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HomeMy WebLinkAboutTR-9747A Glenn Goldsmith, President QF so(/�y Town Hall Annex A.Nicholas Krupski,Vice President �QV� OlO 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J.Domino G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 Irou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1792C Date: January 29, 2021 THIS CERTIFIES that the as-built automatic generator to be placed on'a 3'x5' concrete-pad; - --- - - - - - - --- - - -- - At, 2667 Loniz Creek DrIve, Southold 'Suffolk County Tax Map#1000-52-9-1.2 Conforms to the application fora Trustees Permit heretofore filed in this office Dated October 15, 2020 pursuant to which Trustees Administrative Permit#9747A Dated November 18, 2020, was issued and`conform- s to all the requirements and conditions of the applicable,proyisions of law. The project' ` for which,this certificate is being issued is for the as-built automatic generator to be placed on a 3'x5' coricrete pad. The certificate is issued to Timothy Casamento &Kleo Kin's owners of the aforesaid property. Awl, Authorized Signature Glenn Goldsmith,Pres ' t QF soTown Hall Hall Annex A. Nicholas Krupski, Vice L___ident ,`O �� _ 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III l Southold, New York 11971 Michael J.Domino N be G Telephone(631) 765-1892 Greg Williams � �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 4 � INSPECTED BY: t_ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale-line/silt, boom/silt curtain 1St day of construction constructed Project complete, compliance inspection COMMENTS: T �jz/1 IL -� ✓� /ni'f�� 7bCERTIFICATE OF COMPLIANCE: a� C Jam/ Glenn Goldsmith,President SO(/jy Town Hall Annex Michael J.Domino,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOUAREREQUIRED TO.CONTACT THE OFFICE OF THE BOARD.OF TRUSTEES T2`HOURS-PRIOR TO'COMMENCEMENT OF THE ACTIVITIES CHECkE'b OAF BELOW - INSPECTION SCHEDULE f Pre-con_structfoh Wfe'lhOgilt`booin/silt'cuftain 11 st da of construction constructed When project complete; call for compliance inspection; J Glenn Goldsmith,President �QF SQUj Town Hall Annex y054375 Route 25 Michael J.Domino �� l0 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 BOARD OF TOWN-TRUSTEES TOWN OF SOUTHOLD Permit No.: 9747A Date of Receipt of Application: October 15, 2020 Applicant: Timothy Casamento & Kleo King SCTM#:-1000-52-9-1.2 Project Location: 2667 Long Creek Drive, Southold Date of Resolution/Issuance: November 18; 2020 Date of Expiration: November 18, 2022 Reviewed by: Michael J. Domino, Trustee Project Description: As-built automatic generator to be placed on a 3'x5'concrete pad. 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 forthe,operations-as indicated on the site,.plan prepared,by Samuels & Steelman, dated October 6, 2020 and stamped_appr`oved'on November 18', 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. 44L Glenn Goldsmith, President Board of Trustees N 0 F Rauch Travis N REVISIONS: 93 S Howells Point Rd Bellport, NY 11713 & Ak Tm N 75'31'17" E 2703 Long Creek Dr , 1000-52.-7-1.3 VACANT 210.00 — — — — — — — — — — — SITE- munr iA A SCTM # 1000-52-09-1.2 N/O/F PROPERTY: 2667 ROW off Lon Creek Dr o �\ / \ \/ orton Ang la ADDRESS Southold NY 1197 i \ \ / N 10 PondAve X �.\ ►� Southold, NY 1971 OWNER: Timothy Casamento R OC 5 H2O y ROW Kleo King \ ✓ ' `j/ \; / \ 10 -52.-9-1 .5 17 Woodbridge Court \ \ ,�' ROAD N/O/F West Babylon, NY 11704 \�\ ` \,i / Murtha Gerard, Murtha Robin \ ` �\ / I 411 E Lake Dr SITE: 87,937.5 sq.ft. 2.018 ac " ` �X .✓\ \ `�/ \/ / /\ \` Montauk, NY 11954 64,350 SQ.FT. 1.477 ac LLJ \ \ / 684\ ROW off Long Creek Dr Landward of wetlands boundary \ \ y \� \/ 1000-52.-9-1.3 �\ �� V COVERAGE: 9281 S.F. or 14.4% VACANT TOTAL PROPOSED LOT / ., ZONING: R-80 SURVEYOR: Kenneth M Wo chuck UJ \ ` / . % \ I Land Surveying = Po Box 153 F-- ` , \ \u \ \ Aquebogue, NY 11931 � \/ �_ _�-,-�- �4- _ _ \�� �� � � I IT OF TIDAL AND License # 050882 ♦� "` /`` \ / \ /y\ ,/ \�, FRESHWATER/NONTIDAL Dated Revised 12-13-18 V \ / Revised 10-10-18 LLJ � LANDS AS DELINEATED Revised 06-01-18 � \/ EN CONSULTANTS MA RrH 26, 2018 Revised 05-24-18 Revised 04-13-18 N/O/F / \ \ \ \/ , , , \/ j' \ /\ /\ / Update wetlands flagging 04-03-18 ANGELA NORTON Add 50 buffer 03-08-18 d , r \ i 610 Pond Ave r \; \ - / '�., �. , \N ,I , /\ {— O O Set stakes for NYSDEC 01/18/18 Southold, NY 11971 \ / / / 2653 ROW off Long Creek Dr i ,�,/> _ - \ /� i - 1000-52.-9-1.1 \ i ,� . �! \/ Tl't y\/ \/ � / _ 5 VACANT /x ,� ONE\AE EL/ �,-`'' � ` ONE\X (o X y }, x X x o \ \ \ �• �I Long Island Sound L / V \ / X'\ \ �' �.i ` / , /�� \ \ IRM ZONE0 LIMIT OF TIDAL A \ \ \ � /\ " ' i' /� / BOUNDARY FRE5HWATER/NONTIDAL \ xl�\ �;�'%\ " \ `.�` \,! \. Hashamomuck Pond WETLANDS A5 DELINEATED \ ` -n /X\/ EN-CON5ULTANTS %\ /\/ \ \ `\/ , i \ LIMIT OF -tt �a 0 MARCH 28, 2018 \X\ CLEARING I77pp ' �� ORIGINALLY z X15TING �a y I VE6ETATION TO oar �� Uj 44=\ \ / SHED NOT D i BE REMOVED@o, 000, 0 -;-CONSTRUCTED A ITE 40' 00 FT 5ETBAGK LINE FROM TIDAL �` O > -- 6 ` c �i\ , ,_ ; AND FRESHWATER/ n ," ORIGINAL.