Loading...
HomeMy WebLinkAboutTR-9774A Glenn Goldsmith,President ®W S11 Town Hall Annex A. Nicholas Krupski,Vice President ®� ®1® 54375 Route 25 P.O. Box 1179 AL AL Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® y® Fax(631) 765-6641 ®l�C®UNTI,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1935C Date: July 6, 2022 THIS CERTIFIES that the demolition of the southeast section of existing one-story dwelling;renovate remaining 1 972sq ft of existingdwelling by installing new window,doors and roof,• construct a 2,3 1 Osqft.two-story addition to easterly side; existing 521sq ft seaward side deck to remain;construct a 605sq ft seaward deck with stairs to grade; construct a 451sq ft in ground swimming pool and hot tub, and install pool enclosure fencing;with the condition to delineate the landward edge of the non-disturbance buffer area by installing a line of 50 pound boulders placed every five feet with not less than 4"of each boulder to be above grade along the landward edge of the 20' wide Non-Disturbance buffer that is to be established and subsequently maintained along the landward edge of the tidal wetlands;within the side yard wetland area the existing drain is to be removed filled in and capped;establish and subsequently maintain a 15' wide non-turf area around the side yard wetland area; if non-turf buffer area is disturbed during construction revegetate with fescue;the outer portion of the 15' wide non-turf buffer area in the side yard wetland area above the 2.5' elevation is to be vegetated with bayberry and/or blueberry bushes; and a one- year plant survivability inspection to be performed in 2017 for the vegetation around the side yard wetland area; At 2350 Deep Hole Drive,Mattituck Suffolk County Tax Map#1000-123-4-7 Conforms to the application for a Trustees Permit heretofore filed in this office Dated January 13,2016 pursuant to which Trustees Wetland Permit#8774 Dated April 20,2016,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the demolition of the southeast section of existing one-story dwelling; renovate remaining 1 972sq ft of existing dwelling by installing new window, doors and roof,construct a 2,3 10sqft two-story_addition to easterly side;existing 521sq_ft seaward side deck to remain;construct a 605sg.ft. seaward deck with stairs to grade;construct a 451sq ft in-ground swimming pool and hot tub; and install pool enclosure fencing;with the condition to delineate the landward edge of the non-disturbance buffer area by installing a line of 50 pound boulders placed every five feet with not less than 4"of each boulder to be above grade along the landward edge of the 20' wide Non-Disturbance buffer that is to be established and subsequently maintained along the landward edge of the tidal wetlands;within the side yard wetland area the existing drain is to be removed,filled in and capped;establish and subsequently maintain a 15' wide non-turf area around the side yard wetland area; if non-turf buffer area is disturbed during construction revegetate with fescue;the outer portion of the 15' wide non- turf buffer area in the side yard wetland area above the 2.5' elevation is to be vegetated with bayberry and/or blueberry bushes; and a one-year plant survivability inspection to be performed in 2017 for the vegetation around the side yard wetland area. The certificate is iss ed to John&Kori Estrada owner of the aforesaid property. a f �►'u o e Glenn Goldsmith, President ��� � � Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoskii Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® y® Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: `7,�c5/Z2 INSPECTED BY: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction Y2 constructed X Project complete, compliance inspection COMMENTS: OK C. i,1 � Pr'trn i 6777q and e 5/1 slid. CERTIFICATE OF COMPLIANCE: CC# : C22-23897 COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 06/28/2022 under Liber D00013162 and Page 420 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 06/28/2022 SUFFOLK COUNTY CLERK JUDITH A.PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 06/28/2022 Number of Pages: 8 At: 09:35 :27 AM Receipt Number : 22-0105793 LIBER: D00013162 PAGE : 420 District: Section: Block: Lot: 1000 123 . 00 04 . 00 007 . 000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $40. 00 NO Handling $20 . 00 NO COE $5 . 00 NO NYS SRCHG $15 . 00 NO TP-584 $0 . 00 NO Notation $0 . 00 NO Cert.Copies $20 . 00 NO RPT $200 . 00 NO Fees Paid $300. 00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk -County 5151 RECORDED Number of pages Judith A. Pascale CLERK OF ,, . SUFFOLK-C'00NTY .,, This document will be public record. Please remove all ,p Social Security Numbers prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recoding/Filing Stamps 3 FEES Page/Filing Fee Mortgage Amt. 1. Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub`Total Notation Spec./Assit. ' f or EA-52 17 (County) Sub Total 0 —` Spec./Add. EA-5217 (State) TOT.MTG.TAX Dual Town Dual County R.P.T.S.A. "Poo ®b � Held for Appointment Comm.of Ed. 5. 00 m Transfer Tax Mansion Tax Affidavit ���� pY � The property covered by this mortgage is Certified Co or. will be improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total u� YES . or NO Other Grand Total If NO,see appropriate tax clause on page# of this instrument. 4 Dist. 4916913 1000 12300 0400 007000 5 Community Preservation Fund Real Property P T S IILIII�II IM I�I�IISI� Consideration Amount $ Tax Service R DTY A Agency 28-JUN- CPF Tax Due $ Verification ,• _ Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: Vacant Land HICVA41— 4, TD l'- o- 3 CSC 1047 f GU 7;V6W IVY 11,971 TD TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffolkcountyny.gov/clerk Title# . 8 Suffolk County Recording & Endorsement Page This page forms part of the attached b,45 CU j�>igrldA/ OA C'DY�/x1¢/1G?1' made by: (SPECIFY TYPE OF INSTRUMENT) kOR✓APRAW AAO 0- OM-N 6 ,W The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of SD 4W 4141 �O�jiQIJ O LIEU X67 OF M TOk ly O)e In the VILLAGE SO!