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HomeMy WebLinkAboutTR-9509A Glenn Goldsmith,President ' 'vg so Town Town Hall Annex Michael J.Domino,Vice-President ,`O`k 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski y ,r G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 �y00UNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1748C Date: September 8, 2020 THIS'CERTIFIES that the installation of 468 feet of 4' high"Estate Style"fencing around perimeter of property,with the waterside section of fencing being installed 24' landward so that it is installed on top of existing wood retaining wall thereby reducing the overall footage of the fencing to 43 8 feet, At 900 Holbrook Lane, Mattituck Suffolk County Tax Map#1000-113-6-11 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 5, 2019 pursuant to which Trustees Administrative Permit#9509A Dated August 14, 2019, was issued and Amended on August 19, 2020 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 installation of 468 feet of 4' high"Estate Style"fencing-around perimeter of property,with the waterside section of fencing being installed 24' landward so that it is installed on top of existing wood retaining wall thereby_reducing Lthe overall footage of the fencing to 438 feet. The certificate is issued to Constance Vickers owner of the aforesaid property. Authorized Signature SOF -. Glenn Goldsmith, President SO�rTown Hall Annex Michael J.Domino,Vice-President ,`O� Ol0 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 olyC,OU ,� - -- - ------- --- ------ -- - - -BOARB-OF-TOW-N-TR-1JST--ES---------- ----- - - --- --- ---- TOWN OF SOUTHOLD DATE OF INSPECTION: q 2020 INSPECTED"'BY:T - +,s - . Cli- 275 . faY Ch. 111 INSPECTION SCHEDULE Pre-corlstudtoniz-h'aybfale,linefsiit bdotrfsilt curtain 1 st day of construction constructed Project complete, compliance inspection ,PP MMEIyTSi 8 v',1$Y A, c oca o��� ,�;��• te r,►�' # 9 5®q'A .. a CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President QF S0(/jTown Hall Annex Michael J.Domino,Vice-President ,`O� ��0 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 �yCOUNiY,� BOARD OF TOWN TRUSTEES August 21, 2020 TOWN OF SOUTHOLD Jane P. Costello Costello Marine Contracting Corp. P.O. Box 2124 Greenport, NY 11944 RE: CONSTANCE VICKERS 900 HOLBROOK-LANE, MATTITUCK SCTM#: 1000-113-6-11 Dear Ms. Costello: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 19, 2020: RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment_to_Adronistrative_Permit#9509,to rhove waterside,section of fencing 24' landward so that it is installed on top of existing wood retaining wall, thereby reducing the overall footage of the fencing to 438 feet; and as depicted on the site plan prepared by Costello Marine Contracting Corp., received on June 18, 2020, and stamped approved on August 19, 2020. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, O� Glenn Goldsmith, President Board of Trustees GG/dd J. v i , ,u,oeil�yA/y.5. .v�c. /x¢738-032/0000z 4c%1 GG. 3 , JUN 1 8 2020 Sl;,'roG_ r;l,an C'ovS7'•4.vc� G ViG«25 —bard of . .>of r''¢��-•��o far: 2 r�©..sox 2/24fyR�C.vPe.�.T,N•y��94�,• ScT.�- /Goff-�l�- 6-�� las• �f17-ii�i►y 020 SAla=—c—T 2 ®g= C1 Aar&C' N 720 , ,� ¢►,a¢o�cToY..�w�T�4�.e5T � ���j�h/�✓E Sc��dAa 71 14-)l 117AG 11-771 nir `a�/�NTdC�N� N•�/ l�7`�'3 �'t��6t.vCE C.A1iC/GST=S 4 t4 l d�. •✓ 2!2 02® 7/,9 2O/y 1 JUN 1 8 2020 co/oz/202,0—� svil!6d, Burt J nlos9.� � /G�•9o� Al , q • � t! � rg� Y Pi@oTcClg=n °v�, �f2�ai .APPROVED Bt, ,Im BOARD OF I RU5TEE ��s� OeNN 'OF SOUTHO DAT A'+,t sx' �l ill 2020 /67 fc,�i € L/VJ�&VL6oR�G�rQ:�' •'^•� TIM �.fs�aanr<rs�,.,rT�cs; �f3�rr.