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Home My WebLink AboutPierce, Jennie L Estate of { i John Bredemeyer, President guFF014' Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King y x P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�'�i , , �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: Alexandra Halsey-Storch, Esq. on behalf of ESTATE OF JENNIE L. PIERCE, c/o PAMELA SCHIDER requests an Administrative Permit for the existing 10.5'x32.9' deck attached to dwelling; and for the existing 10.1'x28.5' shed. Located: 2615 Wells Road, Peconic. SCTM# 86-2-1.2 Type f area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: A'Chapt.275 Chapt. 111 other Typ f Application: 'V Wetland Coastal Erosion Amendment ' dministrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: �v � ✓AATy Modifications: Conditions: ,s1�_ �_ s_�`'� -- ��,M •k 6, -d ►�"ov - I see sL Present Were: J. Bredemeyer M. Domino J. King Sanders D. Bergen Bay Constable \\ Other Form filled out in the field by C- 'Yq1 up_) Mailed/Faxed to: Date: . ;5. 1 . ,. '�'5 �. r.�i �' +yc ; 'fes • ennie L. Pierce Wells Road, Peconic ,,fit'y } �.;� .A•.. 0/10/14 Yiijj' '� - t �y� f - ••a'. .• ,, av Jct Nei* •':qtr.; � w. � , OAV Jp ' ! n u - �'• i- v • •_••+sus -tt s ai:w t 0a 4 VIIIe Opi 10, - H - tr >. i ' x+�► �, , f i Y,A • -♦ I .N �,�..,J�jp�► eir Vi.t '. .'yam` �Z adv'_ "c<- 'li.., JL Pierce : •. -state of Jennie L 2615 Wells Road,Peconic . �I. �• I �, v 1 /14Arl twa IX •a r fir} S ".Wg' °, r � r ,.. rT �. •, * ,� �y' + ' k�, 17 x�... ,its .+ +�,,,-. s `r♦ ti ' • 4 l .. �• - . Ab. 41 r* ,.. �. � a «� .h 4M T a ,t r a a � � rr��f• � + L • 111iii ¢ �e�'- A rR .�,i- 7r� Off!► � �1. �• � 1 .�.b•. �f; y , • •s ,� ._ _ ,.-,may � � _ �' "- '1 _' ELEYA DONS k r'ONIO'JRS ARE REFERENCED rO NAYO'88 SURVEY OF PROPERTY 9 FLOOD ZONE FROW FIRM NAP NUMBER J6103CO162N AT PECONIC 0 p TOWN OF SOUTHOLD R SUFFOLK COUNTY, N.Y. t 1000-86-02-12 SCALA'1'=30' R' JVN£6,2014 A9iE ze,J014 N I E C� IN/o/f'a�crN r u�wwc aLwctac m'.rsr [AUG 2 2014 2 s644fiJD E /' tze.m' \ } Southold Town T and Qf ruML._. z , I tt CI I.1 V FR CAP CM to M, 921 o amaip om f 1' A.>C b GAA 1 I =MEAN LOW ROC iG 681' I I STY NSE + GAR sFF.to 17' i 1- ' t •` ":nolo �' I u Ie 1 \ 1 IS>,r— e•- � 'ZONE A�••-_ \ 1. (EL 6) I� ' , I T 3 I � ZONE x 1 I 1 19&18' A 1 Sg4'5B 80'N' RIgCAME MUST N/0/F JOAN M�i01T .RLRAR _ � e uaArt<eNr ' +mn—Futs YS LIG NO 49618 ANY ALIFRAPOY QP AOplIR1NRY69W4£Y[SA NL4 MYl CWVICS .ORS PG 4TnM r16eo�4/E Nf1Y ILwK sTAIF[w6AnW uR FltA�t ��,�59 s��•. (611)766-5020 FAX(611)766-179/ Exrsrr AS efR SEGRtl1 r209-SUHAN90I 2 ALl OJiMGRW6 P 0.BOX 90- NFacar ARE vAw Fne mrs vAP Afro eo�ts nlwav'w+cr v TO TIE LINE 1270 TRAVELER 51REEr 14-068 o5[9gVAlURE APPEARS Rfw 4AL 62 SdGKiAt SOUTH.,NY 11971 AUG 2 2 2014 Southold TownBoard ._ f jrjpks__ —_..._ Above: North Side of Deck. June 17, 2014, 5 PM Below: East Side of Deck. June 17, 2014, 5 PM u PUMP +� i Dec—Below: North East Corner of 1 e. � 4 • j T At facingAbove: Picture taken facing north of front end of shed. August 18,2014, 1:30 PM. Below: Picture taken shed. August 2014, 1 PM. _ 1 _ S ~' SEE SEC. No ul 31c lo I osLc SEE UNE SEE= ———————— ———— —————- ———————— --———— —E�" -- — -- - .0INo SEE SEC 0 Z�SEC No rON PCL NO 12.89 .1 07—2 —11 SEE SEC No �274i IC 11 0, 11 is V 1.2K0 M N 03 Mi$N 31 wq 01, Mi. 4 3 7 3S IlU 11 2. "OkO 2. -NN O�SOUTMOLD 'Ak) N I.Szo ft-oft CREEK IONK,No N SEE SEC 10 OS}WC1, 2 3 IS avµ IIA .0 1,2 two cr, 4µo 42 SEE Smi C No 2.3 3 ZZZwicNz —— ----z— ———z———— -Tc. z UHL CH WE SECNOW UNE L COUNTY OF SUFFOLK CECTION NO E (21) Re al Prop"Tax SeMce Agency 86 C"" A p PROPERT)rMAP ELEVABONs s CGNIOURS ARE REFERENCED TO Naw as SURVEY OF PROPERTY 9 FLOOD ZONE FROM FIRM MAP NUMBOl J610JC0162N AT PECONIC 0 P TOWN OF SOUTHOLD $ SUFFOLK COUNTY, N.Y. P t IJR 251 1000-86-02-12 (S• moo o z SCALE --3 XNr 82014 2M N I so I M/O/f piEEV l Y[pgR[RLIOL•A6fL•/R!