/r/v 7d4.0 or HAMLET of &# 717&C1e BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12-0104..10/08kk (over) DECLARATION OF COVENANTS THIS DECLARATION made this '/--F day of June , 2022, by John Estrada and Kori Estrada, residing at 82 Beaver Street, new York , N.Y. 10005hereinafter referred to as "DECLARANT (S) " : W I T N E S S E T H WHEREAS, DECLARANT (S) is/are the owner (s) of certain real property located on 2350 Deep Hole Drive, Mattituck, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 123, Block 4, Lot7 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT (S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a twenty (20) foot and fifteen (15) foot "non-turf buffer" adjacent to and landward of designated wetland boundary which landward perimeter be lined with 50 pound boulders placed every five (5) feet and not less than4" above grade. NOW, THEREFORE, the DECLARANT (S) do/does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and subsequently maintained a twenty (20) foot and Fifteen (15) foot non turf buffer landward of designated wetland line which landward perimeter be lined with 50 pound boulders placed every five (5) feet and not less than 4" above grade as defined by Chapter 275 of the Town Code; and as delineated in the board of Town Trustees Permit No. 8774,and made a part of this Declaration as Exhibit A attached and as depicted on site plan last dated April 8, 2016 and made a part of this Declaration as Exhibit B A�® �1/1& AY .eaARP ®F 77T?2J,> E. �aWIV c�FOv�01,19 HAY `7Z016J 2) These covenants shall run with the land and shall be binding on the DECLARANT (S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees . IN WITNESS WHEREOF, the owner (s) has/have duly executed this instrument this day of �Yone, 2 - , 2022 John Estrada Kori Estrada 2 STATE OF 46j561 ss : COUNTY OF On the Z4d ay of XU/(� in the year 2022, before me the undersigned, a Notary Public in and for said State, personally appeared JOHN ESTRADA, personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature (s) on the instrument, the individual or the persons on behalf of which the individual (s) acted, executed the instrument. Notary Public MICHAEL A.KIMACK Notary Public,State of New York No.02KIS056823 Qualified In Nassau County Commission Expires March 11.2026 STATE OF A/1-W Y©k7)c ss : COUNTY OF s'(�F�OL1l On the _,;?4Mday of ,�'�J/�L- in the year 2022, before me the undersigned, a Notary Public in and for said State, personally appeared KORI ESTRADA, personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature (s) on the instrument, the individual or the persons on behalf of which the individual'(s) acted, executed the instrument. � Notary Public MICHAEL A.KIMACK Notary Public,State of New York No.021<15056823 Qualified in Nassau County Commission Expires March 11,2026 3 Atlaatic.AmericanTitle'&Escrow. Ag.ency,Inc.: as Agent t'or WFG National Title Insurance Company SCHEDULE A-LEGAL DESCRIPTION File Nose AANY-08053-21 ALL that,,certaln:plot piece.or parcel,of land,situate,lying and being at Mattituck,Town of•Southold,. Couhty-of Suffolk,and State of NeW ybrk,being moWparticularly described as,follows: BEGINNING ata poiht.ori the southerly line of.Deep Hole Drive at the northeast comer of the premises herein.de'scribed adjolning land of Stephen'•King,•formedy'W}heimina.Dletz on the East;. RUNNING THENCE.along:said.land, .South 6 degrees.39,minutes 20.seconds West,326.16-feet to ordinary high water matk'of Deep Hdle Creek; - RUNNING-THENCE Northwesterly along.sald ordinary.high water mark the following three-courses and distances;' 1) North 55 degrees-13'minutes 04 seconds 1Nest, 101.88 feet; 2). North 3.5 degrees.36 niiniJtes 5'1 seconds West;75:06 feet; 3) 'Nbf(h 00.degrees 43'minutes 14 seconds East,45.19 feet to land now or fo"erly of Gladys Dickerson; RUNNING THENCE along said lend;North 16 degrees 05 minutes Fast, 184.56.feei:to he southerly line of Deep H61e.DrlVe; RUNNING THENCE along said line on a curve to the left:having a radius of 336.00 feet,a distance of.. 54.24 feet-and continuing'.: THENCE along said Iine;:South 83.:degrees 20 minutes 40 Seconds East,60.7.6,feet to the point or:place of BEGINNING. NOTE;BeingDistriot;1000-Section:123.00 Block:04,00 Lot:007.006i-Count y of Suffolk: Commonly known'as 2350 Deep Hole brine,•Mattituck;New York. NOTE:Lot and Block shown for informational purposes only. File No.:AANY-08063-21 Schedule A:L•egel TIRSA• Page 1 of 1. EXHIBIT A /� y/� .,;i"l+j:l iSS• �C. s -. iO' ,"i•r �Y li.i5:., - C r jr. r. :. .. M: �?' �hY r1f1;}1_�r ' ;C�`w ,3 Jl t. 3 . �,'�'! ii'�Cy)„'• m y7�,•r� rA.S;�� .;tl�iii: r �q` ,:��i Y, .'�}n�y .,moi � iii�Y,�1:�;= . ' . � �'"_S �a � ��1ll ����� �'9rrt."�:°n� �h f , ., v. � •�r1rA,t$„��L{ !1/��• ;, �S cr'�.`S• ?.� .�•• �'� yr. :� �” r:L4' - ',1.'^,S � �a jir.,5� J�7T 1,: .:j .J_ :..i �r.A, . a?�..i-�` ,IT•l-•j' � ..'e .,- �.ni'F� � - �'-''�• •` r.�� .. � �'�j�-.• .: •. �, h.� 4'-:i` Y�•_'+:l7:Tu:�3fri.b.,:Cff"/r.','m�"N;S)'":N;•.`7yZT.CC:�:.hYk3SR89^•v2Wl,^�A?Z.:OFN,L,>nxn,•,ryip.nn.rSSCYSofi��S":,:12.nC"`:V77r£4`t:V F16JdCnls•?R�tZtd,!4,i•• c a., ,,v 11'• - ..,�•� � .d22-Y.`. .LL'1:S4R:d:L. b;YA h R � ,/'. ": I �: __._ T __� �_^ 1 F� v"JYY.4!f�Yr:GiN'S:•-✓.'N'JG'd4:':iS:'.'."� f :: • ::5a � rl + � �! BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.8774 DATE: APRIL 20,2016 i '{ ISSUED TO: JOHN&KORI ESTRADA r PROPERTY ADDRESS: 2350 DEEP HOLE DRIVE,MATTITUCK SCTM#1000-123-4-7 AUTHORIZATION g9 .i ►111 !� �, Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in ' accordance with the Resolution of the Board of Trustees adopted at the meeting held on April 20,2016,and inr�.,, consideration of application fee in the sum;of 250.00 paid by John&Kori Estrada and subject to the Terms -' and Coriditibns as stated in the Resblution,the Southold Town Board of Trustees auttioriies and permits the { ' -s. following: l ,: '. ` r t ''''Weiland'Permif to demdlish's6utlieast-secti6n-of'eUsting one-story dwelling;'renovate remaining r 1,972sq.ft.of existing dwelling by installing new window,doors,and roof;construct:a C,310sq.ft.two- story addition to easterly side;existing 521sq.ft.seaward side deck to remain; construct a 605sq.ft. ; z% seaward deck with stairs!to grade;&eonstr ct a:451s :f.in-ground ncfl"hot tn ;and t `) �. t;'m install pool enclosure fencing;with the condition to delineatelthe landward,edge;of,the nonn:disturbance buffer area by installing a line of 50 pound boulders placed every five feet with not less than 4"of each boulder to be above grade,along the landward edge of the 20'wide Non-Disturbance buffer that is to be established+and subsequent➢y'niaintainecl along t1►e landward edge of the tidal wetlands;within the sideJ It �'L•` ' yard'wetland areiMie eiiWni g drain is fo be removed,filldd in and'capped; establish and subsequently maintain a 15'wide non-tiirf'area around'the side yard wetland area;if ndif-turf buffer'area'is disturbed >• during constrachon;revegetate with'fesceie; the'outer-portion of the 15'wide non-tuffbuffer area in the side yard wetland area above the 2.5'elevation is to be vegetated with bayberry and/or blueberry bushes; a v1j and a one-year plant survivability inspection to be performed in 2017 for the vegetation around the side Y: , yard wetland area;and as'-depicted on the survey prepared by Nathan.Taft Corwin,last dated April 8;; 2016,and stamped approved on May,r17.,2,916. ' n' �:� ' ''9 !,i .. . . ,. r., r :is •,. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal;to be affixed, and these presents to be subscribed by a majority of the said Board sof this date. ' sowaf Fal/C (04 Ay ed �ti~ `�``fi�'u,"6:"'tSL91LTC71f�7L".Br,:,S�lf.'�1FARdd.w.,'AStI,•rs&:dit•7J:%�•x>.c.,•..ra�-ro.L14TwS:d.IS>7'U. .11..�iYtM'.c4Q7,"J.�dY,6,'YL• •isi'. r..Z�A?,hTLOu"S'w46fi.?S'iT6C,:&fadS.'1!�'7A�•aZE�yr �-S N /,,BN�f ��: - � l`✓.4' �1•�x•"'•�� �k;�l �f - •r _ :.:. 4'!y i• (�' .- ,•,,,..J � _ + (c '; vs of ',� \ .�, .I.,. ` �Z•u.;•/, ,1 r ;;�'` E` ��"-'" �,2,;.;7� �� I,. �: ,i4�riy �:}jL• lt:r`�4 ,� ,,c ifl,`,fi, i 11t; 4� IIa,�Y .. n' •.1 l r .� r:. ., r.@ ''r'• .�.5 �.+LYY. ';�;.. •.V,N .,a '�y 1.;.,,y. � '��':...y.� .�!• •"@-' ...(.� ti��,71��ii W1 t;��`r,r It�!);.. EXHIBIT A TERMS AND CONDITIONS The Permittee John&Kori Estrada, residing at 2350 Deep Hole Drive, Mattituck,New York as part of the consideration for the issuance.of the Pen-nit does understand and prescribe to the following; 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be.the estimated time required to complete the work involved,but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. `5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 11. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in 'order to perfonn the permitted work nor does it authorize the impairment of any rights, title, for interest in real or personal property held or vested in a person not a party to the permit. I • i EXHIBIT 0 SITE PLAN FOR NOTE: JOHN AND KORI ESTRADA 1.ELEVATIONS SHOWN HEREON ARE IN 185E N.A,V,D. PAGE 1 OF 2 EXISTING ELEVATIONS ARE SHOWN THUStm EXISDHO CONTOUR ONES ARE SHOWN THUS:-----s----- SITUATE z.FLOOD INSURANCE INFORMATION TAKEN FROM, MATTITUCK FLOOD INSURANCE RATE YAP No.351DSC0452H ZONE AEI BASE FLOOD ETEVAOONS DETERIDNED ZONE x, AREAS OETFALONED TO BE OUTSIDE THE 0,29 ANNUAL CNANOE FLOOOPIJJN. TOWN OF SOUTHOLD 3'MINIMUM TIANKS 10 OUTS EFFECTIVEI DEPTH 4 BEDROOM HOUSE IS 1,050 GALLONS- SUFFOLK COUNTY, N'EW YORK 4.MINIMUM LEACHING SYSTEM FOR 4 BEDROOM HOUSE 13 300.q ft SIDEHIAIL AREA. S.C. TAX No. 1000-123-04-007 6 P LSI 2'DEEP,6'dlo. PROPOSED EXPANSION POOL SCALE 1"=40' ® PROPOSED LEACHING POOL JANUARY 17, 2008 FEBRUARY 16, 2009 LOCATED WETLANDS ""n®'-,-,." PROPOSED SEPTI TANK APRIL 20,EPTEMBERDRPOSED DECK &UPDATE S.20100 ADDED LOT COVERAGE SURVEY 5.THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD SEPTEMBER 28 2Q10 UPDATE SURV�I; ` 0CT09EERR 301, f201a REVISE SITE P.LIANNI OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. D CEMBER 9 2015 RAE SITE P 6'R(MOVED IN ACCOSRO�ANCESWITH S.0 STRUCTURES SHALL B STANDARDS. CLEAN MIO FEBRUARY 13,2016 R� H•FO t 001 AND_P OR S.C� 'S' NOTICE 02/11/2016 AREA - 39,453 Sq. It. U OI L/ 0.908 as. NEW suP�'B<�c w4 CERTIFIED TO: m°LK AVENLr -'JOHN ESTRADA Uses WA TQ KOR1 ESTRADA s USES LI IC WATER OWE-LUNG 't" USES PUBLIC WA +'^.,;.':;,+r„ _ DEEP PU8L7C WATM IN SR :`':ti �:.1�a E®,. . (?''S.,i,•', \a o �'T �,, ;;:... , TRUSTE .:', R�33 �q��j{/ .Y ;,x��QARD'QF 9 , ,w %V 1 .54.24+ x46 BNRMTION ) so.�s 7>,'YVi/d�!OP`SOUTHIIA � ,;'t` ,° •mTn' - -ya e oP Pa wENr � �T 1. 20laT. - pG011GRETE h _• ^_^010 MIL POLT YtZHYLEfrg; r- :.+•_..• •,i. , 47 N+ \ r F.XISTINa DRI ,7C0 TO BE N0 REMOyET) '�,r,�4;r%' !�:., ..,"r:•i.'.' % �,� 3 sIL7E fO EXISTING LOT COVERAGE OVER UPLAND LOT AREA zpN Rr ION \\' fO' N bio Jam° UPLAND,LOT AREA = 35,934 a I. Ilk @ x ' cO TRucTroN DESCRIPTION AREA Y LOT COVERAGE Ift. s x SHG ••I "'DRAIN HOUSE 1.972 sq. ft. 5.6X a. ��opo (ja,4"•, ..I, DECK 521 sq. 0. 1.BX 3o AL2' I +'11iiiII1;I til'i 7 SLAYE STOOP 45 eq. ft: 0.1% I�•9�4.rr1' OAPOR (2) SHEDS 259 a ft. X J� •'. �•I�1i1M Tri, "'�xf1,gRGQ°�° ,WDq' 0.7 e•Ylsr ,% ')•'i •,'I ';.1,141 ''POOL EaUIP. TOTAL 2,797 aq. ff. 7.5% io lc SYS W stE I '' I liii:l11 I�•I xNf k rho O I 2oNe A PROPOSED LOT COVERAGE OVER UPLAND LOT AREA 6) - • Illi. >RtE 7pEE --4 f(f(, fi) .UPLAND LOT AREA = 35,934 6 ft. j DESCRIPTION AREA X LOT COVERAGE x x.27 3, S HOUSE 1,972 5q. 11. S,SX '� '"'••• 75' X p0�' P/0'EX1�4T. DECK z 431 5q. It. 1.2% 4. r:y •.. ^-� L h STEP&':: (2) SHEOS 259 eq. ft. 0.79 xy --"' � -�� ' PROP.ADDITION 2,310 4q. M. 6,4X �:•:•: � TREE � � ;:ti}:' 6'fRET;• C I PIp� PROP, D K�k ECK �,��YP STEPS 605 sq. ft. 1.7% .. �•.:•.�•::�:. x.4.3 \��` cw"q'4S PROP. POOL \'•: ,�;y: kj\• 1278 "w4�A'4 & HOT TUB 451 eq. ft. 1.3X 01\ 4D 60 ,� di •'j,"PO\ 2 � ^t gy r TOTAL 6,026 sq. ft. 1815X x v s`�� '�•'��+=;:::;• �o�P ter- �� �°A,BGY/!#R..s_Al'P•4t7.�4 .0.1�_7'0 8E L.QaAT.,E2�G.S°s.S!d.XiN.--- Q jz _-A4rlw7'E, ger OF,SPT,.O+&.R.N40oq.0W fti�!;AB.O..Y.C!61�i9A�' ;p�it xs2 ` OFL�,�C( ;W../�F.T wB,rUyvA B..S!FFf.�•e m � A14+ N. M°0°EN Doo w S U111\c� .: x M ./N�(!/d7R/RAC_S'L�17,�..Tt!$P �L�PIpcP�_yVl.7fl��S CU pL3v�oN EaCR&or lA \ •;;.�,� �'�\ � _�.�-��- �� /�S. D.-A *,v ROM ST %'P �� ^:a"P :•. PGa .�s-!�9.•aF��._c.. ATIEKT FuwOJ IN WATER NwAL�.� =~ 9�P��-,�f�ld/_te1Gl1?T�1._ TmE ASsocYATxXL MAY 1 6 2016 N.Y.&UC,No.50457 UxAUNaSUR AL0 A OH DR ADDmOx (Nathan Taft Corwin 111 SWIM CrFE N VO K STATE L> »Dx DRARIAGN SPSrSe CALOu7 DORS, TWT EP Utm s1 Ry x a sNOfa OR Land Surrey®r ADDITION ROOF ARF/U2310'.a. . 1119=10 SEAL m6L NOT BE OONSMO 2.310.q.ft,x 0.17 0 393 NOa,n, TG BE A V"TRUE CM. , 393 Cu.N./42.2 0 9 v.r5al It.of 5'dlo,I.aohing pool r.qulrod ,v crRlvlaATaxs aDKu7�µ�REpx sou:Ra+ Suaaaeor Tal Stantay J.laoboN Jr.I.S. PROVIDE(J)5'dla.%1'high STORY GRAIN POOLS ��+ ONLY TO THE Pat$a/PoR M1bY 1HE SURhY Jwopfi A.Inpapna LS, PROPOSED 0'TNA.X D'CUP ORYWEIU3 FOR ROOF RUN-OFF ARE SHOWN THUS, i.'-1 T PWWOMA. OH EIUli 70 THE Im[c05PA�x j��w4WEWI�i�lLf�N[.pA�DaNN NW NUa SOrwye-SD6d7rfvloa- site Plan- ConaWaUOn Lqvut ADDITION R00r MW 300'p H. TO NaA9gC---'NS E IFx01NON'IXSSD_ 2.310.a.RNLA D.127=J93'w,6. TUITiw�emlGr�no'�e TALE:NOF N O MAmL PHONE(631)727-20BD Fox(631)727-1127 393 N./423.9 1.111,41 H.of W dw.Iw.Idn9 pact r"Wm CMCM LOCATED AT "LING ADDRESS PROVIDE(3)e'dla.x 2'high STORM DRAIN POOLS -F--,& Ne DE D►RIGHT OF WAYS PROPOSED e'Du.X 3'DEEP DRYWEUA FOR ROOF RUN-Off ARE SHOWN THUS. AHO GR FA3EYENi3 OF RECORD V 1485 Noln Read P.O,Box IB AN,NGT SHOWN ARE NOT auA1UMEC0. dama;I4 Now Yofk 11947 Jamapo,t.Nati YwR 1107 CC# : C17-244 COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 01/04/2017 under Liber D00012895 and Page 071 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 01/04/2017 SUFFOLK COUNTY CLERK JUDITH A.PASCALE SEAL _ i JAN - 4 2017 Southold Town Board of Trustees h IIIVIII IIII VIII VIII VIII VIII(IIII VIII VIII IIII IIII 111111 VIII(IIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 01/04/2017 Number of Pages : 6 At: 11 : 12:34 AM Receipt Number : 17-0000927 LIBER: D00012895 PAGE : 071 District: Section: Block: Lot: 1000 123 .00 04 .00 007 . 000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $30 . 00 NO Handling $20 .00 NO COE $5 . 00 NO NYS SRCHG $15 . 00 NO TP-584 $0 . 00 NO Notation $0 . 00 NO Cert.Copies $15 . 