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TR-8228A
John M. Bredemeyer 111,President O��$l1FF�Lk�, Town Hall,53095 Main Rd. O P.O. Box 1179 Michael J. Domino,Vice-President James F. King x Southold,NY 11971 Dave Bergen y ♦ �� Telephone(631)765-1892 Charles J.Sanders j � � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION. Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, silt fence 1St day of construction '/ constructed +t Project complete, compliance inspection. INSPECTED BY: COMMENTS: L _ / _711_ �f/✓� Al A10 �T(701 / I CERTIFICATE OF COMPLIANCE: � 6 James F.King,President g1�FFDt/( Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �� �Gy� P.O.Box 1179 Dave Bergen y Southold,NY 11971 John Bredemeyer oy Telephone(631)765-1892 Michael J.Domino 01 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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-construction, hay bale line 1 St day of construction % constructed Project complete, compliance inspection Y ✓ C-4 7L N HANHANSETVENUE ' D E C E I V E n A f UUN _ �_f 3 2013 Southold Town r Trustees �o �vx /3 N 0 � EL. 5.5' on EL. 5.1' Sx/p 4 EL. 5.5'S8 '00T 4 ASPHALT w� ?�4 / , ;�•� �Ng2'01-5005 .67 3 40 CIV LP EX/S�J ST WZONE W �r SEPn �. (EL. 7 I ZONE AE V 6 / 1000-43- 3' lh a. �' OS—Q6 1 N l�' i N29 8'2o"E V ,`C 187.29' ABC L �h � EL. 5.4' D ^ RR TIE ^ 54.02' N87.05'00"W -'S Ix 3• 6-S° � L I r: APPROVED BY BOARD OF TRUSTEES N / 0 / F JOHN & LUCY TOWN OF SOUTHOLD' RACANELII DATE (0; q vs D TO: ELEVA TIONS J. BAILEY RAII FY WETLAND F r, 129 Inlet Lane Greenport,NY Lot 1000-05-06 Lot 1000-05-20 Total Lot coverage for 1000-43-05-06&20 Estimated Estimated Per Per Owned Dimensions Sq Footage Survey Survey Property Total lot sq footage 17,979 17,073 35,052 Total square footage of house footprint 70ft X 33 ft 2,310 Total square footage of ashphalt driveway 70ft X 30 ft 2,100 Total square footage of existing shed 8ft X 12 ft 96 Total coverage on lot 4,506 • i of lot coverage for-06 25% •of lot coverage for-06&20 combined 13% Estimated wetlands-not owned but in between lots 100 ft X 60 6,000 17% 4. Square feet in an acre=43,560 80% total land is%of an acre �A inlet lane coverage of lot Sheetl 5/2 812 01 3 James F.King,President �QF S�Uj Town Hall Annex Bob Ghosio,Jr.,Vice-President ��� y�lo 54375 Main Road Dave Bergen P.O.Box 1179 J Southold,New York 11971-0959 John Bredemeyer N � Michael J.Domino • OQ Telephone(631) 765-1892 O<yC4UNr1 Fax(631) 765-6641 ,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8228A Date of Receipt of Application: June 3, 2013 Applicant: Robert J. Bailey SCTM#: 43-5-6 Project Location: 129 Inlet Lane, East Marion Date of Resolution/Issuance: June 19, 2013 Date of Expiration: June 19, 2015 Reviewed by: Trustee John Bredemeyer Project Description: To install a 10'xl3' storage shed on a gravel base with gutters to leaders to a drywell. 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 Robert J. Bailey, received on June 3, 2013, and stamped approved on June 19, 2013. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. �7�f James F. King, President Board of Trustees pSUFFO(,�• James F.King,President P.O.Box 1179 Bob Ghosio,Jr.,Vice-President S Southold,NY 11971 Dave Bergen y Telephone(631 765-1892 John Bredemeyer 0- Fax(631)765-6641 Michael J.Domino O T� Southold Town Board of Trustees Field InspectionMlork Session Report Date/Time: �" /—13 /1.)-51J ROBERT J. BAILEY requests an Administrative Permit to install a 10'x13' storage shed on a gravel base with gutters to leaders to a drywell. Located: 129 Inlet Lane, East Marion. SCTM# 43-5-6 XeTof area to be impacted: _ atwater Wetland Freshwater Wetland Sound Bay Dis ce of proposed work to edge of wetland P rt of Town Code proposed work falls under: _Chapt.275 Chapt. 111 other pe of Application: Wetland _Coastal Erosion _Amendment Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Prese ere: J. King B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filledout 'p th field by Mailed/Faxed to: Date: J' b N SURVEY OF PROPERTY -tANHANSET A VENUE A T GREENPORT TO WN OF SO UTHOLD SUFFOLK COUNTY, N. Y. 1000-43-05-06 & 20 SCALE. 