--_ , NONTIVAL �\ \ ,. PROPOSED 7�,, ; WETLAND5 � Imo' / y `}� LOCATION OF 0"z IN5T L TE GENERATORI \�5ILT FENCt\AL6NG' '� ' / \` '6 ' N \r ��\ "�L.IMiS & DISTURBANCE/ �.. / I �� ; � \ �' �pNSTALL TEMPORARY LIMI 'OF I SILT FENCE ALONG .ham \ / , \ \ `, 99, GL MNG i LIMITS OF DISTURBANCE \></ I ' \ moo, � , LIMIT OF TIDAL A `L /� `.dam / /\, /\ 6 s, '\ DW �\ -----CHAIN FRE5HWATER/NONTIDAL �' S / >� v �,, .m , LINK WETLANDS AS DELINEATED / j / 'Q��o \ \ �\ 10x5 �� '�\ FENCE EN CONSULTANTS ; -� \ IMI CLEARING 8 I ' 08 Z MARCH 28, 2018 / c D 15TURBA , `� •c� \ \ 59,000 S. - �� �0 9 4+ EXI TI co Q --- YRE15LI 01 0 - z 0�r=<; '0 (D LIMIT OF ..q ` ` .,lo` ; � W FIRM ZO O / \ � N A CLEARIN c ' L � ' to Z W � w• v wW, / ��------ -- -- --� ofCl) 0 o BOUNDARY LINE Nc 'f"'t /� �� _ 0 _•, ------ --- --r----C� N ► I INSTALL TEMPORARY 5 O '' NU-N\, \ �� q 4 BOARD OF I RUSTEES Q H SILT FENCE ALONG --- --- � i �. �-- � .;�; ;� 2 �3E:�?ROOM � , LIMITS OF DISTURBANCE '� POSE NEW I i ; TOWN OF SOUTE-�OLD y N. fi�Efi� 5I1E:i�IGE: U ER6R UND \ /Ni -NERAT / '� OOOOPLLFLR ELEV��+12.0 LITY LI S ' I DATE ve-�kk g 2,� \ ,Q .'� 40.0' u \ 82.2' i ' ' +84 ,.� .',.. \"••��;;` � �� \ � X � 818 t•" - ;""" ~ ___-__._ 6 EXISTIN / VEGETA N TO 8 6AIRA6W ' `" Q ' , . .-.._.._._ . -.._._._.-__.,_..____ ua BE RE VED i 5�tTH OOM N ,fir F E1-EV +8.5 — :,. ,<' .:,,. +9.6 ` i z �• !' .; crn 100 FT SETBACK LI N � nnil' TEST HOLE o FROM TIDAL AND ; N �� sewer g vrQ 00 L`=L't 6.9 bi FRESHWATER/ NONTIDAL ' , ' 9 _ o +8.5 ' I WETLAND5 T — — I 18.5 - +q.4 r7 , J _ I FRONT Y i , 28.0 i Q w 8 z 00 d I ��, 01-5350- � y �\\ DRY WELL Q ro � 17X6 ; ASPHALT ��in � I� L P ; O 'i MON. ; U PROJECT NO: Dy� m DRIVEWAY \ ' o � _� �A �, LP LP EXp o ��� 1803 � -----� ox6 i p � 0 ; DRAWN BY: 0 \Z .� %� '� -L EXP i O 6 p ; '���• ; i UT z , i � CHECKED BY: MON. ; ; TS VE 1 371.73' 7 S7575 53"W /g, 7 7\A� ' 6 6 275.00' Y ' DATE: �' a 10/6/20 co G o '1 � SCALE: 1" = 20' - 0" LOQ1 _- - - - EXISTIN6WATERMAIN- - - - - - - - - - - - - - - - - - - - - - - W.Y. ' - ' —water— El SHEET TITLE: J ---------------------------------------- - µ? --------------------- ----------------GAN -----------EI-------------------------------- ----------r -� BLUESTONE ROADWAY ------------------------------------------------------------------------------------------------------------ ELEG ------------------------- - --Norton-Angela----------- --i-, 610 Pond Ave Southold, NY 11971 ,;,-' --J SITE PLAN 16' WIDE +/- FRI VATS ROAZ�INAY 0O I 1000-52.-g-1 .5 ROAD__.-' ------------------------------------------------------------------------------------------------------------ELEC/GAN -------------------------- N/O/F Murtha Gerard, Murtha Robin 411 E Lake Dr SHEET NO: Montauk, NY 11954 2668 Long Creek Dr A0� """o 4 1000-56.—l-11 .15 VACANT F SCALE: 1 = 20'-0" Glenn Goldsmith,President *Qf SU!/TTown Hall Annex Michael J. Domino,Vice-President �O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III l l�t Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �® �� Fax(631) 765-6641 } COU L 1 ! l� U BOARD OF TOWN TRUSTEES 0 CT 2 7 2020 TOWN OF SOUTHOLD TT TO: SOUTHOLD TOWN BUILDING DEPARTMENT ' 'D pry Dr + g� r RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENT VJOLI`1�, Property Owr'ler Name: Oft*MTO Kt _ DateS ' ent`tb,B1dg:''Dept: 1017,f.Z.O : :r:..•.. �; _- . _ 4 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's,permiitin requirements stated below: Z .: L . YES NO Will the proposed project require a Building Permit? V Will the proposed project require a variance determination from the Zoning Board of Appeals? ''" •: Will any part of this application be considered, aDemolition as described under Town Code? COMMENTS: Si a ure o evie r Date k - . j� .I V I1 I S . C . T. M . # DISTRICT 1000 SECTION 5 2 BLOCK 0 LOT 1 v 1 1 . 2 TYPICAL DRYWELL CROSS SECTION (CONC. PRECAST COMPONENTS) F #PRE- 17- 16 8 3 6" SLAB FOR NON-TRAFFIC BEARING 8" SLAB FOR TRAFFIC BEARING 50' MIN. HEAVY DUTY CAST IRON FRAME AND APPROVED OUTLET PIPE BUT SUFFICIENT TO KEEP APPROVED INLET PIPE COVER TO GRADE TO EXPANSION RINGS MIN. 4" DIA. MIN. 4" DIA. SEDIMENT ON SITE PITCHED 1/8%1' PITCHED 1/8%1' HAY BAIL AND/OR ❑ ❑ ❑ ZSILT FENCING ❑ ❑ ❑ ❑ z LLCLJ QI ti ti 3: Q 0 p CD 0 s Q�G Q�V CV o w n ' CONSTRUCTION ENTRANCE '- FOUNDATION OF COMPACTED 3/4" STONE BLEND OR N.Y. STATE D.O.T. APPROVED R.C.A. 3' MIN. 8 - FILL TO 18" (Min.) ABOVE EXISTING GRADE FOR DRAINAGE. COLLAR BACK FILL MATERIAL TO BE CLEAN SAND AND GRAVEL i' TYPICAL SILT cppppm - rvwN vF- 3aU►Hol�- -�- DRAINAGE CALCULATIONS: GEOTEXTILE FABRIC PROPOSED LOT COVERAGE: SUPPORT POSTS (BASED ON LOT AREA OF 64,350 SO-FT. WOOD OR METAL LANDWARD OF WETLANDS BOUNDARY) A) DWELLING W/COVERED PORCH: 3636 S.F. 3636 x 0.166=603.57 < 604 REQUIRED FLOW DIRECTION PROPOSED DWELLING W/PORCH: 3636 S.F. - - - PROPOSED DETACHED GARAGE: 1288 S.F. (2) 10'DIA x 5' DEEP ORYWELL=684cf PROVIDED EXCAVATED AND PROPOSED SHED: 144 S.F. BACKFILLED TRENCH TOTAL PROPOSED LOT COVERAGE: 5068 S.F. or 7.9% 61 DRIVEWAY=2445 SQ.FT. 2445 x 0.166= 406cf REQ. EXISTING GROUND C) GARAGE=1288 S.F. 1288 x 0.166= 214cf REQ. NYSDEC LOT COVERAGE i D) WALKWAYS = 665 S.F. _111 I I=1 11='11-1I (BASED ON LOT AREA OF 64,350 SQ.FT. 665 x 0.166= 111 cf REQ. I-I I I (1 I-I_1r=­.'