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TR-8155A
........... .. .... . James F.King,President �4g11FEt1(�-c Town Hall,53095 Main Rd. - Bob Ghosio;Jr,Vice=President � .� �G - - Dave Betgect y P.O:Box 1179- ... John Bredemeyer p �: Southold,NY 11971 Michael J.Domino , Telephone(631)765-1892 �� � �¢ 0 1 lc Fax(631)765-66.41 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 9St.day of construction Vz constructed Project complete, compliance inspection p p tion James F.King,President ��F sv�ry Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O� �Ice 54315 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer Michael J.Domino �Q Telephone(631) 765-1892 ��.COU ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8155A Date of Receipt of Application: April 1, 2013 Applicant: Joseph Lavelle SCTM#: 113-8-1 Project Location: 3500 Cox Neck Road, Mattituck Date of Resolution/Issuance: April 17, 2013 Date of Expiration: April 17, 2015 Reviewed by: Board of Trustees Project Description: For the existing ±50' split-rail fencing on the north side, .and ±150' split rail fencing on west side of property; to remove selected trees and grind down the stumps; trim tree branches throughout property; replacing a ±3' wide slate walkway with ±3' wide steps; and for a 10 year maintenance permit to trim the phragmites on an as needed basis. 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 Joseph LaVelle, received on April 1, 201.3, and stamped approved on April 17, 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 t SURVEY-_OF DESCRIBED PROPERTY SITUATED AT MATTITUCK TO iPN OF KO UTHOLD e14 SUFFOLK COUNTY, NEW YORK 0CIV S.C.T.M. NO. 1000-113-8-1 UPLAND AREA = 23,830 SQ. FT. '�' ELEVATIONS ARE N.G.V.D. 1988 DATUM EXIST.' LOT COVERAGE = 2,058 SQ. FT./8.67 GUARAWEES OR CERTInC477ONS ARE NOT TRANSFERABLE UNDERGROUND URLInES FASFMENIS NOT SHOWN AND UTILITY POLE LOC477ONS ARE NOT GUARANTEED. 'TV C THE OFFSET DIMENSION SHOWN HEREON FROM THE STRUCTURES 70 THE PROPERTY LINES w i O ARE FOR SPECIFIC PURPOSE AND USE THEREFORE ARE NOT INTENDED M GUIDE THE Jo (� ERECTION OF FENCES RETAINING WALLS POOLS PA77OS,PLANTING AREAS, V (\�_ A)MON TO BUILDINGS AND OTHER CONSIRUC710N. THE M7ENCE OF Miff �j OF WAYS, WEIMNDS AND/OR MSEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUAPANTEEZ) ��{• I �4 ��1�i�;,.3 1Y rr���,�,, NAUTHORLZED AL7ERARON OR ADLMION TO THIS SURVEY 6A WOLA77ON OF Y ` ` '��•�' - `4ft NOiy OR SECTION 7209 OF THE NEW YORK SME EDUCATION LAW. COPIES OF THIS SURVEY MAP TOE, NOT OF.p O �RLY ��+ 1 NOT BE CONSIDERED A HEARING THE D TRUED COPY NSVARE AND RED INK OR EMBOSSED SEAL SFWLL ALL LOCATIONS OF AND DISTANCES TO WELLS AND CESSPOOLS ARE BY LOCATIONS - O FROM HOMEOWNERS, ARE OT VISIBLE T AND/OR/NFORMND OBTAINED FROM L7, OE CD SINCE MOST ARE NOT VISIBLE THESE LOCATIONS AND DIMENSIONS GWNOT \ r r V 30.8 \ —_ 2.9 1 to BE CERRF7FD. _y V\ �� O y :tN V c� FFEi�. of - \ �1� -`'`�'��" ) 7'i/ � tG RASE z_z' 301' �� �1, .���� �p MATTITLICK APPROVED, B' O 1� _ oft \ 1 \ �� \ �l_�___ �� .se -HE '�� ��\ �, CRE era Rus�EEs EK of T ODE) C.LEL.16.dt D-- Y�AY \i ��g i� ��,�,r IiOjYARDS BRANCH) °�'� OF SO'UTHQID ' eli OD co 1 29 (� n 6'•, 26 g EZ 15.8' \\ \ a C�C moo �� U.P. �\\ O� Q' 2.5 s3.7,o') 30 2 \ \ o ED � +�� 77 — �ypOD 7� EL 2.9' 26. 56g,1 FF8, 8 f _ �� r � � ra 1L\C --O-_ o — m P442' APR — 1 2013 rl n 045,o0R'ORS ll oocZ - L 24.1' �' �-, s OW TgA Southold Town EL.24.7' �— J AND � :aar of Trustees � JOSEP :. 