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TR-9588
Michael J. Domino, President r�o�o copy` Town Hall Annex John M. Bredemeyer, III, Vice-President ,r'� 54375 Route 25 Glenn Goldsmith r N ,? k P_O. Box 1179 A Nicholas Krupski y �;Y Southold, NY 11971 Greg Williams *%;5% Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed When project complete, call for compliance inspection; 1:9.;;;ee-�." BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 9588 DATE: NOVEMBER 13,2019 ISSUED TO: 5445 PECONIC BAY HOMEOWNER,LLC PROPERTY ADDRESS: 5445 GREAT PECONIC BAY BOULEVARD,LAUREL SCTM# 1000-128-1-5 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on November 13, 2019, and in consideration of application fee in the sum of$250.00 paid by 5445 Peconic Bay Homeowner, LLC and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a private driveway from Great Peconic Bay Boulevard to proposed private residence; clearing for 12' wide by approximately 2001 long driveway; and to install an approximately 5,000sq.ft. of water line and power line within cleared areas; establish and perpetually maintain a non-disturbance buffer running along the demarcation of stones placed along the wetland line; and as depicted on the survey prepared by Kenneth M. Woychuk Land Surveying,PLLC, last dated November 4, 2019, and stamped approved on November 13,2019. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 13th day of November,2019. A John M. Bredevmeyer, III Absent cm w1 v TERMS AND CONL.s ONS The Permittee 5445 Peconic Bay Homeowner LLC 5445 Great Peconic Bay Laurel, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees,the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 11. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J.Domino,President QF SOUrTown Hall Annex John M.Bredemeyer III,Vice-President ,`O� O 1 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams '0 �� Fax(631) 765-6641 UNV,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 20, 2019 Michael A. Kimack P.O. Box 1047 Southold, NY 11971 RE: 5445 PECONIC BAY HOMEOWNER, LLC 5445 GREAT PECONIC BAY BOULEVARD, LAUREL SCTM# 1000-128-1-5 Dear Mr. Kimack: The Board of Town Trustees took the following action during its Regular meeting held on Wednesday, November 13, 2019 regarding the above matter: WHEREAS, Michael Kimack on behalf of 5445 PECONIC BAY HOMEOWNER, LLC applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated July 1, 2019, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council arid to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 14, 2019 and November 13, 2019, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 _ J WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees APPROVE the application of 5445 PECONIC BAY HOMEOWNER, LLC to construct a private driveway from Great Peconic Bay Boulevard to proposed private residence; clearing for 12' wide by approximately 200' long driveway; and to install an approximately 5,000sq.ft. of water line and power line within cleared areas; establish and perpetually maintain a non-disturbance buffer running along the demarcation of stones placed along the wetland line; and as depicted on the survey prepared by Kenneth M. Woychuk Land Surveying, PLLC, last dated November 4, 2019, and stamped approved on November 13, 2019. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Michael J. Domino President, Board of Trustees MJD/dd _ �o�guFFO(�,,VoG Michael J Domino, President Town Hall Annex John M Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A Nicholas Krupski y.�jQ ao�Y;�' Southold, NY 11971 Greg Williams s�' Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: 5445 PECONIC BAY HOMEOWNER, LLC c/o MICHAEL KIMACK Please be advised that your application dated July 1, 2019 has been reviewed by this Board at the regular meeting of November 13, 2019 and your application has been approved pending the completion of the following items checked off below. Pre-Construction Hay Bale Line Inspection Fee ($50.00)— (Silt boom) 1St Day of Construction ($50.00) % Constructed ($50.00) xx Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft) 30-Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) xx The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $.50.00 elb`��� BY: Michael J. Domino, President l%"" Board of Trustees ____EAST./__1N-EST_.ELEVATIO_N (No-t_To__S_cale) .__ .____ _ o - --------------------- 70POFROOF ----------- -- --------------- ,r' ,,-------- --------------------- � a PC l jj{ 1 ;,'' ' ( l4 JUL 2019 ti Southold sown Board Of TMSteeS ------ --------------------------------- — ___� ; , ------ I— ---- ----- -------- ---------- I ------- —I--I--- ------------------------------ I I � ,ili'j•11�''i�{Iii I. .. •. 