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HomeMy WebLinkAboutTR-9415A Glenn Goldsmith,President . ��;if so(/Tyo _ Town Hall Annex Michael J.Domino ,`O l0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A. Nicholas Krupski G • Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1774C Date:November 6, 2020 THIS CERTIFIES that the construction activity within 100' from the landward edge of wetlands for the construction of a proposed 995.76 two-story dwelling with 574.08 sq.-ft. attached garage,• install a sanilM system,• install gutters to leaders to drywells on the dwelling and garage to contain roof runoff, with a 1400 sq.ft. gravel driveway, all structural components to be located greater than 100 feet from the landward edge of wetlands; At 1410 Brigantine Drive, Southold Suffolk County Tax Map#1000-79-4-27 Conforms to the application foi:k Trustees Permit heretofore filed in this office Dated January 29, 2019 pursuant to which Trustees Administrative Permit#9415A Dated April 17, 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 the construction activity within 100' from the landward,edge of wetlands for the construction of a moposed 995.76 two-story dwelling with 574.08 sq. ft. attached garage, install a sanitary system; install gutters to leaders to drywells on the dwelling and garage to contain roof runoff, with a 1400 sq ft gravel driveway, all structural components to be located greater than 100 feet from the landward edge of wetlands. The certificate is issued to Mariah Mills&Kevin Johns owners of the aforesaidproperty. F Authorized Signature Glenn Goldsmith,President �QF SU!/T Town Hall Annex Michael J.Domino,Vice-President ,`O� yp�o 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III J JL Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 �y�OUNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION,: ( �� INSPECTED BY: � � ,Y .Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt,boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: `yr�OS�yfFO(�.o+ Town Hall Annex Michael J. Domino, President �o �yf John M. Bredemeyer, III, Vice-President ��� r. 54375 Route 25 Glenn Goldsmith N ,?" P.O. Box 1179 A Nicholas Krupski y ® �' Southold, NY 11971 Telephone (631) 765-1892�of � �a Greg Williams � ° 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 15f day of construction Y2 constructed When project complete, call for compliance inspection; Michael J.Domino,President OF SOUjy� Town Hall Annex John M.Bredemeyer III,Vice-President Q 54375 Route 25 P.O.Box 1179 Glenn Goldsmith [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 CUUNI�I,� BOARD,OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9416A Date of Receipt of Application: January 29, 2019 Applicant: Mariah Mills & Kevin Johns SCTM#: 1000-79-4-27 Project Location: 1410 Brigantine Drive, Southold Date of Resolution/Issuance: April 17, 2019 Date of Expiration: April 17, 2021 Reviewed by: Board of Trustees Project Description: Conduct construction activity within 100'from the landward edge of wetlands for the construction of a"proposed 995.76 two-story dwelling with 574.08 sq. ft. attached garage; install a sanitary system; install gutters to leaders to drywells on the dwelling and garage to contain-roof runoff; with a 1400 sq.ft. gravel driveway, all structural components to be located greater than 100 feet from the landward edge of wetlands. 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 survey prepared by Nathan Taft Corwin, III Land Surveyor, last dated March 19, 2019, and stamped--- - approved on April 17, 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 PROPOSED SEPTIC SYSTEM DETAIL HOUSEMP DIED NOT TOS SURVEY OF L111t F'� 4'DEEP mmc FINISHED GRADE FLAG PREGISr REINFORCED CONCRETE COVER ELEV. .a• �pNc.wA7Eli0GHr d:INSECT PROOF FINISH GRADE BURIED V DEEP min.2'DEEP mmi. aAs<;TON COVER TO GRADE �"'' LOT 5 4 - MIN.4'aw. MIN.4'dia. 'I TOP EL 10.0' 3 _ MAP OF FLAG APPROVED PIPE zo-min D•min. _ HARBOR LIGHTS ESTATES �f PITCHED 1/4'/1' TOP a". 70"0' APPROVED PIPE 44f OP ro c PTICtEED 1/8 ♦' 3•CLEAN INV. E] g� •. 92• INVERT ;� m , _ ` awCOLLAR SECTION THREE �M A�.,_ �'s'Q +_■I �W { INVERT'•�, —OVER o. FILE No. 5147 FILED AUGUST 7, 1968 °sVoi��ner FuBAFFLE i Ott«i SITUATE BAYVIEW SEPTIC TANK (1) f B 3 WATER GROUND 1.MINIMUM SEPTIC TANK CAPACITIES FOR A 4 BEDROOM HOUSE tS 1,250 GALLONS. TOWN OF SOUTHOLD I TANK;8' DA.4 LIQUID DEPTH. 