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HomeMy WebLinkAboutTR-9693A Glenn Goldsmith,President �QF So Town Hall Annex Michael J.Domino,Vice-President ,`O� yOIO 54375 Route 25 - - ------ ----- -- --- -P.Q.-Box-M9--------- ohn M.Bredemeyer III L Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams %�� �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9693A Date of Receipt of Application: August 25, 2020 Applicant: Thomas B. Shearman, III SCTM#: 1-000-12-2-14.1 -Project Location:1721 Wilderness Road, Fishers Island Date of Resolution/issuance: September 16, 2020 -Date of Expiration: September 16, 2022 Reviewed by: Glenn Goldsmith, Trustee Project Description: Construct a deck facing Block Island Sound which is 12'x40' and on the opposite side of the house 4.6'x16' with a 4'x4.6' set of stairs. 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 Evelyn Cole Smith Architects, LLC, dated December 14, 2018 and stamped approved on September 16, 2020. 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. Glenn Goldsmith, President Board of Trustees Glenn Goldsmith,President sou�� Town Hall Annex Michael J.Domino,Vice-President ,`O� tel® 54375 Route 25 P.O.Box 1179 �-- - -- - - — - - - --- - outlioldT=Ngw=Yarl�i�9�?--- --- ---------A.Nicholas Krupski Telephone(631)765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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-OPF --'BELOW - INSPECTION-SCHEDULE ; Pre-c©nstruc ioh, heji bale1indsilfbbomWsilt bUrtain 1st day of construction constructed When project complete, call for compliance inspection; ! -,r �u EVELYN COLE SI ARCHITECTS.LLC APPROVED BY AUG 2 5 2020 ' PO Be.182 `` /—LIN=Oc DECK ABOVE 134 MoIn SIam. y(// PufnCT --BOAR® OF 1 RUSTEE �2x2PT B'� 060 I �`` -•' 860313159570 ! 2-2x6 COL.WITH SPACER 9LOCK Cn 7 I - 'TOWN--OF SOUTHOL FR�2Xn BEAMBFARINS v www eaan:hlenz co I , y I \� Board of fro,,^r! m ®ATE I . STAMP S6k !G� 2ozp ' I SE A I O I ! / �� ♦\\ I O � RESI 26 '� ' \ ' �/ ♦ \♦ o,J 28 O\ I % © I.04 PLY"O Ov F LOTHIOOR FiNNI OVER yEXl5T0i5 O \ 1 4R�3S !/ / \\♦\ `\ \,'� -- -�•� ` // /' /'/ `\\�` O ``\ \\♦LCiLRaE \ O ?WILL 55�2x4 FRAMING O 16 04 POR 26' �/ /' ' O CEILI S,FINISH N OF I/2'6W8 / ` / \ 6 ♦\ T :' ' 6 INSTA L.FINISH / / y \; Round House -• FJrIST.P.DOORS 1 a - I Wilderness Point ' �---- � 7�� ! ' 6 r,c�%A-""'�"'-"Y^-^-•„��--� '- � � E%ISTI�K STAIRCASE TO LPPER Fishers Island,NY ' b FLOOR TO B.REMOVED 1 { "/- /. \ ! !+I•t' ` \� x / ♦\ `\ i r _fb2�2 / /�/ \``` Prepared for 23 �'" � �� '-<-c' � ♦� ♦� 5�;.� 23 __ -,r �< �0 , 4 � \�� \ Tom Sheazman O Wilderness Point / \ _ Fishers Island,NY ,5`` ///' // /, //�/ ' , \ \�\ \ ♦\ `\ 1 - ° E%ISTIN55TAIRCASE TO LOWER' 0INM6 ♦ - FLOOR TO BE REMO,rap INSTALL 1 C yy ♦ NEW 2xb FLOOR INFILL STRDGTIIRS, 22 ` i /' // / ! i ' \ \\\\ ♦\ `/ r 10 22 _ // /, '/ ! I 1 ! \\�♦\ O SHEATHNS Z SJBFLOR TO MATCH IO EXISTING FLOOR ELEVATION \� ' / ( ' \I \ \♦ ♦\ // RAILINS WtTT� , / ♦ / , \ \ /� REVISIONS t`\` / / ' I 1` ` \ \ /;/ II 21 - - a ` \ ♦\ II D4W DuaWPWII VP �/�V/`♦` / \ / 2 TO REMAIN. TYPICAL. O / KITfMEN } 12 10'DIA COtLRETE PIER TO 42' \ 1 ! I �' 13 14 1 _-�__ BELOW FINISH-ED&RADE,TYPICAL \\ / \_ I - � A� I SHEETTITLE 14 2-2X8 COLUMN WITIH SPACFJ2 BLOCK Is EX1STtN5 STRUCTURAL WI FOR MEN 2XBEAM BEARING Ib I 4 Construction e 1 OOlyy I6 I I AND BEAMS TO REM.MN Documents I IF 1 Foundation HEN STAIR K74 MIN.12'TREAD[6'CLOSED RISER First Floor Plan NEW GONSTRUGTION FOUNDATION PLAN ., NEW GONSTRUGTION FIRST LEVEL PLAN PRO]NO, 2018034 SGALEe I/4°=1'-0" L SiGALEr I/4°=I'-O' 4) SCALE AS NOTED NORTH NORTH DATE D—b.14.2018 DESIGNED LYN SMITH,NA,LEER AP DRAWN CLINTONRICHMOND CIIECKED ECS SIIEET I CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA GROUND WIND DESIGN SEISMIC SUB ECT TO DAMAGE FROM WINTER ICE BARRIER AIR MEAN e SNOW Spa ctal wind wind•borne DESIGN FLOOD r]- Speed Topo efraets Weathering Llne Termite DESIGN UNDE REDID NT HAZARDS IRE ANNUA LOAD region debds zone CATEGORY TEMP REO'D G INDEX L TEMP 20 140 no no yes B Sdele Moderate 10 yes no AHJ AHJ 20F5 'K A--4 TYPICAL 1 lI� 14 19 12 II 10 � , III GT � � 2�2� A j EVELYN COLE SMITH ARCHITECTS,LLC 1 I I I I I I I I 1 I I I 1 1 II I I 1 I I I 1 I I I I I 11 - - I — — - - - — PO Box 182 