/ST 112&071 lb w D 11 b 1 J AUG 2 2 2014 ALL. $'• Iii I \ - Board of Tru fres comc r ayfo U� 4 \ C" FR OAR � AAr \ q1 R i Onuc��SIE' -` IR b, C MEAN LOW RDE l STY,HSE' I �'I CAR I I I 9FF 1075• i I w \ I (El 0 naR roR or b``tt 1�� Q I \ �y ZONE X 11` I I I Sg{•5050'W N/0/F•pAN M'cw1MT REN•—E MST � +MCNUYOVT ' +ItERAND INGf YS.LIC ND 496I0 AMI ALRIMRw ce ACOIOw TO B95 SJ—a A.—R l FFCONIC .-YOBS R.G o"SECOw 7z9oT TH<MEIY YwI slA]e mvrwnw ur A ��,�FJ9 SQ r• (631)765 5020 FAX(631)765-179/ ENff➢T AS PER SLOW 1709-AIBOIN90V 7 AIL�MTffiG"IBIS pa BOX 909 xwEw ARE VALO fOR R49 Y.W AMO ewes lHt Ea"Ot2Y v 1230 7RA 9WOER STREEt stlo uAR m cwEs rsAR mE>yfRcsscn sEAC n na s'"`E''w TO TIE LINE MI02 9wANRE APPEARS HEREw. 50BRIOLO,NY 11971 14-06 - � V I , r Certificate# 91877 Surrogate's Court of the State of New York Suffolk County File#: 2014-315 Certificate of Appointment of Executor IT IS HEREBY CERTIFIED that Letters fo,ratWEstate�of the Decedent named below have been granted by this Court, and such Letters are unrevOked,'are==valid_and ar `iriJull forceas of this date. Name of Decedent: Jennie?Lee Pierce m, , �, � fA { Date of Death: Nov/embef 22, 2013 Domicile: County"of Suffoi',` a' tz �F.-•�`^•"��7, t�)z�E tis � a S. P'a�,'�''`"�'a Fiduciary Appointed: Pamela Schider'` � = �Y � Eby µ ,R Letters Issued: LETTERS TESTAM'tw RY ro ew , Letters Issued On: i= February 27k2`01s14� yl Limitations: NONE S_ e ,w (�k".?fL�rn"P,-'+x e•".'.,`'X,_•rx..y fa:.'�11 -b .,,� THESE LETTERS, granted pursuant to a,d �ree enteredbythe:=court,`authorize and empower the � tr r above-named fiduciary or fiduciaries to perform all,acts requisite to:the proper administration and disposition of the estate/trust of the Decedent An accordance_with.the decree and theslaws oFNew York State, subject to the limitations and restrictions,ifs"any�as set forth above. 'x °mak 'TMS w,�� '�.z�,•r�� .M_ ��- ,�� ' ,,� U V 'a `< and such Letters are unrevoked and in full force-as-of this�dati :` Dated: May 29, 2014 IN TESTIMONY WHEREOF, the seal of the Suffolk Riverhead, New York County Surrogate's Court has been affixed. WITNESS, Honorable John M Czygier Jr,Judge of the Suffolk County Surrogate's Court. Michael Cipollino, Chief Clerk Suffolk County Surrogate's Court This Certificate is Not Valid Without the Raised Seal of the Suffolk County Surrogate's Courl ELEVATIONS & CONTOURS ARE REFERENCED TO NA VD '88 SURVEY OF PROPERTY FLOOD ZONE FROM FIRM MAA NUMBER 36103CO162H A T P CONIC ® � TOWN OF SO UT.HOLD g° SUFFOLK COUNTY, N. Y. 1000-88--02--1.2 5 R, SCALE.• 1'-30' { JUNE 6, 2014 \ JUNE 28, 2014 1� �1 N N Cj el L� N/O/f EjLEE/V T. McGUIRE REVOCABLE TRUST 141 i S8444'30"E L +y\ 128.07' , ' SET \ 'o L (q 2 1 Ito \ 2 f' Lx t r�� \ 1 �-1 cv ® \� �' I '(oII 1 3 !C \ J i\ Nil 01L e 2 \ \ i - -- x 4F c IN, w 1 op IN, e N� Top of \\ o o1L S TANK Pl. �F��as��u'4 FR GAR- d- AR• U1 CCN / .2 / / I o C 41 UTILITY POLED STONE o STATION /I Q F C STONE SNC F \ vy STATION 1 Ut r01-t4�� \\� �l \I \� 2.6' 2.71 2.9' 3.0' '... GA,I,F D,q4 Nrq� SU�OS qS 0.7' 1.2' 2.7' 3.0' 2.9' 3.2' ® / \6 ti nN�p>°F2F)p \ PILING 2.3' 2.0' 2.5' M y�N o `'''O -— • 8 ' \ \ \\ q za'4 \}r DEtAP. o.s' \ I DOCK ( ® 0.6' 1.0' ERI 1.6' 2.1° 2.0' 2.4' 2.6' 2.6 3.4' 3.6' 4J I 36.2 ' ! t(J I I Ln \ GAR. I II I tv F.F. MEAN LOW TIDE \ ml I ! 61.8' I I I I r- UTILITYno I II + El POLE 0 Z 1 STY. HSE. Q I I ' GAR rT I i \ - / ➢ � � N ,C-) I I I / ' F.F. 10.73' I i 7 cr) ?p ORFS UPROP. IL AUV 2 L L�1 \ TANK01 7.8' )1 I \ \ I u \ 40.2' i 1 57.5 _ II ZONE AE\\_ \ (o ! (EL 6) \ n I IZ rc0 `�\ \ - ZONE UNE- 6 N j x s ZONE X /' 1 M 196.18' S84656'50"W Nip/F JOAN M. CONYT REVOCABLE TRUST = Cl REBAR ct� n ,rl- – MONUMENT = WETLAND FLAGS t ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION L'IG'. N 496 OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. PtCONIC EXCEPT AS PER SECTION 7209–SURDIOSION 2. ALL CERTIFICATIONS �� 109,159 ��. �'. (63 41) 765-5020' X:- 31) 765-179; HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IFP.O. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ]-Q TIE LINE 1230 TRAVELER STREET WHOSE SIGNA TURF APPEARS HEREON. L�—�� SOUTHOLD, N. Y. 11971 ' r `� OFFICE LOCATION: � ®�J�®��® MAILING ADDRESS: Town Hall Annex �® �® P.O.Box 1179 54375 State Route 25 y^ �-�, Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Q Telephone: 631 765-1938 Southold, NY 11971 A�\a® Fax: 631765-3136 com LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: September 10, 2014 Re: Proposed for Administrative Permit ESTATE OF JENNIE L. PIERCE, c/o PAMELA SCHIDER SCTM# 1000-86-2-1.2 Alexandra Halsey-Storch, Esq. on behalf of ESTATE OF JENNIE L. PIERCE, c/o PAMELA SCHIDER requests an Administrative Permit for the existing 10.5'x32.9' deck attached to dwelling; and for the existing 10.1'x28.5' shed. Located: 2615 Wells Road, Peconic. SCTM#86-2-1.2 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 actions are INCONSISTENT with the Policy Standards (Policy 6.3) and therefore are INCONSISTENT with LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 9. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. Permits were not found in Town records for the "as built" structures. In the event that the action is approved, it is recommended that a non-turf, vegetated buffer encompassing the existing vegetation on site be required landward of the wetland line. Due to the build out of the parcel the buffer should be of varying widths and placed on the survey. 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: Lori Hulse, Assistant Town Attorney John M. Bredemeyer III, President ��®F S®(/T�® Town Hall Annex Michael J. Domino,Vice-President ,`O l0 54375 Main Road P.O. Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Charles J.Sanders,Trustee '� ® Y� Telephone(631) 765-1892 l�`,®U ,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEE TOWN OF SOUTHOLD I 7r ,� To: Southold Town Building Department AUG 2 6 2014 Re: Verification of Building Department Permit Requirem nts B[DG DEPT ii TOWN Or SOi)THOLD SCTM#: �- - Property Owner Name: S- -k 6d 7�nni"k_ PICVce._. Date Sent to Bldg. Dept.: { Zc /l 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 I the proposed project require a Building Permit? Will the proposed project requirea yanance determination from t oning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS:, Signature o' eviewer Date i James F.King,President �sorry Town Hall Annex Bob Ghosio,Jr.,Vice-President O� Ol 54 Main Road '` ® P.O..Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer �� Telephone(631)765-1892 Michael J.Domino Q Fax(631)765-6641 COUHlt`1,�1 BOARD OF TOWN TRUSTEES I TOWN OF SOUTHOLD ' i i Office Use Only i Coastal Erosion Permit Applicatiotl/ _Wetland Permit Application ��d Administrative Permit -- PP E AmendmentlTrans r/Ext rasions eceived Application: i ��eceived Fee:$ PD, 6 Liu! Completed Application 2 . AUG Z 2 2014 ,incomplete SEQRA Classification: _ E { Type I Type I1 Unlisted ---- - - -� _Coordination:(date sent) tVLWRP Consistency Assessment Form —SAC Referral�/ Sent: ' Date of Inspection: `Receipt of CAC Report: Lead Agency Determination: echnical Review: \/Public Hearing Held: __J* —Resolution: Name of Applicant Pamela Schider as Executor of the Estate of Jennie L. Pierce Mailing Address PO Box 193 Cold Spring Harbor, New York 11724 Phone Number:( ) Suffolk County Tax Map Number: 1000- 86-02-1,002 Property Location: 2615 Wells Road Peconic, New York 11958 (provide LILCO Pole#, distance to cross streets,and location) AGENT: Alexandra Halsey-Storch, Esq. (If applicable) Address: 33 West Second Street Riverhead, New York 11901 Phone: 727-2180 ex 323 I I hoard of Trustees Applicatiou i GENERAL DATA Land Area(in square feet): 109,159 Square Feet - Area Zoning: R-200 i Previous use of property: Private Residence i Intended use of property: Private ReGidenre Covenants and Restrictions on property? Yes X No If"Yes",please provide a copy. 