HomeMy WebLinkAboutTR-10534A Glenn Goldsmith,President *19 S®UT�® Town Hall Annex
54375 Route 25
A.Nicholas Krupski,Vice President P.O. Box 1179
Eric SepenoskiL Southold,New York 11971
Liz Gillooly thr Telephone(631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 10534A
Date'of Receipt of Application: January 22, 2024
Applicant: Nicole Eckstrom & Carlos Saavedra
SCTM#: 1000-104-5-22
Project Location: 590 Haywaters Drive, Cutchogue
Date of Resolution/Issuance: February 14, 2024
Date of Expiration: February 14, 2027
Reviewed by: Board of Trustees
Project Description: To conduct construction activity within 1 00' from the
landward edge of wetlands for the construction of an in-ground swimming pool,
stone terrace and pool shed.
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 Ryall Sheridan Architects, dated January 19, 2024, and
stamped approved on February 14, 2024.
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.
Xlennol PrWith, President
Board of Trustees
Glenn Goldsmith,President ���®� S®U��®�
Town Hall Annex
54375 Route 25
A. Nicholas Krupski,Vice President ® P.O. Box 1179
Eric Sepenoski E Southold, New York 11971
Liz Gillooly Telephone(631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SOUTHOLD TOWN BOARD OF TRUSTEES
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF
BELOW
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1st day of construction
'/2 constructed
When project complete, call for compliance inspection;
i
EXISTING BUILDING COVERAGE DATA PROPOSED BUILDING COVERAGE DATA
OVER UPLAND AREA (21,006sq.ft.) OVER UPLAND AREA (21,006sq.ft.)
DESCRIPTION AREA % LOT COVERAGE DESCRIPTION AREA % LOT COVERAGE SURVEY OF PROPERTY
HOUSE 1370 sq. ft. 6.5% HOUSE 1370 sq. ft. 6.5%
(2) ROOFS O73TI
& UTILITY ROOM 73 sq. ft. 0.3% & UTILITY ROOM ROOF O/STOOP 41 sq. ft. 0.2% SITUATE
GARAGE 453 sq. ft. 2.2% GARAGE 453 sq. ft. 2.2% C U T C H O G U E
SUN ROOM 144 sq. ft. 0.7% SCREEN PORCH 144 sq. ft. 0.7% TOWN O F S O U T H O L D
SHED 83 sq. ft. 0.4% SHED 83 sq. ft. 0.4%
TOTAL 2,123 sq. ft. 10.1% TOTAL 2,091 sq. ft. 10.0% S U F F O L K COUNTY, NEW YORK
S.C. TAX No. 1000- 104-05-22
EXISTING TOTAL COVERAGE DATA PROPOSED TOTAL COVERAGE DATA SCALE 1 "=2 0'
OVER UPLAND AREA (21,006sq.ft.) OVER UPLAND AREA (21,006sq.ft.) MARCH 28, 2017
DESCRIPTION AREA % LOT COVERAGE DESCRIPTION AREA % LOT COVERAGE 6
� JULY 5, 2018 ADD SPOT GRADES & FLOOD ZONES
HOUSE 1370 sq. ft. 6.5% HOUSE 1370 sq. ft. 6.5% OCTOBER 1, 2018 UPDATE SURVEY
FEBRUARY 16, 2019 LOCATE FLAGGED WETLANDS LINE
& UTILITY
73 ft. 0.3% 41 ft. 0.2% Y . JANUARY 20, 2022 ADD PROPOSED ADDITIONS
GARAGGEEROOM sq'453 sq. ft. 2.2% GARAGE
ROOM sq.
453 sq. ft. AUGUST 3, 2022 REMOVE PROPOSED CAR PORT
& 2.2% 1
SUN ROOM 144 sq. ft. 0.7% SCREEN PORCH 144 sq. ft. 0.7% .�: TOTAL AREA = 24,542 sq. ft.
SHED 83 sq. ft. 0.4% SHED 83 sq. ft. 0.4% 0.563 cc.•�8 q' 'e .• ♦' '• p'• °° ' UPLAND AREA = 21,006 sq. ft.