134M..St %UPPEQ t LEADER,TYPICALI Putnam.CT 06260 9600 31 315 957(1 1 I I I w .actorchllecmaom STAMP ti I ^1 RESERVED I I i I i I GEDAFt RAIL r P05T9 MOTH WRE I ► I I Ll I- I I I I �1 � �� t+DRIZONTALS o 4'-O'O,C.TYPICAL 1 I i t I i li�l iZVI i I' I PRAIELT 1111141111 111 IIII lit 1 111 ill ill 111 1 141 ill fol Illlll J1111111111 III III[ ill lit ill ill 011 Illt Ill ill IIIIIIII WEST ELEVr14TION NORTH ELEVATION Round House 1 5GALEv • L SGALEY I/4"vl'-0" Wilderness Point Fishers Island,NY Prepared for Tom Shearman Wilderness Point o o ��^ ^ ^ T ^ ^ ^ ///---��� ^ Fishers Island,NY I T 4 I OI I y 3029I26251IT29t�I, 261Z4 l�1 `�, �IT14IB I 17 7 7 7 7 7 ttewsloT� I I I I i I I 1 I I I I I I I I I I 1 1 I 1 I I i I I 1 1 I Dtl= Dptttipbon I I I I 1 I I I 1 1 I I I I I I I I I I I I I I I I I I I I i I I I I I I I I 1 I 1 I I i; I I I I 1 I r l I I I I I I I 1 I rl SHEET TITLE I I I I I I f 1 I I I I I I I I I I I 1 I Construction — _ Documents I I I I I I I i I I I I I i I i I I I I I 1 1 Elevations PRO]NO. 2019034 I I SCALE AS NOTED I I I I I I I I 1 I I I 1 I I 1TILIIII DATE DI—ba 14,2018 I I I I I I 1 I I I I I I I I DESIGNED LYNSMrTH,AIA,LEEDAP II I DRAWN CLINTON RICHMOND I II I I I i I I I I I h I 1 I I I �I I 1 CIIECRED ECS 9°EET 111111 I U I ill 1 0 1 Ili I Ill ;it I 1 ilii i III ]ill Ili I r l l illi! , II I II 1 1 1 1 1 1 1 1 111 1 Ill Ill 1 1 1 lit I ill 111 1 I i i III Ili 1 l ilii A 50UTH ELEVATION EAST ELEVATION LEADERS TO EE TIED l 1_3 3 SGALEv I/4"=I'-0" 4 SCALE V4'•I'-0" Tor ETNEF A7ER6R0JW ROUTW TO RAINIDARDEN ' 40F5 Glenn Goldsmith,President if SOU�y Town Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold, New York 11971 A.Nicholas Krupski y G Q Telephone(631) 765-1892 Greg Williams �' �� Fax(631) 765-6641 COUnDNTY,� ' F` BOARD OF TOWN TRUSTEES AUG 3 1 2020 TOWN OF SOUTHOLD TO: SOUTHOLD TOWN BUILDING DEPARTMENT BUmp11,TGDE ° RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REMOtMENTS� O��'� $CTM# `Properly Owner Name: {; =s , ... :-:,;- .' : .fit✓; .t`C3. „',. ..:• ,"`.,_x' Date§S hhf'16_61dg:'Dept: The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building TDepartment-'s permitting requi;dements stated below: t Will the proposed'project,require a Building Permit? Will the proposed project require,a variance_ determination from the Zoning Board of Appeals? - " r, Will any part-of this application be considered-- Demolition -as described under Town Code? COMMENTS: I.J/k nature eviewer Date Glenn Goldsmith, Pre' ';nt ��SUFFO(,��0 - Town Hall Annex Michael J. Domino, Vice-P�uwdent ,��� Gyr,Q '� 54375 Route 25 John M. Bredemeyer III o =` P.O. Box 1179 Za A. Nicholas Krupski Southold, NY 11971 Greg Williams oy ® �!� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD l Date/Time: 918A2000 -) :00 Completed in field by: G. Go) Sm J.M.O. Environmental Consulting Services on behalf of THOMAS B. SHEARMAN, III requests an Administrative Permit to construct a deck facing Block Island Sound which is 12'x40' and on the opposite side of the house 4.6'x16' with a 4'x4.6' set of stairs. Located: 1721 Wilderness Road, Fishers Island. SCTM#: 1000-12-2-14.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: -Actual Footage or OK=� 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: S2VS N e�e�lp e I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino J G. Goldsmith N. Krupski G. Williams Other [,F- EVELYN P� I I,t I - COLE SMrtH ARCHITECTS.LLC L� 8603159570 UG 2 5 2020 1J _ LIO= ABOVEDECK ABOVE PO Box 1B2 M 134 Box nSt 06260 182 Putnam,CT ` 9-7x14 P.T BEAM I 2-2xD_GOLLTRN w1TH SPACER BLdK �'�I�•e`I�Ii� I��f'I FOR1 2xt7 s=aM�rnRss Burd of fru;:yes www eaorcIutects com I r / �; sTAlwtP r I J � A 2MKv,cD A . A-4 y I O T —I�5T/8"PLO'r`v °DeXlsnrs RESERVED FLOOR FINISH,TYPICAL \\ �c I 1 \ L, © 2x4 AMINSaB MS>FO LO.` 7x4 FRAMING O 16' -L FOR 26 \\ ` ��'" --_ �✓ / /" \\ O 26 `\ - /l ' O I EILINS FON OF 1/7`6Y�F3 T v' ` Y / ` ' , ' 6 LEILINS FINISH PROTECT r y ' 1 -1 �I t i - i - _�! _ - Round House I I 1 -•-r\ 1 1 I<—EK nNs vom, DOORS - I I _ .0 REM'uN Wilderness Point t - `. '7'--- 1 a _ —^ M'--� u - - FM5TINS STAIRCASE TO LQPER \ As v ` * r --�-— I O 24 --- - _ O Fishers Island,NY 14s � \ ry' J� � r E3T 8 � p�1. 