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HomeMy WebLinkAboutTR-10105A Glenn Goldsmith,President ®®e�®f SU, � Town Hall Annex A. Nicholas Krupski,Vice President 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 ®It�&I U�l�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1942C Date: July 20, 2022 THIS CERTIFIES that the removal of a 460 square foot brick patio on the eastern side of the house; remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds; remove a 15 square foot stone wall on the north side of the property; continue on the north side of the property, a stone retaining wall of approximately 55 square feet; install a 565 square foot bluestone patio on grade at the northeast corner of the house; install a 156 square foot bluestone patio onrag de at the southeast corner of the house; install stepping stones to access the proposed patios from the door on the eastern side of the house; At 2385 Pine Tree Road, Cutchogue Suffolk County Tax Map#1000-104-3-2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 17, 2022 pursuant to which Trustees Administrative Permit# 10105A Dated April 13, 2022,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for removal of a 460 square foot brick patio on the eastern side of the house; remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds; remove a 15 square foot stone wall on the north side of the property; continue on the north side of the property, a stone retaining wall of approximately 55 square feet; install a 565 square foot bluestone patio on grade at the northeast corner of the house; install a 156 square foot bluestone patio on grade at the southeast corner of the house,• install stepping stones to access the proposed patios from the door on the eastern side of the house. The certificate is issued to Eugene C. Burger owner of the aforesaid property. Authorized Signature Glenn Goldsmith, President 3 Sol Town Hall Annex A. Nicholas Krupski,Vice President ' '"! �' 54375 Route 25 i-. P.O. Box 1179 Eric Sepenoski tb Southold, New York 11971 Liz Gillooly ; Telephone (631) 765-1892 Elizabeth Peeples , Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: INSPECTED BY: fiJ h—r ' /Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 15t day of construction Y2 constructed Project complete, compliance inspection COMMENTS: azo/2� .�„( e- l� Plod 014 -to rSScr CERTIFICATE OF COMPLIANCE: Glenn Goldsmith, President q so�jy Town Hall Annex A. Nicholas Krupski, Vice President ,`O� Ol0 54375 Route 25 P.O. Box 1179 Eric Sepenoski y. [ Southold, New York 11971 Liz Gillooly G Telephone(631) 765-1892 Elizabeth Peeples �Ol� �� Fax(631) 765-6641 �DUNI`l,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED.O.FF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St d:ay of construction. Y2 constructed . When project complete, call.for-compliance inspection; Glenn Goldsmith, President W so Town Hall Annex A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O.Box 1179 Eric Sepenoski i�i Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® y® Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10105A Date of Receipt of Application: March 17, 2022 Applicant: Eugene C. Burger SCTM#: 1000-104-3-2 Project Location: 2385 Pine Tree Road, Cutchogue Date of Resolution/Issuance: April 13, 2022 Date of Expiration: April 13, 2024 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Remove a 460 square foot brick patio on the eastern side of the house; remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds; remove a 15 square foot stone wall on the north side of the property; continue, on the north side of the property, a stone retaining wall of approximately 55 square feet; install a 565 square foot bluestone patio on grade at the northeast corner of the house; install a 156 square foot bluestone patio on grade at the southeast corner of the house; install stepping stones to access the proposed patios from the door on the eastern side of the house. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Peconic Surveyors, P.C., last dated March 3, 2022, and stamped approved on April 13, 2022. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. ��_ 44-W-41 Glenn Goldsmith, President Board of Trustees N SCDIS REF# R10-18-0046 SURVEY OF PROPERTY ; A T CUTCHOG UE TOWN OF SO UTHOLD APP OVED ZY SUFFOLK COUNTY, N. Y. 1000-104-03-02 BOARD OF I RUSTEES SCALE: 1'=30' TO�/1� OF SOLITHOLD JUNE 10, 2010 JUNE 18, 2010.(FLOOD .ZONE & WATER METER) JULY 30, 2010 (SOUNDINGS) DA. AUG. 9, 2010 (PROP. DOCK) /�i��elL 13� �z� APRIL 26, 2011 (WETLANDS FLAGS) DECEMBER 6, 2017 FEBRUARY 26, 2018 (10' CONTOUR AUGUST 12, 2019 (HOUSE, DRIVEWAY REVISED) L_ J SEPTEMBER 5, 2019 (SEPTIC LOCATION) MARCH 3, 2022 (PROPOSED PA710) E�TE1LTIDAL0 MARINE ON APRIL 24,"ELANDS As 2�M/NED BY LOT. �6 PROPOSED � STONE RET 15 §F WALL 55 SF p�S D WOOD RET. 15 A 298.71' SEC W CMF WALL 0.1 N. ) N87'01'20"E FEN.END TBR grOCKAOE FEN. w `1 0.1'N BTiM. WA EL8:8 CMF SLATE PROPOSED ONE X v BB CURB UW N STOOP PATIO DW v 565 SF Z CONC. F.F. EL 12.5' 19.1 WOOD � �r b AKRON 11.2' O1NG � C LA W R ASPHALT DRIVEWAY �' GAR. FZR. EL o 0 ME R ee c�RB w 1a1' OMP 1 S COMPOSITE METAL 'o, •A� 29.8' 2 STY TO BE VED DOCK'/CATWALK RAM N FR. NSE & GAR: 41SF joo' A6' y SLATE WALK STONE C WINDOW c E11.2' ' 14 c5R$ Dw L3 N BOXES a. 1' � � ; Be W. A LP2 iv PROPOSED ^�. o� 00 ST PROP. STEPPING yc V DBL LOT 15 R/0 DECK 27./E m 21.4' 156nSF o S�rOWNIS WA n PtUNGs LP3 LP1 O�WgD W STONE RET. WALL YJ EL A6' �' co a N EN m B�""EL i 4ALL 285.55' E E I V E d MON 0.5 NN END TIMBER Er. ❑ ❑ D 0.9E UA TY GYAF SpUT RAIL PENCE ON NT WALL N 0.3 SA POLE 10' CONTOUR LINE SEPTIC LOCATION a'S S87-01'20"W LOT 14A RAR 17 2022 - w v ST 20' 19' _ Southold Town. LPI 27'27' moo, Board of Trustees, L 22 17' 39' LP3 32' - MEADOW LANE 1 LWETLAND5 FLA& (UNIMPROVED) ■=MONUMENT ` FLOOD ZONE FROM FIRM MAP 36103GO164H LOT NUM15EK5 REFER TO "MAP OF NA55AU FAKM5" 5EPTEMDER 25, 2009 FILED IN THE 5UFFOLK COUNTY CLERK'5 OFFICE ON MARCH 26, 1935 A5 FILE NO. 1179 0 ggELEVAT IONS ARE REFERENCED TO NAVD ei ANY ALTERATION OR ADDITION TO TH 15 5UKVEY 15 A VIOLATION. OF LIC. N0. 49618 CONI 5ECT I ON 7209OF THE NEW YORK 5TATE EDUCATION LAW. EXGEPT A5 YORS, P.C. PER 5EGT1'ON 7209-5UDDIV15ION 2. ALL GERTIF:IGATION5 HEREON AREA 19,477 SQ. FT (631) 765-5020 FAX (631) 765-1797 ARE VALID FOR TH15 MAP AND 6OPIE5 THEREOF ONLY IF 5AID MAP t0 tie lines P.0. BOX 909 OK GOPIE5 DEAR THE IMPRE55ED' 5EAL OF THE 5UKVEYOK WHO5E 1230 TRAVELER STREET 516NATUKE APPEAK5 HEREON. SOUTHOLD, N.Y. 11971 186-357 Glenn G(" �Mith, President �OS�F' Cp Town Hail Annex A Nicholas Kr�;S�i, Vice-President h�0 Gym 54375 Route 25 Eric Sepenoski o =` P.O. Box 1179 Liz Gillooly v: Southold, NY 11971 Elizabeth Peeples �y�jp' �•ao�� TeleFax phone 7665 6641-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD f Date/Time: z2 Completed in field by: �• �� "� Eugene J. Burger on behalf of EUGENE C. BURGER requests an Administrative Permit to remove a 460 square foot brick patio on the eastern side of the house; remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds; remove a 15 square foot stone wall on the north side of the property; continue, on the north side of the property, a stone retaining wall of approximately 55 square feet; install a 565 square foot bluestone patio on grade at the northeast corner of the house; install a 156 square foot bluestone patio on grade at the southeast corner of the house; install stepping stones to access the proposed patios from the door on the eastern side of the house. Located: 2385 Pine Tree Road, Cutchogue. SCTM#: 1000-104-3-2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 y Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards:mpleteness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: E. Peeples L. Gillooly G. Goldsmith N. Krupski E. Sepenoski Other SURVEY OF PROPERTY N SCDHS REF# R10-18-0046 A T CUTCHOG UE TOWN OF SO UTHOLD SUFFOLK COUNTY, NY. 1000-104-03-02 SCALE: 1`_-30' JUNE 10, 2010 JUNE 18, 2010 (FLOOD ZONE & WATER ME7ER) JULY 30, 2010 (SOUNDINGS) AUG. 9, 2010 (PROP. DOCK) APRIL 26, 2011 (WETLANDS FLAGS) DECEMBER 6, 2017 FEBRUARY 26, 2018 (10' CONTOUR ADDED) AUGUST 12, 2019 (HOUSE, DRIVEWAY REVISED) SEPTEMBER 5, 2019 (SEPTIC LOCATION) MARCH 3, 2022.