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HomeMy WebLinkAboutTR-9851A Glenn Goldsmith, President ®f S®�/_� Town Hall Annex ® A. Nicholas Krupski,Vice President �® �® 54375 Route 25P.O. Box 1179 Eric Sepenoski6 Southold,New York 11971 Liz Gillooly Elizabeth Peeples � ® � Telephone(631) 765-1892 a Fax(631) 765-6641 c®UNTi,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1930C Date: June 27, 2022 THIS CERTIFIES that the installation of an 11'x11' bluestone patio with a 2'x3'6"path; At 3245 Wells Road, Peconic Suffolk County Tax Map#1000-86-2-7 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 23, 2021 pursuant to which Trustees Administrative Permit#9851A Dated April 14, 2021,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 installation of an 11'x11' bluestone patio with a 2'x3'6" path. The certificate is issued to Mary Ann Howkins owner of the aforesaid property. Authorized Signature Glenn Goldsmith, President ° Town Hall Annex A. Nicholas Krupski, Vice President � 54375 Route 25 P.O. Box 1179 Eric Se enoski p Southold, New York 11971 Liz Gillooly Elizabeth Peeples ® Telephone (631) 765-1892 Fax (631) 765-6641 TI, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: b 2.1 121 INSPECTED BY: 54k6f,�k Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction '/Z constructed Project complete, compliance inspection COMMENTS: I���1 Ip120-hV.e bn.'ho WASt1reS lD X 10"x lti�toy CERTIFICATE OF COMPLIANCE: 'SSu2. �/�'� Glenn Goldsmith,President �q so(/j Town Hall Annex A. Nicholas Krupski, Vice Presidenty�lO 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J. Domino cn �c G Q Telephone(631) 765-1892 Greg Williams �', YO Fax(631) 765 6641 � ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF " - BELOW _ INSPECTION SCHEDULE Pre-construction,'haybale line/silt-boom/Silt curtain 1St day of construction- % constructed X When project complete, call for compliance inspection; Glenn Goldsmith,President �Qf SOUlTown Hall Annex A.Nicholas Krupski,Vice President ,`O lQ 54375 Route 25P.O. Box 1179 John M.Bredemeyer III lx[ i[ Southold,New York 11971 Michael J. Domino G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 �yCOUNV I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9851-A Date.of Receipt of Application: March 23, 2021 Applicant: Mary Ann Howkins SCTM#: 1000-86-2-7 Project Location: 3245 Wells Road, Peconic Date of Resolution/Issuance: April 14, 2021 Date of Expiration: April 14, 2023 Reviewed by: Greg Williams, Trustee Project Description: Install an 11'x11' blue stone patio with a 2'x3'6" path. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Salty Roots Garden & Landscape Design, dated March 23, 2021 and stamped approved on April 14, 2021. 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. ` *_ 4&�I _ Glenn Goldsmith, President Board of Trustees APPROVED BY SALTY ROOTS DMON BOARD OF 1 TRUSTEES PO BOX 894 MAIN ROAD TOWIy OF SOUTHOLD Mattituck,NY11952 s salt rootsny.com 631.315.9091 DATE TC :IA AIL 14 20Zr Project ' HOWKINS o WWII, — —--------- ----•—----------- r . ----- — -- --- -- -- ------------- 324 5 Wells Road m 86°09�1a^'E fe -�-_�------------- ------- Peconic,NY Title Z ,---- -----f -s - — PrQposod"11'x11'-blue st a'patio Patio Plan i ----- N =Z STORM --___--' L-i S''.' ❑ —_I I �� JrI ❑ - ❑❑ with a`2`-x, _'.6" path,-,,. ath--\" I 7❑❑❑❑❑❑❑❑❑❑❑❑❑�?IEI❑❑❑❑❑❑❑❑ ❑❑� ,II Scale 1/16" HOSE BIB 1 ' lu,[7 I ZI Date N O'' I, O3.23 .2021 LEADER NEW GRAVEL DRNE W) PLAN METAL TRUE NORTH NORTH yPGUfEORWN S_- $ o WATEe,, ;CONTAINMENT; DWMLL ❑ 1 ®l ® I' I I 1� 1 cn LEAFIER ❑❑ \ I I C.2ca El i Of I 111 , Iii /` _ -;�. - .� * tEAr� T ❑❑❑ \ I I i1 m (n - I I I 4'WOOD CATWALK I I RAMP 4'X!0'BOAT UIWTYPOLE }` ,`, - . ❑❑❑❑❑❑❑ f 1 I� Il```k ' I 1 NEW ul-m S SEEO16A6- LE I \ S q T40POSED 4 BEDROOM SYSTEM, ' C 1250 GAL S.T. n -LEADER ' .