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HomeMy WebLinkAboutTR-8325A James F.King,President Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President h���a c0 �y P.O.Box 1179 Dave Bergen W i Southold,NY 11971. Tel 765-1892 John Bredemeyer 4% Telephone(631) Michael J.Domino 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 list day of construction / %constructed: �/ Project complete, compliance inspection James F.King,President �*OF SO(/T�O Town Hall Annex Bob Ghosio,Jr.,Vice-President �� l0 54375 Main Road P.O.Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino Telephone(631) 765-1892 lCOUpm Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8325A Date of Receipt of Application: October 28, 2013 Applicant: Lucie Harris SCTM#: 70-6-12 Project Location: 305 Private Road #3, Southold Date of Resolution/Issuance: November 13, 2013 Date of Expiration: November 13, 2015 Reviewed by: Trustee Michael Domino Project Description: To remove five (5) dead/dying oak trees around the existing dwelling and power lines; re-vegetate areas with various plantings and add garden fencing. 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 Lucie Harris, received on October 28, 2013, and stamped approved on November 13, 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. James F. King, President Board of Trustees S.C.T.M. NO. DISTRICT: 1000 SECTION:70 BLOCK: 6 LOT(S):12 -LES. JOCKEY CREEK .��..-........--.:•_.............. _ - STORAGE LOCATION - - .•. .•.•...-. . . - - OCT 2 8 2013 82^ :- E 45:0:L 6 111 2 ..b .... ..-. I I;O'E cc j f1.., ZONE x II i/ \BOON �5.0'E 'TY 0 LAND NIF ' z • r` R APPROVED Y BOARD OF TRUSTEES LANor D NIF ;� 22.J'IOW14�'OFSOUTHOLD ' VANPORE—GIO OU ?25.9' N D m 7.7 LAND �,DA � a � Im.RY: 1. 3 I3 COND 4, �o 2.2' co - n2CY i •, 71.3' IF r N a.e'� s.r & Ju' 0' n rs• P W.40 YON. coOAw p l _ I n.aw 001.17 1 LAND NIF a g¢. 5.00' .. OF NA44ESFA14R '' LAND NIF I 250.7? 7,1°1,fJEO STONE .. RIISSELL �j• OFU a A� YON. f `Kf •^�O O PR�IR TE / - w Y c FIRM PANEL 166H MAP REVISED SEPT. 28, 2009 O TH£ VIA TER SUPPLY, WELLS, ORYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS I AND OR DATA OBTAINED FROM OTHERS. AREA: 10,103.10 SQ.FT. or 0.23 ACRES ELEVATION DATUM: UNAOTHORI2£D ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENGING INSTITUTION _ LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 774E PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: LUCIE HARRIS; FIDELITY NATIONAL TITLE INSURANCE; MAP OF: EVERBANK; FILED: SITUATED AT: SOUTHOLD TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design f �J� P.O. Box 153 Aquebogue, New York 11931 PHONE (831)298-1588 FAX (631) 29EI-1588 FILE N 13-82 SCALE: 1"=3Q' DATE: MAY 29, 2013 N.Y.S. LISC. NO. 050882 m.Lnt.Lning the record.of Robert J.Hennessy&Kenneth M.WoycLssfc I, gpf FO(,� James F.King,President �pG P.O.Box 1179 Bob Ghosio,Jr.,Vice-President � y� Southold,NY 11971 Dave Bergen y Telephone(631 765-1892 John Bredemeyer u, Fax(631)765-6641 Michael J.Domino y col Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time:' LUCIE HARRIS requests an Administrative Permit to remove five (5) dead/dying oak trees around the existing dwelling and power lines; re-vegetate areas with various plantings and add garden fencing. Located: 305 Private Road #3, Southold. SCTM# 70-6-12 Type 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 Type of Application: Wetland _Coastal Erosion _Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: Conditions: -- Present Were: J. Kin B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: CONSULT YOUR LAWYER BEF RE 'IGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE, made tie 7 'day of September, 2013 BETWEEN LAWRENCE MARKS and MARION MARKS, both residing at 305 Private Road #3, Southold, NY 11971 party of the first part, and LUCIE HARRIS, residing at 521 Sixth Avenue, Brooklyn, NY 11215 party of the second part, WITNESSETH, that the party of.the first part, in consideration of TEN and no/10 `. $. .00}dollarsvaid by the party of the second part, does hereby grant and release unto, the party'bf the second part; the heirs or successors and assigns of the party of the second part forever, SEE SCHEDULE "A" ANNEXED HERETO AND MADE APART HEREOF BEING AND INTENDED TO BE the same premises conveyed to the parties of the first part by deed made by Robert Wheeler and Richard Wheeler, as Co-Executors of the Last Will and Testament of Mary M. Wheeler, deceased dated April 10, 1982 and recorded'in the Suffolk County Clerk's Office on April 19, 1982 in Liber 9170 Page 49. TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party-of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered.in any way whatever, except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party' shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. i i i E ' I I I IN PR S NC OF• LAWRENCE MARKS C. MARION MARKS '`� »• I r. o sp 4.. .tk r, } .emu ' fib...