©�q 8�•$ av J N 8 2020 -i'>,11777 �ocN Taro,/ A77/T�Ga.: Michael J. Domino, President Town Hall Annex John M. Bredemeyer, III, Vice-President ,r"� y1 54375 Route 25 Glenn Goldsmith r N z (' P.O. Box 1179 A Nicholas Krupski y ;t:Y Southold, NY 11971 Greg WilliamsTelephone (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 '/z constructed When project complete, call for compliance inspection; Michael J.Domino,President �QF so�ly Town Hall Annex John M.Bredemeyer III,Vice-President ,`QOl0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith l�[ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 �< 00UNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9509A Date of Receipt of Application: July 5, 2019 Applicant: Constance Vickers SCTM#: 1000-113-6-11 Project Location: 900 Holbrook Lane, Mattituck Date of Resolution/Issuance: August 14, 2019 Date of Expiration: August 14, 2021 Reviewed by: Glenn Goldsmith Project Description: Install 468' of 4' high "Estate Style" fencing around perimeter of property. 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 Costello Marine Contracting, dated July 3, 2019 and stamped approved on August 14, 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 Michael J. Domino, Pre si '\s o��SQFFt1(,�COG ? - Town Hall Annex John M. Bredemeyer III,Vice7'resident tya - 54375 Route 25 Glenn Goldsmith cmz P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 1 0A 3 3 o Completed in field by: G. Co)ods Ml Costello Marine Contracting Corp., on behalf of CONSTANCE VICKERS requests an Administrative permit to install 468' of 4' high "Estate Style" fencing around perimeter of property. Located: 900 Holbrook Lane, Mattituck. SCTM#: 1000-113-6-11 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. 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 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: Perles_ .s ap�c'oX�c�,o,�e`y 1� �co� P�� o� weTlan�s I have read & acknowledged the foregoing Trustees comments: Agent/Owner; Present were: ✓ J. Bredemeyer V M. Domino f G. Goldsmith ✓ N. Krupski °t/G. Williams Other i J U L 5 201 aas ��•®c..�d�T.'i �`i11c. - ,.rex R LA = 4 MIN KIDa Es 7 ams _ -� � v�'• 6�®INKS sass n N� NS • ;r—p;e-®—je C TUCK CUB= paCZ tes ¢4AJCj"j6. �� MaLDteC Osl,in _ 73 t�Ea� aaY S 4o.4rvy ,- can Cncrn ' FAat�cY 90 —YC 4"uel4'yx � LAUREL _ dmxYads M 3 25 zg i t 4A 10 V JUL 5 2019 Southo,i Maw. JUL 5 2019 Tul'I'l gj APPROVED, B IRUSTE S -,'8OARD OF -TOWN,;'OF, SOUtHO .D DA FE, A(msT- )*, 20 jq-, N7 14W A7 J'5':sr4'f-C=/,Q /,=->, 11777 S.C.T.M. NO. DISTRICT- 1000 SEC71ON: 113 BLOCK: 6 LOT(S): 11 C DD .......... JUL 2019 0g 0 ie LBR 6K7`---'--- ." 81 LANE 268.7,31 3 (YOUA'G'S'Wo'qr Of'WA� ­S-Otfidd�Tbwp :z G. 101.90, U.P. Pnard,JTrustee— BLUE STONE DRIVEWAY 0) ti % LU O t�j IAV .... ....... L4. .................... ............. N'OFNIF 4. 25.6 ROCHE PROTECTION TRUSTLAND01F N 0� A ROOF BENZION OVER .............. ............ EORESS .......... WINDOW way ............. ............ ............... ............ .................. ENE ... .... {:o . ... .. t X ........... . . . ........ 24.5' ... .................. .......... ...... ....... ..... ..... ................. Iv OR WOOD DECk IV 84. '48 (77C ALONG 8S-971 HOWARD'S BR,4/VCH AM7TITUCK OF CREEK THE WATER SUPPLY, WELLS, DR YWELLS AND CESSPOOL 5 FIXED DOCK LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 31,115 SQ.FT. or- 0.71 ACRES ELEVA 770M DATUM: UNAUTHORIZED AL TERA 77ON OR ADD177ON TO THIS SURVEY IS A WOLA 77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA 77ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING 774E LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED Td BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO 774E PERSON FOR WHOM 774E SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777Z-E COMPANY, GOVERNMENTAL AGENCY AND LENDING INS777V770N