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Josephson, John
4 t James F.King,President QF souz Town Hall Annex Bob Ghosio,Jr.,Vice-President OVA �Ol 54375 Main Road O P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer N Michael J.DominoTele hone(631) 765-1892 Q Coil Fax(631) 765-6641 �� E W OF TOWN TRUSTEES }VN OF SOUTHOLD MAR 2 8 2014 L To: t SOI ment BI DG DEPT �V_ /" :� ( TOVVIIJ Of SOCTHO!D tt (J_S-e.. -- ---- --- Re: Ven Jy QOOl �" lent Permit Requirements SCTM#: Property Owner Name: _D2bh&b� Date Sent to Bldg. Dept.: 3 12 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project rE z' t Will the proposed project rl the Zoning Board of Appez Will any part of this applicc , described under Town Cod COMMENTS: p-�; OR � �C V Signature of Reviewer Date SURVEY OF PROPERTY 0� SI T UA TED A T � Ilk, ,' ORIENT ji ►1A'.92 8 2 01 ItI ! o1101 TOWN OF SOUTHOLD tiP SUFFOLK COUNTY NEW S.C. TAX No. 1000- 17-02- 1 . 11 ,�, �Qo� �, SCALE 1 "=40' til 0,• / � � / 1zz oP ti �- ��• '� /' ' / ° OCTOBER 12, 2004 NOVEMBER 11, 2004 ADDED PROPOSED SITE PLAN MARCHf3.3 MARCH 7, 2013 UPDATE SURVEY 6�S;Se`lt� / ' j h1 ��mg SEPTE BER30,5, 2013 ADD PROP. GAZEBO 2013 REVISEDS PER MARCH 14, 2014 REVISE PROPAGAZEBOSLOCAOTION AREA = 63,651.06 sq. ft. (TO TIE LINE) 1.461 ac. NOTES: 1. ELEVATIONS ARE REFERENCED TO FIVE EASTERN TOWN TOPOGRAPHICAL MAP EXISTING ELEVATIONS ARE SHOWN THUS: 35.5 EXISTING CONTOUR LINES ARE SHOWN THUS:------- 35 -------- f �� SEsrnc PROPOSED CONTOUR LINES ARE SHOWN THUS: 35 TANK 22 /-,"—CESSPOOL 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO068 H ZONE AE: BASE FLOOD ELEVATIONS DETERMINED i A / ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); BASE FLOOD ELEVATIONS DETERMINED ZONE X: AREAS DETERMINED TO BE OUTSIDE 500—YEAR FLOODPLAIN. z \ `� RICHARDAULETTA 3. COASTAL EROSION HAZARD LINE SCALED FROM COASTAL EROSION HAZARD gVERGROWN ec WOODED & IRENE AULETTA AREA MAP PHOTO No. 47-651-83 SHEET 18 OF 49 PWELLING) 4. WETLANDS IF ANY ARE NOT SHOWN. -- --' / 5. MINIMUM SEPTIC TANK CAPACITIES FOR 5 BEDROOM HOUSE IS 1,500 GALLONS. 1 TANK; 8' DIA. 5' LIQUID DEPTH 6. MINIMUM LEACHING SYSTEM FOR 5 BEDROOM HOUSE IS 400 sq ft SIDEWALL AREA. 3 POOL; 6' DEEP, 8' dia. ' Q0 � PROPOSED EXPANSION POOL FOUND o ` EyE GOAD) PROPOSED LEACHING POOL PIPE , AQ(BPRIS ,� E ROAD) � ° PROPOSED SEPTIC TANK 12 9n9r 30.5 D�N99 3 DW PROPOSED DRYWELL r y✓� X 82�13 0 o��m 0 PROPOSED POOL EQUIPMENT I/ X , �o l�'sol 7, THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD X'°; ►/ ' w'� oNEj OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. ,o / LA 1 °�� 8. LATH SET AS SHOWN: • h��/ y /' ► ��' o �/�r 9. ANY PONDING OF WATER IS NOT SHOWN. of ogti y o�� AS m0p, 161' rn A0 Z / AP7 /' m j rn fV �i .5 // �O z7o E F � ;-4 �� TEST HOLE DATA mpF.l� ;, �' y (TEST HOLE DUG BY MIcDONALD GEOSCIENCE ON NOVEMBER 12, 2004) o o' BROWN SILTY SAND SM DW 2 5, s DRI •.�I► 40 0/ a :.. HO BROWN CLAYEY SAND WITH SC i 158' GRAVEL IN LAYERS Uy w!DW A ::::::'::':i':•: •..:.•:.•:•. POS z z �O (70 /moi 7. S k4 30' —' WATER IN BROWN CLAYEY SAND SC OD — —— — X+ WITH GRAVEL IN LAYERS 30 41' MI S5 ——— ——————— — \ WATER IN PALE BROWN SW R. CO400 40A9� FINE TO COURSE SAND m ^ �; 40i� � g1G 111Q pp1 47' op o e Ln � Z p 0 v �/ 45 rn Cn f ti ro w Z pT ,�Gl ,yo JDs 4-010' 0 tip z c /' p0 ASO L �F.�vp�R `1P06 c�`S 19-t 104- 0 gwti Z o �/ 50.7 � 5$ `��Qoo of o���� BOULDERO X 0Ol�OG �O. 0 PREPARED IN ACCORDANCE WITH THE MINIMUM WELL STANDARDS FOR TIRE SURVEYS AS ESTABLISHED H' BY THE LIA.LS. AND-APPROVED AND ADOPTED FOR SUCH USE-15Y THE NEW-YORK STATE LAND TITLE ASSOCIATION.Of- pjC-j. �� 25' WIDE RICHT OF WAY CO Ce tu N.Y.S. Lic. No. 50467 co UNAUTH R ZED h7 p TO SECTION 7209 ALTERATION OR AOF DDITION Nathan Taft Corrin I i i SECTION 720SURVEY TSTA NEW VIOLATION STATE ■ O EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING LSINKED THE LAND SEAL OR Land Surveyor EMBOSSED SEAL NOTBE CONSIDERED TO BE A VAUD TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY Successor To: Stanley J. Isaksen, Jr. L.S. IS PREPARED, AND ON HIS BEHALF TO THE Joseph A. Ingegno L.S. TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND Title Surveys — Subdivisions — Site Plans — Construction Layout M /� T T TO THE ASSIGNEES OF THE LENDING INSTI- 11•j•,�vMION. CERTIFICATIONS ARE NOT TRANSFERABLE. pAD PHONE (631)727-2090 Fax (631)727-1727 (NYS Rte. 25) THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 24-340C SURVEY OF PROPERTY4 SIT UA TED A T �0 ORIENT ,hy TOWN OF SOUTHOLD �yA . a 'SID SUFFOLK COUNTY, NEW YORK -1lll� o ��o�xo S.:C. TAX No. 1000- 17-02- 1 . 11 Qo�1 SCALE 1 " 0 z. +N m S v� cqb °�G '' , � °P OCTOBER 12, 2004 NOVEMBER 11, 2004 ADDED PROPOSED SITE PLAN MARCH 7, 2013 UPDATE SURVEY MARCH 15, 2013 ADD PROP. GAZEBO 6'S m SEPTEMBER 30, 2013 REVISED AS PER S.C.D.O.H.S. .�h��, %o MARCH 14, 2014 REVISE PROP. GAZEBO LOCATION AREA = -63,651.06 sq. ft. (TO TIE UNE) 1 .461 ac. NOTES: 1. ELEVATIONS ARE REFERENCED TO FIVE EASTERN TOWN TOPOGRAPHICAL MAP vA', ,/ EXISTING ELEVATIONS ARE SHOWN THUS: 35.5 _ EXISTING CONTOUR LINES ARE SHOWN THUS:------- 35 -------- ��� PROPOSED CONTOUR LINES ARE SHOWN THUS: 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO068 H ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); BASE FLOOD ELEVATIONS DETERMINED _ ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN. N/OBD AF IULETTA 3. COASTAL EROSION HAZARD LINE SCALED FROM COASTAL EROSION HAZARD 6LVERGROWN & WOODED - �- c NE AULETTA AREA MAP PHOTO No. 47-651-83 SHEET 18 OF 49 (pWELIJNG) 4. WETLANDS IF ANY ARE NOT SHOWN. 5. MINIMUM SEPTIC TANK CAPACITIES FOR 5 BEDROOM HOUSE IS 1,500 GALLONS. 