++��� `•� � - ,.. Alw N4>:, 01 n 10 s � ii F' r v -.^n a s. # .,.-• +.'tirr.:, f p E C ._ . OCT 2 8 2013 """'"fir '�*�•�,,,,,,,. '-�',r�,,,,�,� 3a . {2d 3 ` u� 3� o tz F-I ; �•I .tip- • `.. r 4 �. i ;t. 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I or +IF ,RRe yam"•' - ' -' +�' ,,w sue 'r YA a r 1 s ' r �� ` p 'ar '.tip:: ^�y .Te � y •�� � a d'c� � .- ice♦ � �' f �. _ , .� .e w sip cA `w► " t x If 01% a C ai w c � � R Y ell - Jim t Y ��^ lot 4- ;J TN IA I r 40 y t .. 07 { Ir ✓ ( .1 s , r':: f 'y, r �, • #r sue, � S�,' r jai;: ,MR, —Ad � a / "fit, �• ,,� s �t , .}"I '{ .. r .•�Ii i l.� ,t +, , • .t -t_#• t r�� ` '�'I�I.1f,•.,' .,t.•.v ��,,.��' � ` + ` 'try .�,i;` ,` .� s y •'y' `KIY� y � Ir r T' ti r •. �►J � r � r e ` r r / e w _ a .. °•sue �_` .Aiw �"` " .. v _ .:: XR wN° 4 4 lop w F w._ a .. wMM6WhL AWL A W �4 Town of Southold A 2 7 O Suffolk County-NY I.a The People of the state of New York vs. NAME EFEND LAST <-- � ANT) FIRST NAME MIDDLE INITIAL 2 L--- rx`r'. STREETADDRESS APT.NO. S ZIP ' - - - - LICENSE.OR REGISTRATION-NUMBER-- •• 53FWF2 OCT 2 1 2013 STATE TYPE OF LICENSE DATE EXPIRES SEX DATE OF BIRTH OPERATOR MONTH �A _OWNS VEHICLE a I�ZI 1 K ❑YES ❑NO THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BELOW ..PLATE NO. - ... c i .,-•.• DATE EXPIRES 5oufi)aisi!(iVill� STATE . PLATE TYPE E� .❑N.Y. ❑N.J. ❑N.Y. O N.J. ❑ ❑PASS❑COMM ❑ VEHICLE MAKE - ❑ DODGE `^. ❑ BUICK ❑ CHEV ❑- —CADILLAC ❑ PONRAC _ ❑ FORD ❑ OLDS ❑ PLYM ❑ TOYOTA ❑ VOLKS ❑ X.. �y BODY ❑ 2 DR ❑ 4 DR ❑ BUS ❑ MCY ❑ S.W. - 3:. TYPE ❑ TRUCK ❑ TRAILER :. ❑ VAN. ❑ VIN NUMBER THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS !: PLACE OF OCCURRENCy� C PCT ia id '. DATE OF OFFENSE. AM TIME PM. CI TOWN,VILLAGE OR HAMLET SUFFOLKCOUNTYNY eta 10—/9-13 �S�.. ❑ v Eli3 IN VIOLATION OF SECTION SUBD. OF THE❑VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK u +BOTHER(SPECIFY) ❑O.S. ❑COM ❑BUS ❑HAZ t' ..:. .. Z7 5�S' DEF VEH MAT ❑ .SPEEDING OTHER OFFENSE - MPH IN A MPH ZONE IV-:D; ��h,��,:� MISDEMEANOR❑ z? FACTUAL PART(NOT FOR TVB) THE ABOVENAMED DEFENDANT DID ON THE STATED DATE,TIME AND PLACE «Ia w l v6k �T The Foregoing is based on mm kknnowiedge) of r' ... dated PARKING SCHEDULED FINE y� $ CONTACT COURT❑ THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT ` SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 Y p 1/MTEOF/APPFA CERANCE((NNOT/FOR TVS) . O N �O/ ! W ( AT C� "i FALSE STATEMENTS HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE P.LN.Y.S. COMPLAINANT DATE a lb�l�J #BADGE / a / 5 i COURT COPY ueee sFF sea No.re9 b'°PM,y N^n'=--- z? ----- w-z.-99 NATCN ae.w-Es zi�t=I eE wFST,md fro. I� € 39 sq.t 'b �..a .. T Creek Ilk cfiA♦� { `4j pn+^Ra n rt b, 1bVc7 j R]Ncl b.fi ^" ! 6 m h2 0{ m F 4 ♦R d1 \\ 4 .�. CL,L�9 NECK Mrc"iurwuq �. •:']"°` 1° � surtltaasaoodo—lcrNoS ° � • ",., �:,',v, 1 �re ♦ \ � € i� �y a, i R9 r O°Bbw JAVdWE lA mm ° E N ,� • ' --w.. n� ♦ 1A € °' ,B " "� � .♦ ° a Tti6 �,. is �fi' .._..,,Jv � .\��' j. �... 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Se tvexav t° m u eenw R� bEE6Ea N0.. .l V� fit W a9 n y F rpt 11 a a ..+.i'.k / V_ L ! $ o= anNYuss. e o ! ab lA m ss n al a.{ 1pak) a.t x9z g 1. ._\B]so+— f — -- a w g 9 y uAFai £q 01.r 6'111 P0 SOUT E .� mw Rtl �� --,_ m NOTICE COUNTY OF SUFFOLK © E n HOLD CTION NO E tee. - cu,F�.m9rd{N{w Property Tax Service Agency Y o E N " Cwnry rannr�wc,NY11wt 0O 70 v O '' ..�x ..� ._ ,._ ..✓ m d..F..e:' n, _.bJ - O ERTY MAP 1 w < h'— S.C.T.M. NO. DISTRICT: 1000 SECTION: 70 BLOCK: 6 LOT(4 12 PILES c 1 Y JOCKEY CREEK po SIOnnGC IOCSTION / 45. 