2 CONCRETE SHALL HAVE A MINIMUM COMPRESSIVE STRENGTH OF 3,000 pal AT 28 DAYS. SUFFOLK COUNTY, NEW YORK S 3.WALL THICKNESS SHALL BE A MINIMUM OF 3',A TOP THICKNESS NOF 6'AND A BOTTOM THICKNESS OF C. LEACHING POOLS (21 \ ALL WAILS, BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 300 Ped. S.C. TAX NO. 1000-79-04-27 p 4.ALL JOINTS SHALL BE SEALED SO THAT THE TANK IS WATERTIGHT: 1. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq R SIDEWALL AREA. J2� \ 5.THE SEPTIC TANK SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS(WITH A MAX.70LIPANCE OF 11/47 2 POOLS; 6'DEEP,8' did. SCALE 1�'=40' ON A MINIMUM 3'THICK BED OF COMPACTED SAPID 2 L OR PEA GRAVEL EkCHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REINFORCED CONCRETE(OR EQUAL) \ 6 6.A 10' min.DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED. LEACH=STRUCTURES,SOUD DOMES AND/OR SLABS. G� \ s■10, 3.ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE(OR EDLAIa. JANUARY 8, 2018 QQ' 4—_ \ .20b G 4.A 10' min.DISTANCE BETWEEN LEACHING POOLS AND WATER LINE SHALL BE MAINTAINED. AUGUST 16, 2018 ADD PROPOSED HOUSE 6.AN 8' mm.DISTANCE BETWEEN ALL LEACHING Pori SHALL BE MAINTAINED. DECEMBER 26` 2018 REVISED BY S.C.D.O.H.S. B' ^- 6.AN min.DISTANCE BETWEEN ALL LEACHING POOLS AND SEPTIC TANK SHALL BE MAINTAINED. \ Q 20, 2019 ADD PROP. FENCE 04W �� G ALgC \ \ \\ ?' NS MARCH 19, 2019 REVISE PROP. WETLAND BUFFER FENCE AJ \\ \ �\ at 'u�Nva ��M/ AREA = 25,066 sq. ft. ��rSy A�� C�V Y 0.575 ac. O A` ,s� \\ \ \ ` \\ ^T % � ? Y B®ARD ®F 7 I�USTEES CERTIFIED TO: y, \ \ \ �y KEVINMARIAHMILLS JOHNS C). \' \ \ \\ \ \ °�° `�jil � TO.Vi/N OF SOUTH®LD \ \ \ \\ n CHICAGO TITLE INSURANCE SERVICES, LLC �( off AIL. x��i `\ \\ � �'����� fir° DATE \ 1 - `�' \ \ L � 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM �Illc o��L \ 100' \ \ \ EXISTING ELEVATIONS ARE SHOWN THUS:I= J111c'� 90' n ,,'v� '•-. 10.5 \ SvN2ss3 , MINIMUM BE DIA. 4ANLIQUIDADEPTH FORA 4 BEDROOM HOUSE IS 1,250 GALLONS. _ \ L .\ 4 \ j 1 TANK, N 98 � � � \ BU� �' a 0 •'::�•. \ _ I� MINIMUM OLS; 6' DEEP,DEEP, BSYSdIa. FORA 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA. S8• � I ' x1 ILO \ N FNy�4p mry / R°V� PROPOSED EXPANSION POOL FLAG 20• / / I O I I \ g ` \ i` � Ix 2� ®PROPOSED LEACHING POOL / / N k'� y • 10.e " ~ };I •. , IED .p_• - ::' :: a; ' M� I faPROPOSED SEPTIC TANK 4. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD V / / N 7 h.N I r { OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. 0. i:.:fiiit:::. ' / x 11-2 I L i" TEST HOLE DATA (LEST HOLE DUG ON MAWH 27,2018) is I � EL 120 OT :::;`.•.:: s ,, BROWN SILTY SOD SM 1 — �q o� L/ I OyaJ �a• PRE' 11(•�ACCO WITH THE MINIMUM BROWN BHS TO LFxlw sAHm SP ED AS ND AAo PT - �" ••�` I ��//' J YORK STATE LAND 12------ TEST HOLE x 12.0 I T Iv EL 0.4' \nRAIi CE SYSTEM GaLCULA77ONS, 2 j 10 �Q�� I� SER IN BROWN Sao TOTE TO * Z DRIVEWAY AREA: 1.400 eq_ ft. To F 1.400 sq. ft. X 0.17 - 238 cu. ft. `S'• x _238 cu. ft. / 42.2 = 5.6 vertical ft. of 8' dia. leaching pool required ,0. PROVIDE (1) 8' dia. X 6' high STORM DRAIN POOLS •:o°j �,' ROOF AREA: 1,570 aq. ft. IV ti 1,570 sq. ft. X 0.17 = 267 cu. ft. G// 6 - - N.Y.S. Llc. No. 50467 267 cu. ft. 42.2 = 6.3 vertical ft. of 8' dia. leaching pool required �� w I ,i 7 / 9 P _ - -- �,> >i_ .:UNAIliHORRID ALTERATION OR ADDITION PROVIDE (2) 8' dia. X 4' high STORM DRAIN POOLS a� cs,,� _ tl.� { ;To Tests SURVEY Is A vwunoN of 2 'I� If3 SECTION 7209 OF RHE NEW YORK STATE ■ •j J !!i i'-'., I S EDUCATION LAW. PROPOSED 8' DIA. X 4' DEEP DRYWELLS FOR ROOF RUN-OFF ARE SHOWN THUS: f; ' L„ m 1 1 - it l Nathan aft Corwin 111 r _ , IRR S• I f.i....-'; COPIES OF INS SURVEY MAP NOT BEARING ��� ®�� ;ate ELAND SURVEYOR'S INKED SEAL OR Land Surveyor i O• I BOSSED''.,ETU.SHALL NOT BE CONSIDERED PROPOSED 8' DUI X 6' DEEP DRYWELLS FOR DRIVEWAY RUN-OFF ARE SHOWN THUS: ti:W r A,�y �h f BE A ViwD TRUE COPY. • h Iva j FICAMONS INDICATED HEREON STALL RUN f NLY TO THE PERSON FOR WHOM THE SURVEY _ 'NS PREPARED.AND ON HIS BEHALF TO THE Succor To: Stanley J. IR9�n I.S. LS.S: '!;:.•r'I4?111 91TLE COMPANY.GOVERNMENTAL AGENCY AND JoOeph I.FIIDIN6 TINSITRJTON LISTED HEREON,AND Z B02id Of T`lf�iz'e's —_TO CERTIFICATIONS�N�DING�IN TI— TMe Surveys—Subdivisions — Site Plans — Construction Layout SQUARE RIGGER I,Aj\jE � mPHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHT OF WAYS OFFICES LOC47ED AT AWUNG ADDRESS AND/OR EASEMENTS OF RECORD, IF j ANY, NOT SHOWN ARE NOT GUARANTEED. 