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HomeMy WebLinkAboutTR-7708A James F.King,President o�OgUFFDJt Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President A Gy P.O. Box 1179 Dave Bergen y Southold,NY 11971 John Bredemeyer is Telephone(631)765-l 892 Michael J.Domino �101. ` � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction %constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: James F.King,President �p� `'pG Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President o P.O.Box 1179 Dave Bergen w Southold,NY 11971 John Bredemeyer �� �� Telephone(631)765-1892 Michael J.Domino �Qj $`a� 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 / '/z constructed V Project complete, compliance inspection Ot4 Q, �� James F.King,President Town Hall,53095 Main Rd. Bob Ghosio Jr.,Vice-President w P.O.Box 1 179 Dave Bergen Southold,NY 11971 John Bredemeyer '1tff� �` Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7708A Date of Receipt of Application: December 15, 2011 Applicant: Julia & Joseph Vergari SCTM#: 115-5-18 Project Location: 5855 New Suffolk Ave., Mattituck Date of Resolution/Issuance: January 18, 2012 Date of Expiration:,January 18, 2014 Reviewed by: Board of Trustees Project Description: To replace the existing 20'X 24' front stoop and retaining wall against the house; add pillars on bottom of stoop; install pervious cobblestone driveway; define entrance-with two (2) pillars on each side and add an apron; remove asphalt and re-grade dirt back onto property at same grade. 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 indicated on the survey prepared by John C. Ehlers last dated June 21, 2011.and stamped approved on January 20, 2012. CONDITIONS: THERE SHALL BE NO ACTIVITY SEAWARD OF ZONE AE (EL 6) WITHOUT FIRST OBTAINING TRUSTEE APPROVAL/REVIEW 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. f� 9 JamF. King, Presid nt Board of Trustees Q�d�11FFQ�,{-�Q James F.King,President C Town Hall Annex Bob Ghosio,Jr.,Vice-President w 1ty 54375 Route 25,P.O.Box 1179 Dave Bergen Q.f. �'� Southold,NY 11971 John Bredemeyer �Q1 + �,a� Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated i l S (I has been reviewed by this Board at the regular meeting of and .your application has been approved pending the completion of the following items checked off below. Revised.Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) '/2 Constructed ($50.00) F✓ Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees.will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: �C61 Z TOTAL FEES DUE: $ O BY: James F. King, President Board of Trustees f '1 ✓ A ` ram_ -- _ .__---•�. Iz -W 1.01 r T� j ia&& ph Vergari a 58 55 New Suffolk Avenue,Mattituck q!� SCTM#115-5-18 1/11/2012 All rt it � ���• � � " j A^ I �.�►'. ,' �,� C 1 Sp,__ r4.� 1'.r w..J� t1Cs. '!• ..{� !?_. .•1'' ��• � S *y,yyr..� 4.yrY�� F+�".. S'�Thy` - - ,. E rAIL OV- Air 41 777 PI ♦ ^Y Julia&Joseph Vergari r .+ 5855 New Suffolk Avenue,Mattituck { SCTM#115-5-18 �►° It' 1/11/2012 i l \i , f 74 i VA 41dm1_ Mud B ' n d S ulia&Joseph Vergari 5855 New Suffolk Avenue,Mattituck SCTM#115-5-18 „"- 1/11/2012 $ rMV" _. . V.T . j Julia&Joseph Vergari ' V o 5855 New Suffolk Avenue,Mattituck p f SCTM#115-5-18 ! Ait 1/11/2012 11 04� ! 1 � 1ST M• _ !'`Al. 1, A f��e=i' �y�V�, Y;1`ty4- ... ♦ v�� �f.w �' _ -� _-a `- .ill•'„} • �,� r !�... "'" __ .. • S+ x w� _ _ t � _"!