2 u, �- O < T,f 4f(F( I O � ll-0'E \BOUND4RY � I r to O I . LAND NIF I ,� OF NEHRBAS I'I• 40N. 1 i 21).52•'$ u o EmD NIF ON �� b 22.3' VAMPOREFGIOCOLI W 25.9' ¢t 7,7 VEND iJ/F - R.0' OF O R? STEVENS . O smav w I it Sry FRu,? CONC 1 /605O 1 O O 2.2' I �OJ • BM1rO l� I .. O 22.7' 7.7 '� 6 N 1 ✓ 1 I.5' , C, N w.MO n p0 O IPE Y rcrcL a..40N. O O.aW O 2'42' OF LAND ESFWe I z o g4•. -J.OD' . uoN. I X NIF I 50,12 elb DQ•'flSTDNE RUSSELL 2 �• Syr p'N TE5 W �i FIRM PANEL 166H MAP REVISED SEPT. 28, 2009 O THE IVA TER SUPPL i, WELLS, ORYWELLS AND CESSPOOL o LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 10,103-10 SO-FT. or 0.23 ACRES ELEVATION DATUM: UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A LiOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM 77-IE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER!MPROVEMENTS. EASEMENTS ANDIOR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TTME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIEC TO: LUCIE HARRIS; FIDELITY NATIONAL TITLE INSURANCE; MAP OF: EVER-BAN!"; FILED: SITUATED AT: SOUTHOLD TOWN OF: SOUTHOLD KENNETH M WOYCHUIC LAND SURVEYING, PUC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design p� P.O. Box 153 Aquebogue, New York 1I931 PHONE (831)298-158B FAX (631) 298-15BB FILE # 13-82 SCALE: 1"=30 DATE: MAY 29, 2013 N.Y.S. LISC..N0. 050882 msLntainin6 Lhe records oI Rsberl J.Rennessy&Kenneth M.BBychuR OFFICE LOCATION: OF SO(/ryO MAILING ADDRESS: Town Hall Annex ,`O l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) y �r Southold, NY 11971 @ Telephone: 631 765-1938 Fax: 631 765-3136 COUNT`I,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees NOV - � 2013 From: Mark Terry, Principal Planner ' -�-� c��a .+r+vr� LWRP Coordinator • �T�....: Date: November 6, 2013 Re: LWRP Coastal Consistency Review for LUCIE HARRIS SCTM41000-70-6-12 LUCIE HARRIS requests an Administrative Permit to remove five (5) dead/dying oak trees around the existing dwelling and power lines; re-vegetate areas with various plantings and add garden fencing. Located: 305 Private Road #3, Southold. SCTM# 70-6-12 It is my recommendation that the proposed actions are INCONSISTENT with LWRP Policy 6.3 (below) and therefore, 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 Town of Southold Board of Trustees review or permit. Further, it is recommended that the Board require that the applicant specify the species of native vegetation proposed to be planted. 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 • r James F.King,President SO(/ry Town Hall Annex j Bob Ghosio,Jr.,Vice-President ,`O� Ol0 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer G p Telephone(631) 765-1892 Michael J. Domino 'Q Fax(631) 765-6641 '�OOUNT`1,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit _Amendment/Transfe Exte ion Received Application: 2 13 _Received Fee:$ D E C E I Completed Application _Incomplete SEQRA Classification: OCT 2 8 2��3 Type I Type II Unlisted Coordination:(date sent) �/LWRP Consistency Assessment Form CAC Referral Sent: ZDate.of Inspection: 3 _Receipt of CAC Report: _Lead Agency Determination: Technical Review: V�Publi'c Hearing Held: _Resolution: Name of Applicant L t&c i e- Mailing Address fg no0' /�.�n Phone Number:(7181 9'n- )4 Z 2 Suffolk County Tax Map Number: 1000 - 70 i A I cc—k (o Ldf 12 Property Location: 6,5- I t(Vo)e •0 -3 s00(wid )v L1 P2 I -4 '3 (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: i i i i r„-- rd of Trustees Applicatio: i I GENERAL DATA Land Area(in square feet): l01 lD 3, 1 D 51. I Area Zoning: x �. Previous use of property: rest dt4l�-ic� Intended use of property: re Sf J ei4 J Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes X 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. i. Does this project require a variance from the Zoning Board of Appeals? Yes V No If"Yes",please provide copy of decision. Will this project 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? X 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? x' No Yes If yes, provide explanation: Project Description(use attachments if necessary): re M DV M Ll �n�a r clew I/ O,�& -i-r��s �I�i uJere qCDwr�S JYJ `rAA check oar oVerhal*,5 `Y4 hp%z cund filer-riG I;"es We are ► 4ni-Ar, ija+1VC �Iower6 � Veye�abl�— �Ie a,VJ i Bor= -3 of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: -�o �,Qd n V�� a� Area of wetlands on lot: 2-5-G)(j square feet Percent coverage of lot: J % Closest distance between nearest existing structure and upland edge of wetlands: feet fei-t C 064, , -i.e � s c(Pr'y-bX '�m ► -/c�n d s -tree remov:r Closest distance between nearest proposed structu a and upland �c�bo edge of wetlands: a Y c�GJ t feet 6'© - �rom D�� We,+)Qn a s Does the project involve excavation or filling? No Yes If yes,how much material will be excavated?