1 TANK; 8' DIA. 5' LIQUID DEPTH 6. MINIMUM LEACHING SYSTEM FOR 5 BEDROOM HOUSE IS 400 sq ft SIDEWALL Al op (VACANT) 3 POOL; 6' DEEP, 8' dia. PROPOSED EXPANSION POOL / FOUND` oEye ROAD) ® PROPOSED LEACHING POOL vp PIPE / / (BIRDS ATE ROAD) �° PROPOSED SEPTIC TANK TSO ' S 1 W 3 5�� E � N PIPE 30 99.3 , ow PROPOSED DRYWELL -- -- - - --9 w � - - -- i d ,. N 82-139 0 E _ 5'' C°mm Q PROPOSED POOL EQUIPMENT 10.4 �/' + // �t,�,ol 7. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. '�+o z / �►' �' p�F' 8. LATH SET AS SHOWN: • o ,/5 9. ANY PONDING OF WATER IS NOT SHOWN. i dkl MAR 1 8 2014 i rei lord of Ti Nunemaker, Amanda From: Nunemaker, Amanda Sent: Tuesday,April 01, 2014 1:44 PM To: brute@suffolkenvironmental.com Subject: Josephson Bruce, Regarding the application for John Josephson at the Terminus of Birdseye Road in Orient,we have been advised that the Trustees cannot potentially issue a permit for an accessory structure (proposed gazebo) on a vacant parcel,as per Zoning Code. Once you have received a building permit for the proposed dwelling on the lot,you can then apply for the gazebo with our office. We will hold the application aside until you are ready to move forward with it. In addition,the Bldg. Dept. briefly mentioned that the proposed location of the gazebo will be in a flood zone that will require the structure to be raised. If you have any questions, please contact me or the Building Dept. Thank you. -An,ianda 'Nunemaker Town of SouthoCd Board of 2"rustees Phone: 631-765-1892 Fax: 631-765-6641 i r Sltholk Envimmm"efital Consufltk,rg9 Inco Newman Village, Suite E,2322 Main Street,P.O.Box 2003,Bridgehampton,New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson,M.S.,President October 22, 2013 OCT 2 4 2013 Demon Rallis- Plans Examiner Southold Building Department 5o,TI E5Iu'ioV,ii" P.O. Box 1179 Board f Trustees Southold, NY, 1197.1 Re: JOSEPHSON Property Situate: Western Side/Terminus of Birdseye Road, Orie SCTM#. 1000 - 017 - 02 - 01.11 Dear Mr. Rallis, As you may recall, a Building Permit Application was filed with j August 15, 2013. You responded by issuing a Notice of Non-Conforma (copy enclosed). You point out in your Notice that the required setback from the front lot lines 55 feet for this lot. Enclosed herewith please find a survey prepared by Nathan Taft Corwin last revised September 30, 2.013 which features a single family dwelling with-detached pool both sited 55-feet from the front lot lines thereby removing the zoning non-conformance. By way of this correspondence, I request that your correspond with this office copying the Southold Trustees confirining that the proposed}project as now.amended would comply with the Town's Zoning Code. Accordingly, the applicant would proceed with obtaining a permit from the Southold Trustees. Thank you in advance for your anticipated cooperation. �Mccrely -� Pruce A.Anderson CC. J.Josephson Southold Trustees (survey enclosed) Sufi<�ll{ Em�ir<>i1i11ental Cvnsultiil�;, Inc. Property Ncscman Villapc,Suite I?,232`1 Maio SUcri I'.(}.I3os`1003.I3ridgcli�uuptou, 1', 193` of 1':(G31);i37-51GO F:(63O;i3%-529( C F N7 D SUN*cct Property P s � a _ t n T. Josephson Property Situate: 3190 North Sea Drive,Orient,NY SCTM#: 1000 - 17 - 02 - 01.11 3D� D EEC 1 0 `'v"' i �T '+ r` .k.... �+ *'^ .� •� �� 1y r.�<� gyp(: �, t F, 's Photograph showing the placement of the proposed Gazebo on the shoreline of the subject property. Photograph taken from just east of the proposed Gazebo, facing west. StIIlc�lk I�:II�'Irc�nlYlelltal C011slIlllllr;, Ills. Josephson Pop. rty \c�cu�.m�illage,5uitc 1•:.3ri`>2 Main Slree� 1'.O. 13os`LOOS,13rid;cllamptcul,A1', 11413 1 NorthOrient, P:(Ei311:iii-ilG(1 P:(fRI1.i3! i`�S)1 111 1 01.11 E [D E C 1 0 f Photograph showing the placement of the proposed Gazebo on the shoreline of the f rr f subject • • • - Josephson Property Situate: 3190 North Sea Drive, Orient,NY SCTM#: 1000 - 17 -02 -01.11 DEQ DEC 1 0 tin •, t i y ! h k eh i, v`1Nf sa M rr� 7 Photograph showing the placement of the proposed Gazebo on the shoreline of the subject property. Photograph taken from just north of the proposed Gazebo, facing south. n nae N MLAW ! , ,1 O eb �+ as 3 O t'. IL 10 X10 1 + / AO ♦ w � tiµcl Ry y a t +' w , LA LL LL V: .. /• e B.r+ to 114 � 1 e i rM� COUNTY OF SUFFOLK © x +ouTNo,n sEcrxmNo c��r✓ —�— Iz,l ,. 0 --•-- --•-- Re6l Property Tex Service Agency a w... .Nvn+n M 17 Uraw` a ^N�z��Ve.syn •� --r-- r��—wr-- P P txicrra 1M+ PROPERTY MAP 41 Office Use Only Coastal Erosion Permit Application etland Permit Application Administrative Permit Amendment/Transfe• xt nsion Received Application: 328 4 Received Fee:$ SD Completed Application: Incomplete: (''_ SEQRA Classification: Type I Type 11 Unlisted_ 1 �� Coordination(date sent) ) MAR 2 8 2014 --i LWRP Consistency Asses men Form: 114 f Date of Inspection: -+s;, - •;�� ti0lla.t G 4dw:7 Receipt of CAC Report: 3 oar ' ?fie gs Lead Agency Determination ,zTechnical Review: L Public Hearing Held:—T/-,9-3 Resolution: Name of Applicant John Josephson Address West Side/Terminus of Birdseye Road, Orient,NY, 11957 Phone Number: (631) 537-5160 Suffolk County Tax Map Number: 1000— 17—02— 1.11 Property Location: West side/Terminus of Birdseye Road (provide LILCO Pole#, distance to cross streets, and location) AGENT: Bruce A. Anderson a Suffolk Environmental Consulting,Inc. (If applicable) Address: P.O.Box 2003;Bridgehampton,NY 11932 Phone:-(631)537—5160 r� p LLI C,�C S onAr -1D -3 12Th i rti Board of Trustees Application GENERAL DATA Land Area(in square feet): 63,651 square feet± E M c' V E Area Zoning: R-40 AR 2 8 2014 Previous use of property: Residential A J Intended use of property: Residential rd"' Covenants and Restrictions: Yes X No If"Yes",please provide a copy. Does this project require-a variance from the Zoning Board of Appeals Yes X No If"Yes",'please-provide copy-of-deeision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes X No Prior permits/approvals for site improvements: Agency Date N/A No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): The Applicant proposes to construct a 14' x 14' Gazebo on the property,located 105 feet from the high water mark at its closest point. The applicant is also proposing the construction of further improvements on the property, but those improvements are over Soo' from the high water mark. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed activity: The Applicant proposes to construct a 14' x 14' Gazebo on the property, located 105 feet from the high water mark at its closest point. The applicant 'is also proposing the construction of further improvements on the property, but those improvements are over 300' from the high water mark. Area of wetlands on-lot: -0.0 square feet REUEIVE 4 Percent coverage of lot:' 0.0 % MAR 2 8 2014 Closest distance between nearest existing structures and upland edge of wetlands: N/A feet (vacant parcel) Board 'rr:�r. �... Closest distance between nearest proposed structures and upland edge of wetlands: 105' t Does the project involve excavation or filling? XX No Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) 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 impact to the surrounding environment is anticipated because there are several neighboring_properties that,have existing Gazebos on them. These gazebos have been in place for mM years, and no environmental damage has been documented. 61 Z20 Appendix B Short Environmental Assessment Form R Instructions for Completing Pc Part 1-Project Information. The applicant or project sponsor is responsible for the comof p�' 1., p�o�ises become part of the application for approval or funding,are subject to public review,and may b t tothefvMffdi#1�n. Complete Part 1 based on information currently available. If additional research or investigati n wo d be needed to fully respond to any item,please answer as thoroughly as possible based on current information. -,: -- - oo Boartl'i ru Complete all items in Part 1. You may also provide any additional information which you believe will be nee a ��r awful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: Josephson Project Project Location(describe,and attach a location map): west side of terminus of Bird;'s Eye Road,Orient,NY 11957 Brief Description of Proposed Action: Applicant proposes to construct a 14'x 14'gazebo on the property located 105 feet from the mean high watermark Additional improvements proposed outside of the jurisdiction of the Southold Trustees are proposed. Name of Applicant or Sponsor: Telephone: 631-537-5160 Bruce A.Anderson-Suffolk Environmental Consulting,Inc. E-Mail: bruce@suffolkenvironental.com Address: P.O.Box 2003 City/PO: State: Zip Code: Bndgehampton NY 11932 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ ❑ 3.a.Total acreage of the site of the proposed action? 1.461 acres b.Total acreage to be physically disturbed? <0.1 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1.461 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban []Rural(non-agriculture) ❑Industrial [-]Commercial ❑Residential(suburban) ❑Forest ❑Agriculture ®Aquatic El Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑✓ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑✓ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 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? ❑✓ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 171 ❑ 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. Id�tify the typical h�a itat types that occur on,or are likely to be found on the project site. Check all that apply: M Shoreline Lf Forest ❑Agricultural/grasslands El Early mid-successional ❑ Wetland ❑Urban r_1 Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO I 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 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, E]a.Will storm water discharges flow to adjacent properties? E]NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: Z ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: Z ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applican o sor e: r e A.Anderson-Suffolk Environmental Consulting,Inc. Date: 3-21-14 Signa Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El 1:1regulations? 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 ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El El existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: El Lia.public/private water supplies? b.public/private wastewater treatment utilities? ❑ 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, ❑ , F]waterbodies,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 1:1 Liproblems? 11. Will the proposed action create a hazard to environmental resources or human health? 1:1 El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date 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 :nD ECE EOV Town of Southoi �� - MAR 2 8 2014 a z Erosion, Sedimentation & Storm-Water Firm-off AS E SMENT FOtM PROPERTY LOCATION: s.c.T.M.a: THE FOLLOWING ACTIONS MAY REQUIR THE 'OF Q'��� of 1000- 17 - 02 - 1.11 STORM-WATER,GRADING,DRAINAGE AND ROSION CO P N s net ee on — oe c— 1'T— CERTIFIED BY A DESIGN PROFESSIONAL IN SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENTYes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within 1.461 acres Will this Project Retain All Storm-Water Run-Off Gene the Scope of Work for Proposed Construction) rated by a Two(2")Inch Rainfall on Site? • (S.F.r Acres) (This item will include all run-off created by site X b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all — and/or Ground Disturbancefor the proposed <0.1 acre. Site Improvements and the permanent creation of construction activity? (s F.r Acres) Impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT' DESCRIPTION (ProvMo Add lona/Paaa Nod d) Drainage Structures Indicating Size&Location?This X Item shall include all Proposed Grade Changes and The Applicant Proposes to construct a 14' x 14' Slopes Controlling Surface Water Flow. Gazebo on the property, located 105 feet from 3 Does the Site Plan and/or Survey describe the erosion ` the high water mark at its closest point. The and sediment control practices that will be,used to X applicant is also proposing the construction of control site erosion and storm water discharges. This item must be maintained throughout the Entire further improvements on the property, but those Construction Period. improvements are over 300' from the high water 4 Will this Project Require any Land Filling,Grading or mark. Excavation where there is a change to the Natural ® X Existing Grade Involving more than 200 Cubic Yards — of Material within any Parcel? Cj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand X (5,000 S.F.)Square Feet of Ground Surface? — 6 Is there a Natural Water Course Running through the Site? Is this Projeci within the Trustees jurisdiction X General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving sell Beach? disturbances of one(1)or more acres; including disturbances of less than one acro that 7 Will there be Site preparation On Existing Grade Slopes are part of a larger commas plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to 1:1 X including Construction activities Involving sol disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit Is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off X 1.The SWPPP shall be prepared prior to the submittal of the NOI.The Not shall be Into and/or In the direction of a Town right-of-way? — submIlled to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post•construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ® X consbucted to reduce the pollutants In storm water discharges and to assuro Item Within the Town Right-of-Way or Road Shoulder eomp[iance with the terns and conditions of this Permit.In addition;the SWPPP shall Area?(Ttds Item will NOT Include the Insta0a0on of Driveway aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice, in a Box and the construction site disturbance is between 5,000 S.F.&1'Acro In arca, component shall be prepared by a qualified Design Professional Licensed in Now York a Storm-Water.Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable In the principles and practices of Storm Water Management: Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check flock(4)endlo(Answer for path Quest;on is Required for a Con*cto Apprcat;on) S1ATE'OF NEW YORK, SUFFOLK COUNTY OF...........................................SS BRUCE A.ANDERSON @ SUFFOLK That I, ,,,,,,,ENVIRONMENTAL CONSULTING.INC. being duly s++ern, e ••••• deposes and says that lic/she is the applicant for Permit, (Mame of indrviduai s(gnlrscl Oowment) , AGENT Andthat lie/she is the ..............................................:.......................... (Uvner,Contraclor,AgcnL Corporate Oifcer,etc),,,,••,,,,•,•-•••••••••,.••,..•• Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in dhis.application are true to the best of his knowledge and belief;arid that die work will be performed in the mann r set forth in die application filed her S++om to before me this; <...:�.......................... ay of..... ... -G'":..... ......... Nota Public: Matthew D. Ivans Notary �}otar•�r••Pt,tsh�of Ns;;�•Xork....... .... ....... .............. ... ............. No OlIV6053859 Si atureofAppkop l) FORM - 06/10 Quailtied in SuIT01K Counly Commission Expires January 22, 20/s Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) John Josephson 711 5th Avenue D E CE �� E I, residing at ---=-•..---._- ._ (print owner of property) (mailing address) MAR 2 8 2014 New York, IVY, 10022 do hereby authorize (Agent) Suffolk Environmental Consulting, Inc. to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Ow' igri'ature) Board of Trustees Application ��2 8 li 14,I V V �a 2014 County of Suffolk MAR State of New York Bruce A.Anderson (Agent) BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN, THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMELESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY BIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) -OR REPRESENTATIVES, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF ,20 y otary Public Matthew D (vans- Nc"l Notary Public of New York No. 0111/6053859 Janualy `12, 20 Qualified in Suffolk County ,,miSS+on Ex',• Commission Expires January 22, 20� J , Town of Southold A 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",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus,the action should be analyzed in more detail and, if necessary,modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 (southoldtown.northfork.net),the Board of Trustees Office,the Plann' e libraries and the Town Clerk's office, B. DESCRIPTION OF SITE AND PROPOSED ACTION 2872014 SCTM# 15 - 01 - 05 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ 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: The Applicant proposes to construct a 14' x 14' Gazebo on the property, located 105 feet from the high water mark at its closest point. The applicant is also proposing the construction of further improvements on the property, but those improvements are over 300' from the high water mark. Attach additional sheets if necessary 1 Location of action: West Side/Terminus of Birds Eve Road,Orient,NY Site acreage: 1.461_acres t___ ._ Present land use: Vacant Present zoning classification: R-40 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: John Josephson (b) Mailing address: 7115th Avenue,New York,NY,10022 (c) Telephone number:Area Code(631)537-5160 (d) Application number, if any: N/A Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes❑ No® If yes,which state or federal agency? 