-- -�- \ (2)B'X6'DEEP Lp --- -r ---- --------- 7 �� •\, E ---------- ----- RM --- 1ST5WATER' ./----------------------- 9 I `,,� \\ 1 i "CONTAINMENT /" ---_---_i- --_-_ �_ DRMLL, _- _-- i------ Tw \\\ opin \ \ L 187.59' N .- \ saatsnjl jo paeo8 i a UMOL pioytnog I , � \ Y E 1 0 Q Z Page �51�F,FU(� . Glenn Goldsr , PresidentTown;» Town Hall Annex A Nichola's F\'rupski, Vice-President h4q 54375 Route 25 John M. Bredemeyer, III � P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams 4 ®! Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: � Completed in field by: Eric Martz on behalf of MARY ANN HOWKINS requests an Administrative Permit to install an 11'x11' blue stone patio with a 2'x3'6" path. Located: 3245 Wells Road, Peconic. SCTM#: 1000-86-2-7 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 c mpleteness/comments/standards: I I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski . Williams Other SALTY ROOTS DABD®1�LND"GP" Ds"ION MAIN ROAD PO BOX 894 Mattituck,NY 11952 saltyrootsny.com "" /• 631.315.9091 /• Project HOWKINS i /� -' -------------------------------------- ------------------------- ' ; 3245WeHsRoad -r— ; Pecon is NY — � % '•./'/- Title __ __ _ _ �' -- — ' ' Patio Plan -s `- Proposed i i'xI V-blue st a'patio I nl� with �'2'-x,31 1,path.-,_ 7 ' `------�+ ❑❑❑❑❑❑❑❑❑❑❑❑❑LSI❑❑❑❑❑❑❑❑❑ ❑❑❑ 1 , • s ❑ ❑ rs ❑ � 1 Scale I _� .❑ ❑ \ �i � II _ . N Date 00 �LiER ❑ o' � 1 03.23 .2021 • NEW GRAVEL DRNE WJ — ❑ Y ` 1 I METALEDGE I I 'moi i PLAN TRUE ------------ NORTH NORTH =1"sTORMwATER, s ❑ I❑❑© �' I ;CONTAMMEM, ❑❑❑ DRYWELL ❑ ❑❑❑ ta LWER ❑ -$_-----LEADER ' E:1 \ I I 1 Efl',r '1 ElI 1 , 11 El J - � 4'WOOD CATWALK 1 RAMP 45(10'FiOAT WURUTY POLE SERVICEA6= 4 E --------- I �, ` \ \ LEADER3 11`\ P \ .c� \ 4 BEDROOM SYSTEM I (' y` \�• \. 1250 GAL.S.T. n L___-_ -., ` (2)8'X6'DEEP L,g Lie / — - (r------- ;A--------------------- 7 � I , STORM WATER" __-- -------- ----- 9 I \,, \\ i I ,CONTANMEM, ----- DRYWEu / i --------- -------------------------- '----- \\ Ln 187.59' �� l � NiiCD \\ N 88°12'50"E I I I'fn �_LJO p�e0wA► I�oS 1 • , y L 1 Page S.C.T.M. N0. DISTRICT 1000 SECTION: 86 BLOCK: 2 LOT(S): 7 / ® E C E 11 Lam, MAIN ROAD DWELLINGS LAND N/F W/PUBLIC WATER PROPOSED SILT FENCE / MAR 2 3 2021 +I PROPOSED OF 150' ALONG LIMITS OF DISTURBANCE / N TIMBER RET WALL NORTON 11,000 S F ± EXISTING CONC TIE LINES ALONG N 86°09'10" E SLAB TO BE REMOVED / MHW MARK Southold Town -- - 171.02' �� Board of Trustees 61'W - - - - - - - _ GEN &OA/ C UNIT PPI E z SILT FENCE PROPOSED PROPOSED 9N CO. PADS PROPOSED 0.5'S� 500 GAL STEPPING STONES U, _QUTDOORING1 I / W SHaWER— Iv EL 10.2 OUND L.PRGAS TANK 0❑❑❑❑❑❑❑❑❑❑❑❑❑ ❑ ❑❑0❑❑❑0 �1a- \ $ I V I ❑ �® o � I I ------ 48.1' --_-_ 24.2 w ❑ I � � I �l PROPOSED GRAVEL DRIVEWAY• I NGARAGE 21.5' GF 11.4 ❑ \12 � 71 �;N / I o� 0 I > _- --� ----- 2.0' ry z c„I Q- I �4 0 Z \�� DRY o w ❑ `iv I m O �� �\ ❑\ WELL . 0 m � I `�� U �rn O — ❑ U 3 x m 1 O° \�� \ wwz 15.5' ❑ 66 I (� o A n wLWA-LER LINE a� 1 STY FIRM. 1111111 I I I r�--� 70 I U.P. - - - W.V.-o1i.5- - - -\ DWELLING I I I I I I I I I I Q I Z rrI _ 4'x20' FLOAT _ _ #3245 I I I I I i I I I 1 ' 1 \ll _ I 4' WOOD CATWA K RAMP 4'x20' FLOAT I— -I PROP. UNDERGOUND UTILISES OD 0 0 �„ I I I I I N LI I PLATFORM PROP.