7',J •i,,•�1� 1 •)'tl•Ilf .:,I '�I 1','i''���i.i�{I,, .i ilift'. ROOF I ---- i'4i -------------- I I °'�1i, II:Ii' ii Y!',i^ •'i'il�i�. ,�, i.,•,I I':...�,,,i'� .� ; ill i, "ji j'�.' .{''�'j' ,f:, I I •i i „ ,I'; ��.� ''•'fid" {� ,'�I n EAST ELEVATION ------ ---�-- ---------- '• _...:�:,',L�:..`:ci.... 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I'„ ----------- ------- — -------------------------------------------------------- ------ Fczsrwroz H I II h II II II II I I I I I I I I I I I --------------------- I ' 6AhENT n NORTH ELEVATION April 9, 2019 . . . i A 08 --l-GARAGE-SOUTH / W__ES_T__ELE_VAT-ION_ (Not-To Scale)- - - D E L - J U L 2019 Southold Town Board of Trustee N i M O ri OP EO � \ N O i ,1 m aoaoao 0000�o � ° 00130mMlMl � mMi 000000 o L Li 6" 61-6" 11'-0" 6'-6" 10'1 11`-10" 8" 6'-21/2" 10'-9" 8'-61/2" T-4" 24'-0" 42'-2" April 9, 2019 • - • , A 09 GARAGE_FIRST_FLQQR (N—ot__T_o__Scale) _ _ _ _ _ _ M - ENGINEE, i� E L"T EEA J U L 1 2019 Southold Town Board of Trustees i0 � N M � .-i O 91 En EO 0 `n GARAGE BATHROOM o00 WOR BENCH M O Ln rl N 4 4 M �D ENTRY N .1 l0 r-1 i n CO 28'-6" 42'-0" April 9, 2019 • • • - a , r A 10 _GAP,AGE_SECO_ND_FLO.O_R__(Not To_S_cal_e) EERING _ 42'-0" E C E V E 12'-2" 15'-4" 2'-0" 10'-6" JUL _ 1 2019 U - Southold Town ko Board of Trustees CRAWL SPACE CRAWL SPACE CRAWL SPACE M STORAGE ROOM M MECHANICAL ROOM M o N +- HALL WAY BEDROOM o N a00 bo OPEN TO BELOW 1-10 KITCHEN o LIVING ROOMC) (:D 3'-5 3/4" 6'-8 1/2" 6-8 1/2" 6'-8 1/2" 4'-10 3/4" 12'-0" 6" 28'-6" 6" April 9, 2019 • - e • 77� -C-ELL-AR .ELQ-O-R-(N-ot-To--ScaLe)- M - ENGINEERING 6-01 -01 4-7 � (D F -------T--1 1D 0, 1EN EGRESS —————— EGRESS -9Lill 2019 JUL Crete—————— 8;'rmforce,I i rct;--wgII c� ---—Southold—Town TT rF] n Pn rff of Trustees- T- V - I 1T-2' air gap Alcer 2x4 wall and concrete wa I LIBRARY II _ 444E HANICAL II 3 o oom L- II cI ) t �TTTV HOME SCHOOL BATH AREA m 10-01 N LLLL IL-1 P -F-F T VV/L MIT I I QEFI 33E S�-DRAG in UNDER STAIR I I R\ II sToRAdEl IA I I wall 11 1 IP --_ q� II I I II II I I II 24-6 I 11 - II II II I I 11 II 1 I II II 1 I II -------------- -------------- -------------- --------- I --------------- L---------------r----------------- ------------- ---------- I -------------------- L----------------------------------------------- April 9, 2019 '5445 Pecot • ';e C'm lett Locc�ition*, -I';C'Bay Horn heFLLC'-' ,,'� prpjA 04 % - _ FIRSI_FLOOR _(.Not-To- Scal_e)_ ENGINEERING _ >a�' 4,4„ 4'-V, 7C7-5' 23 6' UP Al D E C, E "V! E 1 9P li ® v L_1 N JUL 2019 \ 6' 24-2 \ $Gt;t i0i(�(UGVfI \ JD 4TT 11" �08f U{I';S!rCS I D BATH BEDROOM \ I I LMN �p KITCHENLu /D -7 = a� CL � I W.I.C. N BATH 7: LO��j a) DN UP / c / DINING W.I.C. 5 ,� i m O , � �Np 19 O @ ` 'K7-10" N / 4-5. 614' 64" 27-3" \ April 9, 2019Pro-ect Location ; A 05 4441 IL 24-2' JUL 2019 BEDROOM Board of m - 4., � SOGfI(�VJQ Q Trisslgps BATH N OPEN10 TO BELOW 6,. BATH :47- W.I.C. A �t E � 5ted railing Q� OPEN a TO BELOW 82 7-IT' 3-1T' 4'2. 3'-10" BEDROOM " DNEEEI 4' I railing Fil 10'sbpe — E STUDY zo 14'-T 444' a� April 9, 2019 Project . . A 06 S.C.T.M. NO. DISTRICT. 1000 SECTION: 128 BLOCK: 1 LOT(S):5 WETLANDS: 27,325 SQ.FT. or 0.63 ACRES J -- - C.I. LOCKING COVER TO GRADE FFL(18 2) GF(14.5) CLEANOUT 14.0) FlNISN GRADE / / / / • • ` I Nov 6 19 1'MIN-2'MAX 2 / / / / \/ / / / / / / / / / (12.6 0'MI FT• LAWN MAINTAINED BY I � / I / I / I I I / LAUREL LINKS GOLF 6'FLOFLED x (11.24) OLITI/S II 6 SLB INVERT-/ 1 FT. (11.84 INVERT / / / / / / / / DWELL(12.32) I / / / /L_/t/ ! ;(GAR.(2.48) ON W 11 8 (11.24) 3'COLLARFOUNDATI WALL POOL - - qI CLEAN �AR� I I / I I 0 6�SAND& TANK 3'MIN GRA / / / / / / w � MAP OF LAUREL LINKS ¢110712 USE 4' DIA. APPROVED SEWER PIPE / / / / M FILED NOV. 23, 2001 2250 GAL. PRECAST S.T. (5.57) �, Z - ' X17---- 25 TYPICAL slLr SCREEN SECTION — HIGHEST EXP. GROUND WATER 2.0 GEOTEXTILE FABRIC SUPPORT PO575 \ WOOD OR METAL \\ J •�- QQ / \ FLOW DIRECTION �� ,ti.,pt. Q� p' ��� Dom. EXCAVATED AND .1 pJQ``VVO,' D( 116 • WEL\ L . l BACKFILLED TRENCH v ^Cb• .:' .:.. O` ———O 4' GE • Pte`. C EXISTING GROUND O(�\`� k p::: ,yM::: Q�' ,B' DRY 16 // \\ 0, o: .........mom \ Sp •uimuuu _ �y� (/i \ °��o PROPOSED` 8'MI ' r N OD (8q�B�TTEppD��RyOO 100 Ib.t STONES \\ \ \ 2250 01 S. ` LP }15�� M �•y TO BE PLACED ALONG T \ _____ (J)10'/x8'DEEP L.P. LID i ,y L,,+. YIA:s',�• THE BUFFER BOUNDARY \ \ - ---—- ---- -�� ` y ;i. OOPpS. XL X i \ A [P \NST 1 PROPOSED X X X �3 �_ 6M :'••;: r'��0.':' ELEC. d<GAS DWELLINGS X \ :v:. W/P UO WATER �— _X-J \z X�\X-X_ X \ P' , .y' :,... .