0N. PAT T. SECCAFI CO PROFESSIONAL LAND SURVEYOR, P.C. � — SUCCESSOR TO = w DONALD TASE, L.S. a w RICHARD WILHELM Anro ASSOCIATES NORTHSTAR SURVEYING, P.C. PAUL T. CANALIZO, L.S., ROBERT A. KART, L.S. GOOD GROUND SURVEYORS, P.C. 328A Main Street Hampton Atrium Unit D-4 Center Moriches, NY 11934 186 W. Montauk Highway i Hampton Bays, NY 11946 Phone: (631) 878-0120 Phone: 631 728-5330 Fax: (631) 878-7190 Fax: f 631) 728-6707 N.Y.S. L/C. NO. 049287 FILE NO. 51067 SCALE: 1" 30' DATE: 0210812012 COPYRIGHT — 2012 PAT T. SECCAFICO P.L.S., P.C. James F.King,President p� GQ P.O.Box 1179 Bob Ghosio,Jr.,Vice-President Gyp Southold,NY 11971 Dave Bergen y - Telephone(631 765-1892 John Bredemeyer Fax(631)765-6641 Michael J.Domino Southold Town Board of Trustees Field InspectionfWork Session Report Date/Time: trs� p �°Z� ��a� ��' 'i JOSEPH LAVELLE requests an Administrative Permit for the existing ±50' split- rail fencing on the north side, and ±150' split rail fencing on west side of property; to remove selected trees and grind down the stumps; trim tree branches throughout property; replacing a ±3' wide slate walkway with ±3' wide steps; and for a 10 year maintenance permit to trim the phragmites on an as needed basis. Located: 3500 Cox Neck Road, Cutchogue. SCTM# 113-8-1 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: ---Clapt.275 Chapt. 111 other Type.�-f Application: Wetland _Coastal Erosion _Amendment c�Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Pres t-Were: J. King -B. Ghosio �D. Bergen, f J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: -^y. ® �. f1 u PS _. i IF door r - - ID E Q �O V E R.Po ; _s-ov4 Ivy i Oil Ezz- 10 •10, •• ` s VIAWIP r :� SkiIr a • E low If _ �. M i_ f. t own ut a4uinuta Io A 2 4 4 6 Suffolk County,NY m \ Me People of the Slate at New Yark vs. m LASTf 4MAE _FBI NI)� RISTKWE JADDME IKR141 iL�Lt i10 Ld ST+�-ADDRESS AM I40_ V IZ 1 ZIPdf N(r�'�fj PAIL't /u-,( //R7 z 9 LICBiSE OP.REGIMATim MRAEm U I I I I TYPE OF E 0.RTE E7¢C�,E3 IX OFTE OF SAhi ME CPERATOFI OR REGIST6i®aNNEFi CF+'elilD.E L1=SGALE7 eF1ol+ PACE KG DATES MISS STATE PLATE lPE ❑H.Y. CN.I. ❑K.Y. ❑N.J. Ca E PASS ❑COW ❑ ` ^ Mg ME MAKE ❑ DMUE o<\�►\/o Z DR ❑ <DR ❑ giss ❑ i=v ❑ S.W. TYPE r SRUrl: ❑ 3P'WL�? G •l4a1 n VIN IO.RAKP. THE PERSON DESCRIBED AE 3VE IS CRUMED AS rOLL6443 ECA^E OF CrVJRFe F'T — W e c.L kl—Tr c�c .. DATE OF IDEMME I AM �'WAE PM GTv.70{tOj KiA=chi H'RYJR SU'.-rOJ;COhm Kr INWOLAMDNOFSE.:'HOR SUM. Of Trc GVF}1FXEAPD 1'RAMr LAWOFTHZSTATEOFhM- YDRY. `✓ ❑c s. ❑ODM ❑BA HSZ 2 7�J Or=F VEPI MT ❑ SPEMI43 1 OTHER OPPETI APHWA AC-HZDtIE � dL r MSDETAEAHOE❑ FAOTUALPATiT grar FOR TVEI THE ABOVE M&ED DEF81DAr,DID ON THESTAUD DATE.TIMEM)PLACE N �6tG 7• rdr LD I— roT„ercm�cF�e�cs 'ktcn,eaz�;�,�. PARKING SO`mUIFD FINES CWO/cr LIXIfiT[ I` THE PERSON DE-MED ABOVE lS SWRONED TO APPEM AT CV SOUTHOLDTO-AWJUS OEC0113'T.S*95RDUTE:S,SOUnllD.RV 11971' '� ucr�rracRavmE14•�r1a.rt� m ON /�� 26 3 AT f 8r j m hl fiVSESTAI'E]1EE:PS:gSCA9:RNf3{rSLEF3 F.QA--s AYb'iENEAMC Pid Vll1%TM S CMON21C.456=TiP&MYS Ifs (V OOFAFWNAr.T DATE. �, ®3 -22-(3 CD COURT COPY ut a# Southold _k- 2 4 4 4 GJ s ##oJkGaunty, NY The People of tite State of fNetti York as. US+'ES4kr(DE�ENDAtIT} F7r5Ti141AE IAID�E ESf1RL . ��.�. 