BRICK PATIO & PLANTER 70 sq. ft. 0.3% BRICK PATIO & PLANTER 70 sq. ft. 0.3% ,. ? ; 3 .'• ', WETLANDS AREA = 3,536 sq. ft.
PADS. WALK, APRON & 208 sq. ft. 1.0% CONC. STEPS & RAMP 289 sq. ft. 1.4% pt oRa�e oGK GARB AGE�!�N za
WOOD WALK 28 sq. ft. 0.1% CONC. PADS 22 sq. ft. 0.1% eE101
0ERTIFIED T0:
,. .
ASPHALT DRIVEWAY 2180 sq. ft. 10.4% TOTAL 2,472 sq. ft. 11.8% 5 I , CARLOS SAAVEDRA
TOTAL 4610 sq. ft. 21.9% to 1� •' NICOLE ECKSTROM
° CN
NA o 0 NOTES:
F NZo �� �'
N LogE � \P` N 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM
TxONY DE \y ,ONp� �p 1pro I `. EXISTING ELEVATIONS ARE SHOWN THUS: ED
01)� F.FL.- FIRST FLOOR
AN ey
2. FLOOD ZONE INFORMATION TAKEN FROM:
s •. . " ° ' ' FLOOD INSURANCE RATE MAP No. 36103CO164 H
A� �e '� VOG�G •• ; '•.° ! ZONE AE: BASE FLOOD ELEVATIONS DETERMINED
1.�" a' 9 ° ', .tl°• ' ." (f 1 ZONE X: AREAS OF 0.2% ANNUAL CHANCE FLOOD; AREAS OF 1% ANNUAL CHANCE FLOOD
Gpr\GG�OY�� G, WITH AVERAGE DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN
ppMpr\ p. �$\ G m n • •d ;..�;•: :, ' e e�-'•e' .� D`'.: 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD.
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y a .-. c of Trustees
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x �+' PREPARED IN ACCORDANCE WITH THE MINIMUM
T!1 r-
�..•• STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
C� I90 BY THE L.IAL.S. AND APPROVED AND ADOPTED
FOR SUCH USE BY THE NEW YORK STATE LAND
TITLE ASSOCIATION.
to FGU"
p,PE 69°2,3
S
0%`1
• N.Y.S. Lic. No. 50467
UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
LA
EDUCATION LAW. 1mathan Taft Corwin ill
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR Land Surveyor
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VAUD TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE Successor To: Stanley J. Isaksen, Jr. L.S.
TITLE COMPANY, GOVERNMENTAL AGENCY AND Joseph A. In a no L S.
LENDING INSTITUTION LISTED HEREON, AND P 9 9
TO THE ASSIGNEES OF THE LENDING NSFER Title Surveys Subdivisions - Site Plans - Construction Layout
INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. Ys - y
PHONE (631)727-2090 Fax (631)727-1727
THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York '''iig
ECKSTROM
SAAVEDRA
POOL
/ LAND N/O/F TAX MAP ID#1000-104-05-22
I ANTHONY DELORENZO �\ 590 Haywaters Drive,Cutchogue,NY 11935
I
I I
\ REVISION DATE
/l EXISTING GARAGE
I / (NO PROPOSED WORK)
I O QI O I
� )
41 TALL POOL SECURITY
I � �
IFENCE
W/SELF-CLOSING GATES I i
50'-0"
I / / 16'-5" 40'-0" 14'-0" I
1 I
EXISTING HOUSE
/ / (NO PROPOSED WORK) a WIRE BACKED PROJECT
El Cili
LIMITING SILT FENCE
/ c I / 102'-0" c, I
I N
/ I N. i PROPOSED STONE PATIO
/ Z - PROPOSED IN-GROUND �� I
I ? r / r o CONCRETE SWIMMING POOL
PROPOSED WOOD FRAMED PERGOLA
/ V I I II 1 I A A II I I
TREE TO BE REMOVED
WI / Y I n u 1 1 1
Z co
I tr� I II II I 11 II A fl II 1 I
0
/ CD 11 II A II II II I 11 11 I 1
/ GOT / Z I HO p� i - 51'-611
lL00
W /H Z —` I -
/ / W I / I � ` � v PROPOSED SHED FOR POOLcz o
Z - 1 4'TALL POOL SECURITY FENCE 3 I �., EQUIPMENT+STORAGE 1
W/SELF-CLOSING GATES o `" N 96sf; i.e. <100SF APPROVED BY
Q / g o I EXISTING I o I 14'-0" 50'-6"