` + U.G. ® 1150' -X---X—X ')C-- `h-\X 70\�X _ X X X\ 7C\ X`9- X\X ` \ X X �`X yC� \,ZC �.B\ X\ \ '� \ ,� EL 13.8 `�'`T, DRY �\ j -X__X X X�2��X `x� Ys.X �-x M X` 'X\ -.�-— .: M1 ..\WELL X X X -5�X �X XS\X�X, �1 ��\ XX - �'V \ ---= .:� �.: tk•\3Z4,\ `x\ �x X\X` \ \ ti a.• �\ K x LAWN MAINTAINED BY AL ,m, ® �' _: < x, X-\X XX \X\ X\X ��^ :ii. -� x OTHERS C .�. \C X \x \X\ X ` X X\ x x AL `11X \X\ X\�X--X-�x __s�x�� •'.�er.;:17• X X \X \,X\x x yc x x x x 1� y. X x \ AL ,� ,� `yc ` �c �c �c�x\x�x 7c---x 1b— x X",X ' -- � �c yc mac\ x \x x x x .:`T`: X XAL A4 AL AL � k Zc _X )C---X---r—S—x atiltAL `x\ J� R\ZC R`X- —sc ..'•\ ..:•.4•. X alt �,, amt ,� � � �� x x i6--r X X x\•y\ �„ '°` ��x �,,X KJ-3z---X-5X_\ x x 1 ;.o? ::•.:. . X x x x.� aW '�` yc x x x AL aNt amr aNt X/ X xN x>4 X x I j'` ` A0 I R,S ,R x X*P� alit ,� \3 x x�x x�c q X x x—•T .� aldr x1 X,X AL 11114 � ELEV. 13.8 x XX FRESHWATER WETLANDS X X X BOUNDARY AS DELINEATED BY{% Ilk DR BROWN + X X EN-CONSULTANTS JAN. 18, 2018: %• A4 X� .� OL 0.8 x x x x x x x x x x yy SANDY LOAM x x x x x x x x x x\ x(X r` a Q\\ \ \ MON. / x x x x x x x x x x x x x\ aetc / X I \ BROWN x x x x x x x x x x x I /x v \.=�.` r�o / W.V. SM LOAMY SAND 1.6' C X X X X X X X X X X X X•� 100 D�' x x x x x x x x x x x�sx' ° , I X /x 0o x x x x x x x x x x x x 'R� be X X X X X X X X X X X X X\� X X% BROWN o,, x x x x x x x x x x x xX X/ x x x 6�. •:/ I MEDIUM x x x x x x x x x x x apt X- x/ x/ x x A SP SAND 2.3 �x x x x x x x x x x x �' X/ ix�x & j XA x x x x x x x x x \ ,� • x x , x GRAVEL 'Po X X NON-DISTURBANCE BUFFER< X '• �X X X /7( �/ �1-/ • / PROPOSED �S�X X X X X X X X X\•.� /X X X XXy X �p R. is'wlt GATE a.X X X X X X X X X X X X X d�pc O ox x x x x x x x x x x Xj x � IJ6I :/P� PALE 7,1, x'F x x x x x x x x x x x o a SS I / �' U.P. x x x x x x x x x x x �' `q SW MEDIUM .� x x x x x SAND jfj x x x x x x x x x x x WATER IN — ELEV. 2.0 TYPICAL CLEAN OUT ' ��� x�`x\_ x�C x x /x �o �+ PALE SLATE OR STOPP R-END 'o, y x x SW MEDIUM 5'2 SUITABLE COVE ORP G - B *R 1§ x x / /•',O SAND 17, �O , X G MARCH 06, 2019 ''OF K. WOYCHUK LS 30' ELBOW DATE / �U'P' REVISED 11-04 REMSED _ _ —19 60' WYE 0V6 l 19 REVISED 08-05-19 LANDWARD OF 100' SETBACK REVISED 07-06-19 26,770 SQ.FT. FLOW-'— - WETLANDS: 27,325 SQ.FT. or 0.63 ACRES E WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL L CATIONS SHOWN ARE FROM FIELD OBSERVATIONS UPLAND: 89,264.5 SQ.F. or 2.05 ACRES •,D OR DATA OBTAINED FROM OTHERS AREA: 116,589.5 SQ.FT. or 2.68 ACRES ELEVATION DATUM: NAVD88 UNAUTHORIZED ALTERARON OR ADDITION TO THIS SURVEY IS A VIOLATION OF SEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING 7HE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO 7HE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON LISTED HEREON, AND TO 7HE ASSIGNEES OF THE LENDING INS77TU77ON, GUARAN77=ES ARE NOT 7RANSFERABLE. 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT 774E PROPERTY LINES OR TO GUIDE 774E EREC77ON OF FENCES, ADDITIONAL S7RUC7URES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE S7RUIffURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 774E PREMISES AT 7HE 77ME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO:5445 PECONIC BAY HOMEOWNER, LLC, MAP OF: FIRST AMERICAN TITLE INSURANCE COMPANY; FILED: ALL STATE ABSTRACT CORP.; SITUATED AT. LAUREL TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design �I P.O. Box 153 Aquebogue, New York 11931 FILE # 17-196 SCALE: 1"=50' DATE: DEC. 18, 2017 PHONE (831)298-1588 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk Michael J. Domino, Pi, ;nt o��SUFFf](�� � Town Hall Annex John M. Bredemeyer III,Vice-President �� �` 54375 Route 25 Glenn Goldsmith ti P.O.Box 1179 A.Nicholas Krupski � 'PSouthold,NY 11971 el)Greg Williams ' ® p� Telephone(631)765-1892 ��� �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD i Date/Time: � � �1 3 :o-5 Completed infield by: Michael Kimack on behalf of 5445 PECONIC BAY HOMEOWNER, LLC requests a Wetland Permit to construct a private driveway from Great Peconic Bay Boulevard to proposed private residence; clearing for 12' wide by approximately 200' long driveway; and to install an approximately 5,000sq.ft. of water line and power line within cleared areas. Located: 5445 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-128-1-5 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 J 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 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: 1 11 C r nliM ��SA kj—, Load 0.re-reorou-n A pool `r0 T)sfl"ak,-� 6)e �Ai'i✓Gwcay, CuAvg-A UsNAer Pfe)a c^%-_-a. �ci V�wc.v I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: '/ J. Bredemeyer /M. Domino �✓ G. Goldsmith ✓ N. Krupski G. Williams Other 00 nod 19 Moja f��iJev✓a � 911fIrl y < g :CTION: 128 BLOCK: 1 LOT(S):5 FINISH CRAKE ( / / / / LAWN MAINTAINED BY o'Mo f�f � / / / / / / / / / LAUREL LINKS GOLF COURSE/ i / 0 / / / , / / / / o / 0 / / / 0 / / 34 NV JERT MI 3cL SUR / / / I i 18--- m--- / / COARSE / / / / / / 6,GRAD n Edi L!a / / / / / / ' l-JOF LAUREL LINKS /10712 SEWER PIPE MFILED NOV. 23, 2001 T S.T. z (5,57) ,�- JUL _ 1 2019 HIGHEST EXP. GROUND WATER 2.0 DRY o Southold Town Oa Board of Trustees_______ ONAVE X160 MAP OF LAUREL LINKS #10712 FILED NOV. 23, 2001 tc :, ———_---16— ... — p 38.5' 0.9'E B 'In 1p �P(ROPOSE n �„; —•.00 �5g 0 1 SrWR�SYSTEI/ \ \` PT \ o� 1500 GAL S.T. — \ N �iPx .(3)8'0X8-DEEP LP.pg4iy A. o DRY LP 0 WEL \ Z - LP Pj�GppSE�o U G. UUnUTIES IP GS1 X40 ::•: OWE J \ 1 N ® WapBUC WATER 23.9. 150' 14 10 9�� \\ \ EL 13.5 x L'r'��::�• DRY ` i \61\�\\ \\ \ \ \ `WELL x LAWN MAINTAINED BY OTHERS x ..L• �Ilc AL AIL \ .\ \ \ \\ \ \ �\ x x x x x x '•\ _ �\0 aSt AW X AL AIL �� \ ��� \ 4 r At AL altc atilt \\ ��` ���_ `——---�,�,7��r— $ .\\, �. .8'E�,.::•�;\0 X. AL AL y1c AIL A4 AL A4 A4 A4AL \J I L I I � I I A4 AL 1 00 FRESHWATER WETLANDS ` M °` %p / / / % l I I \\'� I BOUNDARY AS DELINEATED BY \ \�\ EN-CONSULTANTS JAN. 18, 2018 \ \\ \ \ MONAL / W.V. AIL •'\ arc \100 00'. 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Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) cs, Southold,NY 11971 ® app Telephone: 631 765-1938 ®lyC®M,� 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 8, 2019 Re: LWRP Coastal Consistency Review for 5445 PECONIC BAY HOMEOWNER, LLC SCTM# 1000-128-1-5 Michael Kimack on behalf of 5445 PECONIC BAY HOMEOWNER, LLC requests a Wetland Permit to construct a private driveway from Great Peconic Bay Boulevard to proposed private residence; clearing for 12' wide by approximately 200' long driveway; and to install an approximately 5,000sq.ft. of water line and power line within cleared areas. Located: 5445 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-128-1-5 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 provided the following is clarified to further Policy 6. 1. What is the width of the driveway and limits of clearing? Vegetation on the slope to the wetland should be preserved. 2. How will storm water be controlled generated from the driveway? 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 S�FFO(,t- Michael J. Domino, President Town Hall Annex John M. Bredemeyer, III, Vice-President o� y� 54375 Route 25 Glenn Goldsmith N P.O. Box 1179 A Nicholas Krupski y Southold, NY 11971 Greg Williams l , dao Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUST4 [17 TO: SOUTHOLD TOWN BUILDING DEPARTMENT ` J U L ® 3 2019 RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS ;0i7i 801Tfa2414 ti SCTM#: Property Owner Name: 5 5 P�CoN1C. �iA � �w����, L&C- 72•lR Date Sent to Bldg. Dept: 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 Deriolition as described under Town Code? COMMENTS: b ceSSary a + ba C CC S� lei-(9f j � ! MI DI U -od Signature of Reviewer Date T, Michael J.Domino,President �,*��, ,,�..1,, �'� Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 �* P.O.Box 1179 Glenn Goldsmith ' Southold,New York 11971 A.Nicholas Kru ski P � Telephone(631)765-1892 . . Greg Williams '��� "r Fax(631) 765-6641 e BOARD OF TOWN TRUSTEES --- TOWN OF SOUTHOLD r—, This Section For Office Use Onlyi` oastal Erosion Permit Application i1 Wetland Permit Application JUL 2019 Administrative Permit I omendment/Transfer/Extension eceived Applicatan: 1.1.1 q fTeceived Fee: $ 25-6,00 Bar of it Completed Application: -7,2.7q7- -incomplete: SEQRA Classification: Type I Type II J Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): $,2.lq *7C ConsistencyeferralSent:f Inspection- Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property(as shown on Deed): LSI//C A6-W h&,&t( -_ CLC Mailing Address: 50 !��//��f 7'/ICIC /�Y �� 9J�Z �- �—i •� Phone Number: z z 607 Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: _ ��� ,®®e C O Al C g5y ,��D (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Jl? l c H/M Mailing Address: ,�o 13 nx 04 7. 50P-DD X 1197 Phone Number: j— /6 Board of Trustees Application GENERAL DATA Land Area(in square feet): �. 