1`' �rg-�•o65 � M _,4-�-- UL STAT'e 1 Z S-71 � uCET CRRCi'ba^TFJ¢TMA*.Rlem _ - . . ..._ .. _. .. . .._ _. .... . .. .q T-DHR&TOR CIA F.MSTEED,OfftM CIF VM EDESSMIEDBELOW P;Wa ND. DATE EJO'iRM , STATE PLAT TYPE . ❑r.Y. ❑lJJ. ❑RY. ❑WU ❑ ❑fASE 000MM ❑ 1"EHCLEMARKE ❑ DDDDE ❑ BLRCK ❑ CMI ❑ CADLLAC ❑ A2ADAC 13 Fom ❑ DLD5 ❑ P-I ml I : ❑ T4DYOTA ❑ VMn ❑ I . eDDY ❑ 4O11 ❑ <DR' ❑ sus ❑ M'ti ❑ SAV. TYPE ❑ TRU= ❑ IRNLER 0 ml ❑ VIN NLUMER WE PERSON DESCRIBED ADOVYLSCR ROEDASFOLLMT PL.A—CFOCCU- ENCE FCT. . D,iTE OF R�'6`SE AAA 78AE PLI C.TI: Or.F '1ET SLt3i�UC O�c1\T'IJY IKvooLATLaNCS'SEC'IION SUED. oFTNE❑V71�7 E�VD TPLFr�:.LfJ\'OFT}G-STkTE Oi hE[rYU91r I30DtsT(SPECIFY) ❑OS. ❑oDM ❑s.Js ❑Il �.� DE W MAT ❑ SFEET.V3 OMER DFI.B51�J uPJ?RJA LL�NZLtYE �.� TQ.^I�L LIISD9AEAN7P.❑ F'f.CIUAL PAF t VOW FM T Erj. THE.75'7TMVEDOSM40,A TDLDOKTRESTATMDATE.S1fAEAN/DPL.A,DE e � i .T11r fca--cip k ET�d an�.svltrc..lFs,`�J - d y3—tom-1� J FARKR; MWEDULEDHKEs oO-TA--rco 7C i THE PERSON DESCRIBED AaWEIS SUMIADSEJ TO APPEAR AT. SOMMLD TMVN METECECOURT,53M ROMEJIS.SOUiTiOLD;ITr ft07i � ' oFn7`ow GE0'nMR TVd i ON FAL_SE$TA,TE4131s 1ff9KA°.EFMleKSBLCA3 0.0-f 5L A.LJSDU!EQMPSJ..FIJCCf TO.SELTION 210.G CF TIEP LUXE. CCdlFi.>vM.YtVT DATE . w ' nntTn m J-v�nv ` „f — �Wu"u•, .m'S .wewrae n1 ihf l4'r —I ter ! �-- I.'�'+NV. rnLnu'... I rvart c01`+¢.ImcY I • P I M Ji i� 'PROPEPTY MAP . _ _ _ _ •-__ .. ._... .... ram,., .--.....� 0846Po � m fiMSEC.NC.IM � � —N 1{] - �,1ANc1 � ^p SEE SEC.NO.+® 1.9Hq ldldq Blue) —NUNE' IxouRes UN '0 6EESEG NO.I WR tp3pBi xZ�� MATCM �Z_O °.Bp,ry ,.�,. 3 f '�_yc\ 1MTC UN .BL110 SEE—ML NO. a 1A S , q FOR PCL N0. YY j �Jsw toa-01-0B11 - b w _ 1]HU S 1BbileN �A ♦ ./ O JI FOR ML NO, px'Lgp-01 I BEEBEC.NO. MR—N. �Si�t I 1oa21LBB4a -O aN A ♦ '8 �Wq ,e°' Is 'P c 0 1.iHq 'tt'\ p ia�a6imiz' I: Ba2Bm b I ° m W m m , 7pDK MAm n,e m I 0 m «w a m ° PoaCut�.aval eRwri ,� C � '.^'vv/ ,OF-07 w a ,,F ry�y\ . Po ,�\ rt•*�' ,a` d, 0' r e.-y,m,- x ,�''\ .,�\ I Q1 -I. FOR IL NO. '4 MI NO. xlxatam 1.3 .. 0 � P '�,ese a 9N \ ���' ��'',6 p;�1e`' �n P'� � ',5 •��. ^9\ � ^' a` '� .+ IE)A to P C 1 $�„ p ,,1 , P Pia'i ,^ P',',� �`y ,9 S fv , R° y• P °++ ,9 11 jµl IBS M� e1'i 5f'�jp111 1 °�• 1).BA P e 1938 - O " �[�El•Fl6rMFxiV - 9 � ry A m '✓ ♦ ' ian • � ° of ,b _ J.lI� SEE P0.NO. fiM 199 °x m ~, ill 'N 6EE 6EG NO. nxat�m ♦ m I I fiM GM ^ ,,�F• m TBSF I ♦ m ♦ °�W°0 \B1 COUP OFFS UFFom i - I FCRPCLNO. SEXSEC.10. _______ —N �--- ONE J, MAIGH---�----ONE EE ♦ :� ♦ y9HU �y\II R°•1 � " s SEC. +21 ,x M sEESEG ,2 NO. , ° iBA]r` C.1L AB t NOTICE COUNTY.OF SUFFOLK © KM° �D m BWMOIDtSEIMONI NO c - C�1) ' Real Property Taz Service Agency r ENrv.vu. .__ .IGu113pPFRivunv Cantrell, Elizabeth From: Randolph, Linda Sent: Friday, April 12, 2013 10:26 AM To: Cantrell, Elizabeth Subject: LWRP's Hi I just spoke with Mark. He said to tell you all the LWRP's this month can be marked "inconsistent." Linda 1 James F. King, President SO(/Pg, Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`®� ®�® 54 Main Road P.O.. Box 1179 Dave Bergen i _ _ Southold, New York 11971-0959 John Bredemeyer cn O Telephone(631) 765-1892 Michael J. Domino X11 Fax (631) 765-6641 Tyco f1m BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applic atio _Wetland Permit Application Administrative Permit Amendment/Transfe /Fixtension ceived Application: .3 �Received Fee:$ 3 D E C E IV E ompleted Application- -Incomplete _Incomplete _SEQRA Classification: Type I Type 11 Unlisted APR " 1 2013 oordination:(date sent) WRP Consistency Assessment Form 3 /CAC Referral Sent: -- Southold Town ate of Inspection: 3 Tr st Receipt of CAC Report: Lead Agency Determination: echnical Review: _ public Hearing