00 NO RPT $200 . 00 NO Fees Paid $285 . 00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County DE C E VE JAN - 4 2017 Southold'fown Board of Trustees-- 4 F11 21.. fI Number of pages U _ RECORDEDX017 Jan 04 11.1'2.34 AM JUDITH Nz PASCALE CLERK OF This document will be public SUFFOLK COUNTY record. Please remove all L 000012895 Social Security Kumbers: P 071 prior to recording. Deed/Mortgage.Instrument Deed/Mortgage Tax Stamp Reco ding I Filing Stamps' 3 FEES Page/Filing Fee Mortgage Amt. 1. Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-52 17 (County) Sub Total 7 Spec./Add. EA-5217 (State) TOT.MTG.,TAX co Dual Town Dual County R.P.T.S.A. .® Held for Appointment rza Comm. of Ed. 5. 00 Transfer Tax mr Mansion Tax Affidavit �"^�impg4� ' '� �^ r The property covered by this mortgage is Certified Copy g or will be improved by a .one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES , or NO Other Grand Total n If NO,see appropriate tax clause on page# of this instrument. L23 d 4 1 Dist. 3301496 1000 12300 0400 007000 5 Fcommunfty Pkeservatiorn ]Fund P T Real Property (I ' ,S M! A ''� �!!��!l� � ��!!��l �!�!� Consideration Amount<$ Tax Service 03-JAN-17 Agency CPF Tax Due $ Verification mproved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Ad I E C EV E b RECORD & RETURN TO: nt Land rZ A�1VV 1 JAN - 4 2017 ! TD Southold Town Ooard of Trustees TD Mail to: Judith A. Pascale, Suffolk County Clerk �� LTifie CgMpany gnfoirmatton 310 Center Drive, Riverhead, IVY 11901 ' www.suffolkcountyny.gov/clerk Co.Name Title# auffolk County Recording & Endorsement Page This page forms part of the attached C-)&� � /� made by: (SPECIFY TYPE OF INSTRUMENT) {f�t0j i� The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of fr q '< eve D V/� �'� �"�� ` In the VILLAGE . or HAMLET of �� BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12-0104..10108kk ' (over) 'IMPORTANT NOTICE If the document you've just recorded is your SATISFACTION OF MORTGAGE, please be aware of the following: If a portion of your monthly mortgage payment included your property taxes, *you will now need to contact your local Town Tax Receiver so that you may be billed directly for all future property tax statements. Local property taxes are payable twice a year: on or before January 10"' and on or before May 31St Failure to make payments in a timely fashion could result in a penalty. please contact your, local 'town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes Riverhead Town Receiver of Taxes 200 East Sunrise Highway 200 Howell Avenue North Lindenhurst, N.Y. 11757 Riverhead, N.Y. 11901 (631) 957-3004 (631) 727-3200 Brookhaven Town Receiver of Taxes Shelter Island Town Receiver of Taxes One Independence Hill Shelter Island Town Hall Farmingville,'N.Y. 11738 Shelter Island, N.Y. 11964 (631) 451-9009 (631) 749-3338 East Hampton Town Receiver of Taxes Smithtown Town Receiver of Taxes 300 Pantigo Place 99 West Main Street East Hampton, N.Y. 11937 Smithtown, N.Y. 11787 (631) 324-2770 (631) 360-7610 Huntington Town Receiver of Taxes Southampton TownReceiver of Taxes 100 Main Street 116 Hampton Road Huntington, N.Y. 11743 Southampton, N.Y. 11968 (631) 351-3217 (631) 283-6514 Islip Town Receiver of Taxes Southold Town Receiver of Taxes 40 Nassau Avenue 53095 Main Street Islip, N.Y. 11751 Southold, N.Y. 11971 (631) 224-5580 (631) 765-1803 Sincerely, Judith A. Pascale Suffolk County Clerk � 4 DECLARATION OF COVENANTS THIS DECLARATION made this day of plgylq12W , 2016, by John Estrada and Kori Estrada, ' residing at 82 Beaver Street, New York, N.Y. 10005, hereinafter referred to as "DECLARANT (S) " : W I T N E S S E T H WHEREAS, DECLARANT (S) is/are the owner (s) of certain real property located on 2350 Deep Hole Drive, Mattituck, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 123, Block 4, Lot 7 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referredto as the Property; WHEREAS, the Property is situated , on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT (S) thereforemade application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a "non- disturbance buffer" adjacent to and landward of the tidal wetlands be established and subsequently maintained with the condition to PrE CC IVE JAN - 42017 Southold Town ar of Trus ee delineate the landward edge of the non-disturbance buffer by installing a line of 50 pound boulders placed every five feet with no less than 4" of each above grade along the landward edge of the 20 ft. wide buffer as depicted on the survey prepared by Nathan Taft Corwin, X0,-- last dated April 8, 2016, and stamped approved on May 17, 2016. In addition, a 15 ft' wide non-turf area around the side yard wetland area is to be subsequently maintained. The outer portion of the 15 ft. buffer above the 2 . 5 ft. elevation is to ' be vegetated with bayberry and/or blueberry bushes, with the existing drain removed, filled in and capped, as depicted on the above referenced survey. NOW, THEREFORE, the DECLARANT (S) do/does hereby covenant and agree as follows : 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and perpetually maintained 15 ft. non-turf buffer around the side yard wetland, and a 20 ft. non-disturbance buffer" maintained along the landward edge of the Tidal Wetlands as defined by Chapter 275 of the Town Code: to wit: A vegetated area, as designated by the Board of Trustees, immediately landward of the wetland boundary, shoreline structure, or other line designated by the Trustees where no operations, maintenance, placement of signs or other activities may take place, except that man-made debris may be removed from such area by hand without the permission of the Board of Trustees" . An application for a wetland permit may be submitted for the removal of harmful, "invasive" or non-native vegetation; E C E I V E JAN - 4 2017 Southold Town Board of Trustees and as depicted on the survey by Nathan Taft Corwin, last dated April 8, 2016, and stamped approved May 17, 2016, see Exhibit A? attached; and 2) These covenants shall run with the land and shall be binding on the DECLARANT (S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees . . IN WITNESS WHEREOF, the owner (s) has/have duly executed this instrument�� this �3 day of �'� b 20 6. John oda Kori Estrada STATE OF NEW YORK ) COUNTY OF ss . : On the �I? day of C� 0&&V in the year 2016, before me the undersigned, a Notary Public in and for said State, personally appeared John Estrada and Kori Estrada, personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature (s) on the instrument, the individual or the persons on behalf of which the individual (s) acted, executed the instrument i t Nttary Public JENNIFER MARIE LEVENS Notary Public,State of New York No.01LE6330990 QW tad In Now York County/e7 28,20-LLL CAVE 1 JAN - 420 17 Southold Town AV .I - SIM PLAN FOR NOTE., JOHN AND KORI ESTRADA 1. ELEVATIONS SHOWN HEREON ARE IN 1988 N.A.V.D• PAGE 1 OF 2 EXISTING ELEVATIONS ARE SHOWN THUSt9:0 E%ISTING CONTOUR LINES ARE SHOWN THUSi-----5----- SITUATE 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No.36103CO462H MATTITUCK ZONE.AE: BASE FLOOD ELEVATIONS DETERMINED ZONE Xe AREAS DETERMINED TO BE OUTSIDE THE OSx ANNUAL CHANCE FLOODMAN. TOWN OF SOUTHOLD 3. I TANKT 10'DATa'EFFECTIVE DEPTH 4 BEDROOM HOUSE IS 1,500 GALLONS. SUFFOLK COUNTY, NEW YORK A.MINIMUM.LEACHING SYSTEM FOR 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL,AREA. 6 POOLS;2' DEEP.8'dla. S,Q, TAX No. 1000-123-04-007 PROPOSED EXPANSION POOL SCALE 1"=40' ®. PROPOSED LEACHING POOL JANUARY 17. 