6 FLOOR TO B_RcI+.OVED �Ns D W 1 /� V y� ♦ `EXIS gTAIRCAS-G I _ t .•� `� J u_� , X J TO BE RD--WW_ 1 \ Prepared for Tom Shearman Point `-r----r' EXISTIKa Wilderness STAIRCASE TO LDh'�R I ,Ilt /' /• J / I 1 \ \ \ `\ \ %rl - r \\• Fishers Island, NY } RIA11rlt FLOOR TO BE REMOVED INSTALL EXIS THING t `\ KEPI 7x6 FLOOR INFILL STRUCTURE. ` 1O EXISTINS05FLOOR TO MATCH S FLODR ELEVgnON TERS O \ REVISIONS or I \ r r--- 21 II - - ° ° \ \ \\ II Dale OoeulPUan TO .0 REMAIN s COW:R-,c PIERS �-1AIN NPICAL O µ / l ` O (D i I 10"VIA.CONCRETE PIER TO 42` r I - 19 BELO"FINISNED GRAD$TYPICAL �\ , \ 1 / ,� ' Ai _ _ I SF4>;77r[LE DECK 14 Ai Construction ` ,- - 2-2xa Lo�wt WITH SPACER BLOCK ' _r-r / 1 1 FOR WA 2.12 BEAM BEARINS `� + 1 t I6 15 I I 16 � 15 -WSnKs 5TRUC-MRAL COWMIS Documents 00)* 1 1 AN'o BEAMS To REMAIN Foundation NEK STAIR YBTH MIN.IT TREAD a 6-eLo--W RISER First Floor Plan ��SCL,� NSGEpyWE,GI/ PR03N0 2018034ffl RSGOFOA PLgR �PLAN. (7r) SCALE AS NOTED NORTH NORTH DATE D—ba 14,201 IT DESIGNED LYNSMITH•AIA,LEED Ap DRAWN CLINTON RICHMOND CHECKED ECS I SIIFET CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA A GROUND WIND DESIGN SEISMIC UB EC TO DAMAGE FROM WINTER ICE BARRIER AIR MEAN _ FLOOD A 'I SNOW Special Wind wind-0ome DESIGN DESIGN UNDERLAYMENT FREEZIN ANNUM A LOAD Speed TopO effectsregion debris zone CATEGORY Weathering Line Termite TEMP REO'D HAZARDS G INDEX L TEMP 20 140 n0 n0 yes B Se\ere Moderate 10 yeS nD AHJ AHJ 20F5 I 7� r� CJs —� ` ll.• v 14 13 12 II T T � O T T T TTI I II I 21 T 19 18 17 Ib IB 14 I �FT �1 �O� �O�O I I—l5 ; •I I 11 EVELYN COLE SMITH ARCHITECTS.LLC I PO Box 182 131 Mos sl Putnam.cr yO�ER tiLEAOER TYPICAL 1 -•iii 06260 8603131 i 8 9570 rIIC='_S yI I I I I I I I ecsarchitactt.wm STAMP If -110 `9�t co•�y'$i I I I I I I I 1 I gill, 1a� i RESERVED CEDAR POST5Y0 HORIZONIWS O S'-O'O.G.SYPIGAL 1 I 1 1 I 'I I I I I I I I � I ► I I, �I I Il I° I PRDIECIr 111 1 111 1 1 1 1 1 11 t I I I[ III I 11 1 III III 1 1 1 1 1 11 I 11 I ill IIII 11 111 I 111 1 Ill III fill 1 1 1 III III III 0 1 1 Jill 1 1 t fit I II I I III WE5T ELEVATION _NORTH ELEVATION Round House SGALEa 1/4"=1'-0" L SGPLE.1/4 Wilderness Point Fishers Island,NY Prepared for Tom Shearman Wilderness Point o TT ^ /'� �� Fishers Island,NY I 1 Q T I I I I I Z9 Ili IT24 I t� 26 25 1�c/ I 22 21 T 14 Ib I� I7 ItEV1570\S I I I I I 1 I I 1 I I I 1 I i 1 I 1 1 i i I I I I III I I IfNMI SFO'STTITLE li I i I I I I I I I I 1 I I I I I I 1 I I I 1 I I I Construction Documents I I I I I I I I I 1 I I I I I I I I I I 1 I Elevations I I I I III I I I I I I I I I I I I I I I I I I 1 I 1 I 1 PROI.NU. I019034 SCALE ASNOTED I I I I I I I I I DATE Dcamba 14,1018 I I I 1 1 I I I I I I 1 I I DESIGNED LYN SMITH,AIA,T.FFD AP _ DRAWN CLINTON RICHMOND 1 I'I I I I 1 I 11 I I 1 1 1 I I 1 II I 11 I 1 CTIECKFD ECS 'I I 1 1 I I I I I I I I II I I slim 1IIII i t II I I I I 1 p l I I I I III i i i t T I T i I I I 1 4 1 I l i I C 1 1 Ittl I I MR[I III 1 1 1 i li 1 I I it III f l u 1 1 l I 1 1 1 III 1 III TO 1 1 TIED 1 1 It 11 111 3 SOUTH ELEVATION EAST ELEVATION A_3 $GALE•I/4�=I'-0" i L'. LEADERS VE SCALE:V4':I'-0' To6EYHEia urmErz6R011,rD ROVTED TO RAINSARDEN I 40F5 U SILT FENCE KNOCKOUT INLET AND -J OUTLET OPENINGS ff r 0- WOVEN WIRE FENCE (MIN. 14 pP r,f \ �i °0 L 2 GAUGE W/ MAX. 6" MESH I O E SPACING) �, \\` \ a tb 11\01 H 1Q' MAX. CEN t C D F R \ o f / •� Y V ER TO CENTER 36" MIN. LENGTH /I/�. \ - F pS //� .F,.r °i p O c / a� FENCE POSTS W �\ $ d _ DRIVEN MIN. 16" $ \ } "--._.�l( S z r INTO GROUND `�• R Q \ ~`"~'''-� _ ��� = N D ( OUND) (FOUND} �~J-f �,....__'� Lua � � u) E *; <v E \ CAST `� Q : 2tIi HEIGHT \ \\ CONCRETE COVERS '�� O () N 0 � R.R.SPIKE - _ �, B L N OF FILTER `` ■� N = (FOUND) 16" MIN. 0 U j S PLAN -� -- �' o C N \< \ r F`• p� 6" MIN \9�As'EO \\ LOCKING CASTING ``- . / Q M T o / tiT Ois, AYR T OF TO GRADE . -fJ// W c'`) 0 EB;PECTIVE VIEW TO ORIENTAL AVENUE cn ` MONUMENT FINISHED GRADE =- % i 1520't TO ORIENTAL AVENUE / (FOUND) \ f' = DEWEY WILDERNESS POINT LLC CN1 w \ N S[TE J WOVEN WIRE FENCE (MIN. 14 III iSINGLE FAMILY R.R.SPI KE 1/2 GAUGE W/ MAX- 6" MESH 1 RESIDENCE 6" _ SPACING) WITH FILTER CLOTH z i �,0 (FOUND) MUNICIPAL WATER / P O � N 1 3 ON SITE SEPTIC APPROXIMATE / �''^T-�T '' ' '1 INLET LOCATION _ 36" MIN. FENCE POST o - 3" VENT 3" VENT--XOUTLET ` UNDISTURBED /1 �\ 6" WATER MAIN / r I LIQUID LEVEL----- UNDISTURBED K D Lu FL�W -=. (I GROUND /1 �� 535.75 /// p ;� W:2608.44_ "`�_— — MONUMENT i COMPACTED SOIL z = '\ Ur- ---�� W W (FOUND) n j a" OUTLET \ R.R.SPIKE W \j` S F OUND) N/F ` TEE EMBED FILTER CLOTH \�/� \\'�\\ 6 oR.P,.3P/KE GEORGE P. LEYLAND A MIN- OF 6" IN GROUND \ ���? (FOUND) "VACANT LAND _ __ f S S 04'01'47" W W 2413.Oa X08 LOCATION MAP SCALE 1 "=400' \ `� .