t Cog SHED / I c I
Q / / 3 g I WIRE BACKED PROJECT ?� c BOARD OF I r�USTEES
o LL LIMITING SILT FENCE TOWN OF SOUTHOLD
moo /
�/ ----- ----- ----- ----- -------- ---- ------------------- -------------- ---------------- ---------------- DATE F� ry C-r
6'DIA.4VF POOL DRYWELL TJ '00��
/
Z
1 SITE PLAN
1"=10'-0"
_1 E C _
PROPOSED TOTAL COVERAGE DATA LAN 2 :9MP�
OVER UPLAND AREA (21,006sq.ft.) sour,n;j lown
. rd ofTnls'ces
DESCRIPTION AREA ° LOT COVERAGE
HOUSE 1370 sq. ft. 6.5% RYALL SHERIDAN ARCHITECTS
ROOF O STOOP 174 5TH AVENUE,SUITE 300
do UTILITY ROOM 41 sq. f t' 0.2% NEW YORK,NY 10010
646-809-4343 www.ryalisheridan.com
GARAGE 453 sq. ft. 2.2%
SCREEN PORCH 144 sq. ft. 0.7% PIROJECT#: 2110 ®�l
81-011 PROPOSED SHED 96 sq. ft. 0.5% Q \,
DIRAWN: NC
CEDAR CAP SHED (EXISTING) 83 sq. ft. 0.4% � k
CHECKED: NC
BRICK PATIO & PLANTER 70 sq. ft. 0.3% ,�fl
PIRINTED: 01.19.2024 gpRO
1"X1"WOVEN MESH CONC. STEPS 8C RAMP 289 sq. ft. 1 .4f
SICALE: 1"=10'
0
CONC. PADS 22 sq. ft. 0.1
A
ff
2"X2"ALUM.POSTS PROPOSED POOL 750 sq. ft. 3.6%
PROPOSED PATIO 597 sq. ft. 2.8% SITE PLAN
TOTAL 3915 sf. ft. 18.6%
P�-V-0�"
CURITY FENCE DETAIL
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I
SOUTHOLD T ,
-RUSTEE
No.00 le
-�oS3y
Issued Toirl-kaimM , t� li,.:m Dade
Addiress-,-Sk �►.,./ 1s� V�� �� �J)��� f � -
THIS NOTICE MUST BE DLSPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,T011VN OF SOUTHOLD
SOU7'HOLD, N.Y. 11971
TEL.: 765.1892
_-
Glenn vo'iusriith,President ���o �OGy Town Hall Annex
A.Nicholas Krupski,Vice President < 54375 Route 25
0
Eric Sepenoski ,z P.O.Box 1179
Liz Gillooly �y • Ott Southold,NY 11971
Elizabeth Peeples l �a Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
-Date/Time: /*7 47 Y Completed in field by: (apsP
Niall Carroll on behalf of NICOLE ECKSTROM & CARLOS SAAVEDRA requests an
Administrative Permit to conduct construction activity within 100' from the landward
edge of wetlands for the construction of an in-ground swimming pool, stone terrace and
pool shed. Located: 590 Haywaters Drive, Cutchogue. SCTM#: 1000-104-5-22
TypMaltwater
f area to be impacted:
Wetland Freshwater Wetland Sound Bay
Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other
Type of Application: Wetland Coastal Erosion Amendment
VAdministrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: Yes No '� Not Applicable
Info needed/Modifications/Conditions/Etc.: 1,
Present Were: G. Goldsmith /N. Kru ski E. Se enoski
p p
L. Gillooly E. Peeples
OFFICE LOCATION: �o��OF SOUj�,olo MAILING ADDRESS:
. Town Hall Annex P.O. Box 1179
54375 State Route 25 l Southold,NY 11971
(cor.Main Rd. &Youngs Ave.) N
Southold,NY 11971 �Q Telephone: 631 765-1938
COW T`I,Nc�
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
To: Glenn Goldsmith, President
Town of Southold Board of Trustees
From: Mark Terry, AICP
LWRP Coordinator
Date: February 12, 2024
Re: LWRP Coastal Consistency Review for 590 Haywaters Drive Swimming Pool
SCTM# 1000-104.-5-22
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 and the records available to me, I recommend that the proposal is
CONSISTENT with LWRP Policies and with the LWRP.
