HomeMy WebLinkAboutIntegrity Equity Partners, LLC S.C.T.M. NO. DISTRICT: 1000 SECTION: 54 BLOCK: 5 LOT(S):JZ 1
DWELLING DWELLING
W/PUBLIC WATER W/PUBLIC WATER
150' 150,
N 32°5S'20"E `6' cS 01
6 _ A 235.66'1 b
6
ELEV. 17.0 5 / r� 3 \.
DR BROWN J
OL
ML PALE BROWN .3
SILT —�
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SM SILTY SAND 13'
DARK
ML
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SANDY SILT I 15.6'
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DARK
ML BROWN / ;I
SANDY SILT 19'
WATER N CL BROWN MARSHSANDY CLAY 28' I ' '� -
WATER IN ,_ — 4
BROWN / —'--
FINE SAND 34'
McDONALD GEOSERVICES
DEC. 14,2023
DWELLING `s
W/PUBLIC WATER _—_-- '
DWELLING
9 -- W/PUBLIC WATER
WETLAND BOUNDAR
AS FLAGGED BY
/
JULY / / 6 ROUND;; �2
M.BARRON
1 JULY 28,2016
LIMIT OF MODERATE \ �� q - '!�`, / l '/i ':y;:14' 10.0
WAVE ACTION BOUNDARY_ ♦\� � / ' 301
FRAME
--ZQNE AE(EL 10) \ I ................. l��l
`—'^--- FLOOD 264E -- f
I I $OUNDARY
OA ZONE X--_—_---' / '.•. OWl _ aI.A. TIC SYSTEM
` (;' •;;:• w w 6 BEDROOM SANITARY
N n / •;' O _. (2)10'DIAx7'DEEP L.P.
------ —��- 245.87'
A420.66 14 --'' -- _-r-�----
WATER MAIN
E C E I V _
S E P 1 3 2024 DWELLINGS TYPICAL CLEAN OUT
W/PUBLIC WATER SLATE OR STOPPER END
Sp�l WT014
150' SUITABLE COVER OR PLUG
30 ELBOW
60 WYE
ZONED R-40
FEMA MAP#36103CO154H EFFECTIVE 09/25/2009 FLOW--
AVERAGE FRONT YARD SETBACK FOR ADJOINING PROPERTIES:30.5'
AS DETERMINED FROM PREVIOUS SURVEYS ON RECORD THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL
UPLAND AREA: 30,166 S Feet 069 ACRES LOCA71ONS SHOWN ARE FROM FIELD OBSERVA77ONS
q . AND OR DATA OBTAINED FROM OTHERS.
AREA:72,821.77 SQ.FT. or 1.67 ACRES ELEVA77ON DATUM: NAVD88 _
UNAUTHORIZED AL7ERA77ON OR ADD177ON TO 7HIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF 774E NEW YORK STA TF EDUCA77ON LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO 7HE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TUT70N
LISTED HEREON, AND TO THE ASSIGNEES OF 77-IE LENDING INS77TV770N, GUARAN7EES ARE NOT 7RANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO 7HE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 774EREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE 774E EREC77ON OF FENCES, ADDIT70NAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE PME OF SURVEY
SURVEY OF:DESCRIBED PROPERTY CERTIFIED TO: INTEGRITY EQUITY PARTNERS, LLC;
MAP OF:
FILED:
SITUATED AT:SOUTHOLD
TOWN OR SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Bog 153 Aquebogue, New York 11931
FILE #223-01 SCALE: 1 =40' DATE: JAN. 5, 2022 f N.Y.S LISC. NO. 050882 PHONE (831)298-1588 FAX (631) 298-1588
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COUNTY OF SUFFOLK C)
p .R W..� —_�__ ••. �.,r�
064
171)
Reg a a •ty axService Agency �E os��asna.a�r�rnau a1 mE • �• •• a
Per
-, wi�wrvnrae�� r•. y'�. w,nv
v . .•� S
1 t i
Glenn Goldsmith,President QF SOUl Town Hall Annex
,r A.Nicholas Krupski,Vice President tio�� y01�. 54375 Route P.O.Box 1179
Eric Sepenoski I t Southold,New York 11971
Liz Gillooly G Telephone(631) 765-1892
Elizabeth Peeples Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
This Section For Office Use Only
s E C F
Coastal Erosion Permit Application i 'N RJLU
Wetland Permit Application j
Administrative Permit P
E P 1 ? ?_024
Amendment/Transfer/Extension
Received Application:_
Received Fee:$ Board of Trustees
Completed Application:._
Incomplete:.
SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec.
Lead Agency Determination Date:
Coordination:(date sent):_
LWRP Consistency Assessment Form Sent:
CAC Referral Sent:
Date of Inspection:
Receipt of CAC Report:
Technical Review:
Public Hearing Held:_
Resolution:. -
Owner(s)Legal Name of Property(as shown on Deed): i rvke_ (,-N�4 rer5 G- ;
Mailing Address: �CoSa� �v�} b `"SL
I • O`� 1���`
Phone Number: 1 g r 5— t 5 - - -
Suffolk County Tax Map Number: 1000- ' '---
Property Location:
(If necessary,p ovide L LCO Pole#, distance to cross streets,and location)
AGENT(If applicable): _innmo,5 ACIC
Mailing Address: V , Z�) L a \`CA^k`
Phone Number: � � ` -�0 Email: YNnG(Dr-Y^`( k��l9 G-rAw��
a
Integrity Equity Partners, LLC
10715 Soundview Ave, Southold
SCTM 1000-54-5-37.1
September 11, 2024
Project Back Ground
This Lot was created by action of Southold Town Planning Board on March 15, 1976 as a part of
a 3 lot minor subdivision known as Minor Subdivision of John and Linda Vardy ( file copy
enclosed herein) This subdivision imposed C&R's recorded on 1-24-1976 at Liber 8026, p 589
that provided that no lot should be less than 40,000 sq ft,there shall be no further subdivision,
and that the area known as " bog and meadow" shall not be filled in.
The last two pages of the Town File indicate a residential structure located at approximately 20'
from the wetland line, and it is noted that this lot contains approximately 28,000 sq ft of
buildable area. This application fully complies with the C&R's and our improvements are
located further from the wetlands than the official record of the Town contemplated.
Lots 1 and 2 have been previously improved with single family homes. These homes are at the
following addresses and were approved under the following Trustee Permits
10605 Soundview Ave Trustees Permit 5100
10505 Soundview Ave Trustees Permit 5196 & 5571
We have taken the liberty to attach a summary of other Freshwater Wetland Permits issued in
the immediate vicinity of this project, and we hereby attach these permits as if they were
submitted fully, by reference. Although other projects have been granted permission to locate/
maintain structures at 20 feet from the Wetland Boundary, we are sensitive to the site
conditions and are proposing that we establish a 50 non disturbance area adjacent to the
wetlands, to have our pool fence serve as the barrier. The nearest structure to the wetlands
proposed is 53 feet.
I
# ADDRESS SCTM# ITRUSTEES#-DATE GRANTED(STRUCTURE TO WETLAND iNONDISTURBANCEl PROJECT DESC. -
i
11790 Nodh Sea Dr. 10OW5.14 7306 May 19,2010 i 50' _ wegand pmt to in3ta0 pod,sr.pdo and poolhouse
2!2035SoundvWAve. 1011"M _-5147 February26,2000 76 50' -- —_ _1We&vdpmtfors0far*dweHIng-
- 3(7615 SoundulewAve; ___Tdm PhragMW around opening of 9y pond —
�— 4�10505SaundviewAve. 1100064.5.37.2 I 5196 -- Juh 19,2000175' --- 155 —_—_ IWetlandpmtfors�k*d%,eRMwdedc[nrear
5.West neghbor 10605 SarndviewAve,I1000,54'5,37.3 j 5100 January 26,2000!%, rR jWedand pmt for sgl W4 dwelling w deck
6.East neota 110 Sou&ewAva. 1000.5 8 C7321A June 16,2010120 —]20'SEPTIC Tree removal and extensive regrading
------ _—--- ----- - -
—7110740Sounfiewke 10 5017 July1,1999!30 T30 jWetlaridpmtforsglfamilyt�relling— ---
_ ---
-_---.-_.—
I
f 6'. F r
`0L
Subject and surrounding parcels
Secondary Issues-Street Drainage
As this parcel is located downgradient from Hickory Road, and its intersection with Soundview
avenue, in a rain event,the water flows off of Hickory to the North, across Soundview Avenue
r
Integrity Equity Partners, LLC
10715 Soundview Ave, Southold
SUM 1000-54-5-37.1
September 11, 2024
Project Back Ground
This Lot was created by action of Southold Town Planning Board on March 15, 1976 as a part of
a 3 lot minor subdivision known as Minor Subdivision of John and Linda Vardy (file copy
enclosed herein) This subdivision imposed C&R's recorded on 1-24-1976 at Liber 8026, p 589
that provided that no lot should be less than 40,000 sq ft,there shall be no further subdivision,
and that the area known as " bog and meadow" shall not be filled in.
