees Project Description: To re-vegetate the disturbed/cleared areas from the top of the bluff landward. 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 site plan prepared by Creative Environmental Design, last dated on August 29, 2012, and stamped approved on September 19, 2012. Special Conditions: None Inspections: Final.lnspection. 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. James F. King, President Board of Trustees �4dg�,FFQ�,f-�P James F.King,President y Town Hall Annex Bob Ghosio,Jr.,Vice-President 0 + 54375 Route 25,P.O.Box 1179 Dave Bergen .f� �' Southold,NY 11971 John Bredemeyer 01 �'a� Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: a I APf-Gti 41s C b �r�a-�i v env i r��n►nnP�►-1-a Please be advised that your application dated 9124 112- has been reviewed by this Board at the regular meeting of . and your application has been approved pending the completioA of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 9 st Day of Construction ($50.00) '/Z Constructed ($50.00) t0 Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: Final Tnspc4on - TOTAL FEES DUE: $ �b • �� BY: James F. King, President Board of Trustees � l James F.King,President �� CIO P.O.Box 1179 Bob Ghosio,Jr.,Vice-President Southold,NY 11971 Dave Bergen y Telephone(631 765-1892 John Bredemeyer t 0 $ Fax(631)765-6641 Michael J. Domino +J Southold Town Board of Trustees Field Insp�ection/Worksession Report Date/Time: Creative Environmental Design on behalf of EMANUEL MORAITIS requests an Administrative Permit for the re-vegetation of the disturbed/cleared areas from the top of the bluff landward. Located: 40 The Strand, East Marion. SCTM# 21-5-9 Ty�f area to be impacted: _Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Pa f Town Code proposed work falls under: _Chapt.275 Chapt. 111 other T�of Application: Wetland _Coastal Erosion _Amendment Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: King B. Ghosio D. Bergen, .� J. Bredemeyer ! Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: 0 • _;' , ,,._•, � ,Fn��ThePeople`�nffh,`e;;StaterofNew'�o��ys ' �,'`�;,�°`�, , ; LAS E(DyE�FE'NOANTJ_ - - €IRST NAME M�pDIE JNITIAL t5-.1.t �. <:. n:v.:z., `K'�varC.i r 3 i .r.-. ST�RgEETADDRESS �lou ri ;jLi`"�STATEr� r+ ly ? �_f;•,",.'.Y"7 i'v-+-�y�r•�� t_ 1 `)r LICENSE OR REGISTRATION NUMBER i `STA'fEl r'-W TYPE(OWLICENSE •`DATE EXPIRES SER DATE.OP^BIRTH6 1- EOPERATAfT � v!� y V t�SIONTH--`D' o �''R�"rOWNS``V�'Fi1C:�E. -`p 't•'�r— "'-i7•- .'i�YES'.�ND_'. . T�.iE.-OPERATORRtE�EGISTEREOINNEROFVEHICI:E�DESCR7BED BEOW..: PLATE NO. ... s•, t 3^ c., :nt f :w DATE >TIREs� • STATE v, PLATE TYPE ?C:)',V - .❑N.Y. ❑N.J. ❑N.Y. ❑N'J. ED li PASS ❑COMM law-, 'r1tT.nrt.=t ai_:•�i VEHICLE MAKE - ❑ ��OG�F:�t;1JT- 0 BUICK ❑ CHEy, - ❑ CADILLAC ❑ .PON¶g6 - • FOR0.. OLDS a; ❑ r PLYM CI ;:.TOYOTA -. _r_.❑ ,u6LKS: ,,.,•;❑,rr- BODY ❑ 2 DR ❑ 4 DR ❑ BUS- ❑ MCY ❑'Sm. .. TYPE ❑ TRUCK ❑ TRAILERf�.;`:•�❑ VANS! r-r.❑3 "•+c �4.:_:; . ,YIN NUMBER - - ...}',.. •, -'».I _ - THE'PERSON.DESCRIGED ABOVEIS CHARGED AS FOLLOWS, "„•. .PLACE OF OCCURRENCE - v PCT DATE OF OFFENSE AM TIME PM. CITY LL TO N,VIAGE OR HAMLET SUFFOLK COUNTY NY IN 7EOFNEWYORK OTHER—(SPECIFY) �; } ©Q-S �1 COM ❑BUS..<(7 HAZ: - 4 — .. .. •�� i} "•'!7 OEF VEH --tMAT ❑ SPEEDING : OTHER OFFENS MPH INA MPH ZONE MISDEMEANOR BLS n cp c TA{CTUALTART'(NOT FOR TVB) r.. THE ABOVE NAMED➢EFENDANT DID ON THE STATED DATE TIME AND PLACE -� 1 ( 7-')� c 1 I s�C i'` 110 . �ht J �Ca1 iq. 16 The Fore om s based on rsolfel knowledge)a tl/or.in1 1 i'e9 to .y--cabei thesttaMlEtl'sWo`m a 9}af 9 9 (Pe 9 ( n9' P, {i } ' dated .. ...A� 1.. - ., . f•�". 1• :ate. I ' PARKING SCHEDULED FINES , 'GONiACT COURT -�__��_ .. THE PERSON�DESCRIBE6ABOVE IS$UMMONED TOAPPEAR AT.. - - SOUT+IOLD:TOWN'JUSTICE COURT,5309S ROUTE 25,SOUTHOLD,NY 11971 DATEfOOF RAN N JAPPLICE{NOT FOPNBy /— -- FALSE STATEMENTS HEREIN ARE PUNISHABLEAS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE-P.LN.Y.S. ` COMPLAINANT .: DATE --f BADGE# \/1 L�"' 'I ��4�ti 'i�� �= �� {� is(.�� p F ,� O '�►=} T�Lr ► nri� 1=hi�'i C { i t- e Pe All r .,* �"�;t � � _ �IP. ? `+) ,��� '��'• � # mot" f � a I P. EMANUEL MORAITIS LICENSED REAL ESTATE BROKER EMORAITISNYC@OP'FON LINE..NF.T 631-477-6150 4o THE STRAND LANE EAST MARION NY 11939 APOLLO REALTY CO HONESTY FIRST 631-477-6i5o CEL.917-593-0763 u« a �...