-c, •�-�--•-'.•.r•a N/F ; 4.84' MONUME T 4 :CTION VIEW JAMES N. BAILEY 8.14 (FO NO) MAP REFERENCES �' 3" SINGLE FAMILY / � /� W:2664.59 � CROSS SECTION CONSTRUCTION SPECIFICATIONS MUNICIPAL RESIDENCE WATER I \ - ^�o / 1000 GALLON 1.) PLAN MADE FOR JACK RIVERS PROPOSED SEPTIC SYSTEM FISHERS ISLAND ON SITE SEPTIC / NEW YORK SCALE 1"=40', DATE APRIL 10, 1990, REVISIONS 22 JUNE 1990, 1. WOVEN WIRE FENCE TO BE FASTENED SECURELY TO FENCE POSTS WITH WIRE TIES OR STAPLES, POSTS 'SHALL BE STEEL EITHER "T" OR "U" TYPE I SEPTIC TANK PREPARED BY CHANDLER, PALMER & KING NORWICH, CONNECTICUT OR HARDWOOD. NOT TO SCALE 2.) C04STAL EROSION HAZARD AREA MAP, TOWN OF SOUTHOLD 2. FILTER CLOTH TO BE FASTENED SECURELY TO WOVEN WIRE FENCE WITH / /� \� SUFFOLK COUNTY, NEW YORK, SCALE 1"=200' (APPROX.) TIES SPACED EVERY 24" AT TOP AND MID SECTION, FENCE SHALL BE 1 SHEET 47-FI OF 49, 8/29/88 WOVEN WIRE, 6" MAXIMUM MESH OPENING. 1" WATER SERVICE 3. WHEN TWO SECTIONS OF FILTER CLOTH ADJOIN EACH OTHER THEY I ' �r APPROX. LOCATION CoQ O SHALL BE OVER-LAPPED BY SIX INCHES AND FOLDED, FILTER CLOTH SHALL BE EITHER FILTER X, MIRAFI 100X, STABILNKA T140N, OR APPROVED / ��� NOTES EQUIVALENT. Q s 1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED 4, PREFABRICATED UNITS SHALL BE GEOFAB, ENVIROFENCE, OR APPROVED �I ' 2 BENCH NARK- HEREON. ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO EQUIVALENT. �! ' `C'� NAIL-ECFV. 28.73 BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE PROPOSED 20 NOVD88 N/F 7 EASEMENT FOR BETTY RUBINOW �F' ENGAGEMENT. 5. MAINTENANCE SHALL BE PERFORMED AS NEEDED AND MATERIAL • - EXISTING WATER I 1 ��� REMOVED WHEN "BULGES" DEVELOP IN THE SILT FENCE. "� �' MAIN SINGLEFAMILY `rTd' 2.) IT iS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, L O MUNICIPAL WATER �<" OINIMU UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO \ \\ ON SITE SEPTIC F �" ALTER AN ITEM IN ANY WAY. APPROXIMATE PROVIDE CONSTRUCTION LOCATION ENTRANCE- (SEE DETAIL) \ R F 3. ONLY COPIES OF THIS SURVEY MARKED NTH THE LAND SURVEYOR'S 3 PROVIDE CONCRETE 6" WATER MAIN AeRI� SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF —_ / � \ �\ .'� `� STRAW BALE BINDER 6 3/ \ �' THE LAND SURVEYOR. TRUCK WASHOUT � \ � PLASTIC LINING WRE oo AREA I �1 `,__-�' `� CONSTRUCTION ENTRANCE NAnVE MATEF!IAL ry� �/ `� NOT TO SCALE 4.) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC Z (OPTIONAL) FLOOD ZONE �/ �� ELECTRIC 1t SURVEY TRIANGULATION STATION "NIN" BROKEN �\ 1 < y SECTION B-B AE9 �/ / 20' STAGING AREA PAVEMENT �r SERVICE 5.) SITZ= IS IN THE TOWN OF SOUTHOLD COUNTY OF SUFFOLK TAX MAP 1000 m WOOD OR NO 0 CALF , , METAL STAKES �/ 3 �� LOCATION__ 1 SECTIOIJ 012, BLOCK 2, LOT 14.1. Q O (2 PER BALE) / ��-_���- �� } PROPOSED CO TEST HOLE DATA - / I OD STAIRS & DECK X24 / N �/ O PROVIDE FILL ",,";:';:` 6.) TOl"AL AREA = 2.29E ACRES (99 733E SQ. FT.) ry _.-.. -F ,_ epi __.. TEST HOLE DATA ' 11 -.- . .- ._ . _- s°$ o` (SEE ARCHITECTURAL / `V . F L UNDER STRUCTURE O (!} �/ . GAR. BY: R. STROUSE P.E.,L.S. -1990 SITE PLAN Z (n Z ,o' MIN.— - 0 PLANS) , 30 `\ TO PROVIDE FROM 7.) SITZ_ IS LOCATED IN R-120 ZONE. g = W B J.'� THAN 6 FT �I/ �`' y \ FINISHED FIRST FLOOR 0-12" TOPSOIL L'� Of z •'I `- ,I / TO GRADE " " 8.) OWIJER- THOMAS B. SHEARMAN, III � (� W Z VARIES �!� I N ►7 I ?2 �-- \ 4 12 -54 SANDY SUBSOIL 3615 HOLLY HILL ROAD Q p g .! / PROVIDE / / „ 0- _j _ 1 \ 54 -14 SANDY TILL (MED. COMPACT). SANDS WITH SOME FINES (SM) LAKE G!IARLES, LA 70605 U7 w _ cn _�, �� �� �� �� �� ���I o RAIN GARDEN J / _ \ EXISTING .:i fl.i` FLOOD ZONE o C4 SEE DETAIL '. ,=1 :... g SEPTIC HE BOULDERS AT 14' I ;:: . AE11 2 \ ) ! 