's Will this project require a Building Permit as per Town Code? X 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 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 Does the structure(s)on property have a valid Certificate of Occupancy? _Yes No *The one-family dwelling and detached garage(accessory building) have valid COs;the shed and deck do not. Prior permits/approvals for site improvements: i Agency Date Building Department June 17, 1931 (CO forri(�-.vate Done-family dwelling) L Building Department Nov. 10. 1983 (CO for accessory building) Building Department Ian 30, 1989 ( for Satellite Antenna) Town Clerk's Office Sept. 3. 1989 (Wetlands Permit) 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): Applicant seeks a certificate of occupancy and administrative wetland permit for a pre-existing deck, dimensions are 10.5. x 32.9 feet Applicant also seeks a certificate of occupancy administrative wetland permit 8.5 x 10.1 feet. i I rd of Trustees Appl.icatiou. WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Private residential recreation. feet Area of wetlands on lot: 36,186 square j i Percent coverage of lot: 3.01 Closest distance between nearest existing structure and upland edge of wetlands: 24.3 feet Closest distance between nearest proposed structure and upland edge of wetlands: N/A feet Does the project involve excavation or filling? X 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): N/A i ' 1 - 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 I based on information currently available. If additional research or investigation would be needed to fully i respond to any item,please answer as thoroughly as possible based on current information. I 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: 1 Project Location(describe,and attach a location map): 2615 Wells Road Peconic, New York 11958 j Brief Description of Proposed Action: i c Applicant seeks an administrative wetlands permit for a preexisting, 10.5 x 32.9 foot deck. Applicant also seeks and administrative wetlands permit for a preexisting 28.5 x 10 1 foot shed. Name of Applicant or Sponsor: Telephone: j Pamela Schider as Executor of Estate of Jennie L. Pierce E-Mail: i Address: PO Box 193 Cold Spring Harbor, New York 11724 l Citylpo: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of 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 [Amay be affected in the municipality and proceed to Part 2. If no,continue to question 2. 11 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: ❑ •Although this property falls within"DEC Jurisdiction,"applicant's agent has confirmed with an advisor x at the DEC that they do not issue permits for pre-existing structures and that submitting and applicationould b futile 3.a.Total acreage of the site df the proposed action? 2.69 acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2.69 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial []Commercial [N Residential(suburban) ❑Forest ❑Agriculture []Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 I i 5. is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ® ❑ I b.Consistent with the adopted comprehensive plan? F-10 ❑ 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: El ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ❑ F-1 b.Are public transportation service(s)available at or near the site of the proposed action? ❑ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ® ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES ` If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ X 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 I 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? ❑ 3 ❑ 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? 