1586 Main Road P.O. Box 16 A. Jamesport. New York 11947 James ort. New York 11947 r Michael J. Domino,President ��OF SO!/lyo Town Hall Annex John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q � O Telephone (631) 765-1892 Greg Williams O Fax(631) 765-6641 �y00UMf`1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: qxt4414 2'�_/ 2---5-7,17 V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction constructed Project complete, compliance inspection. INSPECTED BY: O COMMENTS: __/� Gyl CERTIFICATE OF COMPLIANCE: BOTTOM _ GR SEPTIC TANK (1) ELEV.1,5: t ELI IF +` 1. MINIMUM SEPTIC TANK CAPACITIES FORA 4 BEDROOM HOUSE IS 1,250 GALLONS 1 TANK; B' DIA 4' LIQUID DEPTH. — '� \\ �a 2. CONCRETE SHALL HAVE A MINIMUM COMPRESSIVE STRENGTH OF 3,000 Psi AT 26 DAYS. LEACHING POOLS (2) I� 3 WALL THICKNESS SHALL BE A MINIMUM OF 3•.A TOP THICKNESS OF 6-AND A BOTTOM THICKNESS OF 4•. \ 66• ALL WALLS, BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 300 psT. 1. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE G� \ �Q� p 4.ALL JOINTS SHALL BE SEALED SO THAT THE TANK IS WATERTIGHT. 2 POOLS; 6' DEEP, S'die. Q' 4— � \ 2Q'� Q. 5.THE SEPTIC TANK SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS (WITH A MAX.TOLERANCE OF 11/47 2. LEACHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REIN A _ — \ F ON A MINIMUM 3-THICK BED OF COMPACTED SAND OR PFA GRAVEL LEACHING STRUCTURES,SOLD DOMES AND/OR SLABS. 6.A 10' min.DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED 3.ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE 4.A 10' min.DISTANCE BETWEEN LEACHING POOLS AND WATER `41 \\\ \� 5.AN B' min. DISTANCE BETWEEN ALL LEACHING POOLS SHALL E FLAG \\X AJ \ Z01- 6.AN B' min. DISTANCE BETWEEN ALL LEACHING POOLS AND SE Cv \\ �\ \ \ ct AL \\ \ � � tom TO Jlllc M zm o \ \ \ \ �L\m \\ \\\ \\� I2�� I JAL 100' ' \ o•z 2 O J Jlllc_ I 90' \ n��E /N\�e. 10.5 I I I _ zo 4 �- �1Vc �m I I 0,I I ~ fB -A ry S82 xl 3> _ Fuc ____\ QDo �off E a 6+� Ix � {{ ' ro f \?4�I ,�/ a y? x 11.2 I +� TEST HO 0� 1, p..... I /'y (TEST HOLE DUG BY umoNun r 44 ,^� I �� EL 120' - o ?' s fix/ c G/ ZI aQ ,4? 12—————— TEST HOLE 0) V'�SYSTEM CALCULATIONS: I �� ►Y,AREA: 1.400 sq. ft. 'SS, x I 0 sq. ft. X 0.17 = 238 cu. ft. cu.,ft. / 42.2 = 5.6 vertical ft. of 8' dia. leaching pool required �^ IIDE (1) 8' dia. X 6' high STORM DRAIN POOLS REA: 1,570 sq. ft. ti^h N 0'sq. ft. X 0.17 = 267 cu. ft. cu. ft. / 42.2 = 6.3 vertical ft. of 8' dia. leaching pool required %ryfyil� IIDE (2) 8' dia. X 4' high STORM DRAIN POOLS [ gl,�lrl Y'{t(fyi CD 8' DIA. X 4' DEEP DRYWELLS FOR ROOF RUN—OFF ARE SHOWN THUSt.S: kOU@uh�19N lAW IED 8' DIA. 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I p THROUGH our CEILING m 2-314!SUPP. 3'RADON VEN - FM 2nd Stt7RF p� I I+� STUDY I �a I 1----- ` M Roam Sq H: 163.38 I IA I N I LW Ray 13.07 ( =< I \ Q I I O U PfN1bk 33.03 Q O 4 Va"d.Rcy X54 I n a! 1 I I 1 2" GYP ¢ 0 Z 0= Vmt Pratidad 17.34 I v I I c I 1 Q D IL FOYER S-10 1/2" HDR 0 82 1,72;ASF 3046 MDR®62 1/2-ASF3046 to w " a =N I IHart 3-2xfi HDR: 3-2x9 1 0 6'-4' SPF SPF#2 15'-1D 1/2' I snmficaao I ' 10'-3" iI _ _ 1` LOT LINE SET BACK FIRE-RATING/SEPARATION NOT REQUIRED UNLESS SPECIFIED OTHERWISE m U DOOR TESTING - to I MDR 3-1 1 2• BY BUILDER AND CERTIFIED BY STATE. TEST SHALL.BE z In p 1 B•_o° 3046 7'-B' _„i+IrK[3046 310-EX3 . I ; 5_O" COMPLETED BY HALCD ENERGY, 865 COUNTY RD., Q =m PHELPS NY 315 588-1945. r o PORCH OVERHANG, SLAB, POSTS AND RAILING -MECHANICAL VENTILATION ON-SITE BY BUILDER I� r, I FOR PORCH TO BE SUPPLIED AND INSTALLED ON-SITE BY PER TABLE M15D7.3.3(1). I BUILDER + THE ON-SITE WHOLE-HOUSE MECHANICAL VENTILATION S SYSTEM SHALL PROVIDE OUTDOOR AIR AT A m m fi -- L-___ ___---__--__-___- -_---___-____-----_-� CONTINUOUS RATE OF NOT LESS THAN 60 CFM PER E; an w M TABLE M1507.3.3(1). 'N �N CONTINUOUS HANDRAILS ON-SITE BY o o N c BUILDER SHALL COMPLY WITH R311.7-6 - hhmin - GREGO 8/20/2018 __ 6:27:37 AM _ :VOTES: 1.*-DENOTES ADDITIONAL,COLUMN IN BASF-,V ENT MP 5.9'-0"CLG.IN MAIN HOUSE t 8'-5114"CLG.IN GARAGE 9.CEILING BEAOVER GARAGE TO BE:(2)1 lr1">;9 14'LVL(PER UNIT) 3.1X6 EXTERIOR WALLS 16'O.C. &STAIRS TO BE 814"RISERS AND 9"TREADS. 10. 