1'= 40' o SEPT. 6, 2006 JAN. 8, 2006 (ADDITIONS) JAN. 17, 2007 (LATH DECK) FEB. 13, 2007 (DECK) MARCH 29, 2007 (REVISIONS) APRIL 11, 2007 (REVISIONS) 2 5.5' N 0 F VERIW FAMILY LLC APRIL 18, 2007 tz. EL. 5.1' o p SEPTEMBER 29, 2008 (UPDATE & TOPO) a £L. 5.5 587105'00"E APRIL 4, 2013 (UPDATE) I ' l l "&45' — / 424.08' ASPHALT O 24.4 �a .rjl *•� /N82194 `� 3s• o, / 03 5 142.520 673• O ZaV7 I _ O`� / / %K' LP Inc Ys s o'IQ; HW o l l�. J � GjOJ �I 3 .`�►� rf 6 I £ S ems ,, / / • ii ,p� 67 _ ��. l$ •'A I A�y # // 1000-43-05-20 N I 1000 43-05-06 ` /�' "s i'go E '� ,00 _ i 3. Arc �� �, i 187'1541 �+ I RR TIE l J N 5 ED 4.02' N87105100,,W 3.4'S 123' S.6'S ) A / 19�91 < - 440.65' N / 0 / F JOHN & LUCY RACANE - -- - - LL! & JON-RAC ASSOCIATES CERTIFIED TO: ELEVATIONS ROBERT J. BAILEY REFERENCED TO N.G. V.D. HEIDI E. BAILEY WETLAND FLAGS BY ROBERT H. FOX - AUGUST 2006. `° tom. FIDELITY NATIONAL TITLE INSURANCE COMPANY ■ =MONUMEIJT �A DE CAPITAL MORTGAGE }�,� c 4�609 • =PIPE -. A =WETLAND FLAG v' 1000-43-05-06 AREA=17,979 SQ. FT. ANY ALTERATION OR ADDITION TO TH1S SURVEY IS A VIOLATION , N. Y.S LIC. NO. 49618 1000-43-05-20 AREA=17,073 SQ. FT. OF SECTION 7209OF THE NEW YORK STA7E EDUCATION LAW. ECONIC SUR EYORS, P.C. EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICA77ONS (631) 765-5020 FAX (631) 765-1797 FLOOD ZONE FROM FLOOD INSURANCE RATE MAP HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909 MAP NUMBER J610JC0176 H SEPTEMBER 25, 2009 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 7HE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N• Y. 11971 188-2691 d �r - fix. )� � -s, �- -� .•~ - k �� -+� �_•� d - - i _ t M% age kt 71 , 71 �e k � Date — May 12, 2013 — view to the north 4 4�.�4 Y 1� ,�.� �y, -,u': •`7 r' jra-..L .,f `��„c.. R��y�`���,�Y X, �f r :: i '- -�`'. Ii �• f y � - '. - ��.� -.1...�. Ifs `..�"J�:i-w'.'t>t^v w.: �~:��.. :Y,��`Ihk4�,A"1>/��� '1~�fI ,1 _ 1 .i y.�f'.+ �. �' � f' ` , ''�,,,yyy..4...yy���... -�4ie��•j. r^.".i Me1L.:7 w _. •• ar ■ ■ ■ z' f. r X -A LZ OPP* g! view to the north 1 s; r 1 � IIIII1A��a ' a I�L' _'R i. zz IF. - _- - ,1, � __ t F _ 4,� ,sx is � '4p '"•'�/ a i • �� ° t t � f r � ,g i.' — �i'' to , , Date — May 12, 2013 — view to the west w t ' y _ _ .. _ „s, {�• mom. ` e' ti t � r /'� .; ;;: - •sfi� `r a F:i -r tr.'t r'4.x±}re ei;+ •'ti d< a _ } u. tv ���..._�-tom ry �� ti :r .� s •+ ? Date — May 12, 2013 — view to the east ' 6 i ,•, a' s �''^ w a Y 54375 Main Rd, Southold,NY 11971 to 129 Inlet Ln, Greenport,NY 11944 - Google Maps Yage 1 of 2 Directions to 129 Inlet Ln, Greenport, NY 11944 Goosle 6.7 mi-about 12 mins r';k I �yrld'11l g East bllarinn h. Islandrs End Golf r, r3 $"Country Club e S In1etP Coon ark 0 Grees�p6rt �L+ c Greenport r.I cr tirv�.t b ° Island ry`� w Ga ,und ✓rAes Cove � (Z5'i� Oerrn�+ c kn Ln 114 J Na;A4^' Nashar►om,:;:s�. -.;;. Shelter Pwaml r'ona Q Heights nU ,reek 1 'g 5helferlsland "'kiyo Car,ntrly Club Svelter Wand ` Shelter ies 'k Founders Laming Park s Goose �a ©201k Google-Map dat5''6 013 Google- "n As http://maps.google.com/maps?f=d&source=s_d&saddr=543 75+Main+Road,+Southold,+N... 5/28/2013 54375 Main Rd, Southold, NY 11971 to 129 Inlet Ln, Greenport,NY 11944 - Google Maps Page 2 of 2 54375 Main Rd, Southold, NY 11971 1. Head southwest on Main Rd toward Wells Ave go 0.2 mi total 0.2 mi 2. Turn right onto Horton Ln go 0.5 mi About 1 min total 0.7 mi 3. Turn right onto Middle Rd go 1.7 mi About 3 mins total 2.4 mi 4. Continue onto N Rd go 3.1 mi About 4 mins total 5.5 mi 5. Slight left onto Main Rd go 0.4 mi total 5.9 mi 6. Turn right onto Manhanset Ave go 0.7 mi About 2 mins total 6.6 mi 7. Turn right onto Inlet Ln go 0.1 mi Destination will be on the right total 6.7 mi 129 Inlet Ln, Greenport, NY 11944 These directions are for planning purposes only.You may find that construction projects, traffic,weather,or other events may cause conditions to differ from the map results, and you should plan your route accordingly. You must obey all signs or notices regarding your route. Map data 02013 Google Directions weren't right?Please find our route on ma s. oo le.com and click"Report a problem"at the bottom left. http://maps.google.com/maps?f=d&source=s_d&saddr=54375+Main+Road,+Southold,+N... 5/28/2013 129 Inlet Lane, Greenport West,NY - Google Maps rage t of i Gooste Address Gre Inlet Ln Greenport West, NY 11944 Get Google Maps on your phone Text the word"GMAPS"to 4664 5 3 fl e.it-!1 b �A qF Oradow rn e C y j 5 v ySi 0. 