2 � � 1 �2� i I SYSTEM EXPECTED HIGH GROUND WATER BELOW ELEVATION 10 FINISHED PROVIDE FILL RST FLOORETOSGRADE.RE TO PROVIDE LESS THAN 6 FT. FROM N W PLASTIC a STRAW BALE \ / yPLAN (TYP) APPROXIMATE \ r EXISTING ^ �� LINING NOT TO SCALE EDGE OF PHRAGMfTES 3 BEDROn M ^ SEPTIC SYSTEM DESIGN FOR 3 BEDROOM RESIDENCELIMITS OF WETLANDS�uT I IT INN/ 2 STORY \ �, $� / 1000 GALLON REINFORCED PRECAST • RE MENCE �' CONCRETE SEPTIC TANK (SEE DETAIL) - O NOTES: APPROXIMATE \ 6 PVC FOR � E` i' 1. DIMENSIONS SHOWN ARE FOR TYPICAL RESIDENTIAL EDGE OF PHRAGMITES I P-67 5 f �1 i 2- PRECAST CONCRETE LEACHING POOLS (SEE DETAIL) CONSTRUCTION, LARGER PROJECTS OR PROJECTS REOUIRING LIMITS OF WETLANDS �`' \ J ROOF LEADERS /� `i� COASTAL EROSION PUMPS MUST BE SIZED ACCORDINGLY (7 GALLONS/TRUCK, S / -� HAZARD UNE 50 GALLONS/PUMP, PLUS MIN. V FREEBOARD). ` .-16' I �� PER MAP REF. 1 #G ! AVO 2 Il F � / MATERIAL A I I MUST REMOVED R M R N U E E OVEO OM L D L OS S B 2 CAPTURE TE OU '! \ .4 PIT AND PROPERLY DISPOSED OF WHEN THE PIT REACHES \ \ X ' 1 12" COLLAR OF I ! -i�-i� -i�-i�-i�-i�-i�-i r \\\\ PROPOSED DECK 4 I 75r OF ITS CAPACITY. "'"^' � STONE-EFFECTIVE a BENCH MARK � o F. � - � 3. INSPECT PIT PRIOR TO EACH USE TO ENSURE CONTAINMENT / PROVIDE SILT O. (SEE ARCHITECTURAL �G �, ��DIAMETER-8' FENCE MAINTAIN\ IRON ROD PLANS) FF. / 9 TOP AND BOTTOM OF BANK / OF WASH WATER. I 14-'- -•~ "2 ELEVATIONS FROM FIELD THROUGHOUT ` ELEV. 31.32 \ \\\\ 30'5 _ �/ / �I CONSTRUCTION \ �?� �� SURVEY- OCTOBER 2017 �\ LJA l i •� I ...•�;•'"'� !� \ \ 129. „ 12" ERRY / �, .�!m',L I �' >- _ _ = x �� \\ COASTAL EROSION .,� 1 , 4" CHE Y PINE ,� �� 41111' " 1 'G HAZARD UNE ���l ur / / �,' /'';_ j a ;, z i ti� N•' 3 ' ' I�CHERRY r w`% / E`� z: �i. / 0 a Q II �`__: w w �•�, ? c>,A` o \ PER MAP REF. #2 b1E Y 6., , _° ///�E Off_ - i0 , �, Elf Of FLOOD ZONE a, ! 4,1 IL �u ° /�/ �, •0+ Qj, / a 1• 6111,E?,:: ' 1 S 2 ' Z/ 0 /'1 ;: �� a ? Lu � �` rr g n �i •J � �Il ll.�.� �,.,L � � I /�O� '-- � `.- ._ ._. FOUR AVAILABLE �/ / / / 1�fL'''r ti`"'*� -� \P N �� �0�/ ,,l:tl '� /�/ice / �72 -�{ 5"DIX OUTS ARE O U I \ I E TRC / S'pA — W w 1 1 7 \ \ 14 J/4 o r of LIMITS OF FLOOD 0000®0000000 0 I a w V) —N-S ZONE VE16 11.2-yt 000 0®000 0 000 0 > (n z 0000®0000000 w N/F ' L1+, ROCKS SNO / 000000000000 I 12' COLLAR OF rn o 0 JAMES N. BAILEY TYP. i� -b / / I SINGLE FAMILY ( ) -� EtOGo/ - -�'' >6 u+ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I nl STONE-EFFECTIVE 0' N N Ire 000 G®O O 0 0 000 DIAMETER-8' \ \ - � PROPOSED C4 04 ROOF LEADER RESIDENCE �. / �� I Q o N n ADDITION MUNICIPAL WATER ��� ram / 0000®0000000 o N N o ON SITE SEPTIC ��� �� /� I OODO®00®0000 I o 0 0 0 000000000000 I o /�` A` 0000®00 0000 II z OVERFLOW PVC WYE N , \ \" a 1I/7 _j31.- O � \J NOTE- 6x6 DRYWELL 4•" PVC CUT FLOOD ZONES FROM FIRM DESIGN NOTES 10 LENGTH �-^ ...----_--� Q rn MAP 3SI03CO038H / �• 1)CONCRETE STRENGTH 5000 Py, MIN. 28 GAVS 3 RIEM D 09-25-2009 "- i'� 2)TYPE U CEMENT ASTM C150-81 1000 3) TWELVE INCHES IN HEIGHT.17B GALLONS 2 MARKS ON Q J O .• � � 0 COLUMN16 GALLON Q APPROXIMATE TA N K SEPTIC 00 00 00 HIGH WATER UNE o, rn 90' BEND LIMITS OF 77DAL 18" (MIN) WETLANDS ` •� N 1g$ m CIA I I O O 6" SDR 3!5 PVC SLOPE AS REQUIRED O O 0 p __j z Ld PROVIDE STONE PROTECT DOWNHILL a� Y 7) zLu z Y 3 MARKS ON sr• 0 00 w � = 0 1J AT PIPE OUTLET LOAM AND PLANT PER SLOPE WITH STONES O. PLANTING SCHEDULE COLUMN m 0 0 U 0 L, DRAINAGE CALCULATIONS , DATE: 01/15/2019 STORMWATER RAIN GARDEN DETAIL LEGEND s LEACHING NOT TO SCALE: AREA - NEWR0 SFX 210 X 1 = 219 CF PROPERTY LINE -- ?82• POOL SCALE: 1 " = 30' REQUIRED 3 ABUTTERS LINE QUALITY CONTROL CERTIFICATION PROVIDE A 20' X 10' X 1.5' DEEP RAIN GARDEN= 300 CF OF STORAGE EDGE OF PAVEMENT LEACHING ( � � , PROJECT: #2019801 POOL GROUP REVIEWED DATE EXISTING CONTOUR ——— 28 PROJECT MANAGER SOIL CLASSIFICATIONS TREE LINE SURVEY ENVIRONMENTAL p g - PLYMOUTH AND LOAMY SANDU� 3E 8 eBS SLOPES Y SOILS - 3-8% SLOPES 30 15 0 30 NOW OR BOUNDARY POINT LY N®F SHEET GRAPHIC SCALE IN FEET SEPTIC SYSTEM- LOCATION DETAIL 1 OF 1 STRUCTURAL ARCHITECTURAL N/F OUND) :ORGE P. LEYLAND �- # R.R.SPlKE 'VACANT LAND" (FOUND) 1 S 04'01'47" W MoNUME T 4.84 (p 4 � 7"N W:2664.59 \ e t lq lam it E ~` " WATER SER\ APPROX. 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' --.-- ie rnwvtm m A 1» umecr xo 1000 PROPERTY MAP E' -...