(PROPOSED PA 770) COSTELLO MARINEEON APRIL 24,201RM/NED BY LOT s PROPOSED TS 15 SF WALL 55 SF' 0.11S STONE REr FE'SND WOOD RET. TIM. W L `� 298.71' CMF W LL Q 1 W EL. .4 FEWEND SECTION W (n N87'01'20"E TBR STOCKADE FEN. BTIU. WA N 0.1'N TBR -k V CMFSTONER SLATE PROPOSED ONE X to v �, V BB CURB to STOOP A 565 SF DW To 59. m ? CONC. r..F, EL 12.5' 19.1' y APRON n� GAR. FLR. EL 11.2'' DING o c 14, W ASPHALT DRIVEWAY D MAE SR BB CU�tB wA� 2 571 �. TO BER , DO cINDorn rA7E METAL 29.8 TWAUC RAM FR. NSE. & GAR. N 464 SF tao 4.6' H p m STONE g is SLATE WALK WINDOW o BB CURB DW 1p4 B BOXES CL ROPOSED EL1.2' o0 LP2 ST PROP. STEPPING �! DBI. LOT 15 R/0.DECK 2717'' 21.4' 156SFLAW"N� wA F a PIUNcs 71 O LP3 LPl Oytl DW .B. STONE RET. WALL N ELA6' �' R WALL END ❑ .0 °` WALL END BT E ALL 285.55' F1- M C " V E b MON l-v �0.9'E 0:5'NTIM ER UA tY CMF SPLIT RAIL FENCE L NTTIIC N. -C.XS /f0' CONTOUR L1NEJSEP'T'IC L60ATM 0.S S87.01'20"W LOT 14A W 114. R 1 � 2022A a ST 20' 19' I Southold Town 23' 27' rn ; Board of,_TruS ees LP2 17' 39' LP3 32' Sf' OF Iq MEADOW LANE o , T Mer O -WETLAND5 FLAG (UNIMPROVED) ■=MONUMENT FLOOD ZONE FROM FIRM MAP 36103CO164H LOT NUM15EK5 REFER TO "MAP OF NA55AU FAKM5" ; 5EPTEME5EK 25, 2009 FILED IN THE SUFFOLK COUNTY GLEKK'5 OFFICE ON ELEVAT I ON5 ARE REFERENCED TO NAVD MARCH 28, 1935 AS FILE NO. 117°1 � $ ANY ALTERATION OR AD�ITION TO THIS SURVEY IS A VIOLATION OF Y.S. LIC. N0. 49618 . CONI MORS, P.C. 5EGTI.ON 7209OF THE NEW YORK 5TATE EOUC.ATION. LAW. EXCEPT A5 (631) 765-5020 FAX (631) 765-1797 PER 5ECT I ON 7209—5Uf3D I V 15I ON 2. ALL GEKT IF I CAT I ON5 HEREON AREA = 19,477 SQ. FT. P.0. BOX 909 ARE VALID FOR THIS MAP ANC GOPIE5 THEREOF ONLY IF 5AID MAP t0 tie lines OK GOPIE5 DEAR THE IMPKE55ED SEAL OF THE SURVEYOR WH05E .0 TRAVELER STREET 51(7NATUKE APPEAK5 HEREON: SDUTHOLD, N.Y. 11971 186-35 RE C E I V E FA/ MAR 2 4 2022 Southold Town J Board of Trustees R,S- X 1,3 3.23- 's G d p Ao S F= 20 %C 1.3 = 60 C �5-SF d X o& : S-6 1,5-6s F y • � t �{ + r w 6 } a r. eta V w . 03 08 2022 East View South Patio ", - i lip { - l' 40 I� F _ ,�. 4 .a A,• n t « { 03 08 2022 West View, South ..Patio r • f i } v �"` • M '!' Oj -I,M4.w. Y _ r • r . �-- .� ��•y�,_ j! ''��,r; ISI �:.,•'i 03 08 2022 East View `North Patio , t _ Arm .... ae� t Y, - i!�'r'.,p" _' a.�e. is syi.�s•.�� ye ,w��e�N.4�:.. +t°' "7idrsr>FJri Pam: ! �s +•la ^��`�'yti��er r fi ^ • t '�—tee•...-.5.:.,. s: } r i r 4 ^. S•F�f i�• r. ' 1 J�1 R ,��. 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"•A?'ti \ BROADWATERS COVE `\ Z e, to n• 5 •f \ 9L ,e OPS •�•B 4 g" ei t° 4 tb?� 1Y ) TOWN OF�SOUTHOLD ` \i �` r t _ tx y lw<I O q ' __ 9 �1 s F _ • d \ .P ttlyc\ ♦ n 1 O �" �:�n�] t 11",M1) ^">it N b \i �< Vim NG s 1 � 3 • liw J Y Q9 b ' J � 4I 1 � r s "e r�rA ,,.,ywa] nt eX •_ ��� -��tr'" \ 5 a \ MAYWATER COVE IF 'd L mow"•. i.r •• ... — -- uw� --.w-- er_� --x-- NOTICECOUNTY OF SUFFOLK © K F SOUTHOLD SECTION NO Real Property Tax Service Agenoy r �a NDM. .....NVllwt M 1O4 r sn5P rmcr xo 1000 PROPEXTV MAP OFFICE LOCATION: rjf SUy� MAILING ADDRESS: Town Hall Annex �� 0 0 P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 • Telephone: 631765-1938 Cow T`I,� � LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees . r From:` Mark Terry,•AICP LWRP Coordinator Date: .April 6, 2022 = Re: LWRP Coastal Consistency Review for EUGENE C. BURGER SCTM# 1000-104-3-2 Eugene J. Burger on,behalf of EUGENE.C. BURGER requests an Administrative Permit to remove a 460 square foot brick patio on the