5T' e r w Ma3et�Ye ?V ' St A.�res � Cemetery mED m is n 3 e RuWs Cave �and Brea kfeet ©2013 Google-Map data©2013 Google-, http://maps.google.com/maps?hl=en&q=129+Inlet+Lane,+Greenport+West,+NY&safe=ac... 5/13/2013 m�w. W y I • +o wra—————4Z---_—_'ne_ StT S ,allot a wit -- r_-2z--"—ram / \ 1 r TORNar % TvwR OP t a4r1 2eNq ``� arN�ow. r.eNu N • e Ali e a • e • �;/ / 'Ib u ,a m O 4Ck- • a m • zx torrR or a soim,o,n D d I ic b j j a �� f6 I1T O 1a3 I •s.�vr FO m • se ji S corm or x, P GARDINERS BAY xx xa C rEwraRR G eaiE � to /. m rx,R. I ,•S 2W.1 ,e 1 rr r ..— — -- �w --a— r� --•-- � ROT�cs COUNTY OF SUFFOLK © R > aouman secTRx+Ro Real Property Tax PService Agency y °i 43 P PROPERTY MM OFFICE LOCATION: 0� SU!/T 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 COMM LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD D E VE MEMORANDUM JUN 14 2013 Southold Town B ar f Tru tees To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 13, 2013 'Re: LWRP Coastal Consistency Review for ROBERT J. BAILEY SCTM#1000-43-5-6 The proposed action is partially located within FEMA Flood Zone AE el 7. ROBERT J. BAILEY requests an Administrative Permit to install a 10'x13' storage shed on a gravel base with gutters to leaders to a drywell. Located: 129 Inlet Lane, East Marion. SCTM# 43-5-6 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed actions are CONSISTENT with the LWRP provided.that: The Board locates the shed outside of the AE flood zone to the greatest extent practicable. 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 James F.King,President �Qf soUry Town Hall Annex 01 Bob Ghosio,Jr.,Vice-President ,`O� �Ire 64 Main Road I P..O.O.Box 1179 Dave Bergen l�[ Southold,New York 11971-0959 John Bredemeyer Michael J.Domino �0 Telephone(631)765-1892 O Fax(631)765-6641 i f . BOARD OF TOWN'TRUSTEES j TOWN OF SOUTHOLD i Office Use Only _Coastal Erosion Permit Application j _Wetland Permit Application %/ Administrative Permit j Amendment/T ransfqr/9 tension Received Application: 3 3 eceived Fee:$ I h0:6P2Town ✓Completed Application 3 D _Incomplete —SEQRA Classification: Type I Type II - Unlisted JUN _Coordination:(date sent) } �/.CWRP Consistency Assessment Form Jr 3 3 ? CAC Referral Sent: Southold ate of Inspection: Z ard of , es _Receipt of CAC Report: _Lead Agency Determination: echnical Review: Public Hearing Held: ,3 Resolution: Name of Applicant Mailing Address amr7", O CoDZ Phone Number:( 7iU Suffolk County Tax Map Number: 1000- yu - y Jam- 19,6 Property Location: (provide LILCO Pole#, distance to cross street and location) AGENT: (If applicable) Address: Phone: i Board of Trustees Application ' I i GENERAL DATA j. Land Area(in square feet): 17, 97 044.11 /U' • `< �.. Area Zoning: ZViAtz Previous use of roe P P rtY= Intended use of property: Covenants and Restrictions on property? Yes No �OI2ix- If"Yes",please provide a copy. � �/1?J1rJ�a��•1�/ 1 Will this project require a Building Permit as per Town Code? ✓ Yes No ' If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this J ro•ect re uire a variance from the Zonin Board of Appeals? Yes °� No P q g 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 ✓ No Does the structure(s)on pTperty have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date 0 ) ) 1W •t- dz95- No prior permits/approvals for site improvements. Has any permittapproval ever been revoked or suspended by a governmental agency? ✓ . No Yes If yes,provide explanation: Project Description(use attachments if necessary): Application for storage shed Project Description My wife and I purchased a home at 129 Inlet Lane in Greenport during May 2013. The home is located on