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HomeMy WebLinkAboutTR-9396A Glenn Goldsmith, President Z� s®(!,� Town Hall Annex A. Nicholas Krupski,Vice President ,�®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski dE J�L Southold,New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 C®UN BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1943C Date: July 20, 2022 THIS CERTIFIES that the installation of a 200' long by 18"high by 24"wide stacked stone wall at south property line with drain pipe at base to drywells and install a 4'x16' basement entrance at grade, At 2385 Pine Tree Road, Cutchogue. Suffolk County Tax Map#1000-104-3-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated January9,2019 pursuant to which Trustees Administrative Permit#9396A Dated March 20, 2019,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for installation of a 200' long by 18"high by 24"wide stacked stone wall at south property line with drain pipe at base to dawells and install a 4'x16' basement entrance at rg_ade. The certificate is issued to Eugene C. Burger owner of the aforesaid property. � m 4�v_ J Authorized Signature 1 Glenn Goldsmith, President ° Town Hall Annex A. Nicholas Krupski,Vice President �a� q� 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples Fax (631) 765-6641 UN BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 7&/7z INSPECTED BY: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction '/2 constructed Project complete, compliance inspection COMMENTS: //(f a r d�� -4v CERTIFICATE OF COMPLIANCE: Michael J. Domino, President ��o�OSUFFO(�C y Town Hall Annex John M. Bredemeyer, III, Vice-President , 54375 Route 25 Glenn Goldsmith N ,_ P.O. Box 1179 A Nicholas Krupski fi y • �6 Southold, NY 11971 Greg Williams Ol , c �' Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed When project complete, call for compliance inspection; Michael J.Domino,President OF S0 lTown Hall Annex John M.Bredemeyer III,Vice-President '`� ® 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G ® Telephone (631) 765-1892 Greg Williams COU a Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9396A Date of Receipt of Application: January 9, 2019 Applicant: Eugene C. Burger, Jr. SCTM#: 1000-104-3-2 Project Location: 2385 Pine Tree Road, Cutchogue Date of Resolutionlissuance: March 20, 2019 Date of Expiration: March 29, 2021 Reviewed by: Board of Trustees Project Description: Install a 200' long by 18" high by 24" wide stacked stone wall at south property line with drain pipe at base to drywelis, and install a 4'x16' basement entrance at 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 as indicated on the site plan prepared by Frederick R. Weber, dated December 18, 2018 and stamped approved on March 20, 2019. 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. Michael J. Domino, President Board of Trustees I FREDERICK ROBERT WEBER LOT COVERAGE: DRAINAGE CALCULATIONS: Addition and Contributory Roof Area = 2122 sf EXISTING ADDITION TOTAL x .16' (2" Rain) ARCHITECT T of Wall HOUSE/Garage: 2313 sf 349 sf 2122 sf Drainage Capacity Required: 451.8 cf oP , EI +10-6 iFProperty Line DECKS: 161 sf -161 sf - Structure Capacity Grade (Varies) I SHED: 80 sf —80 sf — Gal"/cf 1 8'0 x 6' Deep Drainage Ring Proposed � Grade (Varies) TOTAL: 2614 sf 1-49 sf 2122 sf A` w/ Traffic Bearing Slab 253.2 cf Stacked Stone" �; I 6'0 x 5' Deep Drainage Ring Wall (To Mean High Water) 14.90/0 15.5% B w/ Traffic Bearing Slab 111.5 cf Burger Property_' pe to (To Top of Bank) 11.1% 11.870 410 x 6' Deep Drainage Ring t7r w' ?,kl C w/ Traffic Bearing Slab 52.2 cf PROPOSED STONE WALL w 4'(P x 6' Deep Drainage Ring D w/ Traffic Bearing Slab 52.2 cf Drainage Capacitg Provided: 469.1 cf 4'0= 8.1 cf/ft Note: 6' Deep Drainage Rings Located in Areas ^ 6'(P= 22.3 cf/ft of Minimum 10' Elevation, 5' Deep Drainage Rings �1 H 8'0= 42.2 cf/ft Located in Area of 9' Elevation LOT 16 EDGE OF TIDAL WETLANDS AS Tn DETERMINED BY C05TELLO v 1 WOOD RET. I MARIV ON APRIL 24. 2011 WALL 0.PN 1° OIC 2O° SPLIT RAIL FENCE (DELAP) O.5'S i ' I N 8 w 1st 8. 2nd / _ _ emove, Addit�rott.,ZONE X p �p NO Z �12_ — O r e .' _ - -=_ �`A ! ----!�O . . a rb ' io I �� w --�, - _ � -_-_� move / o l 13 DRAWING TITLE. W -----------i- i j O � W 60 --- N i EX .... istin -- ---- i STORY 9.6' : : :: :: e I loo V SITE PLAN to �p,TER '� w GAR. FLR. EU 11.2' FR ME o 9:i' ; 1 I �z m No TE N METER i LING F. EL. 12.'' 