0 ❑ 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: ER Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional E$Wetland ❑Urban ❑Suburban r 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? ❑ [1 I 16.Is the project site located in the 100 year flood plain? NO YES i 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, 1-71 ❑ a Will storm water discharges flow to adjacent properties? F-1NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 4 I i 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: _ ❑ ❑ i 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: ❑ ❑ f I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE r / App Iicant/sponsor e: ! Date: Signature f n j i Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions*in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur i I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ j 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? a ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the Q F-1establishment 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? 1 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate Q El available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 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, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 . i 5 No,or Moderate small to large impact impact may may € occur occur i 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? X� 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. N/A I, E] 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 vironmental 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 I R / I )1 Name of L Agency Date President Print or Type NAe of Responsible Officer in Lead Agency Title of Responsible Officer Signat a Respo e Officer in Lea gen y Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application i f County of Suffolk ! State of New York _ f I , ?-O tl,� �! Il BEING DULY SWORN I I 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 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 of Property Owner SWORN TO BEFORE ME THIS o-O* DAY OF— �_ 120 Notary Public SUSAN T.YOUNG Notary Public, State of New York 01Y06209293 Qualified in Suffolk County Term Expires: 7/27/20-Ll_l Certificate# 91877 Surrogate's Court of the State of New York Suffolk County - File#: 2014-315 Certificate of Appointment of Executor IT IS HEREBY CERTIFIED that Letters for.the'Estate of the Decedent named below have been granted by this Court, and such Letters are unre§yoked,=ares,valid and are irigfull force as of this date. �._a x , Name of Decedent: JenniwLee Pierce µ _ h __ ,;fes ' NovemberA22 2013 Date of Death: , k W1.: } Domicile: County of Suffolk': = d 1 l; ` R W'f��6S.6T.",3'y '�° W `Y Lx�t xF✓ " ^�ZC' ttt"m^ Yae Fiduciary Appointed: Pamela€� Schide� 4k_,!:,,, 1, d Letters Issued: Y LETTERS TE Al 7d �"_§' �'��tfit�,�:p.•'.,�+r<�f"-;f�F"'• �'��k::.-'` =g mem� �s Letters Issued On: February 27 2Q14'` Limitations: NONE a °' T= THESE LETTERS, granted pursuant to_adecree enteredt 6ythecourt, authoze and empower the above-named fiduciary or fiduciaries to perform alkacts requisite to'=the proper administration and disposition of the estate/trust of the Decedent-n accordance_with,the decree and the,.laws of`New York State, subject to the limitations and restrictions,Iif any.'as set forth above. 