2008 FEBRUARY 18, 2009 LOCATED WETLANDS APRIL 20, 2010 ADDED PROPOSED DECK dT UPDATE-.SURVEY PROPOSED SEPTIC TANK SEPTEMBER B. 2010 ADDED LOT COVERAGE SEPTEMBER 28 2015 UPDATE SURVEY ., 5.THE LOCATION:OF WELLS AND.CESSPOOLS SHOWN HEREON ARE FROM FIELD OCTOBER 31, 11015 REVISE SITE PLAN OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS, DECEMBER 9 2015 REVISE SITE PLAN' 6. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND FEBRUARY 13, 2016 REVISE WETLAN6 NOTE AND PELLR S.C.D.H.S.NOTICE 02/11/2016 REMOVED IN ACCORDANCE WITH-S.C.D.H.S.STANDARDS. APRIL 8 2. 2 ADD D POAOND BUFFER AREA = 39,453 sq. ft. 0.906 cc. Uses e Nay cNA CERTIFIED T0: SUOLK AVENUE JOHN ESTRAD'A ljses°P �"D KORI ESTRAD"A A IN USES PUBLLIIC WATER d . USES DWELLING PUBLIC PUBLIC WATER - } TT ER I"STREET BY.,. 19 X41 E °As R_330: HOLE DRIyoF TRUSTEE --54,24+ x$9 C,OMTION 3.20, E„NETw+,6NAOeoB76' 6 " •� � �1'.'SOUTHo4�. - �d EDGE OF PAVEMENT OyJO �� • 9 10\\ �* � ••`•T'ERNFAO •` �?.,?4i//a��lr� ( a.•T�f/'�f -, p) $ :,�;; f2�it 10 x 10'X 3'pEEP :.. O ►•�, t!. •id9'' -GONGRETEWASHOU PjT..LI�NI'D� 97 M's •; • \. X.;:v,. - -8.10 MIL'POLYETHYL F N \\ ;'k y; Al•I . p'BE DRIVEWAY H0 _.. CI ` �f SIC '7tD �`'� �fr REMOVED T67-n_, Z�\ t n.'.•.. �•! 9.:k:: PROPp5E0 *ziu a • .. _ 4 q 7• » r '1•? BET FE�p TO EXISTING LOT COVERAGE OVER UPLAND LOT AREA NOH f A R=OHR X cc 3 10 cc) p1 aR T UPLAND LOT AREA = 39,934 sq. ff. O "s 7-16N DESCRIPTION AREA Y. LOT,COVERAGE I NSAAX sHo R \ W - '"! I•!' SEN DRAIN HOUSE 1,972 sq. ft. 5.5% GIZA, EL.SOP 14?I7 ?!;.•,....:... I�I� Q' H,I!:� BPROOP, .DECK 521 sq. ft. 1.59 �D;pO 2 '•Ilii!!::. 5 - OLP'p,�E\ a 3a 12.2 Illiilll� ((,''r DRYAD SLATE_STOOP 45 sq. ft. 0.1% NEO +!Irw! L!Spp ..(2J SHEDS 259 aq, ft. 0.7X l';.DI7O Ij;4 x :•DISCNARIINOFP A� dl('Illpil(ll�.' PROP Rte.. .. ExjgT SE MK. + lith 5 POOL I gUIP TOTAL 2,797'aq.'ft. 7.8X 7.OBFlO /sEE srsip, ,4./ .sT>: .('y��l�lt'i�ij I'm 6b O 41 167 (b-<04, PROPOSED LOT COVERAGE OVER UPLAND LOT AREA (f( UPLAND LOT AREA = 35,934 sq ft. DESCRIPTION AREA X LOT COVERAGE OAL X 25 � •q� HOUSE 1,972 sq, ft. 5.5X _ ,�••' .PO�5' x PPR.OL '�F k/STEPS EXIST. DECK 431 sq. ft. 1.2X --VIREr X21 I (2) SHEDS 259 sq. f6 0.7% tot J, 2MFE X�2 .\ X I-'-.a/1�ai6 - N' PROP. ADDITION 2,310 aq. ft. 6.49 I ':•;:;' �0'IREE \�� PROP. DECK 605 s. ft. 1,7X t•.; X �� K� STEPS`\ \ ,iIY4,6 4, PROP. POOL q. \•'•::\;•:::•' 12'iREE�`Q� •L 89'1'9ft:,HH�„y 8t HOT TUB 451 sq. ft. 1.3X •:•�• i .,i>.ti\ tZTNR-�7 r x2k0 PgyfRHr TOTAL 6,028 sq. ft. 16.8X \ ? XA2 ao•\ X sP Fu°R4jy XAR s��,,2 �, :•.; el, 11° �rr�tzElts QNo�8 :[acArAs�7s!arr�,v__.._ ,9• �\ ;!JlvA:.°`os \\ 4 zQ,.C.,.AD At°fOtC..4.?!ABq.VE�G/7A442' Xd2 N. - �_O�sly6? LO..ISFr w A.BvFfLc.C' ro RfHA4IrV PNNCS Off EACH S1 �3r \\;;� ;y;�� ..\ '.s If'D✓S'l-'U.2'B,�IJpU.,Ql...4�Cs..coit/,1p;2vcT/oA/... ...._._ g,�p wg W Ernel fNp.9 09 A401-25 prL�L�/T�'�RL�A,AEd� kdGGI�iAX •�y' ./j��� Gu'y0 R71rP L�, )iIIL \ ;J,S7•,•R,'•L�''•'• ,• /TAN Of�r.jj�}�1/ pf'\R../ .g''MTIIE LiALS.AND APPROVED R TITLE stiRvm u+DiDOOPTED V,� -��''Ayf' •. •" pL•�,' C7 Q-�r-�,.C_ FOR SUCH USE B1 THE NEW YORK STATE LAND �� �''�:• `TIRE ASSOCIATION. FILINGS IN WATER N 'h' J1IIL.\��':•� ••�;T dL C�L� s'92, F �O7sROS,�o „OR�R�� dS �..v..;i N.Y.S.U0.No. 50487��-�;A���ir •.��;y: ;-• Nathan ,�1,a� yip_ p{ •. � TO THIS SURVEY ALTERATION DR ADDITION Nap han '�"�:lift':`0.�or in 119 1 1 S THIS 200O IS A NEW VIOLATION K U V A100 D�1 ',!SEC11aN 7200 OF THE NEW YORK STATE , :. 1 .,, EDucnnOH uw. Land p p{p1p� nauNAGIS SYSTEM L74S.CULATTONc; I MAY 1 6 2016 i, CO%®"OF'THI9 9WMY MAP NOF DURING f5 a d S{�.51:;,.tl eiyor I t THE LAND SURVEYOR'9 INKED SEAL Oft . . ADDITION ROOF AREA:2;310'.0.N. EMBOSSED SEN,SHALL NOT BE CONSIDERED 2.310.q.fl.X 0.1/-393 au.N. TO BE A V/LD iRUECQPY. , 393 cu.N./42.2 9 v.rllccl ft.of a'dlo.Ieaohln pool tequ T l4lailGtrong INDICATED HEREON swu RUN Su....-To:Sianley J.lock...,Jr.L.S. SUU11^I :!V R f ONLY lb THE POWN FOR WHOM THE SURVEY Joseph A Ingegna I.S. PROVIDE(3)a'dla.%2'high STORM DILUN POOL4 .1 PROPOSED a'DIA%3'DEEP gRTWEt19 FOR ROOF RU E SHO�,a,rr,,TTTF.IgS t3 PREPARED.AND ON H14 9UrAIF TC THE �t1.... :Tt.... ��N.,- ..,... TME COYPAxr camaMFNfN ACQ:Cy AND lifle Su7veye-Sufxlir alone- S!19'Plona -'Construction Layout LENDING INSIff(mON-US=HEREON,AND :ADDITION ROOF AREA:2.300.y.N. TO THE ASSIONE7.S OF THE U..N.MSn- PHONE(831)727-209° Fax(631)727-1727 2,310.q.If.%0.17 0 393 OU.It. TUgON.CERTIFICATIONS ARE NOT TRANSFERABLE 393 Qu.,/42.2 v 9 vertical It.of S'dla.leaching pool required THE EXISTENCE OF RIOHT Of WAYS OFFICES LOCATED AT MAILINGADDRESS PROVIDE(3)W did,X Y'high STORM DRAIN POOLS AND/OR EASEMENTS OF RECORD IF 1588 Male Road P.O.Box I PROPOSED a'DIA X 3'DEEP DRYWELLS,FOR ROOF RUN-OFF ARE SHOWN THUSt ANY NOT SHOWN ARE NOT OUAIUNTEEO. Jamesporl,New York 11947 Jammixort,Now York 11947 ""Id,Republic National 71tle Insuran V ce Company by ftslufhoilzed,.Agent Title Numbu- A-4116-$"40R Page 101 'PUL $M41: 1. B A V9$CRj*PWQN ALL that mrtam* plot piew copar parcel o.f , situate, lying Ck,Tpw n of Southold, County Qft-ffolk, an tate of New York, being QYqparticu arly described-as follow,5; U De t the northeast BtGfNNING at a.poi t on the southerly line of -ep Hole Drive a orthe , t eorner of the premises h rvin described adoring gJandof Stm phen ung, forerly Wilholmina Dietz on the East RUNNING THENCE along said land,:South .6 degrees 39 minutes 20 seconds,Wept," 326.16 feet to ordinary high water mark of Deep Hole Cbnk; RUNNING THENCE Northwesterly Tong said Qrdinary high water mark iwli bp fbilong three courses and distances, i) North 55 degrees 1.3 minutes 04.5e.conds West, ioi.88 feet; 2) North 35 degrees 35 minutes 51 s"onds West,75146 feet; 3) North )) degrees 43 minutes 14 SOC nds East, 4-5,19 fejt to land pow or fpr M_erly pf Gladys Dickerson; RIRTNW -ni East, 184 Q THE NQ� along said land, No 4 degrees o,5 i n 56 feet to the southerly line o Deep Role Drive-; RUNNING THENCF, along said line on a come to the left having a radi-qs of 33o.00 - f eet, feet, a distance Of 54-24 feO'AM COUtInU148 THENCE, along