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. ®F's0&LN Ty
Town Hall Annez
® ` 54375 Route 25
A.McholasKrupski,"Vice;President :�®. ��
P.O.Box 1.179
Eric Sepenoski
Liz Gillooly. ;G "
•• h New York"11971 Southold,' w
Elizabeth Peeples ' " • Telephone(631) 765 1892
Fax,(631).765-6641- ".
BOARD OF TOWN_TRUSTEES. . ..
TOWN:OF.SOUTHOLD ..
This Section For.OfTee,UseEC
Coastal Erosion Permit Application
Wetland Permit Application
7_Administrative Permit.: 2 2024 .JAN 2"
Amendment/Transfer/Extension.,..
,.22•
. Received Application;.'. Southold Town.
)C .Received Fee: $7�.� of Trustees
Completed'Application: i.22. .
Incomplete::_
-SEQRA Classification:: Type I " Type IL Unlisted Negative Dec: Positive Dec:'
Lead Agency Determination.Date:.
oordination:.(date sent):.'
—✓.LWRP Consistency.Assessment Form Sent:
CAC Referral:Sent:.
Date.of Inspection:. : : . 2'�7�/ .
,Receipt of CAC Report _.
Technical Review:._.
Public Hearing Held:
Resolution:
•
•
Owner(s)Legal Name of Property (as.shown
Deed):I�)CALC fiCkSTlZaM f CkIR S fid�dYF�/lv0 .
Mailing:Address.: 17a Fl/I�(Lh%11Q11� .jT K410.Ow . /�/
Phone Number:. . 6.Y 6.
Suffolk County Tax Map.Number; .1 000 104 p:
Property Location:„ cS`Q 1J"Q�r�rQ�G� D�:[.�1.t1 C�IOGU'6
Of necessary,-provide LILCO.Po16#, distance:to cross.'streets _and location)-
AGENT(If applicable): Af iL :: C.4R:JGOLi "
Mailing.Address: . I L �5�`° �,` Su:I 76. 3c�o� .NG�' :Yo t x. " NY" 10016
Phone Number: T 1 3�.5" g�f6 Email -
::n l'a�L r' I�1S�12,rloi
- _
Board of Trustees Application . _
GENERAL DATA
Land Area(in square feet):: ._
Area Zonin .
g:
:Previous use of property::Ifl/t/G-. FArw
Intended use.of property` : S
V . .
Covenants,and Restrictions on property?- _aYes No
If"Yes"-. please provide a copy.
Willi his project require a'Building Permit as per.Tow.Code? Yes Ln.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 froni the.Zoning Board of Appeals? Yes.. _No
If"Yes",please provide copy of decision.
V�iqhis project re ariy'demolition.asper:Town Code or`as determined-by the Building-Dept.?.
Yes
Does the structure(s) on property have a valid Certificate of O.ccupancyz Yes No
Prior permits/approvals,for site improvements:
Agency. Date. 3
Z"oww7tt,ti
Zo 2-3
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): _.0 F IN.�GlylUll�
!4n%k.k-ft8 . S-MM►ik'6- I004.t t.. S'Tgn/cS j Gic. CG + Poo[:. .: HOP..:
Board: of Trustees Application
NW
TLAND%TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Irl15f� 1�I 6�1/T/�4.L f fL6GR CtA7 /oNA
Area of wetlands.on,lot:, 3 .Lto 3 _ square feet
G . .
Percent coverage of lot; 'O % . ('11.0�'OS �
% . .