.1 11-1 I I-I I I I-I -I 11-1 11-1 1-1 11-1 11- LANDWARD OF WETLANDS BOUNDARY) E) REAR PATIO = 650 S.F. �IiII�Ilill�llill�ll=T1TiI�Ilill�ll�c1�Iil�lli �IIil II�I1111�1111111111�11T11�1- PROPOSED DWELLING W/ PORCH: 3636 S.F. 650 x 0.166= 108cf REQ. 2 MINIMUM PROPOSED DETACHED GARAGE: 1288 S.F. TOTAL 839cf REQ. PROPOSED SHED: 144 S.F. (3) 10'DIA x 5' DEEP DRYWELL= 1026cf PROVIDED DRIVEWAY: 2445 S.F. WALKWAYS: 665 S.F. REAR PATIO: 650 S.F. TOTAL PROPOSED LOT COVERAGE: 8828 S.F. or 13.7% e e I d e a v VACANT 150 e ° o W e TYPICAL CLEAN OUT I � d o SLATE OR STOPPER END a ° SUITABLE COVER \ OR PLUG N/1- 44 W �i CD w d o 30` ELBOW p _ne 60' WYE C"i ¢, o N z\ I , S VACANT q 4 150' FLOW N PROPOSED o �4 12'X12' SHED 40 `n� o` 89' .� STAKES SET C, �o • zv LOT 1 �� d VACANT PROPOSED SOIL 150' OQ ZONE X 99+ STOCK PILE AREA J= 1-90, �<) DRY WELL d O INSTALL TEMPORARY O'DIAX5'DEEP e SILT FENCE ALONG / w LIMITS OF DISTURBANCE �0 PERMANENT FENCE OR I ��CY SE ES � (7.5 vd 4 50' DISTURBANCLL STONES DEBUFFER G ' O�I0o00 01/18/1 PGROUNDN�TR e ELEV. 6.9 S 40.0 dv OL DR BROWN 0.9' 70 Quo �� v 6'6,, L❑T 2 SANDY LOAM 0 Qp�p (7.5) v R`F-WELL OHO t�,ti O j ROW C/T- 1 O'DIAX5'DEE _ Q��p�L'`� 00 (U °� SM LOAMY SAND 1 . 1 O DRY WELL �,J w 10'DIAX5'DEEP � PALE v _ EL 69 BROWN Z S5 P N 7.5) _ \�� FINE ' a w _ 4.9 STAKES :_'CLEAN_ r ��j �J\ MON. SW TO Q SET '�F. �� 7 0 COARSE ° -7-0) 0' N O 01/18/18 A6• N (7.5) \ < ��� X00, L SAND Q os o.� ��44 R� 1 WATER PROP GF 8.5) zC T PROPOSED A 3A 17 a 82.2 o GARAG NR0 9.0� ',5) ?cA_ 3 BEpGA�Ms� I pth MON. WATER IN ELEV 1 .0 o,W/ o o ( z 01200 X 2.5 EE FINE 9 0, 2$ a b x •0{5 d'o-plAx2 p O� y SW TO COARSE OF Q / 7• OveIR OPOSE S x 2 W.V. SAND 6.0 N pN1 YARp C IMPERVW� MIN PROPOSED O / FR DIP0, 5 IMPERVIOUS o � (2) DRY WE S 1p WALKWAY ' CL 6.9 - 1O'DIAX5' EP O_ --- REVISED 10-10-18 D pGE p�F,�� � W,N REVISED 06-01-18 SH DO1 Av� A�r. oPpSEo H CP -1-100 - 08-02-17 REVISED 05-24-18 CRETE V 01 09,1\1 R jAER PR ' EV-CC- D\ ' CL 6.9 CON OP PROP GU � p 1 K. WOYCHUK LS REVISED 04-13-18 UPDATE WETLANDS FLAGGING 04-03-18 IN sEp °25,53os "W ' p, 6.94 ELEG/GAN ADD 50 BUFFER 03-08-18 S75 W P ANT SET STAKES FOR NYSDEC 01/18/18 1500AGER M��N �� p, va5 ' 1 3, P ROWPY $ PRO�oj�ARRP �\OSP E O CL 0 S�P UG RANl 5-�ON t Np r✓O� r ��� FOO W P� - / •��� \ B��E16. NIDE ENR ROP�SEp pR1VE of P .-------- . C.I. LOCKING (7.5) FINISH GRADE COVER TO GRADE _--�- f I6 r i'MIN-2'MAX (o ti T 1 5 2020 20 MI / FIRM PANEL #36103CO158H 1/4 -FT. 1/ 6 COVER 6' COVER UPLAND AREA: 64,350 SQ.FT. NAVD88 1 6" N 6" SLAB (6.0) R 939 SOFT. or 2.02 ACRES ELEVATION DATUM: ___---_--________-------- AREA: NVERT E 87, -- � INVERT-- (6.25) INVERT INVERT UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY (6.9) HOUSE (30-RUN) (5.75) (5.67) 7o GARAGE (35' RUN) MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE. CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN (7.0) 8'0 3' COLLAR ONLY O THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE. TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION FOUNDATION POOL CLEAN MI LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. WALL TANK 2, COARSE THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE 1 -8„ SAND & NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS 3'MIN GRAVEL AND/OR SUBSURFACE STRUCTURES RECORDS-D -OR-UHRECOR3E-D-ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 2 CERTIFIED T0: MCCARTHY MANAGEMENT. INC.; USE 4" DIA. APPROVED SEWER PIPE MAP OF: MILL CREEK PRESERVE 1000 GAL. PRECAST S.T. (4.0) FILED: JANUARY 28, 2005 No.11216 SITUATED AT: SOUTHOLD UNDERGROUND UTILITY LOCATIONS AS PER MARK-OUT KENNETH M WOYCHUK LAND SURVEYING, PLLC PROVIDED BY OTHERS. TOWN OF: SOU TH OLD HIGHEST EXPECTED WATER EL 1.0 Professional Land Surveying and Design DRYWELLS AND CESSPOOL SUFFOLK COUNTY, NEW YORK P.O. Box 153 Aquebogue, New York 11931 THE WATER SUPPLY, WELLS, 4z..x#4 Viva298-1588 FAX (631) 298-1588 LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS PHONE (631} AND OR DATA OBTAINED FROM OTHERS FILE # 16- 179 SCALE: 1 "=40' DATE:AUG. 02, 2017 N. Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk i 1 N 0 F Rauch Travis N REVISIONS: 93 S Hcwells Point Rd Bellport, NY 11713 N 75'31'17" E 2703 Long Creek DrSITE UAT/0% 1000-52.-7-1.3 VACANT 210.00' MIA o / \ SCTM # 1000-52-09-1.2 ---"- o % /�\/ \ \ \ '\ N/O/F PROPERTY: 2667 ROW off Lon Creek Dr _ \ C3 V � / � ��/ '�,�\� � Orton Angela ADDRESS Southold NY 1197 - 10 Pond Ave / \ \ \ \ \ Southold, NY 1971 OWNER: Timothy Casamento \, T \ \/ \�' / �/ / ROW OC1 1 5 )20 Kleo King \,\/ 1000-52.-9-1.5 '\- !` \,:% \/ ��\� '""� \" �/ !' / ROAD N o F 17 Woodbridge Court _ \ \ i / / / West Babylon, NY 11704 ! I Murtha Robin Murtha EdLake Dr SITE: 87 937.5 s .ft. 2.018 ac \ / \ /"� ;' / \ \X i / Montauk, NY 11954 _ 64,350 SQ.FT. 1.477 ac �- / \ XX �\ 2684 ROW off Long Creek Dr Landward of wetlands boundary Z \ y\ \ / \ ' 1000-52.-9-1.3 \ \ice �% \ �' \ VACANT TOTAL PROPOSED LOT COVERAGE: 9281 S.F. or 14.40 ZONING: R-80 >� X \ %\ I \ SURVEYOR: Kenneth M WoychuckW 0 Land \ , / \ �y\ i \/ \/ �K. /�1.\}\ I Po Box 53ying ® _ Aquebogue, NY 11931 �- License # 050882 I1�IT OF TIDAL AND �/ f \ - . / FRESHWATER/NONTIDAL Dated Revised 12-13-18 Q LANDS AS DELINEATED Revised Revised 06-10 18 18 LLJ EN CONSULTANTS Revised 05-24-18 MA H 28, 2018 / \ \ Revised 04-13-18 N/O/F - >, Update wetlands flagging 04-03-18 �\ \ / \ EA \ / / p g9 9 ANGELA NORTON \ ! �. �\ / y\ \/ \ 610 Pond Ave Add 50 buffer 03-08-18 r' ' � \ x%' � � Southold, NY 11971 z Set stakes for NYSDEC 01/18/18 2653 ROW off Long Creek Dr \ ,>-'' � 1000-52.