- - -—-—- �I ❑oo[�oo N FFL 15.0 I 1 , I I I 1 I I � �� EXISTING ASPHALT 0) cn I DRIVEWAY TO BE z o 1 r, REMOVED I �- CO o J J T 01¢RH �a I EXISTING;CONC tO l o o l l l I EXISTINeSTONE l Lu I ' 0 Fq�ORFS STOOP TO BE PATO TO BE R MOVED \ �6o DRAINAGE CALCULATIONS: 3n a I 0 REPLACED I I 1 1 1 1 1 \ EXITING OVERHEAD WIR S TO BE REMOVED O L P� B' CLEAN I I I I I I I I I EXISTING W OD 6' DWELLING FOOTPRINT=2,161 SQ.FT. IN fiAVOR OF UNDERGR UND 0�11 OUT I I I I I I I 1 1 , DECK TO B \ \ ��6'= 2,060 x 0.166=359cf REQUIRED UTI (TIES. S.T. 28.2 (2)' I -I-IJI REMOVED \ 4 5' � / � 10'MIN -- I � � � � � 8'DIA x 4' DEEP DRYWELL=354cf PROVIDED IN. _EXT' i� �_� 0 8 1 \ 8�/N �� ��\ EL 12 3 CELLAR ENT pRY �2EXISTiNG SANITARY I II TIDAL WETLAND \ � L P ` WELL �� SYSTEM TO BE 110 I BOUNDARY AS I = o �, RAIL FENCE ____ 5' 4'- ABANDONED AND BACKFILLED I DELINEATED BY—•I o SILT FENCE WITH CLEAN COARSE SAND. I EN-CONSULTANTS I. rs 5.4'W --_ IN C AR TR ES AL G LINE I I APRIL 8, 2019 I cfl p PIPE I PROPOSED N 88°12'50It E1 I 4 BEDROOM SYSTEM DWELLINGS PIPE I m ELEV. 12. EXISTING LOT COVERAGE PIPE 1250 GAL. S.T W/PUBLIC WATER LAND N/F 0 5'N 187.59' S•E I DR BROWN BASED ON UPLAND AREA (17,456 S.F.) (2) 8'0x6' DEEP L.P. 150' OF OL SANDY LOAM n 4, KOWALCHUK FAMILY 2008 IRREVOCABLE TRUST \ I �\ DWELLING. 2161 S.F. TYPICAL SILT CLAYEY UPLAND PORTION OF CATWALK- 107 SY THE WATER SUPPLY, WELLS,-DRYWELLS AND CESSPOOL SCREEN SECTION 1 SC LOAM/SAND 1.7' FRONT STOOP: 25 S.F. (TO BE REPLACED) LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS GEOTE%TILE FABRIC \ 1 — REAR DECK: 541 S.F. (TO BE REMOVED) AND OR DATA OBTAINED FROM OTHERS. NGVD 1929 SUPPORT POSTS ASPHALT DRIVEWAY. 1410 SF. (TO BE REMOVED) AREA: 18,042 S.F. or 0.41 ACRES ELEVAT70N DATUM• -------_---------_----- WOOD OR METAL MEDIUM STONE PATIO. 225 S.F. (TO BE REMOVED) UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SEC77ON 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY FLOW DIRECTION SW SAND 9.O' MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN & TOTAL 4469 S.F. or 25.6% ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND-ON HIS BEHALF TO THE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON EXCAVATED AND GRAVEL LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE BACKFILLED TRENCH WATER EL 12 — THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 77-IE . E PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE PROPOSED LOT COVERAGE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD177ONAL STRUCTURES OR AND 07HER IMPROVEMENTS EASEMENTS _ EXISTING GROUND WATER IN AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY _ SSI/ MEDIUM BASED ON UPLAND AREA (17,456 S F) SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: MARY ANN HOWKINS; 1-1-III=III=III=III=III= III=III= 11=III=III=III=III=III= SAND -III-III=III=III-III=III=111 III=11 =III=III=III=III-III=_ & 6.0' DWELLING: 2161 S.F. MAP OF. FIDELITY NATIONAL TITLE INSURANCE COMPANY, 1=III=III=III-III-III=III= r III=III= 11=III=III=III=III-III GRAVEL UPLAND PORTION OF CATWALK: 107 SF _I 11=1 I I—III—I I IJ 11=1 I I—I I I I III—I I —III—III—I 11=1 I I—I 11= FILED. REVISED 09-26-19 P 2MINIMUM FRONT STOOP- 22 S.F. SITUATED AT PECONIC REVISED 09-17-19 REAR DECK: 480 S F. TOWN OP SOUTHOLD KENNETH- M WOYCHUK LAND SURVEYING, PLLC UPDATE 07-12-19 OUTDOOR SHOWER: 20 S.F SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design UPDATE/ADD SOUNDINGS 04/08/19 P.O. Box 153 Aquebogue, New York 11931FLOOD MAP#36103C0166H SEPT. 3, 2019 TOTAL 2790 SF. or 16.0% FILE 18-115 SCALE: 1"=20' DATE- SEPT. 20, 2018 f PHONE (831)298-1588 FAX (631) 298-1588 FLOOD ZONE X K. WOYCHUK LS N YS LISC NO 050882 1 maintaining the records of Robert J.Hennessy k Kenneth M Woychuk - x - 02/23/2021 - 1 :20PM. - North East x sf l 4` z -.� �'Y'� �.,'! t�� � C =�1 �+�' ,Z,cul :•�k . mar'' `� � � ,,�• '" .-�-.,. � �a 02/23/2021 - 1 :20PM. - South West �,• �� 6FU9 qi boiA SEI SEE SaG. ' p 111 111 N0 016- / SEE SEC.N 111 xm W N.T LINE ''. H `"" II 1]-6e 9n GH. s T _, ,, SEE SEC NO ei5 LINE 06-06 G0 �•f�Y ,� KVHemu6T' y 'MA p �•,✓ ,!' 01—I 1012A,cL-�o sen ;_. 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COUNTY OF SUFFOLK NDTIc FEE- N kRenl PropertyTax'3elviceAge y w.Ea+ vilwy EAM — —..Or THE -or____ __ rAnw___.