Closest distance..between nearest existing structure and upland.-edge of wetlands:_ feet:
l
Closest distance between.nearest proposed structure and.upland,edge of wetlarids.:.�Q 2 : feet
Does the,proj ect'involve excavatiori-or frllin . 0 No Yes
.es If ..
•r - Y ,how much material will be.ex'cavated? ` � cubic yards
How much material will be.filled?: . 0. cubic.yards .
I '
-
Depth of which material will be removed:or;deposit ed feet
Proposed:slope.throughout the.area of operations:
i
Manner in which material,will be removed or deposited:. `TSG _SQJ ._hW LL' .VC
ExGA'✓A T60 U-S)A A ;MGC~(A L E?GL:c✓ -"o/L.'-4WV wtLL
- : : 13b .. dd�u.l.6a .'�y✓ ay. TiLtiaaL. ': -: - - __- -. -
Statement of the effect,if any;on the wetlands and tidal waters of the town that may result by .
reas,on.of such proposed.operations (use attachments if.appropriate):
lv�u _ l z No. EFFE cr
C6 M04;.A T14AW 100 . F��T -fhawl:. . TXt�. �✓ l W/t ill
APPLICANT/AGENT/REPRESENTATIVE:
TRANSACTIONAL DISCLOSURE"FORM.
The"Town"of Southoldi,;Code of Ethics prohibits coi►flicts=of inte?eit on:t[ie part of town officer's-and"employees:The nuroose of;
_ f
—• -
ahis_fomi';is to•piovide"inforiiiation which can alert"tlie`to'wn of nossible conflicts'of interest"and=allow it to`Cake-wfiateveraction is
necessary t&avoid same: "
YOUR NAME:.
Last name $rstname iddle initial;unless ou area I in lri the name of , .
ei r,iP( Y PPY g�
someone: se or other entity;such as a company.If so;indicate the other
S,
persons or company's name.)
NAME OF.APPLICATION: (Check all that apply.)"
,. Tax' devance" Buildin
g g ,: . "
• Variance Trustee" "
rf. -
Change.ofZone Coastal Efosion"
Approval of plat. - Mooring
Exemption from"plat or official-map Planning -
Other "
(lf"Other",name the activity.)
Do you personally;(or through your•.company;spouse;sibling,parent,of child Have a.relationship with any off cer or employee
of the Town ofSouthold?"".Relationship"in cludes•by'blood;;rnarri5ge„ot b'u§iri@ss interest:"Business"ipteresP•means.a tiitsiness,;
including a partnership,in which the-town offcei'.or employee;has even-a.partial ownership"of-or employment-by)a corporation
i wofer or employe:owsmoe % hwh o - ares
YES ..
NO - -
�. If you answered"YES";complete[he;balance of this form anddate and sign whets indicafed:
Name of person,employed by the Town of Southold.'
Title:oi"position of that person
..
Describe the relationship between yourself(the applicant/,agent/representative),and the town officer&employee.,Either check
the:appropriate line A)thtough-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 S%of thc•shares'of the corporate"stock"of the`appticpnC
. . (when.the appiicant is a corporation);
B)the.legal o al owner of any interest in a non-corporafe;entity(when.-the
r beneficial
applicant is not a corporation);
C)an officer,director,'partne,"or employee of the applicant;or
D)the'actual'applicant:
DESCRIPTION OF RELATIONSHIP
Submitted this day of �.AN 20
re 2 . . .
Signatu . _
PrtntName ' AOAL[_.. "U/liZo%i_
Fonn TS 1
AFFIDAVIT
Carlos Saavedra+,Nicole Eckstrom BEING DUL'.Y'SWORN
DEPOSES AND AFFIRMS THAT HEISHE.ISTHE APPLICANT FOR THE ABOVE
DESCRIBED PERMITS)AND THAT':ALL'STATEMENTS CONTAINED:HEREIN
ARE TRUE TO THE BEST'OF HIS/HER:KNOWLEDGE AND BELIEF,AND THAT
ALL WORK WILL.BE;DONE IN.THE MANNER SET FORTH IN.THIS APPLICATION.