6e4 Area Zoning: R-40 Previous use of property: VA CAN r Z— d 7— Intended use of property: -k F-UP6 1( Covenants and Restrictions on property? Yes ^No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No AIIA 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): _ _7V COA-15-EMa: AeI VA,T, JVR 0 POS-45P o C4 Zeeyw& r-o le Ae Irr &11A4- >e14PAROX Z a a ,0rT- m/ t�ivG 0'OR/V.e /s .7 �- Ta > -- l>d Woe U/l11-5 f,!lIrAXI / CL�ieF,0 .4RI645 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 750 d VJP� A PFI Vi47- Z 'AP-14140A Y r t--MR-M RRo FQWZ? PR/LIAUE FAL DCzAZ c,r_- P C e (_2AOArw5 WZ P7- Area of wetlands on lot:- square feet Percent coverage of lot: Z94010 Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 4 feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? ZQ Qcubic yards 4/' _ How much material will be filled?_ 0' 0 cubic yards -- Depth of which material will be removed or deposited: �� feet Proposed slope throughout the area of operations: -<:� o Manner in which material will be removed or deposited: g0�' C7 rz �.��/ ��✓G w/CI-1,41AIP4 WS, S'&1-PJ.9 CJ"AAID &M O Oz5R, POU62�-J 6RADI&& Z r Q,4, -Q 9' 02AZE 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): 45 /ID Ail—NI& el" 7-0 cP16111 A,& 1411AII -11111 OR Ald lAO'®4Gly' 7-0 AR�ryV W.47ZSe 9 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or finding,are subject to public review,and may be subject to further verification. Complete Part 1 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: Project Location(describe,and attach a location map): �+ �.�j �/ �f ,' J-1, -1/ U�.�L o A1' �Q (�.... Brief Description of Proposed Action: l�lG'Ir1� ro Pip/VSW64y O//'1 / 0I✓/ , !1/� 40YJO W 4W`, �l2lYJ�GIJ�Y My XW rO'.�'i�� D.�E�_ /SIC'/00 4� wEP'L�N®. CI A5g?1/*)gW /zFT L WIVE X AP'00' 0;e- zed JoIrr. IN ,pyY,F 1X,0x71ISI.4T D TD �9A Qd'P OX oo t Gvi47 ie WA $' Nan r:WFJf ffrev elephone: 7 B-Mai Address: P- 41. 8 DZ647 City/PO: State: Zip Code: 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 o 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: _ NysrFc 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? Z, acres 4. Check all land uses that occur on,adjoining and near the proposed action. F-1 Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial Residential(suburban) IF- ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use Linder the zoning regulations? E-170, Il b.Consistent with the adopted comprehensive plan? D 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? F] 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: El 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 1:1 b.Are public transportation service(s)available at or near the site of the proposed action? NX [] 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? 0 YES If the proposed action will exceed requirements,describe design features and technoloi0s- - 9 El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: prao'l 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment, si—"q r-1 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? EJ 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: El Shoreline E3 Forest D Agricultural/grasslands El Early mid-successional Wetland El 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? 1:1 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? 'VO— YES If Yes, a.Will storm water discharges flow to adjacent properties? f-j NO []YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: F-JNO []YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: � �� � _ ____ � ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? if Yes,describe: 20. Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? if Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor ant/sportsor name: Signature: 'bate:��0 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 I and other materials submitted by the project sponsor or 11 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 I. 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 community? EL 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)9 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? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ _ j reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public I private water supplies? b public/private wastewater treatment utilities? 8. Will the proposed action impairthe character or quality of important historic,archaeological, ❑�� architectural or aesthetic resources? 9. Will the proposed action tesult in an adverse change to natural resources(e.g.,wetlands, J—]� ❑ waterbodtes,groundwater.air quality,flora and fauna)? 1 J Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage I---( 1:1problems? �J 11. Will the proposed action create a hazard to environmental resources or human health? 21 Part 3-Determination of significance. 