0 r " and such Letters are unrevoked and in full force-as,of-this date. Dated: May 29, 2014 IN TESTIMONY WHEREOF,the seal of the Suffolk Riverhead, New York County Surrogate's Court has been affixed. WITNESS, Honorable John M Czygier Jr,Judge of the Suffolk County Surrogate's Court. Michael Cipollino, Chief Clerk Suffolk County Surrogate's Court This Certificate is Not Valid Without the Raised Seal of the Suffolk County Surrogate's Court B.,a,.d of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Pa VVV,� 5��I cttff residing at PU 6 C)i 3 (print owner of property) (mailing address) do hereby authorize -�^ (Agent) f tl� 0 Kd-r 01- S ty` 51 yck -to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signadure APPLICANT/AGENT/REPRESENTATM i TRANSACTIONAL DISCLOSURE,FORM The r own ofSouthold's Code of Ethics prohibits conflicts of interest on the hart of town officers and emalovees The pumose of y this form is to provide information which can alert the town of nossible conflicts of interest and allow rt to take whatever action{s necoaam_to avoid same. YOURNAME: Alexandra Halsey-Storch (Last name,first name,ipiddle initial,unless you are applying in the name of i 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 X Variance Trustee X 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 X 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 applicanttagent/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 thisZ 1 day of gel C vS 2041Y Signature -� ��' / r Punt Name e A dri_ 94lfr',c Form TS 1 Town of Southold 1. LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for perntits* 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 E 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 i Waterfront Revitalization Program. A proposed action will be evaluated as to its significant 1 beneficial and adverse effects upon the coastal area(which includes all of Southold.Town). j 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 sunnortina and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. + " I 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 O , local libraries and the Town Clerk's office. B. , DESCRIPTION OF SITE AND PROPOSED ACTION AUG 2 2 2014 SCTM# 86 _ 02 _ 1.002 Southall To,v7 PROJECT NAME The Application has been submitted to(check appropriate response): I 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) ❑ f, (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: ❑X Nature and extent of action: Applicant seeks an administrative wetland permit and certificate of occupancy for a preexisting 10.5 x 32.9 foot deck. Applicant also seeks an administrative wetland permit for a preexisting 28.5 x 10.1 shed. M I , Location of action: 2615 Wells Road Peconic, New York 11958 Site acreage: 2.69 j i Present land use: Private Residence Present zoning classification: R-200 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: Pamela Schider as Executor of the Estate of Jennie L. Pierce (b) Mailing address: PO Box 193 Cold Spring Harbor, New York 11724 f i . (c) Telephone number:Area Code( ) (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency?' Yes ❑ No E If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies;Page 2 for evaluation criteria. ❑Yes ❑ No ❑X Not Applicable 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 [v2] Not Applicable 1 i Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See ; LWRP Section III—Policies Pages 6 through 7 for evaluation criteria t F] Yes E] No 0 Not Applicable 1 i 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 a Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No N Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ 0 i Yes No Not Applicable i i 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 Z Not Applicable j Attach additional sheets if necessary 4( 1' Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous i substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 0 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Yer-1 No Fx] Not Applicable I Attach additional sheets if necessary i WORHING 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. i ❑Yes ❑ No Q Not Applicable i. I 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 IN Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ` ElYes El No 0 Not Applicable i 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 PREPARED BY Alexandra Halsey-Storch TITLE Attorney DATE August 5, 2014