Held:_ Resolution: Name of Applicant Mailing Address o�(o�_A v R I T\j c� . _t)-e ea, Phone Number:( ) — '-A 9 5 Suffolk County Tax Map Number: 1000 - 3 -- $ Property Location: O C CX �e CV__ (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):_ Area Zoning: Previous use of property: S N o e7 y1 i 1 -FA 1— Intended use of property: e S N 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 '><,,_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 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 'A -No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date 1\ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: N o QT-v -S; Project Description_(use attachments if nec,ssary): S�Lecrw �y��e,v51�s v0- Pen 1 RF 1 ) V R\— -TfZ 1 fv.o -EVD to Y� src� �enrt c� q 4G:FLYV\% Vz- R NRsfl`wn TNZ e aca e-\- �V\ '1z-oa-t- SyS :ro Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA -Ch OT-e-v17 VC v'r �/2—P4s Purpose of the proposed operations: env I �c vke5 � �� �-l_ 3 ' r7-O- -� I✓x s-r nc w r��k��-�I -� t�e 5�� 5 S P 1. iT >Z(�c t. ��N C 113 YeRinZ ,mte� �ti�T Area of wetlands on lot: a� � �' s Quare feet h re v�E Percent coverage of lot: --6 % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance betwee, nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? XNo Yes / If yes, how much material will be excavated? iv /cubic yards How much-material will be filled? l�/ A cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: IN Manner in which material will be removed or deposited: Statement of the effect,if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER 617.20 SEAR 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) 1.APPLICANT/SPONSOR 2.PROJECT NAME 3.PROJECT LOCATION: Municipality County 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 5. IS PROPOSED ACTION: New Expansion Modification/alteration i 6.DESCRIBE PROJECT BRIEFLY: l 5-O 5 P L IT g2� 2�C� ay V S I Off. �- — O eve,c c fm 5-�v r�np5 2t +\rfl�fl _ Lo `fi A' cis ti>"-rl ��� t� 4' P12-ao�� 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r❑� Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10."DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes ❑No If yes, list agency name and permit / approval: 1 YZv.S HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes IXNo If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes 0 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO"THE BEST OF MY KNOWLEDGE Applicant / Sp\_—stw,\Nam.ce D te: Signature �. If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART If- IMPACT ASSESSMENT(To be com feted by Lead Agency). A. DOES AC710N EXCEED ANY TYPE tTHRESHOLD IN 6 NYCRR,PART 617 4? If yes,coordinate the review process and-use the FULL EAF. 0 Yes. Q No & VALL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN-6 NYCRR,PART 617.6? If No,a negaflve declaration may be superseded by anodes involved agency. aYes 0 No: C.COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality.,surface or groundwater quality or quantity,noise levels,existing traffic pattern.solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or communlly or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shel(fish'or wildlife-species,signifignt habitats,or threatened or endangered spedes?F,gilairi briefly C4. A community's existing plans;;;oafs as officially adopted,or a-change in use or intensity of use of land or other natura(resources?Explain briefly: C5. Growth,subsequent