Gardiner's Bay near Gull Pond. The home has no basement, garage or attic and as such storage space is very limited. There was an 8 foot X 12 foot storage shed on the property when we purchased the home. This shed will be filled with lawn mowers, snow blower and other yard and home maintenance related items. We are requesting approval to install a 10 foot X 13 foot storage shed in the back yard (see pictures enclosed). This shed will be used to store patio furniture, beach items, kayaks, and household items such as holiday decorations, etc. The shed will be manufactured by a company that makes sheds. . The shed will be located on a gravel base. No concrete footings or posts will be used. The shed will be custom built and will have the same siding and shingle color as the house to make it more visually attractive. In addition, as part of the DEC permit process I will commit to put a gutter on it and also put the gutter into a dry well to help with rainwater run-off. If you have any questions please feel free to contact me at 860-836-2371 (cell phone) or via email at robert.j.baileyapw.utc.com Thank you for your consideration of this matter. Robert Bailey Hoar 'f Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the roposed operations: A-C�Ik7 .pol¢c`J7zGz �-r/'`— — /�'�✓�-- � G`p -: Area of wetlands on lot: d6 rAF0 square feet L_ b vi-A 1oV lJr�� OMrr Percent coverage of lot: % Closest distance between nearest existing structure and upland �G,--� d!-c edge of wetlands: .�P feet Closest distance between nearest proposed structure and upland edge of wetlands: 9$ —J117 feet Does the project involve excavation or filling? X No Yes If yes,how much material.will be excavated? 4 cubic yards How much-material will be filled? o cubic yards Depth of which material will be removed or deposited: 62 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): Q I• PROJECT ID NUMBER 617.20 SEAR I APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART t -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT N E 4 3-PROJECT LOCATION: Municipality r/ f/�j p County ;L 4.PRECISE, LOCATION: /S reet Addess and Road Intersections. Prominent landmarks etc -or provide map !j✓,/�K d /9 V 7L dill 5.IS PROPOSE ACTION:' L�J�Njw ❑Expansion ❑Modification/alteration I i 6.DESCRIBE PROJECT BRIEFLY: 'I.AMOUNT OF LAND AFFECTED: I Initially acres Ultimately acres f� 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ®Yes Elmo If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential [:]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, State or Local) �es ❑No If yes, list agency name and permit / a provak VAI IN PERMIT OR APPROVAL? ❑Yes MNo If yes, list agency name and permit / approval: �'fC7"'L7 12 AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes W No 1 CERTIFY THAT THE INFORMATION PROVED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant 1 Sponsor Name i/ �� Gt a t Signature � 44� /Zz If the ction is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART It- IMPACT ASSESSMENT - o be completed leted by Lead A end. A, DOES ACTION EXCEED ANY TYPE t THRESHOLD IN 6 NYCRR,PART 61.TA? If yes,coordinate the review process and-use the FULL EAF. 0 Yes. Lr l:No a. "LI, 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 quardy.,surface or groundwater quality or quantity,noise levels,existing traffic pattem;solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesdwtio,agricultural;archaeological,historic,or other natural or cultural resources;or community or nei0hborhood character?Explain briefly: C3. Vegetation or fauna,fish,shel(frs •or wildlrfe-spedes,significant habitats,or threatened or endangered spedes?