said line, South 83 de. Tees 20 MirluteS 49 seconds l=ast, 60q6 feet to the point or plaoe.of BEIG'INNING. FOR INFO R M__ATj'QN_ Y: PnMISE'.1 are des' naffed as District iqw, $q ctior .2. -oo, 1113lock 0400, 007 n , . . TP des' o x,.s 090 o .. the tax map for the Town of Southold,Qqwrity'of Suffolk Glenn Goldsmith,President 'of so(/JyO Town Hall Annex A. Nicholas Krupski,Vice President l 54375 Route 250 P.O. Box 1179 John M. Bredemeyer III J [ Southold, New York 11971 Michael J. Domino v' G • Q Telephone (631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1890C Date: January 17, 2022 THIS CERTIFIES that the installation of a 48" high aluminum fence to enclose an approximate 14'k44' area with two (2) 42" widegates; At 1155 Arshamomaque Avenue, Southold' -Suffolk County Tax Map #1000-66-3-6 ; Conforms to:the application for a Trustees Permit heretofore filed in'this office"Dated November 12' 200 pursuant to which Trustees,Adininistrative-Permit 49774A-' "Dated Decem er_21;.2020,was issued arid`•eo'nfornis•"to a11- °the'requiretnents and condition's of the,applicable•provisions of law..The project ' for which this certificate is being issued is for the installation of a 48",high ahimiriun!fence to,eiicl0se an-approximate 14'x44' area, -with two (2) 423',widej `ag tes. The-certificate is issued-to-Dominic_&-P-atr-icia-Grasso__awner-s-of the a'foresai'd property. d Authorized Signature Glenn Goldsmith, President �q sorry Town Hall Annex A. Nicholas Krupski,Vice President ,`O l0 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino N ,c G � Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: , 11, INSPECTED BY: ,Li4 K(Ilw V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction; haybale-line/silt. boom/silt curtain 1st day of construction % constructed Project complete, compliance inspection COMMENTS: CERTIFICATE OF COMPLIANCE: Glenn Goldsmith,President I SOUjTown 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 G Telephone(631) 765-1892 Greg Williams � i0 Fax(631)765-6641 �y�0UNT1�� f BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIREp TO CONTACT T HE OFPICE.OF THE,BOARD,OF TRUSTEES lT HOURS'PRIOR TO'COMMENCEMENT OF THE ACTIVITIES CHEOKED-OFF INSPECTION SCHEDULE Pre-constructf6h di bal''eIiri Glenn Goldsmith,President QF sours Town Hall Annex Michael J.Domino ,`O� O01 0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III l Southold,New York 11971 A.Nicholas Krupski Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 'rou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9774A Date of Receipt of Application: November 12, 2020 Applicant: Dominic & Patricia Grasso SCTM#: 1000-66-3-6 °Project Location: 1155 Arshamomaque Avenue, Southold Date of Resolution/Issuance: December,21, 2020 " Date of Expiration: December 21, 2022 Reviewed by: Michael J. Domino; Trustee Project Description: Install a 48" high aluminum fence to enclose an approximate 14'x44' area with two (2) 42" wide gates. Findings: The project-meets all the requirements-fb'r-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 WSJS Architects dated October 26,,2020 and stamped approved on December 21, 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 NOTE:ALL EXISTING GRADES&TOPOGRAPHY TO REMAIN I ff ��^�� P� '+ :7 �__,_• � ' it� , 1 2 2020 Pia!'d 11{1' i1c ` PETT YS POND S 05 46' 08" E 83.71' ti ZD co 0 C U 0') N w EX TING U N u- BUL HEAD Z Lu TO EMAIN v) UJ UJ C� 1 O �N N Q p PROPOSED 48" HIGH JERITH `- Z z n U) LIBERTY SAFETY PUP FENCE& a rn x CQ U w GATES. BLACK POWDER COATED �O w o X X O0- w w ALUM.W/%" SQUARE PICKETS I _ N EXI TING � ~ 9' 9" O 00 LA N °? rn 1 PR PO D o 3 -q'TO PROPOSED EVERGREEN F=-NC 44'-3z" +/-V.I.F. P P SED FEN E PLANTINGS (GROUND 3_ PROPOSED EVERGREEN SHRUBBERY) PLANTINGS(GROUND o SHRUBBERY) N Z 10' XIS co x 1 45' EXISTING MASONRY PATIO& 3' _ STEPS,AS APPROVED BY EXISTING BOARD OF TRUSTEES 2 STORY FRAME EXISTING 2ND STORY 1 M HOUSE DECK 25' EXISTING COVERED 16' 00 _ FRONT PORCH (2ND STORY DECK ABOVE) EXISTING SLATE - WALKWAY 1 EXISTING LAWN } Q 1 w O 0 EXISTIN LLI GARAG 01 U) o z I o N !�2 EXISTING 997.12' Z w ASPHALT ch DRIVEWA ti 07 o v S 06 22' 20 W 100.00' x` -ARPROVED BY k 'BOARD OF TRUSTEES ARSHAMOM AQUE AVENUE TOWN OF •SOUTHOLD '. DATE 2112020 o� DE�6/n k SITE PLAN W/ PROPOSED FENCE 1"=30'-0" PROJECT NAME: DRAWN BY: CP DRAWING#: wsis PROPOSED FENCE AT THE CHECKED BY: WS WSJS ARCHITECTS G RAS S O RESIDENCE PROJECT#: 202006 755 NEW YORK AVENUE DATE: 10/26/20 spl ' o HUNTINGTON,NEW YORK SCTM#1000-66-03-06 1155 ARSHAMOMAQUE AVE.,SOUTHOLD,NY SCALE: AS NOTED Glenn Goldsmith, PrE ant C,2 i`t Town Hall Annex Michael J. Domino" ��� Gym ✓f 54375 Route 25 John M. Bredemeyer III o '` P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Greg Williams p! Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: j 7 Completed infield by: William A. Scherer, R.A., on behalf of DOMINIC & PATRICIA GRASSO requests an Administrative Permit to install a 48" high aluminum fence to enclose an approximate 14'x44' area with two (2) 42" wide gates. Located: 1155 Arshamomaque Avenue, Southold. SCTM#: 1000-66-3-6 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 / Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey _< 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: L '4Iota AV ��, ►�jl�fi� I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other SURVEY OF LOT IS MAS' OF .BE I XEDON ESTATES N FILED MARCH 16, 1x46 FILE No: 1412 _ E 51TUATE: 5OUTHOLD W TOWN: 5MT14OLD I S SUFFOLK GOUNTY, W SURVEYED 02-24-03 Lot 14 SUFFOLK COUNTY TAX a 1000-66-3-6 �s CERTUMM TO: LA wo"`„y`keaz� GUS%LAVAS N81 '�~E 1Q O `V ti �o v-r- r f`� ------ 3 _ ' -----------wi---- r ca Lot 61+, r-rc 1e House g NOV 1 2 2020 ` E ------- t bdu"",way Garage 269 0 t o S'71��t'�� 16 ovw 10p y,P G T NOTES a MONUMENT FOUND O PIPE FOUND S o.T, �• M W pis w •� �ANC11 a AREA= 24.601 5F OR 056 AGRE5 JOHN C. EH E S LAND A TaTA�u SURVEYOR +T T�[ EYOD GRAPHIC SGALE I"= 30' 6EAST MAIN STREET t 1` 3�ti1V1J �7N.UY.SS..`LIVCrNO.502022 RIVERHEAD.N.Y.11901 369-8288 Fax 369-8287 REF.Mp serverWROS103-122.pro NOTE:ALL EXISTING GRADES&TOPOGRAPHY TO REMAIN L, o NOV 12 2020 1 o I PETTYS POND S 05 4610811 E 83.71' ti (.0 ao 0 N w EX TING U L- BUL HEAD Z N w TO EMAIN O �Nz Nc7 O z PROPOSED 48" HIGH JERITH ~ Z Z O ~ LIBERTY SAFETY PUP FENCE & a rn X ^ tp coI w GATES. BLACK POWDER COATEDw b X X 0- ALUM.W/%"SQUARE PICKETS I _ `- w w O EXI TING 0) ~ 9' 9" O 00 LA N C'? rn I PR PO D 3 -q'TO PROPOSED EVERGREEN F NC 44'-3Z"+/-V.I.F. P P SED FEN E PLANTINGS (GROUND 3'- PROPOSED EVERGREEN SHRUBBERY) PLANTINGS (GROUND o SHRUBBERY) ol d-- N Z 10' 45' EXISTING MASONRY PATIO& 3' _ STEPS,AS APPROVED BY EXISTING BOARD OF TRUSTEES 2 STORY FRAME EXISTING 2ND STORY M HOUSE DECK 25' EXISTING COVERED TEoI _ FRONT PORCH (2ND STORY DECK ABOVE) EXISTING SLATEWALKWAY XISTINGWN Q Q > 0 EXISTIN w GARAG CD Q O i t997.12' O Z C) N EXISTING Z w ASPHALT DRIVEWA i S 06 22' 20 W 100.00' a ARSHAMOMAQU E AVENUE �k OF s� E PLAN W/ PROPOSED FENCE _ OLT 1"=30,_0„ PROJECT NAME: DRAWN BY: CP DRAWING M wsis PROPOSED FENCE AT THE CHECKED BY: WS WSJS ARCHITECTS G RAS S O RESIDENCE PROJECT#: 202006 755 NEW YORK AVENUE DATE: 10/26/20 spl ' o HUNTINGTON,NEW YORK SCTM#1000-66-03-06 1155 ARSHAMOMAQUE AVE.,SOUTHOLD,NY SCALE: AS NOTED jAN mu-Al 1 JT Oil r �r f ,�► l r •. 