eastern side of the house; remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds; remove a 15 square foot stone wall on the north side of the property; continue, on the north side of the property, a stone retaining wall of approximately 55 square feet; install a 565 square foot bluestone patio ongrade at the northeast corner of the house; install a 156 square foot bluestone patio on grade at the southeast corner of the house; install stepping stones to access the proposed patios from the door on the eastern side of the house. Located: 2385 Pine Tree Road, Cutchogue. SCTM#: 1000-104- 3-2 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 action is CONSISTENT with the Policy Standards and therefore is CONSISTENT 1.with the LWRP. In the event the action is approved, it is recommended that the Board establish a vegetated non-turf buffer incorporating existing vegetation. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Glenn Goldsmith,President ®r ®�" Town Hall Annex �� �`�' 54375 Route 25 A.Nicholas Krup ski,Vice President P.O.Box 1179 Eric Sepenoski [ t Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples y0. Fax(631) 765-6641 ECE0Ulu BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 17 20 This Section For Office Use Only Soui:liold Town Board of Trustees Coastal Erosion Permit Application Wetland Permit Application --. K Administrative Permit Amendment/Tran sfer/Extension Received Application: 3-I?•ZZ ►Received Fee:.$ 100.00 _/�" Completed Application:. •L •2Y Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: . -Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: •(3.2Z Resolution: Owner(s) Legal Name of Property (as shown on Deed): Li r L=N,= Mailing Address: . Phone Number: .�s�' 7�=/6__/� Suffolk County Tax Map Number: 1000 - " Property Location; �3$J &2,_—T 4,ccn" ��}��l T �S�-U E , y .�•5" Macro o F 12E-4ago w U R/Vjf' (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): u�-�=N t l Lc—g Mailing Address: boll e), 23,q , J Y ------Phone Number:. --���- "� y763 - -Email: 16R,rP A RJS'T rC' C�' n'1-- 03/14/2022 Eugene C Burger 2385 Pine Tree Road Cutchogue, NY 11935 PROJECT DESCRIPTION Remove a 460 square foot brick patio on the eastern side of the house. Remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds. Remove a 15 square foot stone wall on the north side of the property. Continue,on the north side of the property,a stone retaining wall of approximately 55 square feet. Install a 565 square foot bluestone patio on grade at the northeast corner of the house. Install a 156 square foot bluestone patio on grade at the southeast corner of the house. Install stepping stones to access the proposed patios from the door on the eastern side of the house. (Please see the attached survey with the proposed wall extension, patios and stepping stones shown). Soard of Trustees Applica >n GENERAL DATA Land Area(in square feet): J �� Area Zoning: �to Previous use of property:_ /®C-NL.c= Intended use of property: Sd,0,rNd Covenants and Restrictions on property? Yes __X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes -No If"Yes", be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s)on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date OF T_S.QarHoA-4 -S J34S WUJM q1/ar /� a® iq qIR 3120/ 9 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Appllca,'' an WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: &0 U 1 j? ,5- Area of wetlands on lot:_ L102, square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet FRDrvl Closest distance b tween nearest proposed structure and upland edge of wetlands:: (' feet ��i� P o posE ig f 4ry'o Does the project involve excavation or filling? - _No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: _ feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): No � f V o ,l In p a- � 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing, Part I -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: 1 rgc-+ Pkv Pfd o em t/,#/-t/,#/- , /We✓w 19f�7-t s' _',A s- L c -a Project Location(describe,and attach a location mapl: Brief Description of Proposed Action: 94.