_ A Lcubic 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: f Manner in which material will be removed or deposited:_�1 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): i 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe.will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): 30 s` P 3 Brief Description of Proposed Actio , 1, \ 4/vY , .Lw� ^ AIXe s d V,.e e Name of Applicant or Sponsor: FE phone: [_�� ail: tKe e.L)ah-i5' �� c, l'r, coln Address: 5z1 4 City/PO: State: Zip Code: h 1 YL-t I IIZ1 S 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that El IYJ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 1 rws}e-e5 F] (—f� 3.a.Total acreage of the site of the proposed action? e L3 acres u b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? t 2 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) C]Industrial [:]Commercial 12 Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑.Parkland Page 1 of 4 5. Is the proposed action, NO YE N/A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YE landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes, identify: ff ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES d If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of'Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YE wetlands or other waterbodies regulated by a federal,state or local agency? ❑ 10 b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat.types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional [� Wetland El Urban [XSuburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO I YES by the State or Federal government as threatened or endangered? ❑ 16.is the project site located in the']00 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? [(NO DYES ❑ b.Will storm water discharges be directed to established conveyance systems(ru ffand storm drains)? If Yes,briefly describe: DNO DYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: FA ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? / ❑ If Yes,describe: urn I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE / ��, ( Applicant/sponsor name: LA c; S Date: (O I Z 13 Signature: IiLc , tjgAry - Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ® ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 21 1-1 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate © ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: El a.public/private water supplies? b.public/private wastewater treatment utilities? El 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, El I__! waterbodies,groundwater,air quality,flora and fauna)? L_! Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why,a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. EICheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees 3 Name of Lead Agency_ I Date J Y9 k4 �S {—- )L 1 to LV, President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer car SiFyature of Responsible Officer in tead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 ` I G Town of Southold 0 Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.fl: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 01�yv- STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s1 Vccf ec oo oc — o—t CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION 1TEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within I Will this Project Retain All Storm-WaterRun-Off the Scope of Work for Proposed Construction) � 2 3aGTe5 Generated by a Two(2")IncchhRainfall o on Site? is 0 F.I 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 A c r& Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F.l Acres) 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 10 �- Item shall include all Proposed Grade Changes and -Frees Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion `4-fticf 1,dt,/ L JL&V' ✓`5 . ;iAT AA �VtIti� and sediment control practices that will be,used to 1� control site erosion and storm water discharges..This n -)4A �E � Ip Y p�/@� l item must be maintained throughout the Entire 1 A( Construction Period. yI,D7�t 9 1a11� ' V" Q r�� 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 .�[. p a � n__ of Material within any Parcel? f� IYV� 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand T lad 7�f� (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 a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to r Including Construction activities Involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? 