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Home My WebLink AboutTR-10478A Glenn Goldsmith, President ®v NaUTown Hall AnnexI� 54375 Route 25 A. Nicholas Krupski,Vice President ®� re) P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 Own BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction '/z constructed When project complete, call for compliance inspection; Glenn Goldsmith, President ®f S® � Town Hall Annex A.Nicholas Krupski,Vice President ®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski [ Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® a® Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10478A Date of Receipt of Application: October 6, 2023 Applicant: Nicole Martorana & David Alworth SCTM#: 1000-115-17-11 Project Location: 3400 Deep Hole Drive, Mattituck Date of Resolution/Issuance: October 18, 2023 Date of Expiration: October 18, 2026 Reviewed by: Glenn Goldsmith, President Project Description: Remove existing asphalt driveway; install 1,030sq.ft. of crushed gravel on compacted RCA for new driveway and paths with 220+/- steel edging, and seven (7) 2'x3' bluestone pavers; install 35+/- linear feet irregular stepping stone path to dock; install 160+/-sq.ft. crushed gravel on compacted RCA base on-grade patio with 52+/- steel edging, and one 2'x3' bluestone paver; install 133+/-sq.ft. crushed gravel on compacted RCA base patio on grade with 41+/- metal edging; install 167' 1"+/- 4' tall welded wire fence on 4"x4" wood posts, with two gates. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Salty Roots, dated October 6, 2023, and stamped approved on October 18, 2023. 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. Aennldsmith, President Board of Trustees Fence: '"'`' • 14' 1"±4'tall welded wire fence with gate. SALTY ROOTS APPROVED) -BY DBB[6N PO BOX 894 Driveway/Paths: . ,BOARD OF f RUSTEES • 1,030± SQFT-5/8 crushed mixed stone on compacted RCA base. Mattituck,N saltyrootsny.com.com TO�iVN:OF SOUTNOL® •220'±of steel edging. 631.315.9091 •7-2'x3'blustone pavers. Dock Path: • 35'± of irregular stepping stones. Project MARTORANA DATEB� r 1 j�� 3400 Deep Hole Dr. Mattituck,NY Title --—- --- , Permit Plan / X - X X - X Scale (] X `ll . - �� 1� o 0 O:: X 1 16 0 D. / / X Date n X at 0 X 10.06.23 X PLAN TRUE :':'•:<'�qq �U.:;;:; LU U (C�]-� ////// X X NORTH NORTH m X 000 Q ///// " X X o o0DCATWALK o 0 / X N x 3 W X ///// x / x 27'-2" X LLI � / X� X X ac —= X 00 X X X } // LLi/ x UX x Z X X Fence: ` x aC • 153'±4'tall welded wire fence with gate. 'F-,/ X 00 X X Z /.O,/ x X X C) //Z,/ to x IE/ 'Z r ' Z X =Ol! / X m OCT - 6 2023 X X a X F- X /W SotAold To ag X x � Board of Trustees — X o N O E � E Dining Area: m Fire Pit: • 160±SQFT-5/8 crushed mixed stone on compacted RCA base. • 133±SQFT-5/8 crushed mixed stone on compacted RCA base. • 52'±of steel edging. •41'±of steel edging. • 1 -2'x3' blustone paver. Page Ci'lenn Goldsmith,President �o�QgQ� COGy Town Hall Annex A.Nicholas Krupski,Vice President C 0 54375 Route 25 Eric Sepenoski �' ,? P.O.Box 1179 Liz Gillooly �y • 0�� Southold,NY 11971 Elizabeth Peeples � �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Datelfime: [o 16 L23 Completed in field by: G. Got&5�J— Eric Martz on behalf of NICOLE MARTORANA & DAVID ALWORTH requests an Administrative Permit to remove existing asphalt driveway; install 1,030sq.ft. of crushed gravel on compacted RCA for new driveway and paths with 220+/- steel edging, and seven (7) 2'x3' bluestone pavers; install 35+/- linear feet irregular stepping stone path to dock; install 160+/-sq.ft. crushed gravel on compacted RCA base on-grade patio with 52+/- steel edging, and one 2'x3' bluestone paver; install 133+/-sq.ft. crushed gravel on compacted RCA base patio on grade with 41+/- metal edging; install 167' 1"+/- 4' tall welded wire fence on 4"x4" wood posts, with two gates. Located: 3400 Deep Hole Drive, Mattituck. SCTM#: 1000-115-17-11 Typ¢ of area to be impacted: Y/ Saltwater Wetland Freshwater Wetland Sound ✓ Bay Part of Town Code proposed work falls under: J Chapt.275 Chapt. 