'rhe 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. LJ 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 inn acts. Town of Southold-Board of Trustees &-/f- Name of Lead A66mino ncy Date Ml i c h a e l J. President Print or Type N^arne of Responsible Officer in Lead Agency Title of Responsible Officer —^ Signature of Responsibl Officer in bead Agency Signature of Preparer(if different from Responsible Officer) PRINT page 4 of 4 Board of Trustees Application t AUTHORIZATION (Where the applicant is not the owner) Owe,_ _ 1 / ffl1VN/Ck.�i owners of the property identified as SCTM# 1000-__a49— in the town of New York, hereby authorizes M/WA&A• ���/y.4 C1� 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 fo'r this property. P operty Owner's Signature Property Owner's Signature "RI A11A1A/!C!<' , M�it?B�iP ,5'443' AECONIC A54Yl/L'rsE GYlJ&AR LLC SWORN TO BEFORE ME THIS _. S DAY OF ZO lj_ Notary Public ,,� „BARBARA H.TANDY Notary;Public,State Of New York u No. 01 TA6086001 Qualified In Suffolk County Commission Expires,,0.1413/20 1 Board of Trustees Application AFFIDAVIT le9JNAII. BEING DULY SWORN DEPOSES AND AFFIRMS THAT IIE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL�STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED,BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Si *niropert Owner Signature of Property Owner ��9i H`aNICk HE"ems L� 446'PeCoA11c Bev �or� ocu�v4� SWORN TO BEFORE ME TfIIS E,AY OF �( , 20---16--- (g Notary Public BARBARA H.TANDY Notary Public, State Of New York No. 01 TA6086001 Qualified In Suffolk County Commission Expires,0,1/13/20 07 3 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE]FORM The ToNg of Southold's Code of Etl»cs prohibits conflicts of interest on the part of town officers and employees.Theputrose 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: __ MWS'K K691 _ (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 �— Change of Zone _ _^ Coastal Erosion _ Approval of plat Mooring Exemption from plat or official map Planning i Other (If"Othe(',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest "Business interest"means a business, including a partnership,in which the town officer or employee has even,i partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5"o 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); 13)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is nota corporation); an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitte ihi _ 19 _day of �'CI�,�. 20�q Signature ' Print Nam / _ Form T5 1 � ��� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold' a f thi•, hib"ts con icts a intcresrn fhe o f town officers and c la ees.'fhe u se of this fgrm is Lo-pMvide inforhintion which can alert the town of ossib e c fticbs of interest and allow it to take whatever action is neccessat•v to avoid same. e YOURNAME: j(,,j Ck �j® gga A (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 _,X, Variance Trustee _ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Othe(',name the activity.) Do you personally(or through your company,spouse,sibling,parent;or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,niarringe,or business interest."Business interest"means,a business, including a partnership,in which the town ofl icer or cmplgm has evert 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 K/ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative,)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ' day of 20 IV Signature 70cle L410=, Print Name VIA Ck Form TS 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: any SM�,i'7 STATE OF NEW YORK COUNTY OF SUFFOLK AW-C,6'4�Z C16 residing at 4?0, 80>4 Z 04 7 ,57�0/2> A1Y 1/771 , being duly sworn, deposes and says that on the day of 406057" , 20Z , deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at S'a67-#1041-1) , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this 1 rbW Day of 20 Notary Public CONNIE 0.BUNCH Notary Public,State of New York No.018196165050 Qualified in Suffolk County Coty1mlgsirin Exo1reS Aoril 14,2-jC�- 5,07 48 C®UAIMY CGWf3 �/Y 9 - . Z3' ZX VRhG L6NA�� l? ©. GX d 48 2S" � 2� cL U,� r�.U�I, �Y d!9 o,/N1�Y I Z8- l -� -4 Ro,B. T �l� 700 GRZgr LIN/C LW hpZ 1�`. C 057-AT DA AIA ! AEC 64 57, �� &VIZL/1 �,��,� c` y28 - 1 - 7 �C 5NLe B,#y,.ezYP. , 96560 / C 114OXI A/X 6-6 Lo pp,�5COO C +y, p 948 _ p � z �Rls 12JP Z Rds"Ze Allo Z_ l5 Z�U o°S r °Np l2 Za0ge5Ns Ile Ny �/ y 48 - . i6 333;Si3i j•,yj:� SENDER: COMPLETE THISSECTION COMPLETE THIS SECTION ON DELIVERY j items 1,2,and 3. A, Si ature COMPLETE • • • • name and address on the reverse Agent ,A SicJna can return the card to you. X n 11 Addressee ■ Complete items 1,2,and-3. B Rec ' e by rinfed Nam "—�Di . Date of dress ■ Print your name and address on the reverse ❑Agent 6 card to the back of the malipiece,- ry so that we