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?Exp(ain briefly: C5. Growth,subsequent developmAnt;or related activities likely to be induced by the proposed action?Explain briefly: C6. Long tern•short-term.cumulative,or other effects not identified'in C1-05? Explain briefl : C7:Othec impacts ndudin than es in use of either uantit.or type of every? Ex lain brie&;---' - - D.WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA 7 if .es,a tain brie& . QYes Q No ------------ EfFSTHERF-,OR IS THERE LIKELY To 0t,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If .es lairc Q No PART IN-OETERM(NATION OF SIGNIFiCANCE(ro be completed by Agency) INSTRUCTIONS Foreach adverse effectidentitted above,determine whetheritis substaatial,large,knportarttorothervvise stgnitrcant E&dt effect should be assessed in connection with its(a)setting(Lc urban or(urea;(b)probability of occurring;(c)duration;(d)inevetsibiGty;(e) geographic scope;and(t)magnitude. If nei gamiy,add attachments or reference supporting materials Ensure•that explanations contain- . suftident detail to show that ap relevant adverse impacts have been identified and adequately addressed. If question d of part ti was checked ~ yes,thedetetminadonofrigniflraneemustevaluatethe potential lmpacteftheproposedacfion ontheenvironmentalcharactedsttcsoftheCEA. Check this bout If you have kleaGfied one ormore potentially large orsidnificantadverse impacts which MAY ooatr.Then proceed directly to the EAF and/or prepare a positive declaration. Check(his box If You--havedetermined,based on the information and analysis above and any supporting documentation,that the proposed acG WILL NOT result in any significant adverse environmental impacts AND provide,on'attachments as necessary,the reasons supporting IN determination. Board of Trustees Z O l,3 Name of lead Agency/� Datelk lJ President Print or T pe Name of Responsible Officer i Lead Agency rifle of Responsible Officer 011 ' Board of Trustees Application County of Suffolk State of New York 01 BEING DULY SWORN6 ; i D O S AND AFFIRM9 THAT HE/SHE fS 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 LICATION. 'gn tore of Pro a ner SWORN TO BEFORE ME THIS DAYOF__2412U� Notary Public Heidi C DePasquale Notary Public-Connecticut. My Commission Expires August 31 , 2014 J Boai,%L of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, p�7-!✓ �Gt residing at (print owner of property) (mailin ddress) br— hereby aut rize (Agent) to appl or permit(s)from the Southold Board of Town Trustees on my ehalf. (Owner's signature) i APPLICANT/AGENUREPRESENTATWE . TRANSACTIONAL DISCLOSURE FORM The to orb f Southold's Code of Ethics prohibits conflic interest on the part of topvn ofFcers and employees The purpose of this form is to Qrovide information which can alert the town of Vossible co #licts of interest and allow it to take whatever action Is necessary avoid sLmvj YOUR NAME: /t�—,/ f (Last name,fidi name,Apiddle initial,unless you are applying id the name of I! 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,marriage,or business interest-"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial,ownership of(or.employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agenVrepresentative)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 this day g /n2 20017 Signature• r/ T - - Print Name Form TS 1 i a� k Town of Southold Erosions Sedimentation .& Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S C.T.M.p: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A k 01 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s"IST fii'T ec�3`tTaT Tot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORKASSESSMENT Yes No a. What is the Total Area of the Project Parcels? f q7rl Will this Project Retain All Storm-Water Run-Off (include Total Area of all Parcels located within Generated by a Two(2)Inch Rainfall on Site? i• the Scope of Work for Proposed Construction) (This Item will include all run-off created by site 0/1 � ❑ S.F.J Acres) b. What Is the Total Area of Land Clearing d Z clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? —0 ... impervious surfaces.) (S.F.J Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (P—de—tonal Pages-Needed) Drainage Structures Indicating Size&Location?This _ ❑ item shall include all Proposed Grade Changes and P]et' G„@� ran 10 Slopes Controlling Surface Water Flow.. 