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 ❑ Not Applicable As indicated within Policy 1 "Development that does not reinforce the traditional land use ioattern of the Town of Southold would result in a loss of the community and landscape character of Southold.". this proposal is to construct a 14'x 14' gazebo along the shoreline of the above referenced property so as to facilitate the enioyment of the waterfront. Several properties in the neighborhood have similar appurtenances and therefore this makes beneficial use of the coastal location, while minimizing 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 ❑ No ® Not Applicable Policy 2 is not applicable in that subject lot and the surrounding neighborhood cannot be deemed a substantial historic and/or archaeological resources. Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 5 through 7 for evaluation criteria Z Yes ❑ No ❑ Not Applicable Subject proposal will not adversely impact the visual quality of the surrounding area in that several neighboring properties have gazebos on them. Therefore no detriment will be done to the Quality of the scenic resources in the area. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life,structures,and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ® Not Applicable As the proposal is for a 14' x 14' gazebo any loss of life structures and natural resources from flooding and erosion is kept to a minimal. 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 ® Not Applicable Subject proposal is not applicable to Policy 5. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife-Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 6 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 Subject proposal is not applicable to Policy 7. 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 Z Not Applicable Subject proposal is not applicable to Policy 8. Attach additional sheets if necessary 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 ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 9. Attach additional sheets if necessary WORIGNG COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependence uses in suitable locations. See LWRP Section III—Policies;Pages 47 through 56 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 10. Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound,the Peconic Estuary and Town Waters. See LWRP Section III—Policies;Pages 57 through 62 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 11. Attach additional sheets ifnecessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies;Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable in that the proposal does not involve agricultural lands (i.e. the conversion of farmland, the establishment and/or maintenance of new coastal agricultural production, etc. .J 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 ® Not Applicable Subject proposal is not applicable in that the proposal does not involve the conservation of energy resources on a commercial level and/or the promotion of altemative energy sources.proper maintenance of fuel storage facilities and/or the extraction of mineral extraction Attach additional sheets if necessary Created ron 5/25/05 JL-20 AM r Suf ,.: Suft�ilk Environmental ConsultLk ;Inc. Newman Village,Suite E,2322 Main Street,P.O.Box 2003,Bridgeha ,New;, oz ;17 (631) 537-5160 Fax: 7=5291 Bruce Anderson,M.S.,President MAR 1 8 2014 Hand Delivered eo Tru e March 17, 2014 John Bredemeyer, President Southold Town Trustees P. O. Box 1179 Southold, NY 11971 Re: JOSEPHSON Property Situate: Western Side/Terminus of Birdseye Road, Orient, NY -SCTM#: 1.000 —017 — 02 — 01.11 Dear Mr. Bredemeyer, Asyoumay know,your agency had instructed us to cause the relocation of the proposed gazebo out of the Coastal Erosion Hazard Area because the gazebo is a roofed structure. We were also advised that the remaining aspects of the _project are outside of your jurisdiction. Attached here with please find two copies of the property survey prepared by Nathan Taft Corwin III last dated March 14, 2014 that reflect the requested change of location for the proposed gazebo. By way of this correspondence, I request that you board issue a wetland permit for the proposed gazebo and a letter of non jurisdiction for the remaining upland improvements. Thank_you in advance for-your anticipated cooperation. Yours trulu. -Bruce-A:Anderson Cc. J. Josephson Office Use Only _ Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Ext nsion Received Application: 12-11 b Received Fee:$ Completed Application: 2 D 10 C Incomplete: r[D m!� �f `r SEQRA Classification: Type I Type H Unlisted_ Coordination(date sent) EC1 0 2013 LWRP Consistency As ess ent Form: Date of Inspection: s ,3 E�tReceiptof CAC Report:- epor : Lead Agency Determination ar ' '°J�•�:=' _� Technical Review: _Public Hearing Held: 112-21 L3 Resolution: Name of Applicant John Josephson Address West Side/Terminus of Birdseye Road, Orient, NY, 11957 Phone Number: (631) 537-5160 Suffolk County Tax Map Number: 1000- 17-02-1.11 Property Location: West side/Terminus of Birdseye R- I (provide LILCO Pole#, distance to cross streets, and to C �� ����SCt'(.t K-� no p AGENT: James F. Laird na Suffolk Environmental Q `Caj Ld t n CG(+A (If applicable) nb� Cn5i'&re I a-n bpe-0 Jck Address: P.O. Box 2003; Bridgehampton, NY 11932 ✓ ^I S�\ I ��i`} �s d -I� Phone: 631)537 04 C Board of Trustees Applicatioix GENERAL DATA Land Area (in square feet): 63,651 square feet± Area Zoning: R - 40 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions: Yes X No If "Yes", please provide a copy. Does this project require a variance from the Zoning Board of Appeals Yes X 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 X No Prior permits/approvals for site improvements: Agency Date N/A No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): The Applicant proposes to construct a 14' x 14' Gazebo on the property, located 63 feet from the high water mark at its closest point. The applicant is also proposing the construction of further improvements on the property, but those improvements are over 300' from the high water mark. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed activity: The Applicant proposes to construct a 14' x 14' Gazebo on the property, located 63 feet from the high water mark at its closest point. The applicant is also proposing the construction of further improvements on the property, but those improvements are over 300' from the high water mark. Area of wetlands on lot: 0.0 square feet Percent coverage of lot: 0.0 % Closest distance between nearest existing structures and upland edge of wetlands: N/A feet (vacantparcel) Closest distance between nearest proposed structures and upland edge of wetlands: 63' ± Does the project involve excavation or filling? XX No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) 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 impact to the surrounding environment is anticipated because there are several neighboring properties that have existing Gazebos on them. These gazebos have been in place for many years, and no environmental damage has been documented. 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or 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: Josephson Project Project Location(describe,and attach a location map): Right Side/Terminus of Birds Eye Road,Orient,NY, 11957 Brief Description of Proposed Action: The Applicant proposes to construct a 14'x 14'Gazebo on the property,located 63 feet from the high water mark at its closest point The applicant is also proposing the construction of further improvements on the property,but those improvements are over 300'from the high water mark Name of Applicant or Sponsor: Telephone: (631)537-5160 James F Laird-Suffolk Environmental Consulting, Inc. E-Mail: James F.Laird@gmad com Address: P O Box 2003 City/PO: State: Zip Code: Bridgehampton NY 11932 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 ❑1 F 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: NYSDEC 3.a.Total acreage of the site of the proposed action? 1.461 acres b.Total acreage to be physically disturbed? <.1 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1 461 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) [-]Industrial ❑Commercial m Residential(suburban) El Forest ❑Agriculture ®Aquatic El Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑✓ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑✓ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ❑✓ 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? ❑✓ F-1- c. 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: Proposal is for a Gazebo that will not utilize electricity FY71 ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: F71 ❑ Proposal is for a Gazebo,and therefore does not require potable water access 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: � F-1Proposal is for a Gazebo,and therefore does not require 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 I YES wetlands or other waterbodies regulated by a federal,state or local agency? D b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? Fv_(] ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: m Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban m Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 0 ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ONO DYES ❑✓ ❑ 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 incluacconstruction or other activities that result in tho 111t,oundment 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: Fv—/] ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? _ If Yes,describe: Z ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor n e: James oq F Laird-Suffolk Environmental Consulting,Inc Date: 12,10113 Signature: V OL Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ 11regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? F1 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 ❑ ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: D a.public/private water supplies? 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, ❑ El waterbodies,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 1:1 ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. 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. Name of Lead Agency Date 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 Town' of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM o PROPERTY LOCATION: S.C.T,M.A: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A �1p1 1000- 17 - 02 - 1.11 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s-61 0-cre$e tie on `Block Tot'— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT 7TYes No a. What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm-Water Run-Off (Include Total Aiea of all Parcels located within 1.461 acres Generated by a Two(21)Inch Rainfall on Site? the Scope of Work for Proposed Construction) (S.F.r Area) (Phis item will include all run off created by site )( b. What Is the Total Area of Land Clearing clearing and/or construction activities as well as all — El andfor Ground Disturbance for the proposed <0.1 acre. Site Improvements and the permanent creation of construction activity? (S.F.f Acres) Impervious surfaces.) PROVIDE BRIEF PROJECT DESCRIPTION (P-4deAdd;GoeuaPagcsesNow4 2 Dees the Site Plan Indicating Si Show All Proposed Drainage Structures Indicating Size&Location?This )( The Applicant reposes to construct a 14' x 14' , item shall include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. Gazebo on the property, located 63 feet from the 3 Does the Site Plan and/o"r Survey describe the erosion high water mark at its closest point. The and sediment control practices that will be,used to X applicant is also proposing the construction of control site erosion and storm water discharges. This Item must be maintained throughout the Entire further improvements on the property, but those Construction Period. improvements are over 300' from the high water 4 Will this Project Require any Land Filling.Grading or mark. Excavation where there Is a change to the Natural ® XExisting Grade Involving more than 200 Cubic Yards of Material within any Parcel? lj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ® X (5,000 S.F.)Square Feet of Ground Surface? 6 is there a Natural Water Course Running through the Site? is this Project within the Trustees jurisdiction 0General DEC SWPPP Requirements: or within One Hundred(100')feet of a Welland or — Submission of a SWPPP is required for ail Construction activitios involving sea Beach? disturbances of one(1)or more acres; Including disturbances of toss than one acro that 7 Will there be Site preparation on Existing Grade Slopes aro part of o larger common plan that will ultimately disturb one orm ore arms of land; which Exceed Fifteen(15)feet of Vertical Rise to ® X including Construction activities involving soil disturbances of toss than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that n SPOES permit is required for storm water discharges. (SWPPP's Shari meet the Minimum Requirements of the SPDES Genial Permit 8 Will Driveways,Parting Areas or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off X 1.The SWPPP shall be propamd prior to the submittal of the NOi.The Not shag be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commoncoment of construction activity. 2.The SWPPP shag describe,the orostori and sediment control praciices and where 9 Will this Project Require the Placement of Material, required,post-constructlor"storm water management practices that will be used andlor Removal of Vegetation and/or the Construction of any ® X constructed to reduce the polutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of calls pemsiL In addition,tho SWPPP shag Alga?(fila ttom vda NOT Include the rmtanauon or Ddvcway'A irons.) Identify polonlM sources of poauthn which may reasonably be expected to affect the quality of stormy water discharges. NOTE: If Any Answer to questions Ono through Nino Is Answered with a Check Mark 3.Ali SWPPPs that require the post-construction storm water management practice in a Box and the construction alto disturbance Is between 5,000 S.F.31 Acre In area, component shag be prepaiod by a qualified Design Professional Uconsed In Now York a Storm-Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of that Is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE A Check Mack(4)endfar Answer for gsdh Weston is Repaired for a Commpreta Application) STATE OFNEW YORK, SUFFOLK COUNTY OF...........................................SS BRUCE A.ANDERSON @ SUFFOLK That I, ENVIRONMENTAL CONSULTING. INC. being drily swam,deposes and says that he/she is the applicant for Permit, ...... .... ...... ....... (Nara+,of individual signlxi Documonl) , AGENT Andthat he/she is the .....................................................................:....:......................................................................................... . (O,smer,Confrador,Agent,Corporate Oft,ter,oto.) Owner and/or representative of die Owner or Owners,and is duly authorized to perforin or have performed die said work and to make and file this application;that all statements contained in this.appficadon are true to the best of his knowledge and belief;and that die work will be performed in the manner set forth in the application filed her Sworn to before me flus; Df-00.00 ......... o�................ d�yof...., ...... ,20.13Notary Public: ...... - �`f-� _ Matthew D, Ivens a6.. TV V12 �fubtrc,of•N,ew Yor I 1/" r` r. (Signatu FORM - 06/1 Qualified in Suffolk County Commission Expires January 22, 20/ Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) l� John Josephson residing at 711 5th Avenue (print owner of property) (mailing address) New York, NY, 10022 do hereby authorize (Agent) Suffolk Environmental Consulting, Inc. to apply for permit(s) from the Southold Board of Town Trustees on my behalf. :,(Qw ignature) Board of Trustees Application County of Suffolk State of New York John Josephson BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN 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(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ",Signature SWORN TO BEFORE ME THIS J DAY OF-1' ,20 Notary Public TERENCE C.McCART NOTARY PUBLIC,State of New York No.01 MC4767198 bualified in New York County Commission Expires Sept.30,2014 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", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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: onlin w of Southold's website (southoldtown.northfork.net),the Board of Trustees Office,then#Eg 1& m8n4, I[FeOc libraries and the Town Clerk's office. --`--` - - B. DESCRIPTION OF SITE AND PROPOSED ACTION DEC 10 2013 { SCTM# 17 - 02 - 1.11 -- - - Board '�, The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ 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: The Applicant proposes to construct a 14' x 14' Gazebo on the property, located 63 feet from the high water mark at its closest point. The applicant is also proposing the construction of further improvements on the property, but those improvements are over 300' from the high water mark. Attach additional sheets if necessary Location of action: West Side/Terminus of Birds Eve Road,Orient,NY I Site acreage: 1.461 acres± I Present land use: Vacant Present zoning classification: R-40 I 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: John Josephson I (b) Mailing address: 7115`h Avenue,New York,NY, 10022 I • I (c) Telephone number: Area Code(631)537-5160 (d) Application number,if any: N/A Will the action be directly undertaken, require funding, or approval by a state or federal'Iagency? Yes ❑ No® If yes,which state or federal agency? I DEVELOPED COAST POLICY i I 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. I ® Yes ❑ No ❑ Not Applicable As indicated within Policy 1, "Development that does not reinforce the traditional land use pattern of the Town of Southold would result in a loss of the community and landscape character of Southold.", this proposal is to construct a 14'x 14' gazebo along the shoreline of the above referenced property so as to facilitate the enjoyment of the waterfront. Several properties in the neighborhood have! similar appurtenances, and therefore this makes beneficial use of the coastal location, while minimizing 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 ❑ No ® NotApplicable Policy 2 is not applicable in that subject lot and the surrounding neighborhood cannot be deemed a substantial historic and/or archaeological resources. Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 5 through 7 for evaluation criteria- ® Yes ❑ No ❑ Not Applicable Subject proposal will not adversely impact the visual quality of the surrounding area in that several neighboring properties have gazebos on them. Therefore, no detriment will be done to the quality of the scenic resources in the area. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures,and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ® Not Applicable As the proposal is for a 14' x 14' gazebo, any loss of life, structures, and natural resources from flooding and erosion is kept to a minimal. 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 ® Not Applicable Subject proposal is not applicable to Policy 5. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 6. 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 Subject proposal is not applicable to Policy 7. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 8. Attach additional sheets if necessary 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 ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 9. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependence uses in suitable locations. See LWRP Section III 7 Policies;Pages 47 through 56 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 10. Attach additional sheets if necessary t Policy 11. Promote sustainable use of living marine resources in Long Island Sound,the Peconic Estuary and Town Waters. See LWRP Section III—Policies;Pages 57 through 62 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to Policy 11. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies;Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable in that the proposal does not involve agricultural lands(i.e. the conversion of farmland, the establishment and/or maintenance of new coastal agricultural production, etc...) 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 ® Not Applicable Subject proposal is not applicable in that the proposal does not involve the conservation of energy resources on a commercial level and/or the promotion -of alternative energy sources,proper maintenance of fuel storage facilities and/or the extraction of mineral extraction Attach additional sheets if necessary Created on 5/25/05 11:20 AM I` Suffolk Environmental Consulting, Inc. Newman Village,Suite E,2322 Main Street,P.O. Box 2003,Bridgehampton,New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson,M.S.,President December 10, 2013 E C F Hand Delivered Jim King, Chairman DEC 10 2013 Board of Trustees Southold Town Hall P.O.Box 1179 Board _ Southold, NY, 11971 Re: JOSEPHSON Property Situate: West Side/Terminus of Birds Eye Road, Orient, NY, 11957 SCTM#: 1000 -17 - 02 - 1.11 Dear Mr. King, This Firm represenL- M.r.Joh. J:,�:phson, owner of the above referenced property,who is seeking approval construct a Gazebo along the shoreline of his property. Accordingly I have enclosed four [41 copies of the following: • Southold Town Trustees-Coastal Erosion Permit Application, • Short Envrom-nental Assessment Form for the subject proposal, • LWRP Consistency Assessment Form for the subject property, • Town of Soudiold Erosion, Sedimentation,8;.Stor mvater Runoff Assessment form, • Location Map for the subject property, • Photographs of the subject property, • Survey of the subject property,prepared by Nathan Taft Corwin, last dated September 30, 2013 • A Check made payable to the Town of Southold to cover the requisite application fee. By way of this correspondence, and on behalf of the property owner, I respectfully request for the commencement of review of the attached application, and the subsequent scheduling of this matter bcivre u1G uiai,dva"LoiLc T 0bvii of Sout old Board of Trustees meeting for permit issuance. Should you have any questions regarding this matter,please feel free to contact this office at any time. Thank you in advance for your cooperation. Sincerely, James F. Laird CC. J.Josephson