�.. •r, .... .. f �'�' � +�M _'j,`� .,SIR - -_ �. t vt• ,., _��'�4� �+ �, `� - j�� �, r- %%UFRk.r Jill M.Doherty,President Off' Cp P.O.Box 1179, Bob Ghosio,Jr.,Vice-President G�� Southold,NY 11971 James F.King ti Telephone(631 765-1892 Dave Bergen G Fax(631)765 6641 John Bredemeyer Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: Jl /Z JULIA&JOSEPH VERGARI request an Administrative Permit to replace the existing 20'X 24'front stoop and retaining wall against the house; add pillars on bottom of stoop; install pervious cobblestone driveway; define entrance with two (2) pillars on each side and add an apron; remove asphalt and re-grade dirt back onto property at same grade. Located: 5855 New Suffolk Ave., Mattituck. SCTM#115-5-18 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: GL///r df> w ol2 e e)jL1J;7 u c i-2F Q //-// ,/L) W 11,'l5I7lG�'/�/✓ Modifications: Conditions: Present Were: /J. King B. GhosioBergen, 4/f Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: iI t It wr 'tit 1 * is�i �. 7". �.�!' a•'1 SSA LT ;•1i x �iy: d ,�. 4fSt, � f .-�- t' f ,. ,�.. ,�- .1 �, }. ��` + t,.,' ♦ i� � �*"•4 �.X.•I'j ti ��yr ee S �I y y' •� 1 h�j_ ',y < x "— .� .1•..��r�'e / - - / _ �•,, -. -�r�-t .'74•40!� pwM. �sSr-R �_' � .. ••�� �,• ., � .. - gyp. � 4`_ �w• ..�; '�`;. � .. A r , . 1 t fit, i6 # /t� "'�� `V'.� �. -�h� Y —? 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 v' %C Telephone: 631 765-1938 G Fax: 631 765-3136 �OIycou LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM • ir' c JAM 13 2012 To: Jim King, President Town of Southold Board of Trustees - From: Mark Terry, Principal Planner _..; LWRP Coordinator Date: January 12, 2012 Re: Proposed Wetland Permit for JULIA&JOSEPH VERGARI SCTM#1000-115-5-18 JULIA&JOSEPH VERGARI request an Administrative Permit to replace the existing 20'X 24' front stoop and retaining wall against the house; add pillars on bottom of stoop; install pervious cobblestone . driveway; define entrance with two (2) pillars on each side and add an apron; remove asphalt and re- grade dirt back onto property at same grade. Located: 5855 New Suffolk Ave., Mattituck. SCTM#115-5- 18 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney Jill M.Doherty,President SO Town Hall Annex Bob Ghosio,Jr.,Vice-President �O l0 54375 Main Road James F.King P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen G John Bredemeyer '�. a0 Telephone(631) 765-1892 COUm� Fax(631) 765-1 641 �r BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only �astal Erosion Permit ApplicationLi Wetland Permit Application ✓Administrative Permit Amendment/Transfer/Extension '--Received Application I I ifDEC 15/Received Fee:$ . f 2011 __,.Completed Application l u Incomplete ; SEQRA Classification: Type I Type II Unlisted C ordination:(date sent) LWRP Consistency Assessment Form 1( _CAC Referral Sent: _-Date of Inspection: , _Receipt of CAC Report: _Lead Agency Determination: Technical Review: © ,-Kulb lic.Hearing Held: Resolution: Name of Applicant " Lt A J C; CG?1-( V �`�'4`�t Address q,5 . Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: y S 5; N L W Svl P fb L(C AQG Ao\A— h w L i- (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application GENERAL DATA Land Area(in square feet): 7-7 8 , O $ 3 • (a A c to US Area Zoning: R - D Previous use of property: 1'X c VA4-. Intended.use of property: P R cl A Covenants and Restrictions: Yes No If"Yes",please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes ✓ No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes ✓ No r Prior permits/approvals for site improvements: r Agency Date �UILVI*-a(..P t-4Oa ) o 2O ) 1 Tr rt",>Ae-e S 10 1 2 0 l I No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or sus pen ed by a governmental agency? No Yes If yes,provide explanation: Project Description(use attachments if necessary): R e e l ac e e x 515 i nG' 20�x �-�y J �a���" S"rau,p o�nG� 'r'Q,'+cliv� l.Ja- II GtGCclnS+ �oc�nS2 . ADD in(L P111ar5 on e drtVe, Way c•o66les-+ar,e clr"►VeWa 64P- f-rV)ou5. Dek►r-o -2 •1) La,.S av► ea 2- I6iclb` ' Z-24 x24' ) Rvo npRDn . " J Rern-O"e Asj3ka,4 -/i5► No��T re9)rwP ►aCoce - ReJnae- e- dxsiSf�nS C�1/' hQ6k on -ho jaroP�t !?.� Un61 ��r t ' rJ� ��k e f) ;-c.2.Gle On Cql-l'e,14 '-VVe4 . B d of Trustees Applicatioi WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:'C4ef Ba ce ex S�s+�n5 20'X 3L� '_ .r-r o r►4 s4 oar a d re�aih ►r►q wall ftya�„5+ �tAouse� l��Otng �Illa/s or, �o+}o►.