111 other Typ/e of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: skco"g1.� Nc J ao ��r�s ,ec ��wac� ex�S�:c�c r Present Were: G. Goldsmith N. Krupski E. 'Sepenoski L. Gillooly E. Peeples. c I I S.C.T.M. N0. DISTRICT: 1000 SECTION: 115 BLOCK: 17 LOT(S): 11 1 I I 1 I I 1 I L_, I I I I 1 I I NEW SUFFOLK AVE 1 I I ► I I Y I U I O3 L� LU I r-—--I I I I I I I I I LAND N/F OF I I I FRANK MARTORANA I I I 1 I I Q) I I I L-__ I I PROPOSED PROPOSED 10'x14j- _-- 2ND FLOOR EXPANSION PROPOSED - J S 79000,001r OVER FOOTPRINT OF 4'W x 3'L STEPS 8'W x 6'H E EXIST. FIRST STORY PROP. EX. BILCO TBR EVERGREE EGRESS 4'x6' I / N HEDGE WINDOW WELL EL 10.0 ASPHALT 'X5' CONC/STONE DRIVEWAY WALL6 PROPOSED I 118'74' 18, r 4'x4 EL 10.21 0 7 U.P. o_ ORCH 1U _ `� I� 1 MON' 4 2 4 PROPOSED W.Mo _W - _W_ W/ST EL 8x x/ 9'X14' -W_ 1 1 I ;c.x x x x x x x SCREEN PORCH x x xxx//// x " x / 126 SF iiiiiii{i 1 Zxx x x' x v k / x x /x �: x x W x EX. DOOR AND WOOD 41.6' �� gl 4j x i o '� STOOP TBR ......... LCO I I F .. ti I O PROPOSED ..... g�; x 4.5'x3.9' 4'x6' 2 STY TiT, i +Y�y x x X�x x,o<x x x � C5 MAINTAIN OPEN W/STEPSCH / r( DWELLING i i i i +++ Z x x xM x!x x x x x yx x ' 4ft. WIDE(MAX) Z / #3400 WOOD I14 ' +++++ x x x x x x / PATH TO DOCK EXIST. FFL 12.9 STOOP 1 0 ... + x Cb x x x x xxx ® \ STOOP Tc�j t. j 41 '++++ + x CATWA ��ar BR + + 41' +++ x x x x x xx K ko 0 29.7' �.�' ++ x LLJ 24.2' + + x x x o o PROP. ++++ Ix x x x X xx Ix EGRESS E ++ `x x x x ` x APPROX. 420 SF OF X x x 1 EXISTING LAWN TO BE WINDOW WEL� ++ + 4 x x x CONVERTED TO NON-TURF BUFFER G4 4'X5' PROJECT LIMITING �7 ++++ x x xx 1x x E SILT FENCE/ �' / ++++ jx x x,(x x XX x xxx x I EX. WOOD STEPS TBR / LIMIT OF SITE i� ' +++ txxx ' x xxxx 5'x4' E DISTURBANCE o ++++ x xx x xxxxxx xx I PROPOSED 7.1'X14.5' X ;xx x xxx xxx I WOOD DECK-103 SF o /�1p /��0 � x �r x x x x EX. WOOD DECK TBR � O E o � G '0 TJ g xxx10 xxxxxx Z 7.1' x 8' - 57 SF Im X jlc x xxxxx PROPOSED WOOD STEPS ELEC. � N /� o _/ x x x x x x x 3'Wx4'L V� MT�_ INGROUND o `�/fxx�xxxxxxxx / MON _ - LP GAS �" ,� = xxx xxxxxxxx / ` ti CL 8.9 - 8 = Q xxxx/"xxxxxxxx / 00 �1 / ti V xxx�`xxxxxxxx / OM Z x x x x x x 1V 79000r00'r W /� xxxx xxxxxx / "xxx xxxxx TOWN OF SOUTHOLD I 103.41► 6 o xxx4xxxxxx I _J LOT COVERAGE LAND N/F OF x x xxxxxx (ULPAND AREA 10,494 S.F.) I TIDAL WETLAND BOUNDARY EXISTING COVERAGE HENRY S HUECKER AS DELINEATED BY HOUSE: 885 S.F. IRREVOCABLE TRUST LIMIT OF PROPOSED EN-CONSULTANTS REAR DECK: 57 S.F. BUFFER WIDE NON-TURF / 11-01-21 BUFFER 942 S.F. or 8.98% PROPOSED COVERAGE / \ f `� Lv HOUSE: 885 S.F. // LIMIT OF COVENANTED PROP. SCREENED PORCH: 126 S.F. NON-DISTURBANCE BUFFER PROP. REAR DECK: 103 S.F. / / LIBER 12980 PG.166 EXIST. REAR DECK: -57 S.F. (TO BE REMOVED) o// / OCT - 6 2023 1114 S.F. or 10.61% / v / Southold Town / O / Board of Trustees L\ // REVISED 07-28-22 / REVISED 07-19-22 FEMA MAP#36103CO482H 9/25/2009 // THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS UPLAND AREA: 10,494 S.F. or 0.24 ACRES AND OR DATA OBTAINED FROM OTHERS. AREA: 11,107.75 SQ.FT. or 0.25 ACRES ELEVATION DATUM: NAVD88 ________ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUffURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS,PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF:DESCRIBED PROPERTY CIF NEW CERTIFIED TO: NICOLE MARTORANA; MAP OF: A, N Mvo�y0� DAVID ALWORTH; FILED: CO ��'� 0y � G SITUATED AT:MATTITUCK O TOWN OF:SOUTHOLD "o- '' KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK 'Ls 050882 �J2, Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE # 221-179 SCALE: .1"=20' DATE: DEC. 20. 2021 PHONE (631)298-1588 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk i iqp.'•..�-'4� 3. r may. x ,fir + �.. 1 1tomm wilM' a w ' .� d}. 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COUNTY OF SUFFOLK tf ' NOTICE K E '—�]n_.:.w. /tel ,�w�.�... --r--- ... nu., fp ,.1 I t Y7' Ag— EG Kcn.a W E WNIBruE. 6ME Y' n w,n. WYf110LD —..� — — —�-- f »lY 116 H �.�.., a�.H>�a T.MHev p u+•et_-- ,,,,ter, r... --- w`.r..