__ um'•• ...... ...... r�•.,•� r o-... . )4YI<'nrrr ll4r.R,.rMJ 111/Po/ O W NtMV BNt01lIIEO M DBUTHWD p 086 OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex � � � r.r P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Heather Lanza, AICP, Town Planning Director on behalf of Mark Terry, LWRP Coordinator&Assistant Town Planning Director Date: April 12, 2021 Re: Local Waterfront Coastal Consistency Review 3245 Wells Rd (Martz) SCTM# 1000-86-2-7 The application referenced above is for a Wetland Permit for the installation of an 11' x 11' bluestone patio with a 2' x 3'6" path. 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 with the condition that proper drainage is included that will prevent stormwater runoff from entering the creek both during construction and after. 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 Glenn Goldsmith,President so Town Hall Annex A.Nicholas Krupsld,Vice President 64875 Route 26 P.O.Box 1179 John NL Bredemeyer III Southold,New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams Fax(631) 766-6641 fI BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application E C E Wetland Permit Application _V4Administrative Permit Amendment/Transfer/Extension AR 2 3 2021 rM V, Received Application: ;.Z?;.Zl I — Received Fee:$ 100.60 zq I Completed Application:. Southold Town Incomplete: Board of Trustees SEQRA Classification: Type I Type H Unlisted I'Mg—aRve Board "�u""�'osittve�Dec. —Lead Agency Determination Date: Coordination:(date sent): 71-'_LWRP Consistency Assessment Form Sent:. CAC Referral Sent: 47 _74Date of Inspection: Receipt of CAC Report: Technical Review: �Public Hearing Held: Resolution: Owner(s)Legal Name of Property(as shown on Deed): Mary Ann Howkins Mailing Address: 250 W 94 St. Apt. 5B, New York, NY 10025 Phone Number: 917-885.0855 Suffolk County Tax Map Number: 1000- 86-2-7 Property Location: 3245 Wells Road, Peconic, NY 11958 (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): Eric Ma I rtz Mailing Address: P0Box 894Maft1tuck, NY11952 Phone Number: 917.916.3724 Email: edcO-saltyrootspy.com `1 Board of Trustees Application GENERAL DATA Land Area(in square feet): 17,456 Area Zoning: R-40 Dwelling Previous use of property: Single Family Residence Intended use of property: Single Family Residence Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes !/ No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes N 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? V/ Yes No Prior permits/approvals for site improvements: Agency Date Building Department 09.10.2020 Southold Trustees 12.11.2019 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): Install 11'x11' blue stone patio with a 2'x 3'6"-pa h. Board of Trustees Applida-Uon WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Bluestone patio. Area of wetlands on lot: 3,484.8 square feet Percent coverage of lot: 19% % Closest distance between nearest existing structure and upland edge of wetlands: 74' 8° feet Closest distance between nearest proposed structure and upland edge of wetlands:- 54, 91v feet 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): No negative impacts to the wetlands or tidal waters of the Town of Southold are anticipated - J 61Z20 Appendix B Short Environmental Assessment Form Instructions for Conipletintt Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: 3245 Wells Rd. Project Location(describe,and attach a location map): 3245 Wells Road, Peconic, NY 11958 Brief Description of Proposed Action: Install 11'x11' blue stone patio with a 2'x 3'6" path. Name of Applicant or Sponsor: FE-Mail: elephone: 917,916.3724 Enc Martz edc@saityrootsny.com Address: PO Box 894 City/PO: State: Zip Code: Mattituck NY 11952 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 ®' D 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: V F] 3.a.Total acreage of the site of the proposed action? 