1 �ExistingePatio i i �i 3 WOOD &CATWA I 1k o 0 33,_0 29.a i (Prop se nd S ory w '(To Cie 35 -0 1 DOCK / w METAL ort LOT 15 ofd i istin ous r i 75 ear `� ter N 94' ' ► I �j o Qe 10 8' Foot ri -- 35 — �° l�K N 2nd n.7 - (*�c.w ,,ear) 1 i i DBL. �� 6R 1st �a:::::�:'::_'_ i PILINGS ddit ' Ha 4Bale t f i ° �, 00 >00 ion SdUFencing-- 8� 1 I I JOB: S �e ------- - I EAWAY -m a----- Cn J _ __________ 0---- E E -)_ - o RENOVATION/ADDITION OV RN 1 co _ PROPOSED ST _KED STONE ALL, E DURGER RESIDENCE O MON STOCKADE FE. WALL 1 i 0 N PROPOSED STACKED STONE WALL, EL +10'-6' i 25�S.g5� 0.6'N ;D UT LITY SPLIT RAIL FENCE FE O''N >_e APPROVED BY 2385 PINE TREE ROAD d FE g 81° 01' 20�;�1 POLE 0.315 �� BOARD OF "1 RUSTEES CUTCHOGUE, NY TOWN OF SOUTHOLD 0.2'S m TOWN OF SOUTHOLD SCTM# 1000-104-03-02 LOT 14A DATE 201q �J ARCHITECT: _ NORTH i � :'" �.K •k`. .�.�•:. W SITE PROPERTY OWNER: - ``"`r �a. EUGENE C. BURGER - �',' '" n FREDERICK R. WEBER 41 EAST MAPLE ROAD s I" = 20"-011 SITUATE: CUTCHOGUE GREENLAWN, NY II'140 TOWN OF SOUTHOLD 1 52 NOYAC PATH SUFFOLK COUNTY. NEW YORK WATER MILL, NY 11911 SURVEY INFORMATION: PECONIC SURVEYORS, P.C. -�'� TEL L31 154-5555 SOUTHOLD, NY fweberarchitect9gahoo.com MEADOW LANE SURVEYED: JUNE 10, 2010 LAST UPDATED: DECEMBER 6, 2017 (UNIMPROVED) ELEVATIONS REFERENCED TO N.A.V.D. of 1988 Stone Wall DEC 18, 2018 Revisions NOV 3. 2011 LOT NUMBERS REFER TO "MAP OF NASSAU FARMS" _ . Reduce Porch MAY 1'1, 2011 FLOOD PLAIN: ZONE X FILED IN THE SUFFOLK COUNTY CLERKS OFFICE JAN �� ; - REV.: FLOOD ZONE FROM FIRM MAP 36103CO164H, SEPTEMBER 25, 2009 ON MARCH 28, 1935 AS FILE NO. 1119 DATE: APRIL 20. 2011 8 ' EXISTING CONTOUR SCTM# 1000-104-03-02 __.__ i 8 l REVISED CONTOUR LOT AREA: 11,633 S.F. (TO TIE LINE) SCALE : 1" - 20' LOT AREA: 11,513 S.F. (TO MEAN HIGH WATER) JOB NO: w201103 8 NEW CONTOUR LOT AREA: 15,255 S.F. (TOP OF BANK) =MONUMENT ZONING: NON-CONFORMING LOT (LESS THAN 20.000 SF) DRAWING NO. YARDS: (PRINCIPAL) FRONT 35' SIDE (ONE): 10' SIDE (BOTH). 25' REAR: 35' At HEIGHT (MAX.): 35' FLOOD PLAIN: X OF All Michael J. Domino, Pre O S�FF014' Town Hall Annex John M. Bredemeyer III,Vice-President �� y,,, 54375 Route 25 Glenn Goldsmith C P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams p! Telephone(631)765-1892 ©� �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD J�l� Date/Time: Completed in field by: e• - Eugene J. Burger, Sr. on behalf of EUGENE C. BURGER, JR. requests an Administrative Permit to install a 200' long by 18" high by 24" wide stacked stone wall at south property line with drain pipe at base to drywells, and install a 4'x16' basement entrance at grade. Located:.2385 Pine Tree Road, Cutchogue. SCTM# 1000-104-3-2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet I Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet; 7. Placement of C&D material: 100-feet TOP OF BLUFF: ; 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 J Ch. 111 ;SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion, Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: �f W&'A caul( , C4dam, p ��y �dw�I e�P So1�e �w de Ada r -T)04. I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: �J. Bredemeyer ✓ M. Domino G. Goldsmith v N. Krupski G. Williams Other .p• i w '� *ire, i'��/'. + y AL VIP lot yr.- y ` . y ICU _ * c ne air :. !! pewtv f n e "j7X— r } ice— • - � � ~'y � _ �t y r -wY�,yyua -.�.i-.J...-- -�+1.. �°'-meg ��,r,,,�'"`r -+� � - .. •. z y y �5 i - "rye] .r ♦ � � _ - ��_.. .!AOmni . r �,x y 'd Staeftd Stbn . 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) c Southold,NY 11971 Telephone: 631 765-1938 eouV,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator o "+ •i4 Date: March 12, 2019 °- Re: LWRP Coastal Consistency Review for EUGENE C. BURGER, JR SCTM# 1000-104-3-2 Eugene J. Burger, Sr. on behalf of EUGENE C. BURGER, JR. requests an-Administrative Permit to install a 200' long by 18" high by 24" wide stacked stone wall at south property line with drain pipe at base to drywells, and install a 4'x16' basement entrance at grade. Located: 2385 Pine Tree Road, Cutchogue. SCTM# 1000-104-3-2 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, the proposed action is recommended as 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: Damon Hagan, Assistant Town Attorney a W- � , Michael J.Domino,President Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 Z A.Nicholas Krupski Telephone(631)765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application --/ Wetland Permit Application -Administrative Permit -,4—Amendment/Transfer/Extension,c / V 8 q ] Received Application: Received Fee: $ 100.00 Completed Application: 1.2q.lq Incomplete: SEQRA Classification: Type I_ Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination-(date sent): �LVVRP Consistency Assessment Form Sent: ,,CAC Referral Sent: if =Date of Inspection: U 11 Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): Eugene C. Burger, Jr. Mailing Address: 2385 Pine Tree Road, Cutchogue, New York Phone Number: 631478 1651 or 631484 9763 Suffolk County Tax Map Number: 1000 104-03-02 Property Location: 2385 Pine Tree Road, Cutchogue, NY (135' North of Meadow Lane unimproved) (If necessary, provide LILCO