-9-1 .1 , \ �\\ / D aT l RE5A \ 5 VACANT \ \ %`\ \\ \ ,' \\ - j doll., ft Ink ONE.AE I'EL/8�.,�/�/ ;\ /OZONE .�L \� \ / O Long Island Sound IRM ZONE L LIMIT OF TIDAL A \ / / i /` /' /" BOUNDARY ® V FRESHWATER/NONTIDAL / / / '%l\., , \ �� �\�" �i V LINE Hashamomuck Pond WETLANDS AS DELINEATED �` ! \/ /\/� /� i j EN-CONSULTANTS %\ i i' \ /�� \ LIMIT OF �t �o \ O MARCH 28, 2018 \ \ . '' \ /\ CLEARINS I J /"\ ` �' ORIGINALLY XISTING �a W APPROVED I VEGETATION TO o�p 3 • �� 1 BE REMOVED l o y NOT SHED O STRU CITED I , `00 �a, _ o ITE 40' 00 FT SETBACK `�� o LINE FROM TIDAL A v O ORIGINAL-- - 6 - NND 1 WATER/ \ / PROPC.�SED WETLAND5 �ij \ LOCATION OF \ ;< \ Oma'\ NST ORAR \, \�" /�� GENbRATOR ' FENCE 1ALONC�\f �k / ` \/ ` ,` -6 CD IMIt5,0'F DISTURBANCE / / /� , � `� ' N LIMI 'oF NSTALL TEMPORARY ,�" 9 ` GL TING I `.\\ ' SILT FENCE ALONG o \ ��I , LIMITS OF DISTURBANCE oK LIMIT OF TIDAL AN \ \ O`di ! , \ \ 96� II \� ' \ �\ HAIN FRE5HWATER/NONTIDAL �' / s \. \ v `� .to I �\ , LINK WETLANDS AS DELINEATED ' ,p� i , 10x5eco 1 FENCE EN-CONSULTANTS \ IMI CLEARING i �� ' 08 Z MARCH 28, 2018 ' �� '�c D 15TURBA 8 4+` L o `% fi 3q,000 S. - �1 0 EXI TI cA Q. C E LI \ tz ZO E i6 ` S I i a o M 1 y b -' LIMIT OF „�0 ; 1 a Z LU a o \/ ' 2�N 1` ' GLEARIN c r ------- -- b v w L, FIRM ZO , �_ --, BOUNDARY LINE40 / y\N� 0r1 :JJ...• ------ --i-- - ----C] W• a " = M INSTALL TEMPORARY 5 �",�' O I \ �\ xF- SILT FENCE ALONEOSE NEY4 , LIMITS OF DISTURBANCE 'Olt TMJ 3 Cj �' �` / \:''_` RES� NG U ERGR JN12 �( v �1 Qr0 �� , ,,.y;:: L.. " FLR ELEV��+12.0 U LITY LI S / \ NE RAT ' f.i•'� \,., j `\:. ` 40.0' �` / \ 82.21 � .0 ' +8 4 .�'�• •• •'• "�;"��; �\ \ � � � uEXISTIN G ! VEGETA N TO 1 (5ARA67 W ` W t BE RE VED 1 BATH OOM ` A� y 1 N �\ ;� i P s S oA 100 FT 5ETBAGK LI i N F ELEV +8.5 - � `� TEST HOLE FROM TIDAL AND ; N �� sewer g0 GpQ .. O+q.b 1=L:t b.q W FRESHWATER/ NONTIDAL b _ _ ' � _- J� �5•_ _ 00 q 6 I - I r— � �'; _ _ _ _ J WETLANDS -� FRONT Y I +8.3 I ' �8.3 � +q.4 1— � � J i �° ' • � 28.0 8 \ z ' 018350- cN .\\\ DRY YELL / ex W / aex6 ASPHALT 1P LP LP MON. ' Q d I D ; m DRIVEWAY �� U PROJECT NO: / M / 0 ' �• '---___7,1 -It _ 'IOxb �� �+� LP EXP O� 1��� 0 DRAWN BY: 1803 1 ' b � CHECKED BY: 1 MON. TS 1 Dg�VE 371.73' / S75'25'53"W /g, 7 7\A' 6 F 6 275.00' y DATE: K 1 ❑ 1 I 10/6/20 co El SCALE: If 201 oil LOG EXISTING WATER MAIN 1 - - - - - - - - - - - - - - - - - - - - - - - - - -water- - - ❑ - - - - - ' _ _-- —[7-- 1 _ r-I SHEET TITLE: / J - --------------------- ----------------GAN -----------E7 ------------------------------- ---------- --------------------------------------- r---' r� i- '1.5+ 7.0+ BLUESTONE ROADWAY N/O/F Norton Angela ' -------- ------ ELEG -----------------------PondAv ------------ -- "�'� SITE PLAN -- 610 Pond Ave Southold, NY 119 ----;?,-' / 16 WIDE +/- FRI VATS ROAI�Y�IAY ROW ,=' O O OI 1000-52.-9-1 .5 ROAD------' ------------------------------------------------------------------------------------------------------------ELEC/GAN ------------------------- N/O/F Murtha Gerard, Murtha Robin 411 E Lake Dr SHEET NO: Montauk, NY 11954 2668 Long Creek Dr 1000-56.—l-11.15 [F1 A VACANT SCALE: 1 " = 20'-0" M Wy� S A M U E L S October 13, 2020 S T E E L M A N 00 a a a e © a Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 RE: As-Built Permit for Residential Automatic Power Generator CASAMENTO KING RESIDENCE 2667 ROW of Long Creek Drive,Southold, NY SCTM#1000-52-09-1.2 1 hereby apply for an as-built ADMINISTRATIVE PERMIT for an automatic power generator, installed at the Casamento King Residence. For same, attached please find: 1. Application 2. General Date 3. 11 Vetland/Trustee Lands Application Data 4: Short Environmental Assessment Form 5. Authorization Letter 6. Affidavits 7. Applicant/Agent Transactional Disclosure Form 8. LWRP Consistency Assessment Form 9. Covenants and Restrictions 10. Survey plus(3)copies 11. (4)SITE PLANS 12. Photos of installed generator 13. Check for$200.00 Please note that two structures originally permitted,by this office, a Shed and a,stone paved Terrace, both of which encroached closer to wetlands than as-built generator. Neither of these structures were constructed, nor will'they be. Please get back to me with questions or concerns. If not, please place this application on the agenda for your next available PUBLIC HEARING, notify us of when that will be, and send along materials necessary for that hearing. Sincerely, IA" I Thomas C. Samuels,Architect enc. ARCHITECTS 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 FAX(631)734-6407 -��l Glenn Goldsmith, Pry,f ent �0 C'p ;�`� Town Hall Annex Michael J. Domino'--I �O G-� �- 54375 Route 25 John M. Bredemeyer III o =` P.O. Box 1179 Za A. Nicholas Krupski o Southold, NY 11971 Greg Williams yp�� Telephone Fax (631) 76-1892 BOARD OF TOWN TRUSTEES ` TOWN OF SOUTHOLD Date/Time: N b� �, Completed in field by: Tom Samuels on behalf of TIMOTHY CASAMENTO & KLEO KING requests an Administrative Permit for an as-built automatic generator to be placed on a 3'x5'concrete pad. Located: 2667 Long Creek Drive, Southold. SCTM#: 1000-52-9-1.2 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 f Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: I 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: -�-- - Ala- I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other t i a t 1 Ar op ir Albin - .