can return the card to you. X Addressee ront if space permifs. �` ■ Attach this card to the back of the mailpiece, B. Received by(Printed am- C t of D ry essed to: _ D. Is delivery address A&641ibm item ft-El Yes or on the front if space permits. D `I� If YES,enter deliveryad��ss below: 4 p No 1 '1. Article Addressed to: D.Is delivery address differen m item 1? ❑Yes �wIf YES,enter delivery address below: E3 No C � PIMIA •,�,�001� Ste' r !',EJco/(m�/ c 6h I lI3. u� V C /,r'/• �! / IIII I'f I II I IIII I If I I I I I�I II II��I II I IIIIII IIII III I II I IIII I II I I I I II I II (IIII I III 3❑ trtass® CAdult Signature 13 Registype 1:3 ered ed Ma(Mail P ult Signature Restricted Delivery 13 Registered Mail Restricted Service Type ❑Priority Mail Express® 9402 3554 7305.8119-54I- Artifled Mail® � eeturvery Adult Signature ❑Regred MalTm E]Certified Mail Restricted Delivery Riilpt for i ' I ❑ duIt Signature Restricted Delivery 17 Registered Mail Restricted A Collect on Delivery Merchandise 1 9590 9402 3554 7305 8119 47 �Certifled Mail® dpelivery ,_er(Transfer fromservice label) ❑Cc[eat on Delivery Restricted Delivery ❑Signature ConfirmationTM ❑Certified Mail Restricted Delivery ffiRetum Recelptfor -- --- ❑Insured Matl ❑Signature Confirmation ❑Collect on Delivery Merchandlse 0 8 512 ++ ❑Insured Mail Restricted Delivery Restricted Delivery 1 _ ❑Signature confirmation*" q 3,8 (over$s00) j9--Article Number(Transferfrom service label) ❑Collect on Delivery Restricted Delivery g .. . ---- ❑Insured Mail ❑Signature Confirmation f 1,July 2015 PSN 7530-02-000-905 Domestic Return Receipt j f 8 0680 0 Q O ❑insured Mail Restricted Delivery Restricted Delivery A 8 512 9397 I (over$500 =•2- --- PS Form 3811,July 20 - Domestic Return Receipt �( Reg.Fee $1.15 SENDER: coMPLE-i"E.,THIS SECTION COMPLETE THIS SECTION ONDELIVERY Handling $16.00 Return5� V Charge Receipt =t I ) � Complete items 1,2,and S., A S' I'l3tu w Postage' . Restricted & ■.Print your name and addressiott# e rely se Agent f E $0.00 Delivery 1 k so that we'can return the-eardrtbn'- � _ X � ❑Addressee 0 o Received b �' 5, ■ Attach this card to the back iifi'' • ^ eceived by(Pi ted Name) C. Date of Deliver' �f maliplece, 'i Deliver— CD>, y _ $21.25 ES��. „ or on the front if space permits. o as ~ Customer u�t, eclare - v Insurance up to$25b00-1 included 1• Article Addressed to: D. Is delivery address different from Item 1?- ❑Yes Full VaiuAuba Q8/06�u.1on the declared value.International If YES,enter delivery address below: [3 No P Indemnity is limited (See Reverse) FF04CU&L USE 44 VRI A Y ��948 E `0 y 6 41/ ;v I aeo, IIIIIIIII IIII IIIIII IIIII I III IIIIIIIIIII I III III 3. 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'1 4 }f7�• •r�' Certified Mail Fee $3•S0 0971 r-9 Certified Mail Fee $3.50- 0971 CO $ - $ Extra Services&Fees(checkbox,addfee�5ppp9op te) 02 1 co Extra Services&Fees(checkbox,add fee app te) 02 O [I Return Receipt(hardcopy) $ i•U•tUJ�V1 Q ❑Return Receipt(hardcopy) $ C:31 ❑Return Receipt(electronic) $ $�.�� Postmark C ❑Return Receipt(electronic) $ $0.00 Postmark 0 ❑Certified Mail Restricted Delivery $ $�.�� HBfB O []Certified Mail Restdcted Dellvery $ <k �I Here ❑Adult Signature Required $ 4r4V I I ❑AdultSignature Required $ $ my []Adult Signature Restricted Delivery$ 4V []Adult Signature Restricted Delivery$ O� Postage $0.S5 LZI Postage $0.S5 � $ —o $ 08/06/2019 Total Postage and Fes 08/06/2019 Total Postage and$ s $�.55 � - $2.85 $ $ 1u Sent To - 43 Sent y/�('_ 1 ��/�__� !-N ----vii 0 Srfebfendpt. �o OB 1�Ili.ly / - C3, Street an o. or OOz__o. _ 1 (� �” Q�" / c /+ /}Jy Cary,Sfa{{---P--�------- - -..Y_r/�---------------------- -- ; Crry-Ste e, -- �w --- -- -------"�-`--------- � 3Q PS Forr�380 April 2015 PSN 7530-02-000-9047 See R averse for Instructions 1 4 Postal � IU.S. Postal F _ r` CERTIFIED © - CERTIFIED o RECEIPT ru Domestic Mail . o Domestic Er LAURE� 4 t • a •r °' LA VA Y194$ f 17" Certified Mad Fee $3.550, �g71 i � Certified Mail Fee ffi3..�i0 0971 N $ ;� $ Extra Services&Fees(check box,add feepppnte) 02 Extra Services&Fees(checkbox,add fee ppp ) 02 ❑Retum Receipt(hardcopy) $ VV• j ❑Retum Receipt(hardcopy) '$ *h�y r 0 ❑Return Receipt(electronic) $ fit(.�� Postmark 0 ❑Return Receipt(electronic) $ .nn Postmark (� ❑Certified Mail a Required Delivery $ $.0.0ry�0 Here C3 ❑Certified Mall Restricted Delivery $ r,n Here El Adult Signature Required $ WAG r []Adult Signature Required []Adult Signature Restricted Delivery$ ❑Adult Signature Restricted Delivery.$ 4 Postage $� $S I p Postage `0 $ 08/06/2019 -0 $ R+:i■5 08/06/2019 0 Total Postage and Ee�.$� 0 Total Postage and$eg.