•_. �+„ a �,. —r p N a•••'e_ M ext Nela�3+n u. —__� amu, --.-- sru.— mM.9lblOa[Y.rxiY OFFICE LOCATION: � � ro MAILING ADDRESS: Town Hall Annexe P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 �exj:t",„ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: September 9, 2020 Re: LWRP Coastal Consistency Review of SHEARMAN SCTM# 1000-12-2-14.1 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 DiSalvo, Diane From: gjustl02l5@aol.com Sent: Tuesday, September 01, 2020 11:11 AM To: DiSalvo, Diane Subject: Shearman - Fishers Island Attachments: Round House Deck Dimensions.pdf Diane- Attached is the plans for Shearman. The deck facing Block Island Sound is 12'x40' and on the opposite side of the house it is a 4.6'x16' deck with a 4'x4.6' set of stairs. Glenn Just JMO Environmental Consulting 653-0607 ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i Glenn Goldsmith,Resident SOF SOUjy _ Town Hall Annex -Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 J6hi-M.-$redemeyer III J�L Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 DECEIVE BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD F UG 2 5 2020 This Section For Office Use Only L� 17'u-1"—O ld Town Board of Tru tees Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension 1( Received Application: fas'� Received Fee: $ 100,DD 1C Completed Application: +rzo Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): _)C_LWRP Consistency Assessment Form,Sent: CAC Referral Sent: (,WO- a( Date of Inspection: Receipt of CAC Report: Technical Review: )(_Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): ThQM j S, Mailing Address: ,4�a��sf Phone Number: ��- � 44y 0 Suffolk County Tax Map Number: 1000 - f,--Np—,a r jq 1 Property Location: �1 !RNS_)Det'� SS\a Cd (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): ::TrA0 7 .n�G� �o�( Cc ►�C� Mailing Address: }?O,15rnC 44-7Q,,I VZUe- &N I �9-aUq Phone Number: Cna- 6�S—ffi 7t GENERAL DATA Land Area(in square feet): QR�3S 54- Area Zoning: Previous use of property: Intended use of property: &CJr ,0 4nz\14 8Qati 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 4 No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Un�iN�vx 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): v-\T- Qk42�1 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Prz--C86 64TIL Area of wetlands on lot: — a square feet qs Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: ILA 10 feet Closest distance between nearest proposed structure and upland edge of wetlands: \ZO feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? r\.\(k cubic yards How much material will be filled?— n cubic yards Depth of which material will be removed or deposited: OAA feet Proposed slope throughout the area of operations: JI� Manner in which material will be removed or deposited: :a)o 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): &-A tcygm -A)ne a cx�- z Short Environmental Assessment Form Part 1 -Project Information Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: Proposed deck Project Location(describe,and attach a location map): 1721 Wildemes Road,Fishers Islandl-ocation map enclosed Brief Description of Proposed Action: Applicant proposes to construct an irregular sized deck(see attached plans). Name of Applicant or Sponsor: Telephone: 631-788-7248 Thomas B.Shearman,III E-Mail: tshearman@americanpress.com Address: P.O.Box 2893 City/PO: State: Zip Code: Lake Charles LA 70602-2893 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ElSouthold Town Trustees&N.Y.S.D.E.C. 3.a.Total acreage of the site of the proposed action? 2.29-acres b.Total acreage to be physically disturbed? 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2.29 acres 4. Check all land uses that occur on,adjoining and near the proposed action. []Urban m Rural(non-agriculture) ❑Industrial ❑Commercial ❑Residential(suburban) ❑Forest ❑Agriculture [I Aquatic El Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑✓ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 0 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:Block Island Sound ❑ 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? ❑ 1 ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO I YES If the proposed action will exceed requirements,describe design features and technologies: ❑ W1 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ W1 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 0 ❑ On site sanitary system 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? 