LISTED HEREON, AND TO 774E ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM TRE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD1770MAL STRUCTURES OR AND 077YER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: CONSTANCE VICKERS; MAP OR FILED: SITUATED AT: MATTITUCK TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 SCALE: I"=40' DATE: DEC. 5, 20'—, PHONE (031)298-1508 FAX (631) 298-1588 FILE # 18-136 18 N.YS. LISC. NO. 050882 maintaining the recorde of Robert L RonnosiW & Kenneth M Voychulc . . of s 'op � ! eN ,� 900 Hobook En r' f a e ;. _ ,• f '`�''.� Oxy` �.��. "w' ,.y.y" ,��� � A•� � ., � a '� Google Earth k k r S " IF i� Gomgie Earth, '• C• .• •, . • •• � • - . 111 Client: Constance C.Vickers Location: 900 Holbrook Lane,Matti c, NY 11952 Date: July 2, 2019 Photo 3 , f k 3 ' ,* r i jv3 ,�, E? � ftL y�'.' ,c� ,�+j�!�'A :s:, w+'3 4 'x s •,3 `e ' c �: �r 7 t> i ii ^i. �,� - e+ K "F�1�• ."Oyu.'. ''' ::i '}''�ya�y'y�,. ...�_ �-4r Z•�� � ..°�' r� ;,' !.« <:, �-�+ r` f Photo 4 -a at r wy j a ` r �tea, ,r .q °� ��' ua$r �1.•... �w. � ,�,�.y�c +n,.r.m"�,, J. Prepared by: Costello Marine Contracting Corp. 423 5th Street, PO Box 2124, Greenport,NY 11944 (631)477.1199 Phone (631)477.0005 Fax 2 Client: Constance C.Vickers Location: 900 Holbrook Lane, Matti :,NY 11952 Date: July 2, 2019 Photo 5 r � t i Photo �Y M 6 `�-C r G 1_ tt L. r�++1. '+ 4i�',��: EI:X1'1 w A n' ' ♦ 11ii1i ,iii�ijllj� � . . . . ♦♦♦` V.41',1'1;X11��A 10 ♦ ♦ ♦ ♦ ♦1♦ ''�`� d' Prepared by: Costello Marine Contracting Corp. 423 5th Street, PO Box 2124, Greenport,NY 11944 (631)477-1199 Phone (631)477-0005 Fax 3 Client: Constance C.Vickers Location: 900 Holbrook Lane,Matti, NY 11952 Date: July 2, 2019 Photo 7 { ` ' Proposed fence line 4 Prepared by: Costello Marine Contracting Corp. 423 5th Street, PO Box 2124, Greenport,NY 11944 (631)477-1199 Phone (631)477-0005 Fax 4 ♦.6 ,.= 144 1.Wc1 5EE SEC NO 10]y I 1.Wc1 ,.SNlcl UN ] UNF M a UN Y w 5EE SEC.NO.148 5EE SEC.NO. u �1C1, lY1E B1/,TC11 __ 1{ FON PCL NO. k 'TA SEE SEG. " \ TKd ,0o-9-,9 SEE SEC.NO B 1tNK1 13 ) /pB \ M1 j 5EE SM r o. FON PCL NO ♦ M1� B P ,uK 1 Q9 z T 8 ° 1]Kd � \!�' tta01m,2 I< SEE SEC.NO. .]'. j1 10501ABBJ ° mi M1' ,A-) 9Wd '�' ,°w Y O'�yL� 1lu4`s0h's • 5 -Pe ] x c � � © /� � /'- / ♦ e 1 ' � a B T B e • . w . i I °�� 4" ♦ fYAU .� � r /.rr�'—� Til,••- � w OF ug 10 °? 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) cPs Southold, NY 11971 ® �Q Telephone: 631765-1938 ® Fax: 631 765-3136 �ycOUNT i LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: August 13, 2019 Re: LWRP Coastal Consistency Review for CONSTANCE VICKERS SCTM# 1000-113-6-11. Costello Marine Contracting Corp., on behalf of CONSTANCE VICKERS requests an Administrative Permit to install 468' of 4' high "Estate Style" fencing around perimeter of property. Located: 900 Holbrook Lane, Mattituck. SCTM#: 1000-113-6-11. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the, Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore 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 John M.Bredemeyer III,President `° Town Hall Annex Michael J.Domino,Vice-President �° � 1 54375 Main Road P.O.Box 1179 James F.King,Trustee _ xa _ Southold Ne York 11 1- w 97 0959 Dave Bergen,Trustee Telephone(631)765-1892 Charles J.Sanders,Trustee Fax(631)765-6641 BOARD OF TOWN TRUSTEES . TOWN OF SOUTHOLD ® E E V E Office Use Only JUL ` 5 2019 _Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Southold Towrn _56 Received__ Applicat' n: 7�9 - r o Tr C ►" Received Fee:$ ,��®,DSI _� , Completed Application ?.l . _Incomplete �SEQRA Classification: Type 1 Type 1I Unlisted Coordination:(date.sent) S�244 _/'_LWRP Consistency Assessment Form ZAC Referral Sent: Date of Irtspectinn: Receipt of CAC Report: _ ^Lead Agency Determination: TTechnical Review: Public Hearing Held: _��Z Resolution: Name of Applicant CONSTANCE C. NqYMZ!!