3.2X4 MARRIAGE WALLS 16"O.C. 7.CEILING GIRDER OVER STUDY TO BE:12)11.'1"x 9 14"LVL(PER UNIT)STACKED 11. n_ 4.ROOF RAFTERS 16"O.C. S.CEILING GIRDER OVER KITCHEN LIVING ROOM TO BE:SEE#7 ONPAGE 3.2 1� a 3 * 1_ ll - `THE PLANS AND SPECIFICATIONS OF THIS PERMIT PLAN SET ARE DERIVED FROM AND " CONSISTENT WITH THE SYSTEMS SET OF PLANS AND SPECIFICATIONS APPROVED AND ON FILE WITH THE DEPARTMENT OF STATE, WHICH WERE APPROVED ON JULY 9, 2018 � Lo/ UNDER SYSTEMS NUMBER M013-2016-067. EXPIRES JULY 20, 2020' UI WARNING: IT IS A VIOLATION OF THE NYS EDUCATION LAW ARTICLE 145 FOR ANY w t _ PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL _=O N - N- __ ENGINEER_TO-ALTER Tcc ITEM IN ANY WAY. 51'-8' - 2T-6' 1'SPACE 23'-11" H _ - 11-9' UMT"C' 13'-4'UNIT"D' B 3046 2 3040-2 LL_ y O 12'-11' 12'-11' M © rn U 0_ � knt GIRDER CCDROPPO INECTIR BEDROOM 2 BEDROOM S OF Nc' ( 7 2-t.�s1R'tvL a mm Sq Ft 152.55 R, Sq Ft: 121.63 2+D STORY FLOOR(PSR d L.�t R.¢ 12.2 L ght Ruq 9.73 "i Lfgftt Rot4daC aao3 Light flcNde' V-02 O 3-RDWS 16d NAILS 4 C OA io iii���SSS 5knt Rnq: 6.1 ',4+t R'� 4.87 -o, �� 'S Q lC �'� C� _J 0 o LVL BAND iD 211G BAN] �j L4xt Pmvd.d: 17.34 Vmt R.F t N.fiH D 70A FLOGLOW PERI.U 19 ,�O s ",,... * Z O N s�is'iHRU-Rats 2 4soc A r- t3 r.; i, l.y� -G O 19 s� ----------------------------- ADD COUP.S --------- d RDP FDR wow - TO YARD DOWSTI N Ro1N ENDS OF B Nd rq ul CFI NIS HABITABLE RDOM MUST BE APPROVED r SymIm 310 310 o � 7-2' AND INSPECTED BY THE LOCAL BUILDING 08(}50 t m UIAla 3 O 310 310 UN CLO N INSPECTOR No LIN P" o W-01/27 LABEL 2.6 C'. CLO Q o � -_.z �36d2 w e,f HALL �'' Lj eoAll 9-41/2" i i ¢ nl � _l ,� I 011s i BATH 1 @ d ----- ------------------- uj4o r N D 9'-6 1 j2" - Y' r 0 fL c-- m DRAIN PAN s Td F ' BONUS ROOM va PLB TO&S1dT ,t I• a C� '� i-_� O _ BATH 2 R.-sq FL 211.6 m i •->;T - - - 1 L �z light Req 1rxt13 light PTwld+�: 220z PULL DOWN " VeoL Rrw B.d6 t STAIRS xvxo LANDING Ve.k Pm"d"d: 11.56 !t F �� t t AE7736 i? c UN t 26"e54 1/2" R.O. ' 1 o d a% N JAN 2 9 2019 3-RADON VEN - 5'-11 112' "� T-0 1/2" r I 3'-0• I------------.�_.t ;," xm IIII ;� �� �� �i �I 2"FUTURE VENT—, I _ _ nu x u i; n u u mt t 7x6 2M 1 R34_ w r u n 'nI u n xR ' `-__-..- � FOOT 2-2x4 FS ory� i4_ �_1_LL_� __1' STUD GRADE ' --------HDR.2-1 1 --------- - - . � CO C F3i m iD I `ti9/g i i iii j 9'-2 1/4"R 7 1!4"L N d{. Cal ran I 1 4'-5 1/2" t _ 7-7 1/2' =y BEDROOM 1 I I iiu N uii `OPEN TO uu 11x i, y+ o it 11 Sq Ft 204,48 I _6 I W gELDW -1 1�1� ' till W16.36 II LightPrroNded: 27.72 1;, l m WALK-IN lint Rcq: S18 vent Provided: 11.55 I ~S I CLOSET 1~ s'-o t 2• B i- IIII g i 3 a a c� - HDR®86'ASF A M ! I ----------- ------ ------- --a -------J ¢ 'v a x Ia N v w " a t N I I m, z O c 15-3' I STUD6GRFADE -( �1i 9'-SO 1/2' S 7'-51/2" g'-p" 7'-5]/2' ' m r 3046 WR3­2191 3046 3046 Ncralo �� SA 7-9' A34 4 En D' O A35 t i - c m m m N N N Q N N O -- lA - -_----�c--- GREGO 8/2D/2018 6:27:37 AM p 4 NOTES: 1. DENOTES ADDITIONAL COLUMN IIA BASEMENGT 5.8'-0"CLG. 9.FLR GIRDER UNDER BEDROOM#1 TO BE:(2)1 L27 X 9 1r'4"LVL(PER UNIT)STACKED I 2.2X6 EXTERIOR NVALIS 16"0.C. 6. CEII.ING BEAM OVER BEDROOM#1 TO BE:12)11/2"x 9114 LVL(PER UNIT) 10. 3.2X4 MARRIAGE WALLS 16"O.0 7. CEILING GIRDER UNDER BED#2i BED#3 TO BE:(2) 11.2"s 18"LVL(PER U1TT) 11.1.ROOF RAFTERS 16"O.C. S. (POCKETED DOZ`'Nr) 12. a3 .2 F;` ' Jt � =3 � t� I• iax r :� "r ,'!1_. - p�J ,x',t-nom i x• r,,, ' � +�F'. Vii+ .� I b ..c '• .k T y ti'JR �' � �f"� ~ +� R `� •Iy-'ice ,!y ILL ,,rr��� • ;.� � vim. +.. . ' 4 AJU- Y 1 f i t .;RST ,y� �gA`�`�� r1w r ` - + w !� _ - '- _ j.: '�^-�.a•�:..Y c°"'.r.,,3 �y�i 'cam �h+3 � -§`� ,� '~� ..Ri yip• 9 v. t _ 44 t i 16 F t r 3i s.,f A (3)Mii1s/Johns Residence a z' v s; '�' "t i 's "r#0 Taken Jan.25,2019 Looking NE i Y 1 , R , r-� w r'• "?'Y:. - y +elC (4)Mills/Johns Residence •7 ;i � -' Taken Jan.25,2019 Looking SE AMIN f t � IrI All ,tom �, �Ai G a;- ,���g• i�l) � ' A - s ' R '. •� ,-4 .t��-1 a �rff, I :_Y rr• C `s.6 �.��� Y-✓ _ ` ��''�14- x. - ��_- f�-fir+e 7 s :,�,{-,�`i �C.,, - �� rs ' Rq 1-5 4v Rl - {��•�.+"..��'yt"•'l �.^,' �'L •! .moi �Y`� ♦� � lei—f°� 1tNv� " i,.�4�/�►.� fie.. .Y - "'L SM �� ,,k - ... \�. yet _ OL Ilk- T� I 1 ySl 51 .41 r,.- .5.,.• _ tai.'D �. _ , r `., ♦L rl r 4 r�-=s �;, 3 � °i 1 ...i`' J� .�i�i� ! 