Pole#,distance to cross streets,and location) AGENT (If applicable): Eugene J. Burger, Sr. Mailing Address: Post Office Box 934, Cutchogue, NY 11935 Phone Number: 631/484-9763 - Board of Trustees Application GENERAL DATA Land Area(in square feet): 17,633 S.F. (to the line) Area Zoning: R-40 Previous use of property: Single Family Dwelling ; Intended use of property: _ Single Family Dwelling with Addition Covenants and Restrictions on property? Yes X No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes X No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X 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 X No t Does the structure(s) on property have a valid Certificate of Occupancy? X Yes No s Prior permits/approvals for site improvements: Agency Date Southold Town Trustees Permit#8111 3/20/2013 Southold Town Bldg Permit#42835 Southold Town Trustees Permit#8993 4/19/2017 NYS DEC Letter of Non-Jurisdiction No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes,provide explanation: Project Description(use attachments if necessary): Proposed stacked stonewall (shown on plan)at south property line, with drain pipe at base to drywells, and basement entrance at grade(shown on plan). Proposed stacked stone wall to be approx.18"h x 24"w+/-x 200'long Proposed basement entrance to be 16'x 4' Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: landscaping and basement access. Area of wetlands on lot: 60 square feet Percent coverage of lot: 15.0 Closest distance between nearest existing structure and upland edge of wetlands: 75 feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? 6 cubic yards How much material will be filled? 15 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 0 Manner in which material will be removed or deposited: Backhoe/skid loader 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): No effect. All drainage to be collected into drywells. Haybale and silt fencing erected for construction. 617.20 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 1 -Project and Sponsor Information Name of Action or Project: Stacked stone wall and basement stairs Project Location(describe,and attach a location map): Rear yard of property, south property line as shown on plan attached. Brief Description of Proposed Action: Proposed stacked stone wall (shown on plan)at south property line,with drain pipe at base to drywells, and basement entrance at grade(shown on plan). Name of Applicant or Sponsor: Telephone: Eugene C. Burger, Jr. E-Mail: burgerconstruct@aol.com Address: 2385 Pine Tree Road City/P0: State: Zip Code: Cutchogue 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources thatX may be affected in the municipality and proceed to Part 2. If no,continue to question 2. ❑� ❑ 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: E! Fxl 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? .02 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 5 acres 4. Check all land uses that occur on,adjoining and near the proposed action. El Urban El Rural(non-agriculture) []Industrial ❑Commercial ®Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 5. Is the proposed action, NO YES 4 N/A a.A permitted use under the zoning regulations? ❑ a ❑ b.Consistent with the adopted comprehensive plan? El a ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? •'❑ a 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: 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? '0 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? a ❑ 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: N/A � ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: •❑ ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ ❑ b.Is the proposed action located in an archeological sensitive area? ❑ ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain :NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:' ❑Shoreline [:1 Forest ❑Agricultural/grasslands EJ Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO 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,either from point or non-point sources? NO YES If Yes, ❑ ❑ a.Will storm water discharges flow to adjacent properties? [:1 NO OYES X • b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO []YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 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: El; I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE ,,✓✓ Applicant/sponsor name:O(�,�---.w Q 8Q.,2 Dater 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 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" < No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning Elregulations? 2. Will the proposed action result in a change in the use or intensity of use of land? E 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)? 