AND AS MAYBE APPROVED BY THE SOUTHOLD TOWN.BOARD OF TRUSTEES;
THE APPLICANT AGREES TO HOLD THE:TOWN OF SO[JTHOLD AND:THE
BOARD OF TRUSTEES HARMLESSAND:FREE:FROM ANY AND ALL DAMAGE_S
AND CLAIMS ARISING UNDER OR BY VIRTUE ' PERMIT(S),
' SAID IF
GRANTED,:IN COMPLETING THIS.APPLICATION,IHEREBY AUTHORIZE THE
TRUSTEES,THEIR AGENT(S)OR-REPRESENTATIVES,INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY-TO
SPELT 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
.F THE..PERMIT:
roperty Owner 'Signature of Property.Owner.
SWORN.TO BEFORE NIE THIS DAY OF. ,:Zp
i
Notary:Public
J
Board of Tru8tooe _plication
a
AUTHORIZATION
.(Where tite applicant is not the.owner)
UWe, Carlos Saavedra+.Nicole Eckstrom
owners of the property identified as SCTM#Woo.104-05-22 in the town of
Southold N
New`York,:hereby authonzes..
Niall Carroll to act as my agent and handle all
necessary work involved with the application process for pemut(s)from the Southold Town
Board of Trustees for this propertyel
Pro s Signature - _-- Property-Owner's Signature
SWORN TO BEFORE ME THIS DAY OF6itu.. ,20 Z
: .
`-\ •��' KAMAL R SONI,
:No wry Pubilc,8tete:of,New York,
No•01 S066819 49 '
.Qualified In Kings County
,,v. C$MMIssion Expires March 31,,202r
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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:characier 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 i
If Yes,identify I
J
8: a.Will-the proposed action.result in a substantial increase in.traffic;above,present levels? NO YES'
public transportation services avail b.Are p p able 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? >di
9.:Does the proposed:action meet or exceed the state energy:code requirements? NO.. .;YES: . }
If th;e proposed action-will exceed.requirements,describe design features and technologies: IA I
!
10: Will the;proposed action connect to an.existing public/private water supply? NO.7 1 YES
No,describe method for providing potable.waterc
If �/ a ❑ `
I I.Will:the proposed'action conriecfto existing wastewater,utilities? ;NO .;YES ;
. No,de for prov ding wastewater treatment:
_If. scribe method i stewater treat P
�.
12. a.Does the site contain`astructure 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;ofthe site.of the proposed action,or lands adjoining the proposed_action,.contain ' NO. YES'
i 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?
l
If Yes,identify the wetland.or waterbody and extent of alterations in square feet-or acres::
L 14:` ratify the typic bitat types.that oc n,or are likely to be found.ont rojecf site: Check allahaf apply:
Shoreline Forest Agricultural/grasslands Early:mid-successional
Wetland Urban Suburban.
'15:Does the site of ihe.proposed action•contain any,species of animal,or associated habitats,listed NO . -YES
S
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.6reate storm water discharge,either from point'or non-point sources? NO
If Yes,
a:Will storm water discharges-flowao adjacent;properties? NO ES
El D ..
b.Will storm water.discharges be directed to established conveyance systems�pff an m drains)?
If Yes,briefly describe: q. . YES •:
Page 2 of 4
18.Does the proposed action"include construction orotheractivities that result in.the impoundment of NO. •YES'
Water or other liquids:(e.g.retention-pond,waste"lagoon,,dam)?
If Yes,explain purpose and siie:
ED
19.Has the site of the proposed action or an adjoining property been the'location.of an,active.or closed NO YES
-
solid.iaaste:management"facility?
If Yes,describe:"
t
20.Has•the.siie.of the proposed action"or an adjoin ing.property,been the subject"of remediation(ongoing or NO" " YES
completed.).for hazardous waste?
i
IfYes;describe: ❑
I AFFIRM THAT"THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE.PEST OFF.MY
KNOWLEDGE .
Applicant/sponsorvame.:_ AA
_ _l Date:
1�nJlA-L " - !!!
Signature:. .