development or related activities((kely to bd induced by the proposed action?Explain briefly: ............. -- _. C6. Long.term,s ort•term,cumulative,or other effects not identified'in Ct-05? Explain briefly: C7:Qther impacts indud(Qthan ges in use of either quantity.ortype of energy? Explain br(efl ;-- - ..........._i�. D. VOLL THE PROJECT HAVE AN IMPACT QN THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA)? if .es,ex lain briefly-Yes nil No E. IS THERE,OR IS THERE LIKELY TQ t3E,CONTROVERSY RELATED TO POTENTIAL! VERSE ENVIRONMENTAL IMPACTS? If .es Lain: M Yes Q No PART IN-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS:. Foreach adverse effeetidentified above,determine whetheritissubstaotial,large..tMportant-crotherwisesignW=nL Eadt effect should be assessed in connection with its(a)setting(Le.urban or rural);(b)probabirdy of occumng;(c)duration;(d)irreversribirdr.(e) geographic soope;and(1)magnitude. If necessary;add attachments or reference supporting materials. Ensure.that explanations contain sWolent detail to show that all relevant adverse impacts have been Identified and adequately addressed. If question d of part P was checked ~ yes,the detenminaGon ofsignifrcance Mustevaluatethe potential Impact vfthe proposed action on the environmental characteristics ofthe CFA Ctleck INS box Ifyou hage identified one ormore potentially large orsignificantadverse impacts whkh MAY occur.Then proceed direcllyto the EAF and/or prepare a positive declaration. FULI Check this box Ifyou•have determined,based on the information and analysis above and any supporting documentation,that the proposed actio VWLL NOT result in any significant adverse environmental impacts AND provide,on'attachments as necessary,the reasons supporting th( determination. 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 Pr"Art-1 in ritm rnnr rr,,.,, SuFFQ,� Town of Southold C Z Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T_M.fi: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A loco 1 t 3 q I STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN ts� trlct -6ctlon -bi1oc Tot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION nEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within Will this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Construction) Generated by a Two(2")Inch Rainfall on Site. (S.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 Site Improvements and the permanent creation of construction activity? (S.F./Acres) impervious surfaces.) i 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 V El '_ �� h �s-t- •_ vh Item shall include all Proposed Grade Changes and 1>,W- P��,A C Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be.used to ❑ control site erosion and storm water discharges. This (Z C�•P� 7-gZA vrnm.p'�' A,.3 %,^,p S item must be maintained throughout the Entire a Construction Period. 4 Will this Project Require any Land Filling,Grading or / Excavation where there is a change to the Natural ❑ —✓ CIA itf'/� yY[ t�P r IC e�c4"�1'�4 , Existing Grade Involving more than 200 Cubic Yards ^T�; -} ' of Material within any Parcel? t�f " l+� -l�"�r 'r am f--1 j Will this Application Require Land Disturbing Activities / '�- �Q e �-�Q yL r Encompassing an Area in Excess of Five ThousandAU J_ v/"'` , r (5,000 S.F.)Square Feet of Ground Surface? t7 l� a)�Co's I �AA)-A±Jle �@�� 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 ❑ — including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for stone water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ - for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.