0 ❑ 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: Fresh 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 ❑ 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? W1 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? NO YES If Yes, Ela.Will storm water discharges flow to adjacent properties? ❑NO [:]YES b.Will storm water discharges be directed to established conveyance systemsrunoff and storm drains)? Y ` If Yes briefly describe: (❑NO []YES Page 2 of 3 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: W1 ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Glen ,1 t as a Date: Signature: PRINT FORM Page 3 of 3 -. ' . ` TRANSACTIONAL DISCLOSURE FORM lbe Town of Southold's Code Of Ethics prohibits conflicts of interest on the part of town officers and employees.ne puMose of this form is Wrovide inforr-nation which can alert the town of possible c necessary to avoid same. onflicts of interest and allow it to tak,,whatever action is YOUR NAME: (Last nairle,first name,*iddle 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 0yAPPLICATION: (Check all that uyplyj ' Tax grievance Variance -----_---__ Building Change oyZone ----_--___-- Tnomu Approval vfplat Coastal Erosion --� Exemption from plat or official map ------------ &4»»d»g --------- Otho, ---_--____- Planning --------- (If'^0dbrr',name the acbvity') uoyou personally(or through your company,spouse,sibling,parent,orchild)have xn,|ubooxhyv�� �� �^,~ ^,.""^"""umm/ 'u«mu �c�d�hyh�o�no�hu8nu,hux�ox bn��x�"B " any officer includingupu�nomhi�inwhidb�etowuof�curoccmyloyrobuao=`� ,d�: u«��o�mm»�mnrun»uemployee business, rporation mwhich the town«f��ro,employee owns mor thun5Y6ufdhosh��^aP« u/»wo«mh��»[(»ccmP!oy�co�hMaco - YES ___------_ NO - L_--____ If you answered"YES",complete the balance Of this form and date and sign where indicated. Name ofperson employed kythe Town ufSouthold Title orposition o[that person Describe the relationship between yourself(the uppU iro)uud!�ouo,, [O the appmPnmu»o�&}dbmu8hD)an&trdoncdhn� ~'-''-"'-~^~^ »» «or»'mn�l»ye� 8i�e,check o the ' The town officer or employee or his or her spouse,sibling,paren�or child is(check all that apply): ____A)the owner ofgreater than 5%o[the shares o[the corporate stock o[dm |/ (when the upp|i�ntivuovgmmbon); »PP cant _____8)the legal o,brn:fiuialowner ofany intoreo �ov ' uPv)iwmtionot^on,pon�i�n); ^ »«o-«»m»m�on�hx(�b�u�� ____�Qomofficer,director,partner,ur employee of the applicant;o, __-_ D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi#sof A Form TS I Print Name U - _ _-'- - Board of Trustees Apt; ,.;ation AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. Signa ur roperty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF �S� , 20-m— cpm L Notary Public _ Christie Consunado#52134 Louisiana Notary Public � Commissioned for Life Board of Trustees Applv'-=y-ation AUTHORIZATION (Where the applicant is not the owner) I/We, Q.Ktae '' at owners of the property identified as SCTM# 1000- QQ- in the town of T'•S�"Q`LZ �"' ,New York,hereby authorizes •- ' SU , 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 (BVI M�' , 20U_ Notary Public Christie Consunado#52134 Louisiana(Votary Public Commissioned for Life r � r APPLICANT ONAL DISCLOSURE FORM TRANSA T r T wn of SO tlr"1't'�Codes wli' nc aler the ops ofintoesci tie cotte�j of to-ale.id ala wit to lake v uteveu act oltt this form is to nrovr e m o all n wh c necrecnry to avoid saint,. p YOURNAME: _ (Last name,first name,.tltiddle initial,unless you are applying in the name o 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.) Building Tax grievance -----"""' Trustee Variance -- Coastal Erosion – Change of Zone Mooring ___----- Approval of plat Planning —_---- Exemption from plat or official map Other (lf"Other",name the activity.) sibling, � � esrelationship With any officer or r oYce Do you personally(or through Your company, or business inteest13uness intost'inem's abusiness, of the'1'owrof