1 v 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 Run-Off ❑ J 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 ❑ /a censWcted 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?(Mls 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 Storrs 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(.V)and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, So(C 0 L COUNTY OF...........................................SS That I,......�. ..1 ` .................................being duly sworn,deposes and says that he/she is the applicant for Perrni4 (Name of individual signing Document) And that he/she is the .............. ...........................caner,c . ... ....... ...... .. ... (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; ............2,8: ..................da of........... .(, ?.�Q/✓..........,2013 I C NotaryPublic: ..... . ........ ...........�(.............................. l/t.4i................................................. MELANIE pQRQSKI (Signature ofApplicant) FORM - 06/70 N OTARY No,01D04634870eW Qualified in Suffolk County `Commission Expires September 30,c, Bo,` of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,.AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN.THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF 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 APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THISA4 _DAY OF ,✓ ,20 ti L Notary Pub MELANIE DOROSKI NOTARY PUBLIC,State of NewYork" No,01 D04634870 Qualified in Suffolk County Commission Expires September 30, I i Ba - 1 of Trustees Application - I i AUTHORIZATION (where the applicant is not the owner) I Z i t CAII [4 y Y L S residing (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's signature) f: I i I 1 APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,fast name,piddle initial,unless you are applying to the name of someone else or other entity,such as a company.If so,indicate the.oiher person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change ofZone 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 �l 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 br 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 orbeneficial owner of any interest in anon-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 '2 f' day of 6-ZZ- 20gl('3 Signature s Print Name Lwoye urr,S Form TS l I i I 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 ficant 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 Office, the Planning Department, all local libraries and the Town Clerk's office. E �� B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# — _ OCT 2 8 2013 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: ouk �iwLG�u� °a� UF- a zy c. D IV ,� Gr a'U t�harms-Y—e Location of action: Site acreage: 2 3 Present land use: 4ta�*i&j 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: 'l (a) Name of applicant: I—b-GcQi (�-r►1 (b) Mailing address: 6-2 1 bO t Z I S (c) Telephone number:Area Code (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ 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 iYer ia. es ❑ No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LYMY Section III-P licies Pages 3 through 6 for evaluation criteria Yes ❑ No Not Applicable i i i i i Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI—Policies Pages 6 through 7 for evaluation criteria i ❑ Yes ❑ No U] Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria #1 Yes ❑ No ❑ Not Applicable I 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 Yes ❑ No Not Applicable i i Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including j Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ F Yes No of App ale 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 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 wast . See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. El 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. ❑ Ye�] No F Not Applicable Attach additional sheets if necessary i I i WORKING COAST POLICIE' Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. S LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. Yes ❑ No Not Applicable I 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 D[Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No El Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies Pages 65 through 68 for evaluation criteria. ❑ Yes El No Not Applicable PREPARED BY Lwc.L& TITLE DATE to I z63 I I