4 acres b.Total acreage to be physically disturbed? -00 3 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? .4 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑industrial ❑Commercial [Residential(suburban) ❑Forest OAgriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 S. Is the proposed action, NO YES N/A a.A permitted use under the zoning-regulations? 1 IV 1—I F] IV I❑1 b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? , ❑ 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? M ❑ 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: NSA 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method.for providing wastewater treatment: NSA M ❑ 12. a.Does the'site contain a structure that is lisied-on either the State or National Register of Historic NO YES Places?° b.Is the proposed action located in an archeological sensitive area? �J I❑J 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? ❑ V 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:_ Lr 1 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: V❑ horeline El Forest ❑Agricultural/grasslands El Early mid-successional Wetland El Urban ❑Suburban 15..Does the site,of the proposed-action contain,any_species-of animal,or,associated habitats,listed N®_ YES_ by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES TT 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. AYES_ L�'J, ❑, b.Will,stomi water discharges be directed to established conveyance systems runoff and storm drains)? If Yes,briefly describe: NO AYES Page 2 of 4 1"8.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: LTJ ❑ 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? 1f Yes,describe: © ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name:_Eric Martz 3�A h Signature: Part 2-Impact Ass ss t. 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 projectsponsor 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? 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 ❑ L _1 establishment of a Critical Environmental Area(CEA)? J—J 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ 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 ❑ E]reasonably available energy conservation or renewable energy opportunities? 7. Will-the proposed action impact existing: (- ❑ a.public/private water supplies? tt�—tt b.public/private wastewater treatment utilities? ❑ ❑ 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)? Page 3 of 4 I4 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 F—I -❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El 1 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. 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) C PRINT Page 4 of 4 Board of Trustees Applin; :ion AFFIDAVIT MAW Y AIW4 40�-d 4 t 6,(S BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 09, Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS 23�c _DAY OF M1412G 14 ; 20__?L CAROLINE M MACARTHUR NOTARY PUBLIC-STATE OF NEW YORK No.01 MA6384635 Qualified in Suffolk County Notary Public My Commission Expires 12-17-2022 Board of Trustees Appli .ion AUTHORIZATION (Where the applicant is not the owner) IIWe, Mary Ann Howkins owners of the property identified as SCTM# 1000. 86-2-7 in the town of Peconic New York, hereby authorizes Eric Martz 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 wner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS. �. _ ! _DAY OF J%�r�G% ,.20. a f FIONAVONDRACEK Notary Public-California N6tary Public - Monterey County Commission N 2231217 �� lOFN'^ My Comm.Expires Apr 7,2022 APPLI CANT/AGENTME-PRESENTATM TRANSACTIONAL DISCLOSURE FORM The ToWrn of Soothold's Code of Ethics prohibits conflicts"of inierest on the part ditiiwd iafticers and employeos The pumose`of this form is to gmyide-inforina(ion which"can alert-the'town