The last two pages of the Town File indicate a residential structure located at approximately 20'
from the wetland line, and it is noted that this lot contains approximately 28,000 sq ft of
buildable area. This application fully complies with the C&R's and our improvements are
located further from the wetlands than the official record of the Town contemplated.
Lots 1 and 2 have been previously improved with single family homes. These homes are at the
following addresses and were approved under the following Trustee Permits
10605 Soundview Ave Trustees Permit 5100
10505 Soundview Ave Trustees Permit 5196 & 5571
We have taken the liberty to attach a summary of other Freshwater Wetland Permits issued in
the immediate vicinity of this project, and we hereby attach these permits as if they were
submitted fully, by reference. Although other projects have been granted permission to locate/
maintain structures at 20 feet from the Wetland Boundary, we are sensitive to the site
conditions and are proposing that we establish a 50 non disturbance area adjacent to the
wetlands, to have our pool fence serve as the barrier. The nearest structure to the wetlands
proposed is 53 feet.
11/22/24,8:46AM DEC Permit Applications
INEIWYORK Department®f
@ usmr Environmental
Conservation
New Search Or use the browser back button to get to previous page
DECPermit Application Detail
Application ID: 1-4738-05038/00001
Facility: Integrity Equity Partners LLC
Location: 10715 Soundview Avel 1000-54-5-37.1, Southold, NY 11971
Town or City: Southold
Applicant: Integrity Equity Partners LLC
Permit Type: Freshwater Wetlands
Application Type: New
Date Received: 09/16/2024
Status: No Jurisdiction as of 11/18/2024
Complete Status:
UPA Class:
Short Description: DMS-P, PARCEL NJ (EXP. 12/31/24) - NEW HOUSE, DECK, POOL,
SHED, SEPTIC
ENB Publication Date:
Written Comments
Due:
SEQR Class:
SEQR Determination:
Lead Agency:
Environmental Justice:
SHPA Status:
Coastal Zone Status:
Final Disposition: No Jurisdiction as of 11/18/2024
Permit Effective Date: 11/18/2024
Permit Expiration Date: 12/31/2024
Stimulus Project: No
Other Known IDs: None
DEC Contact: Kimberly L Lamiroult
SUNY @ Stony Brook150 Circle Rd, Stony Brook, NY 11790
Tel:(631)444-0365
https://extapps.dec.nv.qov/cfmxtextapps/envapps/index.cfm?district id=10,24523&county swis code=47&stimulus=0 1/2
11/22/24,8:46AM DEC Permit Applications
Please email the Regional Office for additional information or questions regarding this application.
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a
f
and into this private property as it makes it way to the wetlands carrying whatever it picked up
along the way.
According to Southold Town Engineer Michael Collins, (1-5-23 phone conversation ) recent
Town drainage and piping infrastructure improvements located on Hickory Road have been
constructed in order to alleviate some of these issues and to capture runoff from a natural
spring located further north on Hickory that creates a wet condition on the roadway and forms
ice in the winter. If it is determined that Southold Town needs an Easement on the North side
of Soundview Ave to further catch runoff from Soundview Ave ( east and west drainage) and
recharge before it enters the wetlands, we are willing to discuss this Community Improvement
Project on this parcel.
Project Description
Site-to remove dead, diseased and storm damaged trees and stumps from site, remove debris
illegally dumped in wetlands and adjacent areas by others, as well as other illegally dumped
yard debris and vines. To trim for view up to 15 feet from grade, deciduous trees within the 50
foot adjacent area.