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will ba.used to �✓ control site erosion and storm water discharges. This y/y g/y hie 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 04 Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? Pj Will this Application Require Land Disturbing Activities / Encompassing an Area in Excess of Five Thousand ❑ c/ (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 then one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb ane armore acres of tend; which Exceed Fifteen(15)feet of Vertical Rise to o ✓ 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 storm water discharges. (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.040-001.) Surfaces be Sloped to Direct Storm-Water RunrOff 1.The SWPPP shall be prepared prior to the submittal of the NOI.The NOI shell 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 shag describe the erosion and sediment control practices and wilare Q Will this Project Require the Placement of Material, required,post-construction storm water management practices that win be used and/or Removal of Vegetation and/or the Construction of any L 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?Mft It=vdr NOT Include the hodaradon of Driveway Apmm) identify potential sources of pollution which may reasonably be expected to affect the quall(y 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 p9s4eonstruc:tton starm water management practice In a Box and the construction site disturbance Is between 4000 S.F.&i Acre is area, component shall be prepared by a qualified Design Professional ticensed In New York a Scu ding,m-Wate,Gra Drainage&Erosion Control Plan to Required by the Town of that Is knowledgeable In the pdnclples and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Bhdlding Permit. (NOTE: 'A Check Merle(4)endror Answer for each Question is Required W a Complete Applratlon) STATE OF NEW YORK, rr COUNTY OF...ch?it ......SS That I, iQ.to!�.✓.. ... ..49.0.x.......... ...being duty sworn,deposes and says that he/size is the applicant for Permit, (Name of ttldlviduai Sljning Document) And that he/she is the ........, ...........................( n ttt ,cf , )................................................................owe.Conraior.Agent on-ate o etc. Owner and/or representative of the Owner or Owners,and is dtdy 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, .1 ... .......... ....... d//ay''of�f++..... ...... ............:... 20/.: Notary Public: ........ l� (/11 c (t . .....�......:.. ........ ....................... ....... .................... (signature of Applicant FORM - 06/70 Notary Public-Connecticut My Commission Expires August 31, 2014 Application for storage shed Project Description My wife and I purchased a home at 129 Inlet Lane in Greenport during May 2013. The home is located on Gardiner's Bay near Gull Pond. The home has no basement, garage or attic and as such storage space is very limited. There was an 8 foot X 12 foot storage shed on the property when we purchased the home. This shed will be filled with lawn mowers, snow blower and other yard and home maintenance related items. We are requesting approval to install a 10 foot X 13 foot storage shed in the back yard (see pictures enclosed). This shed will be used to store patio furniture, beach items, kayaks, and household items such as holiday decorations, etc. The shed will be manufactured by a company that makes sheds. The shed will be located on a gravel base. No concrete footings or posts will be used. The shed will be custom built and will have the same siding and shingle color as the house to make it more visually attractive. In addition, as part of the DEC permit process I will commit to put a gutter on it and also put the gutter into a dry well to help with rainwater run-off. If you have any questions please feel free to contact me at 860-836-2371 (cell phone) or via email at robert.j.bailey(a_pw.utc.com Thank you for your consideration of this matter. Robert Bailey Town of Southold i LWRP CONSISTENCY ASSESSMENT FORM j 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 i 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. - i 2. Before answering the questions