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OA ) 41 21Y1 BAY O �e • J m e �,a 3w ,n., S.,F � n n � � � b � O ' m a3 a 'b1A'a qNC a.r >n _ 1 ��� ' ♦ J.10 n" �� HDR e � � $ —.. -__ —•a—< 20 k' 12_ 39 4i " 12A(c)� LprFN eacEr m ,� 31 mta r _n, 1s• 'b� 209 ]AA NOTE "' 29 43 r.E AN A~ENT 1 14. n, 32 M • m ! wn1 I a N CONgTKIN Ex sTS 1)Alc) w I),0 3• a 9E1EN PARCELS f,2 ny -a 1128 •' 33 W992-0p110 OpJ.9 wpy�A a w no1s1 15w 33 w ij 4.4 n, 32 H -"' 12A(c) ^r 31 w A I,) E a 51 m, 20.11 • @ 1620 - "a^" 3, 70.12 221. x 211 r w 52 a a �_ 117.4 a 24 f -wc) M >e a n+>' Q O 9 tm aNGNCIMOl1Yr �" a o' 19 O g �a a D 37 s i +9 m y r,a 37 n: a F S „ se a \ 4 y .14 xoA r „ w 17.31 w Ig a m "s1 114.4 m 1dA 7.3 - Hh m 1 12A(c) n'1(c) ` iIA q xt Towrl or SIXfrNOLD k T a ?3 ry ?a TS 1 M D '7 +° A 200 1]20 ^ 72 fil g a+lA(c) fn, 4 163 f m I 1pA1�) ra 1 n21 22+ Zq w 1.G 2a m ,w 2t Z 82 aP 11Nc1 f.3Alc1 G 19.1 w F I f) 71 Z 2S1 O 251 ^ " Aa Q MYclalr� _ I.1yc) 20.11 1 J F to 11 _ 1722 1]19 m m rr $ O ay SQ NO U 1 a Z cl a 1.0.1 SIA , r ; r 71 g 1 q4i t9A N. 9ArnEw 18 ss E es 1M(q T2A(cJ 12A(c) cr 149.4 'moo I ms tw Re +SNc) I.S1(c) iSA(c) 131(c) 154(c) 41 2 "tN I 191 9 $ 2)A t.1A(c) 1.oyc1 3 4 M 9 10 t+ 13 w 13 SZ a S3 •,� as 5 a 111 122 e ¢ a © a 29 w 14 sl w$ 2 n• 3.8A rw_ ,o a 11,31 219.4 I7 �'�AD 4., a8 `"25 a bq _gg TOwN or soufNan b a, •QR b y wy slg{ 19 - w.oNc) 1 2g w ZM 2, 8 ^�, I,k/ In a v 6.y w 114 r ) sr +e - ," 124 123 a Lb w w Zn1 M 14 ^ / M 4> g2 M g m 4. 4.n1 b n� b � X90. � � Zrw � �' e � i � ",i I�I• ��b�➢M w 34 3S "bu , 6 A, " "' 132A W€ w - ♦, i^ WTpI---�--- LINE-wn 9 AIATCN Z" SEE SEC.NO 099 �a ' 9 SEE SEG NO 099 L. �.— •�---u- ^^ r�- ---- — rb ngnc COUNTY OF SUFFOLK 0 x E p.,�� —zz .....a.o....� Izt) m... O2 "- .. Property Agency aw.ab.�N.re.A,... so,t711oLo SECTION NO "« 4"4"44" r� G """' _ Pro --- E ..�,..._ Real ax Service r ' AMnw14..NV Nw, m ' 3 OFFICE LOCATION: �rg S® �® MAILING ADDRESS: Town Hall Annex �® �® P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) CIO Southold, NY 11971 Tel 631 765-1938 ® a Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: April 10, 2019 Re: LWRP Coastal Consistency Review for MARIAH MILLS & KEVIN JOHNS SCTM# 1000-79-4-27 Michael Kimack on behalf of MARIAH MILLS & KEVIN JOHNS requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a proposed 995.76 two-story dwelling with 574.08 sq. ft. attached garage; install a sanitary system; install gutters to leaders to drywells on the dwelling and garage to contain roof runoff; with a 1400 sq.ft. gravel driveway, all structural components to be located greater than 100 feet from the landward edge of wetlands. Located: 1410 Brigantine Drive, Southold. SCTM#: 1000-79-4-27 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 provided the Board considers the following recommendation: A 37 acre parcel owned by the Town abuts the rear of the parcel. 1. Establish a vegetated, non-disturbance buffer landward of the freshwater wetland preserving the trees to further Policies 4 and 6. 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 Michael J. Domino, President �o�aSUFFQ[K'002 Town Hall Annex John M. Bredemeyer, III, Vice-President._ o 54375 Route 25 Glenn Goldsmith N P.O. Box 1179 A Nicholas Krupski ti y . - o� Southold, NY 11971 Greg Williams ��l , �a Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES TO: ' SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS SCTM#: Property Owner Name: I�ttl✓GTO JAN 2 9 2019 5I t�15 Date Sent to Bldg. Dept: I,2q`Iq T. The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? will, any part of this application be considered a Demolition as described under Town Code? COMMENTS: t/ hq ignature of Reviewer Date 0,0P����/.4LS Michael J.Domino,President �` � „iz,F` Town Hall Annex aw;"� John M.Bredemeyer III,Vice-President ya, �?s ' '�1 `, 54375 Route 25 P.O.Box 1179 Glenn Goldsmith " . 3i; ` s' 9 Southold,New York 11971 A.Nicholas Krupskit Telephone(631) 765-1892 Greg Williams . <° i7'`' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES STEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application ,,,Wetland Permit Application dministrative Permit Amendment!Transfer/ExtensiopZgr t� Received Application: I Received Fee: $ 100 40 Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: -- ---- - Coordination:(date sent): 2tLWRP Consistency Assessment Form Sent: 3` ;`T CAC Referral Sent: Date of Inspection: ��12 �'I JAN � Receipt of CAC Report: ' Technical Review: Public Hearing Held: ;31 Resolution: -- Owner(s) Legal Name of Property (as shown on Deed): Mailing Address: /ygi�G•t7�� M/LLS e- //N TUh�iVS' Phone Number: .?060 A/aAW k_Z2, Q�e��RT 41,V Suffolk County Tax Map Number: 1000 - 79_ 04� 2!7 Property Location: Z4/�J ��PlG.