� ✓1 CK6k-S Mailing Address 10 BELL CIRCLE,BELLE TERRE,NY 11777 Phone Number:( ) (631) 721-3889 Suffolk County Tax Map Number: 1000-113-6-11 - Property Location: 900 HOLBROOK LANE,MATTITUCK,NY 11952 (provide LILCO Pole#, distance to cross streets, and location) AGENT: COSTELLO MARINE CONTRACTING CORP. (If applicable) - Address: PO BOX 2124,GREENPORT,NY 11944 Phone: 637-1199-1199 Board of Trustees Appls �Ltioa GENERAL DATA Land Area(in square feet):31,115 SQUARE FEET Area Zoning:R-40 Previous use of property:SINGLE FAMILY RESIDENCE Intended use of property:SAME-NO USE CHANGE 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 Does the structure(s)on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency Date TOWN (11-88-113-6-11) 4/4/1989 TOWN(CO- 0243-C) 8/27/2007 TOWN(TR 6034) 11/17/2004 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):_ INSTALL 468 FEET OF 4-FOOT HIGH "ESTATE STYLE" FENCING AROUND PERIMETER OF PROPERTY. Board of Trustees Appli< ';ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: TO FENCE IN YARD TO ENCLOSE BACKYARD AND KEEP CHILDREN AWAY FROM THE CREEK. Area of wetlands on lot: 1,020 square feet Percent coverage of lot: 3.2 % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 100 feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: 0 Manner in which material will be removed or deposited: ALL WORK WILL BE PERFORMED BY HAND. 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): ALL WORK WILL BE PERFORMED LANDWARD OF THE HIGH WATER MARK AND LANDWARD OF THE WETLAND BOUNDARY LINE. NO ADVERSE EFFECTS ARE EXPECTED. Board of Trustees Appl Ition AFFIDAVIT Q l 001jG-1B-ft(Q:E . J ' f 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 SOUT_HOLD 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 COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS IS DAY OF JU ILI 20jq FLORINOA SAWY108 Notary Public NOTARY PUBLIC STATE OF NEW YORK QUALIFIEO IN SUFFOLK NOMBA5076825 22 COMMISION EXPIRES.041201-2-023 Board of Trustees Appl Ltion AUTHORIZATION (Where the applicant is not the owner) I/We, C'®WSr?+aC-e- 0, �� C owners of the property identified as SCTM# 1000- l.3 ' /0 in the town of A f} 2'rV CIC ,New York, hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF U r , 20_Lq FLORINDA BATUMt ` _ NOTARY PUBLIC STATE OF NEW YORK Notary Publ' QUALIFIED AsSUFFOLK COMMISION EXPIRES:04120/1013 i APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM Ih.c Town of Southold's Code of Fthics prohibits conflicts of interest on the part of town of t ers and cmnlovees.Titc purpose of this form is to provide inforination which can alert the town of possible conihcts of interest and allow it to take whatever,action is Degessla to avoid some YOUR NAME: VICKERS, CONSTANCE,C. (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 relationship with any officer or employee c of theTown of Southold? "Relationship"inludes by blood,marriage,or business interest."Business interest"means a business, including a partnership,ia which the town officer or employee has even a partial ownership of(or employment by a corporation in which the town officer or employee owns more than 5%of the shares. 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 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(whets 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 A2 lay of Jit 200 L( Signature Print I CInc g Gjq-(- Form TS 1 APPLICANT/OWNER 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: COSTELLO MARINE CONTRACTING CORP. (Last name,first name,middle 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.