-m,6v c- R PRrlo; Rt rnd vi i,CCF WHOS eka..5r W//ttOW 0,11n fi-6-C 1N R Irs g: IrTMF Wh,k' . M's-r4l,�- ��i`S l; or .S`TD,v e 1?E%r 1'V jd C' w4 L.,4j N �LS P";t7'l o - 1x.61'r_- P19-TAO Name of Applicant or Sponsor: "Telephone: !� 4� 4 /E' E-Mail:��. alswel 6'rYl/1/L G'0 Address: ass A d F _l� City/PO State: Zip Code: �?a-rd'��0 6(6 6- I W/X 1 w.3 s- 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that rV1 ❑1 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? p acres b.Total acreage to be physically disturbed? ®,, ®a acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) [-]Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑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? LfJ ❑' 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: l�1. ❑ 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? 91 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? EL 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? SJ ❑ 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? �1 ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: ISI 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands El Early mid-successional ❑ Wetland ❑Urban ❑Suburban I5.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? 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO _ YES, If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ❑NO []YES b.Will storm water discharges be directed to established conveyance systems-(runoff and storm drains)? If Yes,briefly describe: El No []YES - -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: � FI 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: ® a 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: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE / Applicant/sponsor name: d9- If "/Pi ff Date: 311,6 6 a'�3-0 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 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 a affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 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)? 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 El a problems? 11. Will the proposed action create a hazard to environmental resources or human health? l El I Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information-and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) _. PRINT7---__ . - -- _- Page 4 of 4- ' Board of Trustees Appliew )n AFFIDAVIT -G!6-,C#yr 6&f.,� BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT.ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF �GI � ✓ 20_,2 otary Public _V a NOTARY f • AmwNo me `• "' I^ oe �,����,�•OF NEN�����• �16a.xd cif Trustees Appl.scatw,' .'�'i AU _THOPMATIO (Where the applicant is not the owner) �r owners of the roe identified as SCTN1# 1000= 10°' �� 'in the,town of -.property.p rty C� ,New York,hereby authorizes to act as my agent.and handle all, necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's-Signature SWORN TO BEFORE ME THIS' / t� -� DAY OF 20 J o i OF NF!11YORK Notary Public �� � 1'� �l-i. r r v l '-� - in Su !4 Jo�n y Oc be - 20 APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Town of Southold's Code-cf Ethic prohibits conflicts of interest on the'hart of town officers and emaloyees.Thipuroose of -this form is to provide information which can alert the town of possible conflicts of interest and allow rt to.take whatever action is necessary to avoid same. �q YOUR NAME: GI (Last name,first name,.tpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee , Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you pcisonally(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,atarriage,or busmcss.interest "Burin ss interest"means a business, including a partnership,in which the town officer:or empldyee haseven.