Part 2-Impact'Assessmem, The Lead Agency is responsible for the completion of Part 2. Answer all ofthe following
questions in Part2"using the information contained in Part�l 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?. .,
a 0
2. Will the proposed action result in a change in the use or intensity of useof land?
K Will the proposed action impair the character or quality of the existing community? a1
4..'' Will the proposed action have an impact on the environmental:characteristics that caused the
establishment"of a.Critical Environmental Area(CEA)?. Ell a
5. Will the proposed action result in an adverse change in the existing level of traffic of
affect existing infrastructure for mass transit,biking or walkway? El
i 6, Will the proposed'action cause an increase in the use of energy and it fails to"incorporate
El reasonably avai lab le:energy.conservation or,renewable energy opportunities?. . " F.
7: Will the proposed action impact existing:
f a.public/private water supplies?
b.public.1 private wastewater"treatment utilities?
8. Will the proposed action impair'the.character orquality"of important historic;archaeological,
El o
architectural or aesthetic resources?" . .
9. Will the.proposed action result in.An adverse:change to-natural resources;(e.g.;wetlands,
El
water groundwater,air quality;flora and fauna)?
Page 3 of 4
N6;or ` Moderate.;;
small to lar
ge
impact impact
-may may: . .•� '.
i.
—
-,occur occur• .
il'] 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 resource'or human.health?
Pket 3=Determination of significance: The Lead Agency,is responsible for the completion of Part For every I
question in Part 2 that was answered"moderate to.large tripaet inay occur",or if there is itzeed to explain why a particular
element of;the proposed action may or will not result in.a.sigriificant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail;identi e impact,including measures or desi n elements thathave been included b
fYth a
.. 1? . , g.any m. . g y
the project sponsor to'avoid or reduce impacts.. Part 3 should also.explain how'the lead agericydetermined that the impact
may or will hot:be' significant.Each potential impact should,be:assessed considering its.setting,pro6'bility.ofoccurring;
duration,irreversibility,.geographic scope and magnitude: Also consider the potential for.short-term,.long-term and.
cumulative impacts:
•
a
i
t
Check.this.box if you have determined,based oii the information and analysis above,and any supporting documentation;
that the proposed action may result in one or more.potential ly large or.sigoificant 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 eriviront-dental impacts:
Town of Southold-Board of Trustees
Name of Lead Agency Date ---
Pres
ident
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer;in Lead'•Agency Signature'of Prepares(if different:from Responsible Officer)
.:PRINT
Page 4.of 4.
Town of Southold
LWRP CONSISTENCY:ASSESSMENT FORM
A. INSTRUCTIONS
I..-: All. applicants for:permits*. including Towri of Southold'.agencies,.shall.complete. this. CCAF:for �
proposed.actioris that.are subject.to the.Town of Southold Wate&6nt Consistency Review Law. This
:. assessment-is, intended to supplement.:other information used by a.Town of.-Southold agency in.
making a determination of co''nsist6ricy *&xc pt.:minor.exeinpt-actions fncludit;Buildfng'Permits -
and other ministerial permits:not located within the Coastal Erosion Hasard 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.
er&ont eAtal on Pr am: nrono action. will`. be� evaluated: as, to its si nce
Wat.. R izati ogr _ rA sed
i.. beneficialrand`adverse effects:.upon the eoastah•area=fwhicli'.includes'all:Of SoutholS Town).,
an uestiori in Section C on.this form is answered es .or . no then the. ro osed action will :
Y q. y,. . .. p. P.
.affect the.achievement.of-the LWRP.policy standards.and.:conditions. contained.in the consistency:. !:
review.law. Thus, each<answer_must W 6xyhdned:in detail;_listiug both..supporting.and non'
sii ipo ng,:faets: If an action:cannot be certified as consistentwith the.IAW policy standards:arid `
conditions,it:shall not be•undertaken:
A copy of the LWRP.is available in.the £ollowing.places:-online at the Town of Southold's'
website(southoldtowii.northfork.net);.the.Board 'of Trustees 01 0 the:Planning_Department.all
aocal libraries.'and;the Town.Clerk's office: ..
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM#. QaD: :- 10
22 : :. . .
! PROJECT NAME S`IO. .hl A.yV✓WT67/L:S. D!L l:✓'6: SWIM M r/✓ti- /? L.