�yr. 1411 p a -_ -_.. —__— •a.w... .. "- .. ., a: xmxrn rmr>&mafssof 02M - ++,.. __-- s.n S Pav Hartlnr rM SBr.rl nouty �,y �„ wr v...... OFFICE LOCATION: �*rjf SU(/jy0 MAILING ADDRESS: Town Hall Annex �� l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold,NY 11971 OQ Telephone: 631765-1938 a CnUNT`I,Nc� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: October 16, 2023 Re: LWRP Coastal Consistency Review for NICOLE MARTORANA & DAVID ALWORTH SCTM# 1000-115-17-11 Eric Martz on behalf of NICOLE MARTORANA & DAVID ALWORTH requests an Administrative Permit to remove existing asphalt driveway; install 1,030sq.ft. of crushed gravel on compacted RCA for new driveway and paths with 220+/- steel edging, and seven (7) 2'x3' bluestone pavers; install 35+/- linear feet irregular stepping stone path to dock; install 160+/-sq.ft. crushed gravel on compacted RCA base on-grade patio with 52+/- steel edging, and one 2'x3' bluestone paver; install 133+/-sq.ft. crushed gravel on compacted RCA base patio on grade with 41+/- metal edging; install 167' 1"+/-4' tall welded wire fence on 4"x4"wood posts, with two gates. Located: 3400 Deep Hole Drive, Mattituck. SCTM#: 1000-115-17-11 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 action is CONSISTENT with the LWRP provided the following is considered to meet policy 6. 1. Require NYS specification RCA to lessen environmental exposure to contaminants and hazardous materials. 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: Honorable Lori Hulse, Attorney Glenn Goldsmith,President 0U� Town Hall Annex • l� 54375 Route 25 A.Nicholas Krupski,Vice President AS�. . w P.O.Box 1179 Eric%penoski � Southold,New York 11971 Liz Gillooly .� Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application �? Administrative Permit AmendmenttTransfer/Extens ion _Received Application: i0•/aZ3 �C Received Feer$ 25-0• Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): E C E � V E X LWRP Consistency Assessment Form Sent: @L� CAC Referral Sent: f -X—Date of Inspection: OCT — 6 2023 01 Receipt of CAC Report: _Technical Review: Southold Town X Public Hearing Held:�� BoardofTrustees Resolution: Owner(s)Legal Name of Property (as shown on Deed): Nicole Martorana& David Alworth Mailing Address: 3400 Deep Hole Dr. Mattituck, NY 11952 Phone Number: 516.527.0054 Suffolk County Tax Map Number: 1000 - 115.-17-11 Property Location: 3400 Deep Mole Dr. Mattituck, NY 11952 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT Of applicable): Eric Martz Mailing Address: PO Box 894 Mattituck, NY 11952 Phone Number: 917.916.3724 Email:eric@satlyrootsM.com Attachment Project Description: Remove existing asphalt driveway. Install 1,030± SQ FT of crushed gravel on compacted RCA for new driveway and paths. With 220'± steel edging, and seven 2'x3' bluestone pavers. Install 35± liner feet irregular stepping stone path to dock. Install 160± SQ FT crushed gravel on compacted RCA base patio on grade with 52'± steel edging, and one 2'x3' bluestone paver. Install 133± SQ FT crushed gravel on compacted RCA base patio on grade with 41'± of metal edging. Install 167' 1"± 4' tall welded wire fence on 4"x4" wood posts, with two gates. oard of Trustees Applica )n . . GENERAL DATA Land Area(in square feet): 11,107.75 SO FT Area Zoning: R-40 Dwelling Previous use ofproperty:Single Family Residence Intended use of property:Single Family Residence . Covenants and Restrictions on property? Yes =No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? flYes _allo 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 cf A ppeals?=Y es �_No If"Yes",please provide copy of decision. WYes .project re any demolition as per Town Code or as determined by the Building Dept.? ✓ No Does the structure(s) on,property have a valid Certificate of Occupancy?, Yes_Z_No (CO-Pending post construction final inspection.) Prior permits/approvals for site improvements: Agency Date Southold Building,Dept. 11.30.2022 Southold.Trustees 0.9.14.2022 ❑ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? NoYes If yes,provide explanation: Project Description(use attachments if necessary):See Attachment I for Project Description. oard of Trustees Applica', )n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: See Attachment I for Project Description. Area of wetlands on lot: 613.75 SO FT square feet Percent coverage of lot: 0.055 Closest distance between nearest existing structure and upland edge of wetlands: 40' feet Closest distance between nearest proposed structure and upland edge of wetlands: NSA feet Does the project involve excavation or filling? N o_ �/ Yes If yes,how much material will be excavated 15 u bic yards . How much material will be filled? 