� _ � �- � ■■a�.te� , �. ". J4 t ■� t t x _ r k DECLARATION OF COVENANTS AND RESTRICTION Subdivision of Map of"Mfl Creek Preserve" THIS DECLARATION made by Angela Norton,;this 14�day01 , 2017, hereinafter "Declarant", the owner of certain remises described as that Berta P n plot, preee or parcel of land, lying, situate East of the Village of Southold, in the Town of Southold, County of Suffolk .and State of New York, known and designated as Lot 1, Lot 2 and Lot 4, as shown on the "Map of Mill Creek Preserve" filed in the Suffolk County Clerk's Office on 01/28/2005 as Map Number 11216 (hereinafter"Premises")desires to restrict the use and enjoyment of said Premises and has for such purposes determined to impose on said Premises covenants and restriction and does hereby declare that said Premises shall be held and shall be conveyed subject to the following covenants and restrictions: 1. The purpose of these Covenants and Restrictions is to maintain the natural and agricultural characteristics of the Premises,to the extent practicable. 2. There shall be no further subdivision of the Premises, even if permitted to do so by any governing municipal authority. 3. Other than the agricultural uses permitted on Lot#5, there shall be no commercial activity conducted on the Premises; this includes but is not limited to, professional offices, fabrication; art studios, manufacturing, garage sales, tag sales, etc. No vehicles may be displayed for sale at the Premises. 4. The minimum foundation footprint for the primary structures built on any lot at the Premises is 1,600 square feet including the garage. The maximum total square footage for the primary structure built on lots 1 through 4 shall be 5000 square feet. 5. All structures built at the Premises must have exteriors made from natural materials, (i.e. cedar shingles, stone, brick, wood clapboard, etc.). Garage doors shall not face directly towards the roadway without natural screening. Driveways shall be designed to avoid a straight ran from the roadway to the garage as much a practicable. Declarant, her successors and assigns, reserves the right to modify this clause as needed to accommodate the design mandates of each individual lot at the Premises. 6. All utilities must be underground. 7. No recreational vehicles, campers, commercial vehicles,trailers,boats over 26 feet, or industrial equipment shall be parked at the Premises. Boats under 26 feet in length may be stored at the Premises in the side yard or rear yard of each lot, provided the boat is shielded from the view of the adjacent lot(s). 8. Dumpsters and tarps of any size, except during construction, are not permitted on the Premises. ar 9. Garbage pails, satellite dishes, fuel tanks, swing sets, windmills (except Lot #5), trampolines, and clotheslines are permitted at the Premises, but must be shielded from view from the roadway and adjacent lot(s). 10. No livestock of any kind may be raised or kept on Lots 1 through 4 at the Premises. Domesticated dogs, cats, and rabbits are permitted. 11. All outdoor flood lighting must be on a motion detecting -switch and timer not exceeding 5 minutes, All other light sources must be shielded from the roadway and adjacent lot(s). 12. Amplified music, live bands, or other similarly loud activity must be shut down no later than llpm. No lawn or yard maintenance using motorized equipment is permitted at any-time on weekends or holidays. 13. No non-farm related all-terrain vehicles, snowmobiles, motorized trikes, quads, off- road motorcycles, or similar recreational vehicles may be used at the Premises at any time. 14. The Easterly view of Lot#3 shall not be obstructed by any plantings on Lot#5. 15. Taxes, maintenance, and insurance for the roadway known-as North Pasture Drive shall be apportioned to each lot based on Paragraph 2 of the Covenants and Restrictions recorded in Suffolk County Liber 00012329,Pag e 581. 16. Any damage by an individual lot owner, or their agent, to the common roadway, shall be repaired at the sole cost and expense of tha lot owner A - l A GE A NO ON State of New York } :ss County of Suffolk ) On the 24th day of MAY in the year 2017 before me, the undersigned, a Notary Public in and for said State, personally appeared ANGELA NORTON, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. Notary Public LYNNE R.ESPOSITO Notary Public, State of New York Qualified In Queens County . Reg.#01 ES6086011 Comm.Ewes January 13,2015 �. 94 FOR PCL No. e` - `` SEE SEC.NO. 1 ``• fi e nWN • ode' 'B • r ti 3,. a �Y ~ aw i t e q Q 11.1 OCL NO. Q � ,� •� .$ • Ida w e ed A�EWED FOR MW u—YGROI. ) , +sA(q • � 1zW4 • e e e�` � v ,� � .•` � �fi A. o .. � zeµq a u Isat I t v'K) i M(W 01-4 ink) �. e d\Co •VI1, \ • �e SOa - I VV /Q• 1e71N(a) 58.10 • \�Yom OFSOUntno - •'� ,4 Bfy�_�:. G�,: to sYc) aloA I _ saw ASO. o a I r O , I s: FEcaSeLAND musr IJ TAW moo\ I 7 I" w zeA d \ zap ♦ \ � 2 saw \ /) bO ``� iOR PCL NO. "^w4 \ \ SEE SEC NO. raRf1>L»o \ os•aaa+t —- sEE sEc.No. UtE eHTCIt �— uNE nmcN NATCN �--- ---�---- SEE SEC.NO.obs SEE BB.NO,ase vnmx '♦�ces`' 0 Notice COUNTY OF SUFFOLK © E ++a 01 016 ""OF UPON NO E w.w•�� —�— ,,.....w.fw tst) ... O ...,,.. --, a..... --•-- . E� .ffr� 2 RealProperryTaxSernceAgenq r Of 0$2 C' ------ o.