1 f 1 f 1 t PO Y ► ` IV oil s ,4'•` �• 1'��1� � � �'l y�y'., �.� 'y tea`.s,` s• 117E I R imp � -a..a s��'�a -- ��{ f � e r1 '9•ji �i jrrl - . Y * Y 4 It N. Grasso Residence- Avenue 1155 t'•} �_ Southold, NY photo date-2-22-20 del xx .: Grasso Residence 1155 Arshamomaque Avenue , iSouthold, photo date:3-2-20 rf ,�^` lam,-+t-` J ._ _ • - Y: F e i fi,, e � �=. �� .: �•+th;f «cl��� �`'s D4, RTS i+�«;�,.,r �, t4 .. � {u ..r-�„✓•`" T i"f �� a x f f M n � •+ � � • z "4 z r���.,. t ': a 7�, � � � � ,� - S r��� �'' e°..t �:� r„..>. ar 4 ..._ +�,. '� 4 �# x"'9M'�• �"��'.-e3.a + '�� +”. ." �„. . ., .: It1'. ''1 .6A �_y "ta. t :,-go � f : r - , r .+'. q.: 1r. 4,. t,.`{f:C.i M + r:a, ,0.r r. k V ,' ,. -.. ,• r '* :',., } 7 �s�«.., ,,r.0. :: ,•,e y � •�+ 99�"M '+«' .�. ._ - �,. 'r,.. �F '�'` t��� � "�t�''r�r,t 4 t �rM t(5-k'�a',ai'".v -'; n ?�� }�-. i,. "��• � �" + [fie ? I ,.eh ` ��e��i�cf .1 �R'p�M; �'�, G` ��� ~x _�... '_ .I,. ••�• tea pn' 't' d..p -' 'M�` ;x r f �p t •.r w�:`t �'� ��.� �tnx�' � r�; •�t� W,• ' 1 p�.. •`', i� '. t ...: �'a•��,f� � «+�,r^k+e 1 ;'If�t" .w• ar » dg is w +-� ✓ �,lf I' 1 I p w�° ""fi t, s -�$wCM;' in fM " I t■■ F F � F4�` :P y I I I■ � f M"M ug „� �- �•� � � ,r� � F°sem�. r 411,a ion View looking in northwest direct' IN 1 D fL Orr: `r +� cM .... ..• S'�'--F'1. .•�� "f' t t . '.,_ -' `„« ,..r' � � • - .., 41':�, -,.df.:•.r,�r�'r•° mak. �� v�4 sz�4' �5,. .>�',�,h r x wow ;. yr, p s fit Grasso Residence 1155 Arshamomaque Avenue View {, �';W<.��4!°'•j,r?�.. ',: a xt,� ��� p � r w - wR _ y i r+ "A 9Y+ y„w _'Ay■` ,'ter s �?:}, looking • direction Southold, photo date.2-22-20 m 0 . i ;�silar. w• Y x 1Ja1 � ` y,, a �I} k , )� r 1• �• PIP µ Grasso w } t 1! ' Residence 1155 Arsham - • _• - Avenue View •• • in southwestdirection Southold, NY photo date:3-2-2CJ-14 7-7 4 .z w � FOn CGS.NO �"� 5+ JS6OSO01.3 � Y ,so® '06 _ M eWU i��o Mw1 ~m, a at�HU � � J .BOJ LY�M rn•A_�Y 1 M � �Y3� ;.�.1.... �a�w".u." � s`'C� 5g ��.Y p•B'a��a 4 M O Q' - .�NH 4.UM(9) t e t ��n • M e I e 9ta0s 40 es t M ea as K g "• zz • c• • 4 e M i.eatel vente) •�. #"•, °5 g R'' ••a• O`1 i ' �\ .B , ,SAY$ a R R +•tea 9. ry',&,.Aiai • \ap� .'AJC �" ♦ AV � • 4� '� �/'�'4` r n - s l „c � N ti -, MIRT71W Tr — _ wcr ra SECTICN No. N NOTICE K 90o _ oln 1 COUNTY OF SUFFOLK © swan sx Y Real property Tax Service Agency atoaml°�u 066 u osnnanxw a Im raaTKrK of,HE t1.t Nc) Aswlx calmvT,,x aura >=� M 3oo Cr,un fM,e.9wAmd NY/1901 E WmlfRn wnmara i8a.640N p --�-�' yayNw as —_._— �' �----M — —_— am wr. (21) >r •• W S. IiEI1 wSPHlfT Trl%�NI�IaBf.Y OFFICE LOCATION: P `n � «�' � �� MAILING ADDRESS: Town Hall Annex y � 'yk P.O. Box 1179 54375 State Route 25 " Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) � hone: 631 765-1938 Southold, NY 11971 �u Telephone: 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: December 9, 2020 Re: LWRP Coastal Consistency Review of DOMINIC & PATRICIA GRASSO SCTM# 1000-47-2-3. William A. Scherer, R.A., on behalf of DOMINIC & PATRICIA GRASSO requests an Administrative Permit to install a 48" high aluminum fence to enclose an approximate 14'x44' area with two (2) 42" wide gates. Located: 1155 Arshamomaque Avenue, Southold. SCTM#: 1000-66-3-6. 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. 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 r z i` re Glenn Goldsmith,President *QF SO(/r Town Hall Annex Michael J.Domino,Vice-President Oy�lO 54375 Route.25 John M.Bredemeyer III P.O.Box 1179 Southold,New York 11971 A.Nicholas Krupski c/n G Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 e4UNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application -- =--= - Administrative Permit Li Amendment/Transfer/Extension a Received Application: 1Z.2.0 NOV 1 2 2020 y✓ Ceceived Fee: $ led.va om letedA Application: 1320 P PP Roar1 of T„ , Incomplete: -- -- -�----� SEQRA Classification: Type I Type H Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): o M:h I C, I G 163 C, r A 5 5 d Mailing Address: (o S ort fook, i Phone Number: Ot - 4 5 4 0 Suffolk County Tax Map Number: 1000 - (,,(o - 3 - �o Property Location: A r o wt q o 1 e- AV e n U4_� D� N� (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): U r[ 1 a inA Q • � c.� r e r . Mailing Address: S Sr G, Z G :2156N ek.��o r kAve- i,v\-�-ir.a 4 0+-t. ix'/ Phone Number: �1�43 Board of Trustees Applic' ion GENERAL DATA Land Area(in square feet): _ Z!! - Area Zoning: 9- 40 Previous use of property: S� '¢ q r'1 11�� e5 i�t Q v\,c 2. Intended use of property: 4 1z e,I e h ee, 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 vl" No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes ✓ No Does the structure (s) on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date I Z /l Of/ I/ G u 01 a� Q dc, 2It�-�. 41°6 2 l2 o G b 0 i�,O, + I -? °� Sov4-L,014 130ar 64 0 VJ^- '-u 5th 5 8/19lZo Aam'Jois-4rc-4z c We-M.-t- A Nerr,,;-F 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): <4 ct 0, ' ova Lk e, a L p v G v Li G a s a (o m., n,) L d c, a s 4q 5knfu Sa G -er i J-t,1 at ` r LLL . �►•, c� ' s ��.c (d e a ea -o r� X 4;4:1- 3 �l Z 1 a i i A t o c�r a Board of Trustees Applie, "ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: n c I o!5 e, b o r o n o� �/a Kdg re of Area of wetlands on lot: b square feet Percent coverage of lot: a % 9-L!'/0 -Fo 54e -s Closest distance between nearest existing structure and upland edge of wetlands: feet,�0 P„o Closest distance between nearest proposed structure and upland edge of wetlands: $3 feet, ° +0 propose ev,ce. Does the project involve excavation or filling? ✓, No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 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): peopo sed or pu 10V%5 s l ka ie. 1n,o a ok► �-�e. y4e, �—I ay. 5 arj 4::, J '-, I \AJ a -eV-S. 6I Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: b GS i d e 6 6 2, C. O IS u rt, G Project Location(describe,and attach a location map): e, A vie . m� Brief Description of Proposed Action: I I ` /' S-I-� Q� i on o-l- �-��t �,iq� Lib�Yty Jgte'�y( p.,p LIack. p w Y" e,o c%-4ed a I Li w�r n rvi �' e v►GP- 1v��Zl .�./Z ��!i d Z g q 4 e 5i cos w►ar��-FaG-tJ("2o� b�/ Jet j4� P.%4UriAJ Lt- Name of Applicant or Sponsor: Telephone: 66J1ctM �GLjyer U16J6 'Ar-64j4ee,+6 E-Mail: LJS .JS grOm Address: ll � ,{ ` City/PO: State: Zip Code: HU n o✓o �� Il?