$� cO Sent To C3 �eeeT an -J 01 P o.���__L.,d�I.C�>�� I O Sfieetan - orPO �o.� Q------------------------------------ P j �BJc �+ /s Qn�,/ /� --------- (�(��Q k_ le_QAIJ!/__Ll/7.7__ -X—VD•----------- � =a-��Q� ���r------------- Clty,State,ZIP+4 � � G��ty,state, I +4 '------------------- MUM 11 LAX PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: J _1_l [ - STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of 2C , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAILIRETURN RECEIPT. Sworn to before me this Day of , 20 Notary Public Michael J.Domino, President �QS SCD Town Hall Annex John M. Bredemeyer III,Vice-President �y�� � 54375 Route 25 Glenn Goldsmith P.O.Box 1 179 A.Nicholas Krupski s- g� ;'' "7 Southold,NY 11971 O ',r Greg Williams ��� ® �p� Y Telephone(631)765-1892 0 � Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of 5445 PECONIC BAY HOMEOWNER, LLC COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, /LJ`C/W2 A. �/6�� esiding at/dba F—Q, eoX 104 7 S'6u;We104 //Y 2177/ being duly sworn, depose and say: That on the 6//ay of AUGUST , 2019, I personally posted the property known as 45--44-i�" .4"--C®NIC eAy tgL -VP-.- 44U&V� by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, August 14, 2019. Dated: (signature) Sworn to before me this day o 20 J I (� C0NNIE b.15UNCH � Notary Public,State of New York No.03 SU6785050 Qualified in Suffolk County Notary Public Commission Expires April 94,UZ _o NUTILL Ulm Ht: AKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNERS OF RECORD : 5445 PECONIC BAY HOMEOWNER, LLC SUBJECT OF PUBLIC HEARING : For a Wetland Permit to construct a private driveway from Great Peconic Bay Boulevard to proposed private residence; clearing for 12' wide by approximately 200' long driveway; and to install an approximately 5,000sq.ft. of water line and power line within cleared areas. Located : 5445 Great Peconic Bay Boulevard, Laurel. SCTM# 1000-128-1 -5 TIME & DATE OF PUBLIC HEARING : Wednesday, August 14, 2019 — at or about 5:30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between P the hours of 8 a.m. and 4 p.m. f BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 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 sigi icant 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. Titus, each answer must be MplainM in detail, listingg,both supporting. and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not,be undertakers. 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 PROJECT NAME„ 50CDNl C MA Y A�QHA OLUMR IJ— C The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: " CV NMe(1 Cr AZ1 V,4)Z ARIMA16014Y �i?d# P�ECONIC B'AY�G1��!.To p'ROPoS�D pAvIV4= gor-I ,eWar. 1#10 y UJB POP iZ r-r. wi X AA ox. Zap pT 6N 40NCGrf/ PW1VJ5 6.S v Location of action: 5 �MCaAM 8 Site acreage: ,2,_ 6 8 Present land use: -//4--G A o V7 Present zoning classification:_—4d 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:!!rqd1f6—L°jEjOM/AC 8" /&/ ff&OA1 („6, c- (b) Mailing address: HA)rrZ7VCko NY &Wl (c) Telephone number: Area Code 071 (d) Application number,if any: Ig Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No;Z If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ NoInd Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No N Not Applicable Y � �euCy Zy f°Pl. its MAT Pito DECZ 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 T& r" A&,d XECT 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 ❑ YesF]' No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑, No X Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Yes No Not Applicable POLICY 6 &V r AM U ZVO PAM Cr W-4 P-Ad po rEA WAY Wl--eZ /V4 VO 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 P t C 7 M/OT AM M ?WlSEC1 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. Q Yes [] No 0 Not Applicable POLICY P& M War A& 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—PoIicies; Pages 38 through 46 for evaluation criteria. 11 Yell NoD-2.4" Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III--Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Pdt fV/o NQ r� PM T1) EXT AB JEc'� 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 0 Not Applicable pGtl c 11 A&F- AL614, 7V MIS seft]MCE , --- Attach additional sheets if necessary Policy 12. Protect agricultural lands-in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No Not Applicable ��� Pn u cy rz ill oT .a1°rt. ry mks PAgTecr D Q Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy 'an'd mineral resources. See LWRP Section III-Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable Po0cY /3 /Va t Q t 71L1'7, _e,&J d C PREPARED BY�. , 1�!/�I,CLG TITLE-- Q(�f,�/)"' DATEh/AO