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit X Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. 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 applicantlagent/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 that 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 this day of J it, 20�( Signature Print Na ane Costello for Costello Marine Contracting Corp. f • 1 617.20 Appendix S Short Environmental Assessment Form Instructions for Comnletin� 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: VICKERS PROPERTY FENCE Project Location(describe,and attach a location map): 900 HOLBROOK LANE,MATTITUCK,NY 11952 SCTM#1000-113-6-11 Brief Description of Proposed Action: INSTALL 468 FEET OF 4-FOOT HIGH FENCING AROUND PERIMETER OF PROPERTY. Name of Applicant or Sponsor: Telephone: (631)721-3889 CONSTANCE C.VICKERS E-Mail: CVICKERS1976@GMAIL.COM Address: 10 BELL CIRCLE City/PO: State: Zip Code: BELLE TERRE NY 11777 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 P/1 F] 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: ❑ PERMITS ARE REQUIRED FROM NYSDEC AND TOWN OF SOUTHOLD 3.a.Total acreage of the site of the proposed action? 0.733 acres b.Total acreage to be physically disturbed? 0 0117 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.733 acres 4. Check all land uses that occur on,adjoining and near the proposed action. Urban ❑Rural(non-agriculture) ❑Industrial [—]Commercial m Residential(suburban) ❑Forest OAgriculture OAquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑✓ ❑ b.Consistent with the adopted comprehensive plan? 7 ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ Z 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 ❑✓ ❑ 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? ❑✓ ❑ 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: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ Z 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ OUR PROPOSAL DOES NOT INVOLVE THE PRODUCTION OF WASTEWATER. 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? 7 ❑ 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: THE PROPERTY IS SITUATED ALONG HOWARDS BRANCH OF MAT UTUCK CREEK. 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: m Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional m 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? ®NO []YES ❑✓ ❑ b.Will storm water discharges be directed to established conveyance systemsrunoff and storm drains)? If Yes,briefly describe: NO AYES 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: Z ❑ 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: P1 ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spo or name: CONSTANCE C.VICKERS,OWNER Date: 7/d 3 Signature: t�.S a, 1Z1, 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 El 1:1regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El 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 F1 1:1affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: F� El 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, El 11architectural or aesthetic resources? 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 Y _ 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 1:1 ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El 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 environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date 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 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 si iigi fl 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 ansiver must be extilaindd in detail, listing bath sunnorting and non- suuportine 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# 113 6. - 11 PROJECT NAME VICKERS PROPERTY FENCE The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees V 