+ ^ _. u. -- w•••u• 'w RFfIXlccwBry ru wfinmw�ai[ +� Counry G.M RIv.Tre.NY 11e0t M tse seT 0ea Ntll� N a,wai.iz�iA o 1 a6rncT xs 1000 P me PROPERfr NAP o r.si x�N4 —__-- -- —� m..up•6Rco.ysr Maim Diane From: Tom Samuels <Tom@samuelsandsteelman.com> Sent: Tuesday, October 27, 2020 3:23'PM To: DiSalvo, Diane Subject: CASAMENTOXING Diane,, Regarding the application for an as-built ADMINISTRATIVE PERMIT for a automatic power generator for the Casamento King Residence at 2667 Long View Drive in Southold,the concrete pad is 3'x5',or 15 square feet. Thank you for updating the file with that information. Tom Samuels ATTENTION:This email came from an external source. Do not open attachments or click on links from unknowrnsenders or unexpected emails. " Town Hall Annex Glenn Goldsmith,President Michael J.Domino Vice-President ° 54375 Route 25 ' ` { P.O.Box 1179 <- John M.Bredemeyer III Southold,New York 11971 041 c s A.Nicholas Krupski �*g Telephone(631) 765-1892 g Greg Williams Fax(631)765-6641 � ; ,, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application =, rli rr r Wetland Permit Application ; Administrative Permit !_ f Amendment/Transfer/Extension OCT 1 5 2020 Received Application: 10.16-20 Received 0.15ZD Received Fee: -fib•-00 ^Completed Application:. l0.23•� s°° of l To"e° Incomplete: SEQRA Classification: Type I Type H Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): _----- --—--- -LWRP Consistency Assessment Form Sent: .CAC Referral Sent: Date of Inspection: 114DIA0 Receipt of CAC.Report: Technical Review: Public Hearing Held: , �I•L�•ZO_ Resolution: Owner(s)Legal"Name of Property(as shown on Deed):, 4 UM4 TO q6 Vj(�Cf Mailing Address: �vLztk�[a Phone ber: -?)3 Suffolk County Tax Map Number: -1000- ��� " Property Location: 2b 9 1soa-VWA4 , a (If necessary,provide LILCO Pole#, distance to cross streets,and location), AGENT(If applicable): Mailing Address: o� 2�JCJ Phone Number: Board of Trustees AppliC ,ion GENERAL DATA �y Land Area(in square feet): �, 1 �- Area Zoning: 'To Previous use of property: �, Intended use of property: Covenants and Restrictions on property? i/ Yes No If"Yes",please provide a copy. / Will this project require a Building Pen-nit as per Town Code? /l 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 requ a 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 Prior permits/approvals for site improvements: A enc Date I n No prior permits/approvals for site improvements. / Has any permit/approval ever been revoked or suspended by a governmental agency? Y No Yes If yes,provide explanation: „ Project Description(use attachments if necessary): As LUL If wa(f Afltoaabc, Qb &_r Board of Trustees Appli, (pion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ID ibwv,r t , �'c I Area of wetlands on lot: oosquare feet Percent coverage of lot: 0, -0/0 Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 5 feet Does the project involve excavation or filling? V, - . allo ,Yes If yes, how much material will be excavated? INA cubic yards How much material will be filled?, 0 cubic yards Depth of which material will be removed or deposited: 0 feet 0 Proposed slope throughout the area of operations:_..3 � Manner in which material will be removed or deposited: 4},rL� //\�V Y ..fA�F-Ji+-z�tilr-��� b4+���i�� • -R - 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): TWO,I I di 0- k to-, +,I JAJ j Xv'fl'&UJ'Q l]A 5 � c� i Board of Trustees Application i AUTHORIZATION (Where the applicant is not the owner) f iI/We, N1X.® t a owners of the property identified as SCTM#1000- —.b I e aL_ in the town of n � ,New York,hereby authorizes � l�(� / S to act as my agent and handle all I I necessary work involved with the application process for permit(s)from the Southold Town ; Board of Trustees for this property. 1 i - i roperty Own is Signature Property 071,s Signa i 1 r DC �6- SWORN TO BEFORE ME THIS DAY OF _,20 p p iii Dawn Johnson f Nornar� =Notary Public,state of New York k `*1 PUBLIC *€No 01Jo63 49053 . vdo` Qualified in Suffolk County I NO Pub11C """""""""� Commission Expires 10/11/20 i l 1 i 1 k I I� 1 1 Board of -Tiustees Application a -AFFIDAVIT I� ® BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS OFHE APPLICANT FOR THE ABOVE DESCRIBED PERMTI'(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ' E ALL WORK WILL BE DONE IN THE MANNER-SET FORTH IN THIS APPLICATION AND.AS-MAY BE APPROVED BY THE SOUTHOLD-TOWNBOARD 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 j 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 - i EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THETERM { OF THE PERMIT. ! i Signature of Property Owner Signature of Prop Owner i SWORN TO BEFORE ME THIS_ DAY OF [J_k_h4/ ,-2002(1;') r E oS.pTEpF r,, Dawn Johnson $ NOTAav Notary Public,State of New York PUBLIC ,.1 No OIJ06349053 i Qualified in Suffolk Coanty otic Commission Expires 10111/20,1 �C Ntary P - 1 ' i APPLICANTIAGENTMIKPRESENTATWE T ANSAC'I ONAL DISCLOSURE FORM Tit'T wn of n Ihold's Code o Gthics m ihi 5 ilia of imerest on the art of town"ffiM and a la " s fh ' this farm is to mnxide inforinution whtich can�zti the town afsacsib}c coicflicl� fhttc si M allot it.to take wN teveractlr n is e to avoid same. YOUR NAME: (Last name,first naau,.r*ddle Initial,Unless you are applying in tha name cir someoxmclse or other entity,such as a company.Ifso,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply) Tax grievance Building Variance Thwee -Change o€Zone Coastal Erosion Approval of plat Mooring Exemption from plat or ollldai trap Planning Other (If`Other'',name the activity.) Do you personally(or through your company,spouse.sibling,parent;or child)lt?ve a relationship with any officer or employee of thc't'own ofsouthold? "Relationship'}iricWasby blood;:ttt"arriggt;o`r Cosiness-ii►fcrest`.