1.5 cubic yards Depth of which.material will be removed or deposited: 0.25 -0.5 feet Proposed slope throughout the area of operations: N/A (on grade patio and pathways) Manner in which material will be removed or deposited: Skid steer, and by hand. Statement of the effect,if any,on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): No negative impacts to the wetlands or tidal waters of the Town of Southold are anticipated. -bard of Trustees Applicai' n AFFIDAVIT David Alworth 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 WORKWILL 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 H 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 5th DAY OF October 20 23 ECHARD BIEN-AIME Notary Public-State of Florida Notary Public Commission#HH 153739 Expires on duly 14,2025 Notarized online using audio-video communication 3oard of Trustees Appli'ca�� in AUTHORIZATION •- (Where the applicant is not the owner) UWe, David P►Iworth owners of the property identified as SCTM# 1000-115:-17-11 in the town of Mattituck ,New York,hereby authorizes Eric Martz to act as my agent and handle,all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property:Owner's Signature 23 SWORN TO BEFORE ME THIS 5th DAY OF October , 20 ECHARD BIEN-AIME Notary Public-State of Florida � �� a•, a Commission#HH 153738 Notary Public O j 9J"•. Expires on Jury 14,2025 '%� �Imi �.� Notarized online using audio-:video communication bard of Trustees Applicai n AFFIDAVIT Nicol® Martorana 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 H ANY CONDITION OF ANY WETLAND Olt COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. A , NIA Signture of Prope y Owner Signature of Property Owner SWORN TO.BEFORE ME THIS DAY OF C�&a4- , 20 Notary Public CAROL A DACCORDO Notary Public-State of New York NO.01DA6431707 Qualified in Suffolk County My Commission Expires Apr 18,2026 bard of Trustees Applicai n AUTHORIZATION (Where the applicant.is not the owner) I/We. Nicole Martorana owners of the property identified as SCTM# 1000-115.-17-11 in the town of Mattituck New York,hereby authorizes Eric Martz to act as my agent and handle all necessary work involved with the application process for permits) from the Southold Town Board of Trustees for this property. Property wner's Signatur Property Owner's Signature SWORN TO BEFORE ME THIS : �� DAY OF c , 20 a 3 Notary Public CAROL A DACCORDO Notary Public-State of New York No.01DA6431707 Qualified in Suffolk County My_Commission Expires Apr 18,2026 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'sCode of Ethics prohibits conflicts of interest on the Dart oftown officers§84=6M.The nuimose of (his tom►is to lirnvids infor initien whish:ca6 aleri:the tow Obf RgWWe_ceufliat of ititemst and allow it to take whatevel„action is necesriry to avoid same:. YOUR NAME: (Last name,first name,qfiddle 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 ofplat Mooring Exemption from plat or official map Planning Other Of"Other",name the activity.) Do you persaaally.