\ /..�.� / 6t Oq t •tJ t H N.F- • a � �} I V t tN, •y. / tr / O a a s' IT I ci iu J01" a J " �. T t•�t \�BfL. PoR� 6 - 2]]� ]t-0,iM.J 9EE 8FG.N0. � ,tt1 ]D0M] n • WTLII .+ 2 t NcTr-E COUNTY OF SUFFOLK -,- - •• ,- - --- >" — �- __,__ Real FrapwW Tax Service Agerwy r s 21 e�•---- —�— - a,l .. O --—_ ......--'^-- c..�Ntw.ra.rnw Vw .ten MM MIMENTr MNP "i,. • .. ., r it James F.King,President �qf SO(/jy Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O� ��� 54375 Main Road P.O.Box 1179 Dave Bergen l�[ Southold,New York 11971-0959 John Bredemeyer G �r Michael.J.Domino � �� Telephone(631)765-1892 1 Fax(631) 765-6641 Tr_m WCBOARD OF TOWN TRUSTEES 11 TOWN OF SOUTHOLD ! !.A OCT - 9 2012 �'_�f Southhol-1 iovan Bord of Trustees APPLICATION FOR AN AMENDMENT TO A WET -FERMI DATE 4 . � N OWNER ��1� l�l I PHONE ADDRESS ';�- fL-5) AGENT PHONE ADDRESS PROPERTY LOCATION Lfo KrV'& C /k�v\ TAX MAP NO. � UWe C�'VVXXWv'C'1—K,-)04 request an Amendment to Permit#-7zul,4 to V'4. 0 CU - Signed By: _2'.4 ! . E i OFFICE LOCATION: rg 50!/jyo MAILING ADDRESS: Town Hall Annex h0 l0 P.O.Box 1179 54375 State Route 25 l l Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 Q Telephone: 631 765-1938 h0 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM F5 �7 ` SEP 19 To: Jim King, President 2��2 - Town of Southold Board of Trustees 1 Southold Torn From: Mark Terry, Principal Planner LWRP Coordinator Date: September 19, 2012 Re: Wetland Permit for EMANUEL MORAITIS SCTM#21-5-9 Creative Environmental Design on behalf of EMANUEL MORAITIS requests an Administrative Permit for the re-vegetation of the disturbed/cleared areas from the top of the bluff landward. Located: 40 The Strand, East Marion. SCTM#21-5-9 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 CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. 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 i James F.King,President t �QF S0!/ry Town Hall Annex 0 Bob Ghosio,Jr.,Vice-President ,`O lQ 54375 Main RoadP.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer N G p@ Telephone(631) 765-1892 Michael.J.Domino 'O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatiory ,.-v. _Wetland Permit Application Administrative Permit 1 (` ! F _Amendment/Trans er/ tension ' eceived Application: 2 2 1 !, Received Fee:$ b�• D t AUG 2 9 2012 Completed Application 'L I ' _SEQRA Classification: Scathoid To;:vn Focqrd of Trashes Type I Type II Unlisted 4 �_ _ � Coordination:(date sent) LWRP Consistency Asse sment Form 2 _CAC Referral Sent: A) _Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Technical Review: _Public Hearing Held: Resolution: Name of Applicant Z MM6Z- uAA Address Phone Number:(01) L4 7 7 -- - 160 cell, 917-5-8-v261Z Suffolk County Tax Map Number:G 1000 - Property Location: j-117 L.J (provide LILCO Pole#, distance to cross streets, and location AGENT: (If applicable) sign PO Box 160 . Address: Peconic,NY 11958 Phone: Boar_a ,)f Trustees Application I I GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Intended use of property: Pl Covenants and Restrictions: v/ Yes No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes No p J 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 t/ No Does the structure(s) on property have a valid Certificate of Occupancy Yes No I Prior permits/approvals for site improvements: i 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): rrII vL- (LL S LAn Ulv t, - Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA ,I Purpose of the proposed operations: � �BVl t9 I ICA 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 betwef n n crest proposed structure and upland edge of wetlands: t'l feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? LO% cubic yards How much material will be filled? /v cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: >J lA Manner in which material will be removed or deposited: A/ A- 1A 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): { ON, C 1 PROJECT ID NUMBER 617.20 SEARAPPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART-PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME G 1 424 ', 3.PROJECT LOCATION: ��� 5�c� 'a,� Municipality ° D County 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 5.IS PROPOSED ACTION: ❑ New ❑Expansion i ication/alteration 6.DESCRIBE PROJECT BRIEFLY: I I 7.AMOUNT OF LAND AFFECTED: Initially UltimatelyS'Inrl^j,4C acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? es ❑ No If no,describe briefly: I 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) esidential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, ate or Local) ❑Yes o If yes, list agency name and permit / approval: CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes If yes, list agency name and permit / approval: Lld 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes a 10 I CERTIFY THAT THE INFORM DED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor me Date: Signature j f' If the action is a Costal Ar , and you are a state agency, complete the Coastal Assessmen rm before proceeding with this assessment PART 11- 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 EAR ❑Yes [Z]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 a 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: C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: - - C7.-Other impacts(including changes in use of either 9!jantt(X or type of energy? Ex lain bd y. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If yes,explain briefl : Yes a No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: ❑ Yes a 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 must evaluate the potential impact of the proposed action on the environmental characteristics of the CFA. Check this box if you have identified one ormore potentially large or significant adverse impacts which MAY occur.Then proceed directlyto the FU EAF andfor prepare a positive declaration. Check this box Ifyou have determined,based on the information and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary,the reasons supporting thi determination. Board of Trustees p 3'-P 7: Z 0/Z Name of Lead Agency Date President p Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer gnature of Responsible Officer in Lead gency Signature of Preparer(If different from responsible officer) B%3FFQ Town of Southold Z Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM j PROPERTY LOCATION: s.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 01 Jap Ott -5` 1 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN strict e3 c ion oc — o� 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? Will this Project Retain All Storrs-Water Run-Off (Include Total Area of all Parcels located within S� Generated by a Two(2")Inch Rainfall on Site? / the Scope of Work for Proposed Construction) �( .F.I Aces) (This item will include all run-off created by site t/ b. What is the Total Area of Land Clearing r clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed E1d�S of Site Improvements and the permanent creation of construction activity? (S.F.!Acres) impervious surfaces.) 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 C Existing Grade Involving more than 200 Cubic Yards F-1 ,V/ of Material within any Parcel? I 5 Will this Application Require Land Disturbing Activities / Encompassing an Area in Excess of Five Thousand v (5,000 S.F.)Square Feet of Ground Surface? — — i 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? j disturbances of one(1)or more acres; including disturbances of less than one acre that T Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to V including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for stone water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious a / for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off r/ 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not 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, j required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm 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?(Ibis Item will NOT include the Installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm 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 Storm 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 Permit (NOTE: A Check Mark(.(I)and/or Answer for each Question is Required for a Complete Application) I SPATE OF NEW YORK, Notary Public,State of New York COUNTY OF...........................................SS No.01 BU6185050 Qualified in Suffolk County�/j. t� l ('A r v LZ Comm',si I I That I...........................