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 F] constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(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 Stone-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(4)and/or Answer for each Question is Required for a Complete Application) STATE OF NEW YORK, ' COUNTY OF.......................... �/.............SS That I,.. .!l1....�^ ..!!... 4../ .....being duly sworn,deposes and says that he/she is the applicant for Pertnit, (Name of individual signing Document) Andthat he/she is-die ........................... .1�. ......................................................:................................................ (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 h rewith. Sworn to before me this; .......................(.......... ....,....'.^da•� f... .....X Y.. ..y...�...............,20.� Notary Public: .... .°�........... .................. 1.3 ..............Vl�, .IOTkI EYO i'ubllc of New Yol Si nature of A licant FORM - 06/10 Qualified in Suffolk Courtf�/ Commission Expires lulu au Le Boara ^f Trustees Application County of Suffolk State of New York 7—O S C IA- L N BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE i DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN.THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TH APPLICATION. C� Signatu of Property Owner SWORN TO BEFORE-ME THIS. .DAY OF r 20_3 j Notary Public VICKI TOTH Notary Public Stag Of New York No.01`�06190696 Quamed in Suffolk County Commission Expires July 28,20__ _� I Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) l� residing at (print owner of property) (mailing address) i do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) I i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The 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,first name,qiiddle 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.) j i Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval.of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee ha en a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 50 of e 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 greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or-beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted th day R 1 L 200 13 Signature. Print Name 'Tl`s_% MS ,0A �_� Form.TS] 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 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. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 10(D(7 - l 1.3 PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees l. 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: !_ I S-a I 5 QL fT c<` `\.%E7�> k%eys ( N� P ` Location of action: v J p CO X (y I-c,�e� Site acreage: Present land use: �. Present zoning classification: -e 5 c e-7\ 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: o S�a P\- L. (b) Mailing address: (E,y v ��,�c, c1 w N--\j 1l (c) Telephone number: Area Code( ) _ �-k C `j — g 5 (o (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No� If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria ❑ Yes 0 No ICJ 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-K'**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 Pa 8 through 16 for evaluation criteria ❑ Yes ❑ N 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 KNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP.Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Yes No Not Applica 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. ❑ N Yes No ot Applicable 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 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. 0 Ye�] No Z of Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. Se LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ 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 waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No Not Applicable . . Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY TITLE DATE . I i OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO i N.Y.S. Dept. of Environmental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services 360 Yaphank Ave., Suite C Yaphank, NY 11980 852-5700 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 917-790-8007 I N.Y.S. Dept. of State Coastal Management j 99 Washington Ave. Albany, NY 12231 518-474-6000 SURVEY OF DESCRIBED PROPERTY SITUATED AT TOWN OF KKOUTHOLD f14 SUFFOLK COUNTY, NEW YORK �S S.C.T.M. NO. 1000-11 3—8-1 PTEEIDENSQ 88•S GVDi9DATUM EXIST. LOT COVERAGE = 2,058 SQ. FT./8.67. ,C LJ� //�7 GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE UNDERGROUND UTILmES EASEMENTS NOT SHOWN AND UTILITY POLE LOCAAONS ARE NOT GUARANTEED. W ti� �•I THE OFFSET DIMENSION SHOWN HEREON FROM THE STRUCTURES 70 THE PROPERTY LINES ARE FOR SPECIFIC PURPOSE AND USE,THEREFORE ARE NOT INTENDED 70 GUIDE THE 'w 'TV O ERECTION OF FENCES, REPINING WAIL$ PODIA PATIOS, PIANTTNG AREAS, ,y ti ADDITION TO BUILDINGS AND OTHER CONSMUC770M THE EXISTENCE OF RIGHT Cl I w OF WAYS, WETLANDS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE CUGUARANTEED�]� UNAUTHORIZED AL71RA710N OR ADD!lION 70 THIS SURVEY IS A VIOUiRON OF �"`•• - ND SECTION 7209 OF THE NEW YORK STATE EDUC477ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS SIGNATURE AND RED INK OR EMBOSSED SEAL SMALL 10.7' FD.iyp S Tow OF Sp�RLY OF NOT BE CONSIDERED A TRUE VAUD COPY. O ,Z0 F,Ag N 84 18'0 p"rr FZD ROM O EOWWNNS ERS AND OBSERVATIONANCES TO S AND/OR INFAND FOORMM47TOON OBTAI OBTAINED FROM �• Jr D_XIVEryyAY (� \ �� 156.v�3) OTHERS SINCE MOST ARE NOT VISIBLE THESE LOC477ONS AND DIMENSIONS CANNOT \ BE CE7MF7ED. EL /11 1 y FRBA1jN \�/�\ F=FEL.10.6' o W \ \ \� — " v ,40.7 " v LS ,O \ , ' ~ w MATTITUCK RO E \\ �1 2��' 30.1' I\ g 1 ! WOODED t4 DRI V _QD___ �� 1 c_ ; L�L.9 81 CREEK j _ i APR 1 nD, 2013 1 (HOWARDS' BRANCH) C.L.EL.16.6' G>�ar 0 T ------- ,_ �� �9\Ci �'s op�y o. �� ? Southold Town Truste REU ` \cS ti iIOOD \ 'EL.16.`3 \ ` �^ 1 \ n n n \ Gm C 28.7 26 4 EL.15.8' \\ \ \ C 9oG g, STONE o� z.5s3.7' Fir STOOP z '� \ \ dAl �'� 00. U.P. \ � e 7� 3500E 30. `�r \\ D , \ 8 ��— \ p00DE \ EL.2.9 \ 26.5 y 56 STY 4,E FFEB. —�yr� W04\ CC JrOOD CC, 6vp mor,' 18.0= \C\ 0.7s YOF S 7345 OltF0 Oj91CZ EL.24.7' JOS $ FD MAN PAT T. SECCAFICO m PROFESSIONAL LAND SURVEYOR, P.C. — SUCCESSOR TO — w DONALD TASE, L.S. a w RICHARD WILHELM Auvp assoc�arEs NORTHSTAR SURVEYING, P.C. PAUL T. CANALIZO, L.S., ROBERT A. KART, L.S. GOOD GROUND SURVEYORS, P.C. 328A Main Street Hampton Atrium Unit D-4 Center Moriches, NY 11934 186 W. Montauk Highway Hampton Boys, NY 11946 on Phone: (631) 878-0120 Phe: 631 728-5330 Fax: (631) 878-7190 Fax: (631)' 728-6707 N.Y.S. LIC. NO. 049287 FILE NO. 51067 SCALE: 1 30' DATE. 0210812012 COPYRIGHT — 2012 PAT T. SECCAFICO P.L.S., P.C. "