�1 �"/ �AgeZ�/� SC�7�0 N Y ,/l 9 711 2 9e9 A57 ` r-0 SW Q?9 C 9/G 6E 6441 (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): M/CA,�,E� 4_At/M� lVC Mailing Address: S'OU7-41,01P IVY OFF Phone Number: LQ07 Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: V4,C 4 All' Intended use of property: O�P/� Covenants and Restrictions on property? Yes _y No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? )C 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 __>g�_No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date -No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): C'O&l`T,etl .4 /IAA yWOO s �x,76-0 S IV,4 US'4i �l4oa s� C S 6 Board of' Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 7�d CONS,er"Cr� Area of wetlands on lot: _1200 square feet f0 Percent coverage of lot: /.� �% Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: low feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? 4cubic yards How much material will be filled? ®Z 4 cubic yards ¢� -PropDepth of which material will be removed or deposited: 7-8 feet A/— Proposed osed slope throughout the-area of operations: F Manner in which material will be removed or deposited: EXC,iQ V4 Z 0/ll ,t5 < r AW e�_Q fit! 0V09 L a� &AtL4 5y iz YE 12r1IV! allrk_2 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): s S a Na,' 8,454 1-25_ •4N /SJ'U&C • r//ACLr 0,77 AHCl 5V,FP ,qT" Y 6 7 0 r CGOS,5S PDlA17,' fl 61Z20 Appendix B Short Environmental Assessment Form Instru6tiotis-1'or Completing Part l -Project Information. The applicant or project sponsor is responsible.for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: MIS • 646 ",Q Xu/ ,QAC Project Location(describe,aannd attach a location map); / B� G/ 7 Brief Description of Proposed Action: ' 6 r'e0CrA AIAW Tw d f] rn)-"' 1.el'o .�n�o. G��.O G,� - CO3V.r,27�8"x " �1Vv z3'i� Jac Pe avoasop G.�•�YEG �,�/►/ � o l 0 r,,), N�cuJ-1rVnC sy57-�M y� s s 60 sem® 15 7. 84 Name of Appl icant or Sponsor: Telephon!VA 14-8_ (S R 0 7 E-M &KC1 / ./Il Address: Q Q City/PO: State: Zip Code: �Oawznzaw - Al 1 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ,"� ❑ 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: 1VyXp5c- Jl'JKA�VZ COU/✓7Y ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the,applicant or project sponsor? ,57,5 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑'Urban ❑Rural(non-agriculture) []Industrial ❑Commercial tKResidential(suburban) ED Forest ❑Agriculture E3 Aquatic ❑Other(specify): .._._._ __, ❑Parkland Page 1 of 4 5 Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ■ M ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify )7iwk6J ._-//4n ,R XA.44, I0—/�sC_—-_ — M 1571 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES IFI I b.Are public transportation service(s)available at or near the site of the proposed action? � ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? LXJ ❑ 4.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. T _ � _C'DlliUcFJ 01 ES4_ACC�S_ _-._.__.._._ ..._.... ... 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 Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered?rl&,eW_011MJ/`1lWA" ❑ 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? NO YES ❑ b.Will stone water discharges be directed to established conveyance systems(runoff and st rm drains)? If Yes,pbriefly describe: NO ]YES Page 2 of 4 1 S. 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: _ _ ME] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: �f /�✓ ,4 C� Date: — � Signature:_ ?! Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community9 (� _ 4. Will the proposed action have an impact on the environmental characteristics that caused the t(—[t ❑ establishment of a Critical Environmental Area(CEA)? E} 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? El 1:1 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? t_1 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? _ 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, F1 Page groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. W ill the proposed action result in an increase in the potential for erosion,flooding or drainage El (� problems? u _ 11. Will the proposed action create a hazard to environmental resources or human health? F ] 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. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 A.PPLICANT/AGENT/R]?PRESENTATIVE TRANSACTIONAL DISCLOSURE FORM rhe Town of Southold's .'ode of fahics prohibits conflicts or interest nn the Part of town officers and employees The purpmtr cat this forst is to provide information ahich can alert tltw town r1,�(iobsL,conflicts or interest and allow it to take whatever;fiction is necessary to avoid same. YOUR NAINE' —_•,��J�[.�_- /t'JIi�/iQ��—s,'T (Last name,first name,middle initial,unless you are applying in the name of someone else:or other entity,such as a compan).li so,indicate the other person's or company's name.) NAME OF APPLICATION, (Check all that apply.) Tax grievance —_ F.uilding �! Variance _ Trustee Change of Zone _� Coastal E-osion —_ Approval of plat Mooring Exemption from plat of orficial map ____..... - Planning _-- Other (If*'Other",name the a,tivtty) --__ --- ------_ _ -_-- _—__--_--- Do you personalh•for through your company,slx)use,sibling,prenl,or child)have a ielatiow,hip with crit'011"cu•or rinld r,ee of the Tawe of Suuthold'i "Rel.ltronahip"includes by blood,irttirnage,m busam-s uttciest."leu rtcss uttcrcsl' 11•:,111,a I,u,nte,., including a partnership in which th•.town officer or;inployee has eve i a paetial uevnership of(oi cir.pllyntcnl by I.t eurlu t.tunl in which lbe town officer or employee owns more than 5"„of the shares. YES _- NO __ _--• It you answered'YES",complete the balance ofthes form and Cate and sign where indicated. Name of person employed by the Town of Southold Title or poaition of that person Describe the relationship between yourself(the apprr4attt/agenViepresentative)and the town officer or employee Etcher Jhec,k the appropriate line A)through D)and/or descriN -in the span:provided, The to"n officer or employee or hip or her spouse,sibling,parent,or c iild is(check all that apply) __A)the owner of greater than 54o of the shares of the auporate stock of the applicant (when the applicant is a corporation), 13)the Ictal or beneficial owner of any interest in.t sou-coiporate entit, (alien the applirvn is riot a 1.ur]')orruron); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this S day of 2Q49_- Signature_— j,r4 _ �— Print Name_ blio e/A).! Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL ]DISCLOSURE FORM fhe Town of Southol(rt C-pde of Rthics prohibits conlTrcts of interest on 11 c )ir tf'town officers vtd employccc rlie mr ttiS i nl_' lhjs form is to fg_ovide i t imnntion whiolp_eitn alert tho townof ISSssihle conflicts of interest na(I nllow it to take wlintevcr,iclion n jiecessary to avn d smut. YOUR NAME: _ 4I/`Jf/SI i_ kjE _— (Las name,first name,.riddle initial,unless you are applying ill 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 Lone , . Coastal Erosion 4pproval of plat �__•__ Mooring Exemption from plat or official map Planning ether ,lf"Other",name the activity.) Do you personally(or through your company,sponse,sibling rtrertt,o child)have a relationship%villi anN officer ui oro ft nr of the Tov,n ol'Nouthold? "Relationship"includes by blood,marriage, x-busiue:•s interesl."business interest' meaus a hu,utr,,, including a partnership,in which the town officer or employe-:hes ever a partial ownership of for employn,cnl hy)a an1101 1111)11 in which the town officer or employee n,vns snore thus 5",,of the share:, YFS _ _ NO It you answered"YES",complete the balance ofthis form and date and sign where indicated. Name of person employed by the Town of Southold Title or positron or that pe,son Describe the relationship I-etween yourself(the applic•trtt/agentirepresenlalive)and the town officer or employee.Enna oici k the appropriate line A)through D)and/or describe in the space provided ]'he toA n officer or employee or his or her spouse,sibling,parent,or el-ild is(check all that apply): A)the owner of greater than 5'*of tile,shores of the coi-nate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest it it non-coipura•e entity(when the npplicont is nDt a corporation); C)an officer,director,partner,o•employee of the appl.cast;or D)the actual applicant. DESCRIPTION Of RELATIONSHIP Submitted this Z5-dda f C1nvaf 20$1131 Signature_i — .�-- Print Narrcij AN _ Form TS 1 APPLICANT/AGENTWPRESENTATM TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Fthies prohibits cnnoiets of interest on the part of town officers and employees The purpose o#' lhts Cnrnl is to provide inforimation Whirlyoun alert town of nossthie oonfltets oCintgrcct and allow it to tale whatever action is tne_eeSsarry to avoid same. n ° YOUR NAME: , 1J1,A� _,C1L�� (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 !C Variance Trustee Change of Zone Coastal Erosion Approval of plat _ Mooring Exemption from plat or official map Planning Other (If"Other-,name the activity.).