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 br position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200,0 Signature Print Name Form TS l 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 sipmwcanfi beneficial and adveise:effects upon,tle coastal area(which.iiicludes-all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be.explained itudetail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall.not-be°undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑' construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval, license,certification: Nature and extent of action: r- c /t 7-17Aen e d lxpr4--d:t-45,75C-kfP 7,o�r� 03/14/2022 Eugene C Burger 2385 Pine Tree Road Cutchogue, NY 11935 PROJECT DESCRIPTION Remove a 460 square foot brick patio on the eastern side of the house. Remove a tree in the eastern yard whose branches threaten severe window damage in easterly storm winds. Remove a 15 square foot stone wall on the north side of the property. Continue,on the north side of the property,a stone retaining wall of approximately 55 square feet. Install a 565 square foot bluestone patio on grade at the northeast corner of the house. Install a 156 square foot bluestone patio on grade at the southeast corner of the house. Install stepping stones to access the proposed patios from the door on the eastern side of the house. (Please see the attached survey with the proposed wall extension, patios and stepping stones shown). Location of action: Site acreage: �S Present land use: � Sf D�a✓t�- Present zoning classification: #0 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailingaddress: RO. 6ZI7-e/f0bVV Y /1935— (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 N. 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 E] No 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 F-1 Yes ❑ No ® Not Applicable 1 f Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No 5�'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 Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages.22 through 32 for evaluation criteria. Yes No Not.',_ )licable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes [:]_No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LNVRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No ErNot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Yel[�] No Not Applicable Attach additional sheets if necessary WORKING COAST POLI( _3 Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No R1 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes ❑, NoNot 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. Yes ❑ No�J Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑.Yes ❑. No Nr Not Applicable PREPARED BY C ,�-- -- TITLE /yjC— �CG'Nct,? DATE Fu 4-4=ti�= <2 u FQ Town Hall Annex Glenn Goldsmith,PresidentU H A.Nicholas Krupski,Vice President ,ti� 54375 Route 25 P.O.Box 1179 Eric Sepenoski :BR Southold,New York 11971 Liz Gillooly G' Telephone(631) 765-1892 Elizabeth Peeples ® ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER STATE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY at Stony Brook 50 Circle Road Stony Brook, NY 11790-3409 (631) 444-0355 Wednesday & Friday only during the hours of 8:30a.m. — Noon & 1 p.m. — 3p.m. Email: ,r.l.dep -gw.dec:state.ny:us Suffolk County Dept. of Health Services Office of Wastewater Management 360 Yaphank Avenue, Suite 2C Yaphank, NY 11980 (631) 852-5700 Email: VVWM_ asuffolkcounfyny:yov U.S. Army Corps. of Engineers, N.Y. District Attn: Regulatory Branch 26 Federal Plaza, Room 1937 New York, NY 10278-0090 (917) 790-8511 Website for applications & helpful information: hitp::/lwww:han.usaee_arrrmy.mil/fylissionsJRegulatory�.aspX N.Y.S. Department of State Division of Coastal Resources Consistency Review Unit One Commerce Plaza 99 Washington Ave, Suite 1010 Albany, NY 12231-00001 (518) 474-6000 Website: WWW:nyswaterfronts.comi