(or through your company,spouse,sibling,parent;or child)have a relationship with any officer or employee ofthe Town of Southold? "Relationship"includes by blood,marriaM or business interest."Business interest='means a'business, including a partnership.idwhieb the town offlceror employce has cvena pardai,ownetship of(or employment by)a corporation in which the townoEficer,or employee owns more than.5%of the shares. YES NO If you answered"YES",complete the balanceof this form and date and sign where indicated. Name of person employed by the Town of Southold T{tle or position of that person Describe the relationship between yourself(the applicantlagenthepreseritative)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,of child is(check all that apply):. _,A)the owner of greater than 5%of the shams of the coMratc stock of the appiicpm , (when the applicant is a corporation); 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 4 day of ncTA&tK_ 20,2,1 Signatur.q_tjk o�� . M R, Print Flame Form TS 1 APPLICANT/AGENT/REPRESENTATM TRANSACTIONAL DISCLOSURE FARM The Town of Sm thold's Code of Ethics orohibits'confGcts'ofinterest on the Dart oftown officers andsmolovees.The numose of this form is 0-provide information which cair aleft the fawn of.possible conflicts of interest and allow it to take whatever actions nee to avoid same: pn / YOUR NAME: G f L /''Ar T-z— (Led name,first name,jriddle 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"Met",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 busivqss, 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%ofthe shares. YES _F] � NO n .. If you answered"YES",complete the balanceof this form and date and sign where indicated. Name of person employed by the Town of Southold Tide or position of that person Describe the relationship between yourself(the applicant/agenNrepresentative)and the town officer or employee.Either check the appropriate line A)through D)an(Vor describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,of child is(check all that apply): _aA)the owner of greater than S%of the shares of the corporate stock of the applicant . _nB)(when the applicant is a corporation); the legal or beneficial owner of any interest in a non-corporate entity(when the- applicant is not a corporation):. C)an officer,director,partnci or employee of the applicant or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this D G day of G 20 Z Signature Print Name U Me— MA e 7-7— Form TS 1 I 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 l 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: 3400 Deep Hole Dr. Project Location(describe,and attach a location map): 3400 Deep Hole Dr. Mattituck, NY 11952 Brief Description of Proposed Action: See Attachment I for Project Description. Name of Applicant or Sponsor: Telephone:917.916.3724 Eric Martz E-Mail:eric@satlyrootsny.com Address: P® Sox 894 City/PO: State: Zip Code: Mattituck NY 111952 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: r ❑ 3.a.Total acreage of the site of the proposed action? Q.25 acres b.Total acreage to be physically disturbed? n n�� acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.25 acres 4. Check 11 land us at occur on,adjoining an ar the prop 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? ✓ 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: F1 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? ✓ 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: - ® W1 10. Will the proposed action connect to an existing publiclprivate water supply? NO YES If No,describe method for providing potable water: N/A 11.Will the proposed action connect to existing wastewater utilities? NO YES. If No,describe method for-providing wastewater treatment:-N/A R1 : ❑ 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: 14Identify the typic bitat types that.oc n,or are likely to be found on tf�-project site. Check all that apply: Shoreline Forest Agricultural/grasslands u Early mid-successional ✓ Wetland Urban ✓Suburban 15.Does the site of the proposed action contain any species of animal,or'associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ✓ 16.is the project site located in the 100 year flood plain? NO YES_FT 17T. 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes, ^ � ® E a.Will storm water discharges flow to adjacent properties? O ES b. Will storm water discharges be directed to established conveyance systemsff an drains)? If Yes,briefly describe: LNO ES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE 1S TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname: ECIC Martz Date: Signature: Part 2-Impact Asse ent. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe following questions in Part,2 using the information contained in Part land other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I, Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. W ill 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? E 4. Will the proposed action have an impact on the environmental characteristics that caused the a ❑ 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: 0 a.public/private water supplies? b.public/private wastewater treatment utilities? S. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? El 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 l No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? El. ❑ 11. Wil I the proposed action create a hazard to environmental resources or human health? ❑ ❑ Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. 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 i 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 "roposed:action will be evaluated as to its significant ficant benefid al and adverse effects upon the coastal area fmhich includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. .Thus, each answer must be.explained in details.;listing both supporting and non- supportine-facts. If an action cannot be certified as consistent with the LWRP policy standards and conditionsAt 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 Departrnent, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND,PROPOSED ACTION SCTM# 115• _17 _11 PROJECT NAME 3400 Deep Hole Dr. 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: See Attachment I.for Protect Description. Location of action: 3400.Deep Hole Dr. Mattituck, NY 11952 Site acreage: 0.25 acres Present land use: Single Family Residence Present zoning classification:R-40, Dwelling 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Eric Martz (b) Mailing address: PO Box 894 Mattituck, NY 11952 (c) Telephone number: 917.916.3724 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? 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. [Z]Yes ❑ No ❑Not Applicable Project will make beneficial us of coastal location, and minimizes adverse.effects of development. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section,M—Policies Pages 3 through 6 for evaluation criteria ® Yes ® No Not Applicable Project will have no negative impact on historic or archaeological resources. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No❑ Not Applicable Project will have no negative impact on on visual quality,or sonic_resources. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No❑ Not Applicable . Project will have no negative impact on flooding or erosion. Attach additional sheeis.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 1:1 Yes [:]'No I v Not Applicable Project will have no negative impact on water quality or supply. Aftch additiio—nal she ifnecessary 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 Z.Not Applicable Project will have no negative impact on 'Town of Southold ecosystems. Attach additional sheets ifnecessary 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 Project will have no negative impact on air quality. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluatiop criteria. ®Yes ❑ No r7l Not Applicable Project will have no negative impact on the environment. 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. nn ElYell No ✓0 Not Applicable . Project will have no negative impact on public access. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ®Yes [—] No ❑ Not Applicable Prolect will have oo neaatime!MP t on water-d nendent uses Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No Not Applicable Project will have no negative impact on marine resources. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No `❑ Not Applicable Project will have no negative impact on agricultural lands. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies;Pages 65 through 68 for evaluation criteria. OYes ❑ No ✓❑. Not Applicable Protect will have no negative impact on energy of mineral resources. PREPARED BY Eric Martz TITLE DATE 10.0