`Easiness intccest"nieaiifs a t�usincss, _ lnaiud':nga parwership,invihich tfie towitoliectsiremployee hasc+rhn a partlatoevnr isliip of{orecrtplbymeUGby)a txtrptsraon in which the town officer or employee owns more dun 5%v ofthe"chanes. YES - NO Ifyou answerud"YES",complew the balance of this form and date and sign where indicated. Name of person-employed by the Town of Southold Title br positron of that person Describe the relationship between yourself(the ajspli tfla entlnepreseatative)andthe town offaceror emptayee:Either deck the appropriate line�A)thr�uuglt�?)'itftdtor d�s'crit�in the space proi�ided. , The town olteer, or employee or his or her spouses sibling,parent;or child is,(check al that apply): A)the owner of greater titan 5%qf the shares of rte corporate stock of the applicant (Ivh ointhe apphicantasac orpomfitin), n B)the legal orl)=Mciril owner of any inter lit a nnn-�tpotate Wily(when the applicant-is not a corporative); C)an officer,direewr,paitner,or employee of the applicant;or l�)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of r� L 2 Signaiure __ Print Nam i.m +� ! ` Form TS 1 A]PPLICANUAOENUREPI2 r'SENTATIVF TRANSACTIONAL DISCLOSURE�FORM T te.Tawn at Southold' Code oftihics,Rrobibits conflicts ofintemston the Dart oEt` ii" kersd&m plojeg.Tlie u o e iif this'form is to- rovide,inforivation which cavi ale t e"t wn.of aq slli a c' ' icts'.ofinterest""d"flaw It to,talte,�ah" aet%i�" ,i itedessero tb avoid same: YOUR NAME (Last name,fust 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 Other (If"Other'',name the activity.), Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,rgarriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employe has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5°/ of the shares. YES NO 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 Iine A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(whets the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of ID ,�.98'o ZV �Sigtiaturti VI JAJ OL I Print Name '��(AA Form TS 1 61Z20 Appendix B Short Environmental Assessment Form Instructioits-for Completin Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part l 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 I-Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): - ��7 A A Cie r ��� 6 t�© � Brief Description of Proposed Action, L4�,f W 0,h, OVAC)Mp't' c, roVt vLe. PwNr Name of Applicant o Spons r. Telephone: o pWl 9A E-Mail: �. FAddress: IE)VK UIVC X52 f Cc M 2d a City/PO: j� ={- A State.'l Zip�Code: cap s 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 El 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: so()+ke)(& " • Q!pt. , '3.a.Total acreage of the site of the proposed actioni acres b.Total acreage to be.physically disturbed? �� 1 acres c.Total acreage.(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2: S9 acres, 4. Check all land uses that occur on,adjoining and near the proposed action. F1 Urban Rural(non-agriculture) ❑Industrial ❑Commercial 21'Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic nOther(specify): ❑Parkland Page 1 of 4 5. Is the proposed-action, NO VE N/A a. A permitted use under the zoning regulations? o E b.Consistent with the adopted comprehensive plan? .❑ E] 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YE landscape? '7 Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES if Yes,identify: S. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES. b.Are public transportation service(s)available at or near the site of the proposed action? - c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO , YES_ If the proposed action will exceed requirements,describe design features and technologies: (� 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water:-_ G�Q,}�,[,ti/'&tK f11'l 1�1 (..._J i D' 11.Will the proposed,action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Q{ � 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic INO YES Places? T71 nt 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 YE wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,'any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline [I Forest ❑Agricultural/grasslands [Marty 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? 