�.KC ...`�.. l,e� g Y r P Qg �4�RA1��'�tlig'Zplicant for Permit,... ..... ........................bets dui sworn deposes an sa (Name of individual signing Document) //''_� I And that he/she is the ...................................�.. ?.nl�Yz t ��—. .. .. .. ..'........................................ .... . .... ..... ..... .. .. (Owner,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 application;that all statements contained in this.application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; Dr'` f!.1......................day of `C�'1 ..............................,ZO!�- v�1 ) � �p NotaryPublic: ... ....................................'�:�`1...................... ............ . ........ ... .. (Signature FORM - 06110 BoarA of Trustees Application I i County of Suffolk State of New York ` )"dl- C_ 1"Ow 1`(Z 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 i PREMISES IN CONJUNCTION WITH REVIEW OF THIS A TION. i i I Signa i SWORN TO BEFORE ME THIS DAY OF 5201 a L � Notary Public t CONNIE D. BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires April 14,2_ f Boa-�R of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, AMA Nuk, {SDP A)T1lb residing at (print owner of property) (mailing address) ` - _ p,O ,�J� Creative Environmental Design 4k 7h6 5�A✓J 0 5 Mf°4do hereby authorize PO Box 160 (Agent) Peconic,NY 11958 bA-t)-L� c(-k-A-AJOLU(c�?, to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) I i i i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The pumosd 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. Creative Environmental Design YOUR NAME: PO Box 160 (Last name,fi g$io;i iM9Aless you are applying iti 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,rgarriage,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%oft hares. 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 I 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. i The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): I 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 Submitte ay U 2012 Signature Print Name Form TS I i ,-j 0 w(t Z I Town of Southold C rn3 LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS i f AUG 2 9 2012 1. All applicants for permits* including Town of Southold agencies, shallEc68'"1e n his CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Revi� eW Za-aw. 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- supportin*g facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME^ Y�1 Gf,1flLeLc�� INI�J CCc� S The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees L� 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: 4A_�d -/U Jl� r S ka-r3 e a f e(VX_1 S A _Qd u 5 s M a, Location of action: Site acreage: f � Present land use: -- 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: 1E fyJAA'A-` mpya� (b) Mailing address: qD 0 �C�15� (c) Telephone number: Area Code( ) f (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No 1K 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 ❑ 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 ❑ Yes ❑ No F��NotApplicable l Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP ction 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 Sectio I—Policies Pages S 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 —Polici Pages 16 through 21 for evaluation criteria 7Yes El 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 for evaluation criteria. ❑ ❑ Yes No Not Applic Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 3 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 See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. -❑ Yes El No U 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 V Not Applicable I i Attach additional sheets if necessary I i WORDING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP Section III Policies; Pages 47 through 56 for evaluation criteria. R Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estua 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 evalua 'on criteria. ❑ Yes ❑ No of Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Sectio I—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No ❑ Not Applicable PREPARED BY TITLE �)VJ DATE "9-qI p2— Creative Environmental Design PO Box 160 Peconic,NY 11958