5. Will the proposed action result in an adverse change in the existing level of traffic or �j ❑ affect existing infrastructure for mass transit,biking or walkway? lI�-II 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? 21 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? E 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? El 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an E, 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 i pact'7 Town of Southold-Board of Trustees 11 Name of Lead Agency Date M 1 V Aepll J m ®®M 10 President Print or Type Name of ResponsibleOf_ ficer in Lead Agency Title of Responsible Officer Signature of Respoible Officer inin Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT. 3 Eugene C.Burg6Upe text here BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ; ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF 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,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, ' INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE t COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 1 f Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF :,20 19 r i BARBARA M OCONORSCHUTTE Notary Public-State of New York NO. 010C6336E�5 Not "Pic Qualified in Suffolk County hf Commission Expires Feb 8, 2020 k Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, EugenetGnBurger owners of the property identified as SCTM# 1000- 104-03-02 in the town of Southold ,New York,hereby authorizes Eugene J. Burger, Sr. to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF t , 20 19 BARBARA M OCONORSCHUTTE Notary Public-State of New York O ary ubliC NO. 01OC6336E'j5 Qualified in Suffolk County j My Commission Expires Feb 8, 2020 APPLICANT/AGENT/REPRESENICATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Cade orEthics'nrohibits conflicts of interest.on the aart'of town officers and employees.The nuroose of this form is to provide information which can alert the town of possible conflicts�of mterestand allow-it to take whatever action is necessary to-avoid same. Eugene C.Burger YOUR NAME: (Last name,first name,ipiddle 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 x 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 relationshipavi6;m1y ofGcer vefiiployee- of the Town of Southold? "Relationship"includes by blood,ntarriage,or business interest. 13usindss interest",means4a business, including a partnership, in which the town,officer or employee has even a partial ownership df(or employntept by)It corporation in which the town officer or employee owns,more than 5%of the shares. NO x YES ; 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 56/o of the shares of the corporate stock of the{.ipplicant (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 of 2019_ Signatur �,`,�; Print Name Eugene C.Burger Form TS l 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 -ifs s_ignillcant 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 hr 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# 104 _ 03 _ 02 PROJECT NAME Burger Jr.-Stacked stone wall The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees M. 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license, certification: a Nature and extent of action: Administrative Permit to install stacked stone wall (as shown on plan)at south property line,with drain pipe at base to drywells, and basement entrance at grade'(shown on plan). P Location of action:- 2385 Pine Tree Road,Cutchogue,New York Site acreage: 17,573 sf to MHW Present land use: residential Present zoning classification: residential 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: Jr. Burger, . (a) Name of applicant: Eugene C. _ (b) Mailing address: 2385 Pine Tree Road,Cutchogue,New York ? (c) Telephone number: Area Code(31)734-5217 (d) Application number,if any: / )'/,I Ia 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?', s 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 F,] 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 ❑ No E 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 t ❑ Yes ❑ No 0 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria X ❑ Yes 1:1No El 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 E] No El Not 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. ❑ ❑ El 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 ❑ No 0 Not 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 0 Not Applicable - 1 PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye.0 No 0 Not 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. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 0 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 E] 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. ElYes El No FI Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Q Not Applicable PREPARED BY TITLE ��� DATE / $