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: Nature and extent of action: INSTALL 468 FEET OF 4-FOOT TALL BACKYARD FENCE. • Location of action:900 HOLBROOK LANE,MATTITUCK,NY 11952 Site acreage: 0.733 ACRES Present land use: SINGLE FAMILY RESIDENTIAL Present zoning classification:R-40 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:CONSTANCE C. VICKERS (b) Mailing address: 10 BELL CIRCLE,BELLE TERRE,NY 11777 (c) Telephone number:Area Code( )(631) 721-3889 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 91 No❑ If yes,which state or federal agency?DEC 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 OUR PROPOSAL IS TO INSTALL A 4 FT HIGH FENCE TO THE BACKYARD. THE FENCE IS MINOR INNATURE AND WILL NOT HAVE ANYADVERSE EFFECTS ON THE TIDAL WATERS OR WETLANDS. OUR PROPOSAL WILL HAVE NO EFFECT ON THE COMMUNITY CHARACTER, OPENSPACE OR INFRASTURCTURE. 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 91 Not Applicable OUR PROPOSAL WILL HAVE NO INFLUENCE ON THE HISTORICAND ARCHAEOLOGICAL RESOURCES OF THE TOWN OF SOUTHOLD. 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 OUR PROPOSAL IS MINOR INNATURE AND IS CONSISTANT AND REASONABLE FOR THIS RESIDENTIAL AREA. THE PROPOSED FENCE WILL BE 4 FT HIGH, 'ESTATE STYLE'FENCING AND WILL NOT EFFECT SCENIC RESOURCES. Auacn aaainonai ynnnw ii ncn ca�xuy NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No © Not Applicable THE PROPOSED FENCE WILL HAVE NO INFLUENCE ON FLOODING OR EROSION OF LIFE, STRUCTURES OR NATURAL RESOURCES. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ©Not Analicable OUR PROPOSAL IS LANDWARD OF THE MEAN HIGH WATER LINE AND LANDWARD OF THE VEGETATIVE WETLAND BOUNDARYLINE. OUR PROPOSAL WILL HAVE NO INFLUENCE ON WATER QUALITY OR SUPPLYINTHE TO WN OF SOUTHOLD. 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 P Not Applicable THE PROPOSED FENCE LINE WILL BE LANDWARD OF THE HIGH WATER MARKAND LANDWARD OF THE TIDAL WETLAND BOUNDARYLINE. THE FENCE WILL HAVE NO INFLUENCE ON THE PROTECTION OR RESTORATION OF THE QUALITY OR FUNCTION OF THE TOWN OF SUTHOLD IS ECOSYSTEMS. a Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes ❑ No© Not Applicable OUR PROPOSAL WILL HAVE NO INFLUENCE OVER THE AIR QUALITYIN THE TOWN OF SOUTHOLD AS DESCRIBED IN POLICY#7. 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 0 No Z Not Applicable OUR PROPOSAL WILL HAVE NO INFLUENCE ON SOLID WASTE OR HAZARDOUS SUBSTANCES AND WASTES. 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.El nn Ye�1 No© Not Applicable THE PROPOSED FENCE WILL BE LOCATED LANDWARD OF THE HIGH WATERLINE. THE PROJECT SITE IS LOCATED INMATTITUCK CREEK WHERE THERE IS LIMITED WALKING SHORELINE DUE TO THE VEGETATIVE WETLANDS THE PROPOSED FENCE WILL NOT INFLUENCE THE PUBLIC'S ACCESS OR RECREATIONAL USE OF COASTAL WATERS,PUBLIC LANDS AND PUBLIC RESOURCES. Attach additional sheets if necessary f 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 OUR PROPOSAL IS MOTIVATED BY CHILD SAFETY CONCERNS. THE FAMILY ENJOYS THIS PROPERTY TO ENGAGE IN WATER DEPENDENT USES SUCH AS BOATING,SWIMMING,AND FISHING THESE ACTIVITIES WILL CONTINUE. 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 ` THE PROPOSED FENCE LINE WILL BE LANDWARD OF THE MEANHIGH WATERMARK. OUR PROPOSAL WILL HAVE NO INFLUENCE ON THE SUSTAINABLE USE OF LIVING MARINE RESOURCES IN THE LONG ISLAND SOUND, THE PECONIC ESTUARY OR TOWN WATERS. 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 0 No© Not Applicable OUR PROPOSAL HAS NO INFLUENCE ON A GRICUL TURAL LANDS WITHIN THE TOWN OF SOUTHOLD. 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 ® Not Applicable OUR PROPOSAL WILL HAVE NO INFLUENCE ON THE USE OR DEVELOPMENT OF ENERGY OR MINERAL RESOURCES. PREPARED BY Jane P Costello TITLE A&ent DATE 715119