Improvements-
To build a two story single family dwelling, including Public water service, with a 1294 sq ft foot
print, including a 92 sq ft covered front porch, 165 sq ft first floor screened porch with 165 sq
ft second floor deck above and basement stair entrance below, 280 sq ft first floor deck with
stairs to rear grade, outdoor shower, basement egress window, new Innovative Alternative
Nitrogen Reducing septic system located beyond 100 feet from wetland line, roof runoff
drywells, 750 sq ft pervious driveway, 14 x 28 inground salt water heated pool with 18"
bluestone coping, piped to a backwash drywell, 10 x 10 shed with electricity and water, and
pool compliant chain link fence located 50 feet from edge of wetlands. Pool equipment to be
located to rear of shed within fenced area. 500 gal UG propane tank north of driveway. Lawn
area to top dressed with approximately 100 yards of topsoil from materials generated onsite, or
to be imported to meet shortfall and be planted and irrigated landward of 50 proposed buffer
area outside of pool fence to street. All fill generated onsite shall stay onsite and be used to
level the ground landward of the proposed 50 wetland setback line and match elevation of
previously permitted filled yard of neighbor to the east (TR 7321 a).
As per NYS DEC, Lots#1 and 2 in this subdivision, as well as the others on the enclosed
spreadsheet, are beyond their jurisdiction as per Article 24 of the Environmental Conservation
Law. We anticipate and await their formal determination on this specific parcel that they have
no Jurisdiction, and respectfully ask the Trustees to render a decision based upon this.
Lot Coverage
Total area 72, 821.77 sf or 1.67 acre
Wetland Area 42,655.77 sf or.98 acre
Upland Area 30, 166 sf or .69 acre
House foot print 1294 sf
Front porch 92 sf
Screen Porch 165 sf
Rear Deck 280 sf
Side entrance porch 20 sf
Total 1851 sf
Pool 392 sf
Pool coping 90 sf
Shed 100 sf
Total 582 sf
Total Improved footage 2433 sf
Total Upland lot coverage 8.06%
Total Let coverage 3.34%
Driveway 750 sf
Board of Trustees Appl;_ tion
GENERAL DATA
Land Area(in square feet):
Area Zoning-,
Previous use of property:'__
Intended use of property',-- -T 'In Ve A-Viak 4 C.-) VMeA4�
Covenants and Restrictions on property.
If"Yes",please provide a copy.
a
Will this project require a Building Permit as per Town Code? ,._._ 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 project require a variance from the Zoning Board of Appeals? Yes y No
If"Yes",please provide copy of decision.
Will this project requiiany demolition as per Town Code or as determined by the Building Dept-9
-Yes No
Does the structures on property have a valid Certificate of Occupancy? Yes AO
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approVals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?_V No Yes
If yes,provide explanation:
Project Description(use attachments if necessary)
A.4&Wr)k W;Ak� ceor C 0%,
V
CV)C)
sccter\ -oo-sc, 4y) k.
Board of Trustees Appl-,_ ':ion
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations::-
tr, ezwcoo S�CD V, °� -- — ---
Area of wetlands on lot: _ _ square feet
Percent coverage of lot:.
o
Closest distance between nearest existing structure and upland edge of wetlands: _...feet
2 i
Closest distance between nearest proposed structure and upland edge of wetl ds::: feet
Does Does the project involve excavation or filling? - No --Yes
. 2
If yes,how much material will be excavated? -J cubic yards
How much material will be filled?., _� ___ cubic yards
Depth of which material will be removed or deposited:,.. -D_._I/__ _-
feet
a-5%
Proposed slope throughout the area of operations: _ s
Manner in which material will be removed or deposited:
._ Cam- -- -- - - - --_- --- - -
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):
61 Z20
Appendix B
Short Environmental Assessment Form
Instructions'for.Completing
Part 1 -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 I 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 I=Project and Sponsor Information
Name of Action or Project:
�r c tj" l:LC
Project Location(describe,and attach a location map): C;r
10115 Sovnc��AUA) �000
- _-
Brief Description of Proposed Action;., 3ek i
In too
J
Name of Applicant or Sponsor: Telephone:
i
CO 7?Q L44
City/PO:
State: Zip Code: - -
CC
.-Does the proposed action onlyinvolve 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
may be affected inthe municipality and proceed to Part 2. If no,continue to question 2. a
12. Does the proposed action require a permit,approval orfunding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
15
3.a.Total acreage of the site of the proposed action? - acres --
b.Total acreage to be physically disturbed? acres
c.Total acreage(project site and any contiguous properties)owned r
or controlled by the applicant or project,sponsor? 16 _ acres
'4. Check all land uses that occur on,adjoining and near the proposed action. 1
DUrban ❑Rural(non-agriculture) ❑Industrial [:]Commercial &sidential(suburban)
❑Forest ❑Agriculture ❑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? 0 E
b.Consistent with the adopted comprehensive plan? a
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:., a
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
:a
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? IT El
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:
4r%
10. Will the proposed action connect to an existing public/private water supply? y0i,
If No,describe method for providing potable water:
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describ` Method for providing wastewater treatment:OA`40, � � ��C ❑
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? Ell
1 _
I'a.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? 7❑
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
i
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: ET
i
14. Identify the typical hoitat 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 ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO
y YES
by the State or Federal government as threatened or endangered?