� of SF7+oP , DG'F�nt t.11+tl, 06101t54-0htl.d���vc n.Ji1� �G' ���Y,i9kS. C_-�.�.. �r►�/an[t w,�1�i 2p� lla�s dr1.2w�+- s.�dc, - lrax/�• -'2�" x-z����41-2cL -acid- a.Peon. R movie.v�. o►$�ba l-f•• Nod i�C�lRcr� 1f" •2.t�. rw6��c.. -exsi-5+i 5, -ho ai 1 �ack 0&4o Pro oe.-4 , _ w;11 be Sarni 0 rac ,e r. s„rvcy. Area of wetlands on lot: O 1 Z square feet Percent coverage of lot: q0 , 61 % Closest distance between nearest existing structure and upland edge of wetlands: y, c -feet Closest distance between nearest proposed structure and upland edge of wetlands: 9q, 4 feet Does the project involve excavation or filling? No Yes - ' ►'of or,Yevjay or, ty If yes, how much material will be excavated? (P 0-1scubic yards How much material will be filled? o cubic yards Depth of which material will be removed or deposited: - feet Proposed slope throughout the area of operations: I i el' o 1 D -�ee Manner in which material will be removed or deposited: N I A 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): NoKE Hi d of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: r-e e la e_ —e St �� _ �-� ° %,)'wIle ' ,Ciyu �y,..f hoky� a�d1YtS ri �lN\s uh Va�'f-•r- S'�ot ' t7efti�-►e �,{r) v�tJa.' e...) � (z, cobblerto _ftrV)oM,S . J -e�im en+f4nG ��'�1� I��grS Oh pac'g' SId�e (a; 16"C .1 ?�`Y" 1cZ`l'' AG�G✓] gQrOh . 9-evi,,va not -rglace _ �e 5�adc BXSIS't7 hc� -oesa�� Are wetlands present within 100 feet of the proposed activity? Pr°P-e° +y Sa•+-e trade No Yes Does the project involve excavation or filling? No '� Yes (0 r d 1 Vt vv a 7 CJ r) If Yes,how much material will be excavated`. ��'�5 (cubic yards) . How much material will be filled? — (cubic yards) Manner in which material will be removed or deposited: i i Describe the nature and extent of the environmental impacts to the subject property or 1 neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) Not-it 1 , i 617.20 SEAR I PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) I 1.APPLICANT/SPONSOR 2.PROJECT NAME _6� t G&'7 '6" 3.PROJECT LOCATION: Municipality County 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map I Necj S-vt r,5�D 64-k- 14-VLS 5.IS PROPOSED ACTION: ❑ New ❑Expansion n Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: 1 g t 2 yc S t S�'t n c7 x a y f fro 4c f 5�-a a�O •+- f��a t h VWa( � & 01n,4" hokSC e AE din p, I 5 tars a �+ be a-f-o,-,-, o F S+o o Y' , d)-e f r,.-W d_r Je �n1 avt w i '� GO�b Lc S-,o, J r,vt w a wilt be C y 1 o ws �e-EL na er-{-rrtnc-C .,aid-t, Pt 1 (a�5 �gel era ezc •� 1 _a (a - !6 x �6 ♦ � u x ZYJ G.d� G.Pt-oh R.�rnavc 4-�pl,r~I'�' — ofa -� fe�laGe — I.; 7.AMOUNT OF LAND AFFECTED: Initially71 , V6 acres Ultimately `i •�,6 acres i ' &WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? dyes ❑ No If no,describe briefly: I � 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) QResidential ❑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) i OYes No If yes, list•agency name and permit / approval: rd Ian! . or- So J?)4-oi. '' cS T C i S 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ©Yes El No If yes, list agency name and permit / approval: i C e^Fi-frc c,,'f'e of j c&L,,e t c 12. AS A RESULT OF PROPOSED ACTION WILL EXISTI46 PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes ❑No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 11 I Applicant / Son r Nam ) Date: Signature I Signature ` d J 5✓ I If the on is ostalArea,and you are a state agency, j complete the Coastal ssessment Form before proceeding with this assessment i I ' PART II- IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAR 0 Yes a No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten.If legible) Ct. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential forerosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources:or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,'shellfish or wildlife species,signKcant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing,plans or goals as offldially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: �• C6. Longterm,short tens,cumulative,or other effects not identified in CI-CS? Explain briefly: C7. Other Impacts(including changes in use of either quantity or type of energy? Explain briefly: Ll D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? if es,a lain briefl : ❑ Yes. 0 No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Yes exotaft QYes r v+No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency)' . INSTRUCTIONS: For each adverse effect Identified above,deterninewhetherk is substantial,large,importantorotherwiseaignificant. Each effect should be assessed in connection with its(a)setting(i.e.ufban or rural);(b)probabifityrof occurring;(c)duration,(d)Irreversibility;(e) geographic scope;and(0 magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ff question d of part ti was checked yes,the determination ofsignificance mustevaluate the potential impact ofthe proposed action on the environmental characteristics ofthe CEA. Check this box If you have Identified one ormore potentially largeor significant adverse impacts which MAY occur.Then proceed direcllyto the FU EAF and/or prepare a positive declaration. Check this box If you have determined,based on the information and analysis above and any supporting documentation,that the proposed acdu VWLL NOT result in any significant adverse environmental Impacts.AND provide,on attachments as necessary,the reasons supporting thl determination. Board of Trustees ✓�� 13 �o%Z Name of Lead ,A/gency_ Date President Print or Name of Responsible Officer in Lead Agency Title of Responsible Officer ,iJ�YLGO c% ✓I ignature of Responsible fficet in ad Agency Signature of Preparer(If different from responsible officer)' suFfr Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM 0 �} PROPERTY LOCATION: s.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Ol�jY➢- 1000 1113 6- (S STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s6 tri icy section -9(oc cr Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? t 54 9 & 051 1 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within the Scope of Work for Proposed Construction) Generated by a Two(2")Inch Rainfall on Site? ) 3 •G b / ❑ (S.F.I Acres) (This item will include all run-off created by site t� 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 410a OX 2 2 5 Site Improvements and the permanent creation of construction. (S.F.!Acres)activity? impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This ❑ Item shall include all Proposed Grade Changes and b� �t'rxt- D Ca.�v tN�/ Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion r'eetac V-e-4-a c , Wa L( and sediment control practices that will be used to /E1 / control site erosion and storm water discharges. This Q 111 yott.5 Q C,n d 2 �Z 2 Li( t+ !;fbOd, item must be maintained throughout the Entire J / Construction Period. V'C Vy1-Q V-C A$f ti a �"r' .•Ad P t_ 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural r-f en+rc,,el t.c C)+- J r•1-le-W au. Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? reti�a�f ><s�s h w �"D QSO) (� Ivi rJ Will this Application Require Land Disturbing Activities icLc'p— Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the ElSite? 