--.— N �__�-- Do you personally(or through your company,sponse,sibling,parent,or Child)have it relatiorWiip with any officer or employee of the Town of Southold? "Relationship"includes by blood,tttarriage,or business interest."Business interest"means a husinesl, including a partnership, in which the town officer or employee has even a partial ownet•sliip of(or enlpioynlctlt hy)a corporation in which the town officer or employee owns more than 5%of the shares, YES _. NO X, 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 eheck 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°,''0 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 nota corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2 day of /VCJ 20//j Signature Print Name Form TS I Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, Mig5-j--F N iTQHNS ------ owners of the property identified as SC'TM# l0o0---7 9— 04-2 7 in the town of S`DUJr'��1-D , New York, hereby authorizes ZI H ,4nt _ 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 Owners Signature Property Owners Signature HAR/AW J- HIZIL) k€Y/N atliAlg SWORN TO BEFORE MF: THIS 29 DAY OF . 20_/ !� &I I—�?WA Notary Public MICHAEL A.KIMACK Notary Public,State of New York No.02K15056823 Oualified in Nassau County Commission Expires March 11,2022 Board of Trustees Application AFFIDAVIT H.4RI9H .7_'At/LLS K fC,FVIA/ ,;T g3 S_BEING DULY SWORN DEPOSES AND AFFIRMS THAT,HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PEILVIIT(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 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 AGENTS) 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 COMPLIANCE WITH ANY CONDTI'ION OF ANY WETLAND OR COASTAL ]EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE: TERM OF THE PERMIT. Sig ature of Property Owner Signature of Property Owner HART 4�N ,r, Afl�:L S 1eZV/N �T oHNS SWORN TO BEFORE ME THIS z g DAY OF_� �_. 20 _ Notary Public MICHAEL A.KIMACK Notary Public, State of New York No.02KI5056823 Qualified in Nassau County Commission Expires March 11, 2022 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 signilic�ult 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 nou- 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# PROTECT NAME -l�L `®�i�/S a�(/�'LU ®l,U />✓1 ,� c G�,t'�Ila The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees IZN I. 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: CpyS),,-e0 ' 11/,�leu 'TGUO A� .13 Avll o(/Sv I �� H AMP ?3111" k Z410�ls7q.od SFS G�4�Al�,` l�lzo�®s�� G,C�.�7V,�G .�Ivf�.�y p G U-7, r0r19 L BUSS 44 GhAe4GC- S"ist:'t /J-6 ?,84 S - Location of action: 1410 Bid' jAN/ZA125 PtLr-. F_6&V7&A_ Site acreage: �. 7 Present land use: VACAA_1 T Present zoning classification: Q 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: /'-1/LL,_, VW -owNS (b) Mailing address: 60 /A M,ADL (c) Telephone number: Area Code( ) 69 (d) Application number,if any:--A)/A 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. 4J Yes ❑ No ❑ Not Applicable Tm,_ & QEQ, ,- ,O�S%_ & /s JAI �,Z,9.RIyc� J/ /IAZ6I IAv �� 2 0r o os 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 D!!�7sJ,Not Applicable ZO /S lVo &araZo "A "Ch/f "0406/ Cid, )O 'S'600:4 ' Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ® Not Applicable /d /) Al or P.t116,4 V-4VA l— ZMe"r 0.j�: 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 ❑ Yes ❑ No 9 Not Applicable MU CY 4 A10Z-"ZV1 W BlEV 27W-9 P96�C7 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 LNKNot Applicable epy 07- cx-azz 7M 7rnD ?&O-AW 90C 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 Applicable cx`CY 6 &o AL C C 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 F Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWl2P Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No l/J Not Applicable N PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye�] No Not Applicable S � C 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,® Not Applicable PDL/Cy /D�SCa_�' 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 5el 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 Z Not Applicable .86419X / PREPARED By -OUf C1yp,A5/ A r/M,4Ce TITLE 6,CN7--- BATE"26za?