16.Is the project site located in the'100 year flood plain? NO YES
17.Will the proposed action create'storm water discharge,eitkier from point or non-point sources? NO YES
If Yes, -
a.Will stone water discharges flow to adjacent properties? EgNO ❑YES
b.Will storm water discharges be directed to established conveyance systems(runoff and stclrm drains)?
If es,briefly describe: ❑NO ES
\ANARF WAX �rw� Iv, pn Si
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? l
If Yes,describe: (�) "❑
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: ❑
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE 'n VA,\ f,g0i�1RCX ntFIS
Applicant/sponsorname V �n1 (. o.S .Ma .ts Date::
Signature:
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 I 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 a
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?
4. Will the proposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area(CEA)?
ET-
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? a•. ❑.,
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:
a.public/private water supplies? ❑ -
b.public/private wastewater treatment utilities? FJ
8. Will the proposed action impair the character or quality of important historic,archaeological,
architectural or aesthetic resources? El tEl
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, a' E waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
u -fir
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? El,
11. W ill the proposed action create a hazard to environmental resources or human health? ToTo i
Paint 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-tern,long-term and
cumulative impacts.
❑ _.. _
Check this box if you have determined,based on the'inforination 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.
Check 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
Name of Lead Agency Date
President
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
PRINT Page 4 of 4
Board of Trustees Apply,,._ tion
AUTHORIZATION
(Where the applicant is not the owner)
7-in 0MO-S
1/We, O 6%
owners of the property identified as SCTM# 1000-: F=)9 "'S- •_ ____ -.,,
.,in the town of
�O�-
C� ;New York,hereby authorizes
to act as my agent and handle all
necessary work involved with the application process for permit(s)from the Southold Town
i Board of Trustees for this property.
l
i
Property Owner's Signature PropegOwnes Si e
i
h
SWORN TO BEFORE ME THIS_ DAY OF, 20� -
Notary Public
SABRINA M BORN
Notary Public,State of New York.
No.01B06317038
Qualified in Suffolk County 1)
commission Expires Dec.22,20Z,
APPLICANT/AGENT/REPRESENTATNE
TRANSACTIONAL DISCLOSURE FORM
-The Town of Sout}i'old's Cade of Ethics prohibits corifiicts of mferesfoiS the oarto'ftbwn officers and enrnlovees The aruaose of
this'form hs to trovide,hnfon-h ahon which can alert'tfie town of possible'conflicts of Bnterest`and allow'tt to'dake whateveracUon is
necessary't0 AYO1d.Satr18 � •
YOURNAME. 6A-A cqoAA eyoAnus LAG
(Last n first hame,ipiddle initial,unless'you are applyirgin.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 wtth.airy officer or Fmptoyee '
of the Town of Southold? "Relation W'includes by blood,tiI-- ,—biisiness;r7rterest "Bushness interest"means a bu�ness,
including a,partnership„av ihich the town officer or employee has even a partial ownership of(or employment l y)a cotporatioii
in which thd*M offsr or'employee;owns more than %Effie shares.
YES NO
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold..