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 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 including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? M- 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-0-10.001.) Surfaces be Sloped to Direct Storm-Water Run-Off t/ 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be Into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. j 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 constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-Of--Way or Road Shoulder M ' compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(This item will NOT include the Installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check'Mark 3.All SWPPPs that require the post-construction storm water management practice In a Box and the construction site disturbance is between 5,000-S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building PerrniL (NOTE: A Check Mark(4)and/or Answer for each Question is Required for a Complete Application) STATE OF NEW YORK, Nu p �} I' COUNTY OF.... .. -. . ..• ....................SS r I .......................being duly swum,deposes and says that he/she is the applicant for Permit, . .. ..r.�..�,—...p! .14 1hat I, �........ (Name of indrvi I signing Document) And that he/she is the e(OwVnr, ontractor,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 r 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.�. ...... day of.... .1 ..... ,20.1.E ... .. ..... . NotaryPublic: .............. . ....... ........ ....../�a�.��C' . .............-. P.......... .... ......... ............ .. 1_L (Signature o p licent) j FORM - 06/10 Notary Public,State 01 New YOM No.01BE6099317 Qualified in Suffolk County CQMMIssion Expires Sept.29, /� B, d of Trustees Applicatioir County of Suffolk State of New York J J V 1 L V N&/-2� BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO PECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS , LICATIO ' . Signature SWORN TO BEFORE ME THIS DAY OF 6OUkl eV ,20 l I • I Notary Public PENNY BEDELL Notary Public,State of New York No.01 BE6099317 Qualified in Suffolk County n0 1 k Commission Expires Sept.29, D� i i ' I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emtilovees.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: LA1AA- V I.VA-P,t (Last name,first name,.niiddle initial,unless you are applying in the name of ; someone else or other entity,such as a company.If so,indicate.the.other person's or company's name.) NAME OF APPLICATION: (Check all that.apply.) Tax grievance Building Variance Trustee ✓ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other f (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. _ - I YES NO If•you answered"YES",complete the balance of this form and date and sign where indicated. . I Name of person employed by the Town of Southold I Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check ` the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the- applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP I Submitted t ' y of 200 Signature 7 Print Name Form TS 1 3 i. Town of Southold • f 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 i 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 Townl 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. I A copy of the LWRP is available in the following places:online at the Town of Southold's i website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all { local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 1000 PROJECT NAME V �,e--> 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) ❑ i (b) Financial assistance(e.g. grant, loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action: Ke-Qlar,e ex5rs--+:,� has x �'4 -From¢ :s wry It a .1Isisf sel od (Hr7 toII ars e.-. bo *00f , Ptf,r�e_� dry-/,eW-a., kr�-h.. GobbltS tic , c�rrvtw WtI� .bt �e_r toll orw,S. Ftl.� e.►fi't^in � PI�IrM���' oh 2 -1&"Xr� — 2add- Gt,�trO�'1. • .'Q2�►tivVS .�� p��vT 1'�plcctaC e re, -r•ade 01 �lJSo1-0• (JB.E�x �dih�'fy .T`2f�h�-'�Y►'G� �'�li.