�-3 1.Does the propose 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: ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? O acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses th t occur on,adjoining and near the proposed action. ,� [-]Urban CRural(non-agriculture) ❑Industrial ❑Commercial 19JResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic C]Other(specify): ❑Parkland Pagel of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ Z ❑ b.Consistent with the adopted comprehensive plan? El 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: � ❑ 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? L 1 ❑ 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: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Idle tify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: 69Shoreline ❑Forest El Agri cultural/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? 9 ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO DYES 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]If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor Date: 1//0(0/1,0 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 I. Will the proposed action create a material conflict with an adopted land use plan or zoning El E]regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ ❑ 3. Will the proposed action impair the character or quality of the existing community? ]� ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El 1:1affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate 1:1 1� reasonably available energy conservation or renewable energy opportunities? u 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? F] El 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, ❑ Elwaterbodies,groundwater,air quality,flora and fauna)? 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? H. Will the proposed action create a hazard to environmental resources or human health? 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. F1Check 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. F] 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 Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 1 _ APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: V�t ((( CL nA A. (Last name,first name,.tpiddle 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.) J 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 f 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,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi dagf o e, I .age-ZOZO Signature ��// ��dd Print Name i dream Form TS l 'A-c0c �z yG I ERIC M. JAFFE Notary Public, State Of New York Lvu�� SJ lll. No. 02JA6089767 Qualified In Suffolk County ,, 2 Commission Expires March 31, 20 APPLICANT/A.GENT/REPRESENTA.TIVE TRANSACTIONAL DISCLOSLW FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide inforalion which can alert the town ofpossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: G�- (Last name,first name,-piddle 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 y _ Change ofZone 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 ofSouthold? "Relationship"includes by blood,marriage,or business interest.`Business interest"means a business, including a partnership,in which the town officer or employee has even a partial,ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO ---XI 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/agcnt/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the appliepnt (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D}the actual applicant, DESCRIPTION Or RELATIONSHIP Submitted this 0( _day of --0 Signature- ,N Print Name Form TS 1 J i AT f; -F t4 C-,- LK JOSEPH MURRAY Coum-=i of Queens Notary Public-State of New York 6"-ro 15 9.44•01Q J �eve.mw 70,Xz, No. OIMU6184057 y Qualified in Nassau County My Commission Expires on March 31, 2024 Board of Trustees Application AFFIDAVIT 1( -\�\ �C�l�C� 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 TIIIS 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. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF N ay L m 3 iF-2 320 'Lo U-- JOSEPH MURRAY 'Notary Public Notary Public-State of New York No. 01 MU6184057 Qualified in Nassau County My Commission Expires on March 31, 2024 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, C, KC ��\ � .\�)L owners of the property identified as SCTM# 1000. 66- ®3^ � in the town of ZG�7--V QLD New York, hereby authorizes, W u NKr-� 0�� 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 ignature Property Owner's Signature SWORN TO BEFORE ME THIS 9+6, DAY OF N Oy C ulfti3 e-a 20 2-0 Notary Public JOSEPH MURRAY Notary Public-State of New York No. 01 MU6184057 Qualified in Nassau County My Commission Expires on March 31, 2024 / 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 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 significant 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 certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 6 6 - 3 - PROJECTNAME GraSSo f7: 6,vXG4- einc lo4ore. aJ re4str Yoar� The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval, license,certification: ❑ Nature and extent of a��((tion: II a a7-i ovn 0 8r� hi e GZ C2 )slide, w4,e5 +0 2v% c (4) 5e- are- SI! -n� -++ -3 /2 � -, rear Yar� ��LSY Lo a4dl 2® . i Location of action: ( fj q rhy� e S o U Site acreage: •'�(v Present land use: e5 1 c�e n -�-i n I t'O fi e(-�-�! y, 5 i ►��,12, y Present zoning classification: — 4-0 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: Q 6 Q,m A - G Le r e r (b) Mailing address: S J 5 k GL 4 G k5 77'5'S Q,w V or 14 Ave- .l in 0 on V (c) Telephone number: Area Code (d) Application number,if any: ) Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No 2 If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ZNot Applicable I Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Not Applicable i 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 1�rNot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No PNot 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 HI—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Yes No N��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 [:] No 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 ErNot 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. ❑ YesEl No[�rNot Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III•—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No [� Not Applicable 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. 1:1 Yes El No FrNot Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III-Policies; Pages 62 through 65 for evaluation criteria. F] Yes ❑ No U Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III-Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No 0 Not Applicable PREPARED BY V.k'J 4 q,rh A S C�er e,r- TITLE A e fiE DATE49 6 2o