Title or position of that person :•._>-..__-...- _
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of gn6terthan:5,0%;o rpo
ftha:shares of the corate;stock of ;appliW-t-
(when the app)cant is a cgrpijratiott);
B)the legal or beneficial owner of any interest in a non-coipbrate.enUty(wlieri alte
applicant is not a corporation);
C)an officer,director,partnei,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this da
Signature;
Print Name _
Form TS 1
'"chow gA WITT.,-
i
r
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
11 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' ach on. .vrill'be_eydluated ai-Ab its-; carit
beneficial and adverse.effects_upon,the coastal_area(which uicltides 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,' 1 Iauied in detail listing both §ubuortin and non-
supporting-facts: If an action cannot be certified as consistent with the LWRP policy standards and
conditions,!its saallr not be bad&Wt6i..
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
Ste_ ` - 5- �.
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)
El
(b) Financial assistance(e.g.grant,loan,subsidy)
(c) Permit,approval,license,certification:
Nature and extent of action• '
�� CcnCAc�c
Skn e-- `�
Location of action: 1 v-4 I5 �Q�V��i� �``��- dStzoy*`
Site acreage:
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 f
information shall be provided:
a Name of -'hcarit. v\4 c i._ 'N cw-6ness LC.
(b) Mailing address: H rD90 C,Wr+ H$Y
(c) Telephone number:Area Code( ;}. _�O 17 -4 ro 5_- 5s(b
(d) Application number,ifany' _ N11 '
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
Yes Q No.Rf 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.
.[AYes Q No Not Applicable
ThZ, 'mac Se.l'Vc0 C&I* %,Y 1 V� one n 6C
Co r+ ` .
_ = 5 - -
O _
C�
On _Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LVW Section III-Po 'cies Pages 3 through 6 for evaluation criteria
Yes 0 No IV I Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III—Policies Pages 6 through 7 for evaluation criteria
Yes ❑, No ❑ Not Applicable
Nc
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
s ,
Section III—Policies Pa es 8 through 16 for evaluation criteria
Yes No' Not Applicable
_ .
Attach additional sheets if necessary - -
Policy 5. Protect and improve water quality and supply in the Town of Southold.See LWRP Section III
—Policies Pages 16 through 21 for evaluation criteria
. Yes ❑ No ❑Not Applicable
��- 1w�le�e����o r, of �•� 1 III
c, s
C-
Attach additional sheets if necessary,
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22
through 32 for evaluation criteria.
r
Yes No Not Applicable
Attach additional sheets if necessary - -
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies
Pages 32 through 34 for evaluation criteria.
Yes 0 No P Not Applicable
Attach additional"sheets-if necessary
Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
13 Yes ;0: No ENot Applicable
l
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation
criteria.
Yes No Not Applicable
Attach additional sheets if necessary = - -
WORE NG COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III•—Policies; Pages 47 through 56 for evaluation criteria.
❑,Yes '0„ No Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town aters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
>.0 Yes ,0 No Not Applicable
Attach additional sheets if necessary
i
t
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages
62 through 65 for ev duation criteria.
.11 Yes ❑ No Not Applicable
Attach additional sheets if necessary
Pali 13' Promote appropriate use and development of energy and mineral resources. See LWRP
S 'onPolicies; Pages 65 through 68 for evaluation criteria.
Yes ❑: No ❑ Not Applicable
PREPARED BY _ TITLE _ DATE d'5��3
Integrity Equity Partners, LLC
46520 Route 48
Southold, NY 11971
September 13, 2024 FaS
C I V E
In RE: 10715 Soundview Ave, Southold 1 3 2024
SUM 1000-54-5-37.1
Wetlands Application Southold Town
go 011M Uaes
TO: Southold Town Trustees
From:Thomas J. McCarthy, Manager
In reference to this new Wetlands application, I am transmitting the following to be part of our
Application and the record associated with it. We are requesting to be placed on the September
Agenda please.
1. Board of Trustees Wetlands Application
2. Short Environmental Assessment Form
3. LWRP Consistency Form
4. Transactional Disclosure form
5. Affadavit Of Integrity Equity Partners, LLC
6. Authorization of Owner
7. Copy of deed Proving ownership ( has been submitted for recording)
8. Approved subdivision creating the Lot
9. Building Plans, Site Plan and Survey
10. Site Photos with location map
11. Photos of Proposed Residence constructed elsewhere in Southold
12. Project Background
13. Spreadsheet and map of wetland permits in immediate vicinity
14. Project Description
15. Lot Coverage data
We appreciate your cooperation and anticipate being on'the September agenda,
Sincerely,
Thomas J. McCarthy
Integrity Equity Partners,LLC
Manager