in Section C, the preparer of this form.should review the exempt f 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 r 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 Office,the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION —D -t- 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: Nature and extent of action: � dtc Application for storage shed Project Description My wife and I purchased a home at 129 Inlet Lane in Greenport during May 2013. The home is located on Gardiner's Bay near Gull Pond. The home has no basement, garage or attic and as such storage space is very limited. There was an 8 foot X 12 foot storage shed on the property when we purchased the home. This shed will be filled with lawn mowers, snow blower and other yard and home maintenance related items. We are requesting approval to install a 10 foot X 13 foot storage shed in the back yard (see pictures enclosed). This shed will be used to store patio furniture, beach items, kayaks, and household items such as holiday decorations, etc. The shed will be manufactured by a company that makes sheds. The shed will be located on a gravel base. No concrete footings or posts will be used. The shed will be custom built and will have the same siding and shingle color as the house to make it more visually attractive. In addition, as part of the DEC permit process I will commit to put a gutter on it and also put the gutter into a dry well to help with rainwater run-off. If you have any questions please feel free to contact me at 860-836-2371 (cell phone) or via email at robert.j.bailey(W- w.utc.com Thank you for your consideration of this matter. Robert Bailey i i P Location of action: 1.4 ✓r'u Q'� }L � Site acreage: r, G Present land use: i r1 i Present zoning classification: 0evezMikZ I LI 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: (b) Mailing address: t ✓ �� (c) Telephone number:Area (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the,project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. 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. E�rYes ❑ 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=PoH 'es Pages El Yes ❑ N 3 through 6 for evaluation criteria o Not Applicable Attach additional sheets if necessary i Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See s. LWRP Section III—Policies Pages 6 through 7 for evaluation criteria : E Yes ❑ No ❑ Not Applicable i f i I' i 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 R(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 HI —Policies Pages 16 through 21 for evaluation criteria 7Yes ❑ No ❑Not Applicable H ..A-. i i 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 LW"Section HI--Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable i I 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 fo on criteria. .. f ❑ Yes ❑No of A le 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 LNM Section III;Policies; Pages 38 through 46 for evaluation criteria. YJ] No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES 1 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. j Yes ❑ No Not Applicable 1. 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 ` 1 I' r 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 eva uation criteria. ElYes ❑ No Not Applicable Attach additional sheets if necessary. Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies;: ages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable It PREPARED BY ✓ , TITLE DATE J T i J Amanda My name is Bob Bailey and I recently purchased a home at 129 Inlet Lane in Greenport. spoke to you on the phone and then in person in your office last Friday (May 24tn) regarding an application to put a shed in my backyard. Enclosed please find an original and two copies of my application for shed approval. I believe I included all the required information and answered the questions using the guidance you'gave me. Please email (robert.j.baileyepw.utc.com) or call me 860-836-2371 if you see anything that may be.missing or if you require additional information. Thanks for your help.