The Application has been submitted.to(check.appropriate response):
Town Board . El. Planning Board Building:Dept.. Board.of Trustees
.• . 0 .. ;
1. Category of Town of Southold agency action(check appropriate:response)c -
- . (a) Action undertaken directly by.Town:agency(e:g:capital
. tion,.planning activity,.agency,regulation;lan construe d transaction)
•
(b) . Financial.assistance(e.g.grant.loan;.subsidy)
(c) Peninit,approval,license,,certification:
. : Nature and extent of action
C�wS'm.+Lt L7►�rJ:_py I,v--C 094A, wC 76. -1mr4i hG--:!'A�L: :
Location.of action: 10YWATU S. p�i;llr•( : �urC ia�o-u-6 .
Site acreage: . . (L•'$' 3.. -
� � � °l
Present land use K-E
, o � POS C D
Present zoning classification:
2. __ If an application for the.proposed"action has.been filed with the Town of Southold agency, the following .
information shall-be,provided: .
r
(a)'Name of:applicant:NrA VL:GARRn VL: :Fad_ �ViGOh6 .6�I�f77IlAM:t:6&t 0 S. ht1JQ1'6prl,y0
(b) Mailing address:. :�'4 S : iQ Su 17�C 3 oy /VGA✓ �1 4/`l: :I 04/ Q
(c) :Telephone number .�.
Will the.action,be directly undertaken,require funding;or approval by a state or federal agency?
Yes NoRb� If yes;which state=or federal-agency..
g ncY�
: C. Evaluate the.project.to the following policies:by analyzing how the_project will further supporf or . -
j not support the policies. Provide all proposed Best:Management Practices.that will further each policy.
1" 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,Imakes efficient-_use::of.infrastructure, makes beneficial use of a.coastal location,and
minimizes adverse effects.of development.:See LWRP Section III Policies; Page 2,for evaluation.
criteria:.
Yes : ❑:No..❑.Not Applicable
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
Od Yes No Not Applicable
'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 epaluation,criteria
No Not•A Yes pplicable
❑ .
Attach additional sheets if necess
ary: .
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:1,6ahrough 21 for evaluation criteria.
❑"
Yes: No ❑Not Applicable
ttqcl nal Sheets if necessary
Policy 6. Protect and restore the quality and function'of.the Towu of Southold. eeosystems including-=
Significant. Coastal Fish and Wildlife Habitats and wetlands. See LWRP.Section HI-Policies;.Pages-22-- .
through 32.for:ova luation.criteria.
Yes ❑No,❑ Not.Applicable
a
Attach additional sheets ifnecessary
'
Policy. 7. . Protect and improve air quality.in .the Town. of-Southold. See LWItP Section III'—
,Policies
Pages 32 through 34 for,evaluation.criteria:,:
Yes No Not Applicable
❑ ❑
•. . k
Attach additional sheets.if necessary
Policy 8. :Minimize environmental_.degradation in Town of Southold: from solid waste:and.-hazardous:_'
j substances and wastes: See LWRP Section III Policies; Pages 34 through 38 for evaluation criteria:
is ..
"
Yes . No Not Applicable �
f' .
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:
Ye, . No Not Applicable
Attach additional.sheets if necessary
WORKING COAST POLICIES
i
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 blot Applicable. .
❑ ❑
Attach additiona'rsheets if necessary
Policy: 11. . Promote sustainable use .of living marine resources. .in :Long. Island Sound, the Peconic
Estuary and.Town waters...See LWRP.Section:M--Policies;,Pages 57 through 62.for.'evaluation.criteria.:
El- t
Yes' No Not:Applicable
I.
Attach additional sheets:if.necess arX . �. ..
1 _ Policy.12.. Protect agricultural lands-in the Town 4.Southold. See LWRP Section.III=Policies;.Pages
62 through 65,for evaluation criteria:
..
•
j
Yes.'❑ No ' Not Applicable
— I
77
_ 1
Attach additional sheets if aecess ary.
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 A
. . ❑ PPlicable
DATE
PREPARED BY:: /�LL. 44 AAOI L TITLE.:_ I 2.