`(�'R� �'U�. c�'�•Ir�-� -GGS .S4J-f_��� Location of action: -73 nlel�'J S t t,_(�I Ic ,� /Jlvl-= ty(,I-- j Site acreage: 6 ' Ak c f e S I i Present land use: ' 1 O I Present zoning classification: 1Z - 4 u I 2. If an application for the proposed action has been filed with the Town of Southold agency; the following information shall be provided: I (a) Name of applicant: ' (b) Mailing address: (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? i 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. I' Incomplete answers will require that the form be returned for completion. it i DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑-Yes No Not Applicable j � I i. Attach additional sheets if necessary I Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Not Applicable � I i 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 III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No VN,Not.Applicable i I I ! i Attach additional sheets if necessary I I 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 ❑ Yes ❑ No Not Applicable I I I I 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 PKNot Applicable j I i -- I I I Attach additional sheets if necessary ! I I. 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. ❑ ❑ Ind Yes No Not App )le 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 I i Attach additional sheets if necessary Policy 8. 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. ❑ Yes ❑ No Not Applicable I i � I � I it PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public f resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeSEI NoW Not Applicable i Attach additional sheets if necessary f : I 1 WORKING COAST POLICIE I I 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 ❑ No-K Not Applicable I 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 ® Not Applicable I I 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. f ❑ Yes ❑ No 5� Not Applicable I f Attach additional sheets if necessary i 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 ❑ No Not Applicable PREPARED BY TITLEQ (u pW DATE I2 3 0 i 5URVEY OF P1r2%0PERTY -SITUATE: MATTITUCK TO1NN: SOUTHOLD ZI` SUFFOLK COUNTY, NY SURVEYED JUNE 15, 2011 ' CERT. REVISED JUNE 21, 2011 5UFFOLK COUNTY TAX # LOT s P Land of Suffol 1000 - 115 - 5 - 15 �' l'' � ;;;'�" �� Recreate n andn�Dept. of % Weer r I votion Ce�RT�TO. JOSEPH VEGARI ���o , ,y AQ EBOGMABSiII�I� ' Corp.JUUEVEGARI �F �. , SURANCB COMPANY '' yeµ LOT 42 ;t:=M •;�, � �s'" N: /' I-- FA t, r r j c% dti LOT 43 11 , 0 '� 6 tS6°0610011 Pen yJatsr '' ♦ ♦ °�� O 165.64' "' "'°K o �. mo N _ -- -- '.' ♦♦ --drainage easement L.6152 GP o ♦\. f n. - - _-- 1 - -__ PVX Ditch - -_ - " '1r'°�•� �D� �• t \ 1 fTj � 0 3 0 °001 - - - 'a• �V 1' a 165.�f 0' °�3►y®"� •00 Y t FOR -e UOUS R cry o ; d` I,• R Z ,_ O�IP t LOT 44 { Ire? ;. 1 eft a - ..-.,.. ,. i'• ,""`. ._. . .., .._. .. _ Y. m '1 oQ 4.rare++ l�,A`f,� p �,� tact c� I \\G�\e•. � .�" •� •''�t,�C,t '� �} ,a R + LOT 45 0 p ea I 90 \ a too, ` "wooded„ p' as• M I ♦ / t R• �l�a .. I . i � 1 m 1 \/ ta 1 fD• i s 1 6 �J p E�S' 1 jVG�° 9 ' DRAINS e�o�i3'�®" °� , a�$2°5 9 s 9 " N85019%"�Y :APPRO [ BY `— --` ---� � .�1>, 1� `ss�.�®: N88°08 ®® w BOARD OF TRUSTEES e�'' ®111:T Veai: ..: _ wily �)uli II � - TOWN OF SOUTHOLDqu DATE ✓,9/(! a O 1 T ' e� OF NEW U 5 7-�✓= 'e'r;/2�N r9 Of F�/l' rJ �,�P'o N C. E8, n0 'r " Wulllarltea olterot,00 a eeatlee b a wvey 4w mop Wd'by a Ikaruee A,uvpprb!ed b o �'r vawtwn or.su.. i]k , New 7ak State eoxotal lw.' ' - \ 11 j '�'. , mauve w:u m aryrw of fro wW wrvyorb 1'; I eta+pe0 taal,fwl:Ce carowree t0 tx wlwe i NOTE51 o •Le,t,Ynt:orn•ava.a r .19v1 that... ��s 5 20 ti ,\/ nw•�y'coae a�w iv"w/af LL.4 cldcptlod FLOOD ZONE-5 REFERENCE FIRM MAP NUMBER 36103C482H F s �, ��Yak stm.rs.«btwa o<wor. o v w •�����sw�a°� LAST REVI5ED 5EPTEM13ER 25, 200q pe 9 e,e q p e e a„y„•„atb. Latxva. • 1 ona an Ns aNgM to tM tnie cmpo'y.9�/Ovyxymen- bi ogeacy ona w^a'•'9 bNt.tbn a.lea MrIM a:a ' � • tkXb Vl rot IrcwlKwb t0 aaaltgral MUWtlore ■ MONUMENT FOUND GRAPHIC SCALE I°'= 50' JOHN C. EJFII.ERS LAND SURVEYOR Area = 15q,VO 5q,. Ft. 6 EAST MAIN STREET N.Y.S.LJC.NO.50202 . Area = 3b680 Acres vn RIVEREEAD,N.Y.11901 369-8288 Fax 369-8287 0 50 100 150 i REF.-C:\UsmVohn\Dropbox\11\11-134.pro i