of possible conflicts-of interest and'all6w-it to take whatevef nction ls`. necessary to-avoid same. / YOUR NAME: RDW 91 /VS D`'1 Y A4 t (Last name,first name,giiddle 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 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/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 applicant (when the applicant is a corporation); B)the legal or"beneficial owner of any interest in a non-corporate entity(whet 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 Z I Signature" Print Name_ Q 2 Al Form TS 1 APPLICANT/AGENT/REPRESENTATNE 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 inforinition which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same: YOUR NAME: EPIC Martz (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building _ Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning 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 this d 20L Signature Print Name Er rtz Form TS.1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold 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# 86 - 2 - 7 PROJECT NAME 3245 Wells Rd. The Application has been submitted to(check appropriate response): Town'Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: Install 11'x11' blue stone patio with a 2'x 3'6" path. Location of_action: 3245 Wells Road, Peconic, NY 11958 Site acreage: 0.4 acres Present land use: Single Family Residence Present zoning classification: R-40 Dwelling 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: Eric Martz (b) Mailing address: PO Box 894 Mattituck, NY 11952 (c) Telephone number:Area Code( } 917.916.3724 (d) Application number,if any: l� Will the action be bfe directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No U 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 LVVRP Section III—Policies; Page 2 for evaluation criteria. WYes ❑ No ❑ Not Applicable Project will make beneficial us of coastal location, and minimizes adverse effects of development. 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 1:1No LJ( Not Applicable Project will have no negative impact on historic or archaeological resources. 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 9 Not Applicable Project will have no negative impact on on visual quality or senic resources 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 9 Not Applicable Project will have no negative impact on flooding or erosion. 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 WNot Applicable P�olect will have no negative impact on water quality or supply. 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. ❑ ❑ C� o- Yes No Not Applicable Project will have no negative impact on Town of Southold ecosystems. 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 W Not Applicable Prosect will have no negative impact on air quality. 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 EV Not Applicable Project will have no negative impact on the environment. PUBLIC COAST POLICES 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 V1 Not Applicable Project will have no negative impact on public access. Attach additional sheets if necessary 1- 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 V Not Applicable Project will have no negative impact on water-dependent uses. 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. F-1Yes F-1NoNo Not Applicable Project will have no negative impact on marine resources. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III-Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No W Not Applicable Project will have no negative impact on agricultural lands. 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 FV Not Applicable Project will have no negative imna . on anerqy of mineral resources PREPARED BY Eric Martz TITLE DATE 2� 2