0 16.Is the project site located in the 100 year flood plain? NO _ YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will stone water discharges flow to adjacent properties? M"NO YES ❑ b.W ill-,stpfin,water discharges be directed to established conveyance systems(rut)off and storm drains)? If Yes,briefly describe: nNO AYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES' water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining,property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 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? ]f Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE10 THE BEST OF MY KNOWLEDGE Applicant/sponsor name: s Date: 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 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a-material conflict with an adopted land use plan or zoning regulations? o, El 2. Will the proposed action result in a change in the'use or intensity of use of land? u, !l 3. Will the proposed action impair the character or quality of the existing community? F F] 4. Will the proposed action have an impact on the environmental characteristics that caused the �j� establishment of a Critical Environmental Area(CEA)? (--,� 5. Will the proposed action result in an adverse change in the existing level of traffic or n 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 (� reasonably available energy conservation,or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/,private wastewater treatment utilities? Q Q 8. Will the proposed-action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? ❑ 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? �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 ❑ problems? 11. W ill the proposed action create a hazard to environmental resources or human health?' El ❑, Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is-required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency -fr Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1.; All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed- action-will ,be evaluated as to its sib ifcant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer.must,be explained-in detail, listing both supporting and non- .supporting facts. If an action cannot be'certif ed'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 PROJECT NAME G1POA,�41ACJLtot idt We The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees "LTJ 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) n (b) Financial assistance(e.g.grant, loan, subsidy) !—I (c) Permit, approval, license,certification: Nature and extent of action: 6X0 C2 C-Mu i2pmratoL h Sl aglz a Location of action: -� O Site.acreage: 6L Cl Present land use: l V IO LQ V1(t 1 �( g i AV LC& Present zoning classification:. 0 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: Ili CAMI-e-K _ (b) Mailing address: (c) Telephone number:Area Code (d)-Application number,if any: -A;` Will-the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPEWCOAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves,open space,makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See L7Section III—Policies Pages 3 through 6 for evaluation criteria Yes' No ❑ Not Applicable r 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 Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes No ❑ 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 1 , Yes 0 No El Not Applicable Attach additional sheets if necessary " Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No P� _ ;applicable ` Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes N®"R Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town_ of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No VNot Applicable 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 Attach additional sheets if necessary WORKING COAST PO's--'IES 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. Q,Yes F� No VNot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. 0 Yes No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III Policies; Pages 62through65 for evaluation criteria. [:]Yes F] No U1 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate-use and development of energy and mineral resources. See LWRP Section III-Policies; Pages 65 through 68 for evaluation criteria. 1-1 Yes F] No Not Applicable +� DATE �o .PREPARED BY TITLEAt66j ` S A M U E L S & October 13, 2020 S T E E L M A N --- ----- Southold Town Board of Trustees Town Hall Annex Main Road OCT 15 2020 Southold, NY 11971 ;0"vn RE: As-Built Permit for Residential Automatic Power Generator CASAMENTO KING RESIDENCE 2667 ROW of Long Creek Drive, Southold, NY SCTM#1000-52-09-1.2 1 hereby apply for an as-built ADMINISTRATIVE PERMIT for an automatic power generator, installed at the Casamento King Residence. For same, attached please find: 1. Application 2. General Date 3. Wetland/Trustee Lands Application Data 4. Short Environmental Assessment Form 5. Authorization Letter 6. Affidavits 7. Applicant/Agent Transactional Disclosure Form 8. LWRP Consistency Assessment Form 9. Covenants and Restrictions 10. Survey plus (3) copies 11. (4) SITE PLANS 12. Photos of installed generator 13. Check for$200.00 Please note that two structures originally permitted by this office, a Shed and a stone paved Terrace, both of which encroached closer to wetlands than as-built generator. Neither of these structures were constructed, nor will they be. Please get back to me with questions or concerns. If not, please place this application on the agenda for your next available PUBLIC HEARING, notify us of when that will be, and send along materials necessary for that hearing. Sincerely, TA" I Thomas C. Samuels,Architect enc. ARCHITECTS 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 li FAX(631)734-6407