Southold. oI 1y blood. die town officer or employce has even a partial owners including a partnership,in which hilr of(or employment by)a corporation in which the town Officer of employee owns mon:than 5%of the shares. YES -_ NO Z�— 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 br position of that person Describe the relationship between yourself(the applicantfat cnt/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,patent,or child is(check all that apply): A)lite 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 n non-rory�orntc entity(when the applicant is not a corporation); C)an oirecr,director,partner,or employee of elle applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 20---- Signature Print Name_ --------- Form TS 1 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 assessment is intended to Waterfront Consistency Review Law. This Supplement other information used by a To making a determination of consistency. wri of Southold agency in *ExcePt minor exempt actions including BuildinPermits and other ministerial permits not located within the Coastal Erosion Hazard Area. g 2. Before answering the questions in Section C, the preparer of this f minor action list, Policies and explanations of each form should review the exempt Waterfront Revitalization program. ch policy contained in the Town of Southold Local A proposed action will be evaluated as to its sigWfic beneficial and adverse effects upon the coastal area(which includes all of Southold Town). ant 3. If any question in Section C on this form is answered "Yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus each answer must be: 11:,!!;���jldaminedd in detail, listing 111111111�111L§y 11 : supp)rting facts. if an action cannot be c _Ppol''fin and non- , ertified 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#_DQ_ PROJECT NAME The Application has been submitted to (check appropriate response): Town Board 0 Planning BoardEl Building Dept. El Board of Trustees Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital El 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: Apo V)-n - %I Nr oD§)Q (se_pe if c 1 � Location of action: , Site acreage: —4 Present land use: � P Present zoning classification: 2• If an application for the proposed action has been filed with the Town of Southold information shall be provided: agency, the following (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code( ) _ (d) Application number,if any: Will the action be directly undertaken,require funding, or aleproval by a state or federal agency? Yes gNo[:] If yes,which state or federal agency? tetI ;_kN,E%C, C. Evaluate the project to the following policies by analyzing how the project will further not support the policies. Provide all proposed Best Management Practices that will further each p lor Incomplete answers will require that the form be returned for completion. h policy. 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 minimizes adverse effects of development. See LWRP Section III—Policies; Paevaluation ge 2 for and criteria. ®Yes ❑ No [:],Not Applicable , ` 4k Q n Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of S LWRP Section III—Policies Pages 3 through 6 for evaluation criteria outhold. See Yes ❑ No ❑ Not Applicable \Aler 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 W4 YeSE] No ❑ Not Applicable rip V jliim' 4a Ti Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes 0 NoEl 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 YesEl No ❑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. 09--2-If- F-1 F-I Yes No `?t Applicable ' a ,W1_ I W-1 n � 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 1 . / ` e Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ®Yes ❑ No ❑ Not Applicable e PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. Ye❑ No❑ Not Applicable 4 c N Attach additional sheets if necessary *WORKING COAST P(- CIES ! 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 < < � f 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 ` c 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 W1 Not Applicable ` e gap a6W) 1:9 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,21 Not Applicable A c PREPARED BY TITLE DATE 6