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TR-10532A
Glenn Goldsmith,President ®f So Town Hall Annex ®� ®� 54375 Route 25 A. Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoski IV OW _W_ AL Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples ® a® Fax(631) 765-6641 tifl 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; Glenn Goldsmith,President ®f SO UT Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25® �® P.O.Box 1179 Eric Sepenoski l Southold,New York 11971 Liz Gillooly � -c Telephone(631) 765-1892 Elizabeth Peeples ® �14Z Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10532A Date of Receipt of Application: January 31, 2024 Applicant: Matthew Glassman & Tracy Heller SCTM#: 1000-111-9-11 Project Location: 4995 Nassau Point Road, Cutchogue Date of Resolution/Issuance: February 14, 2024 Date of Expiration: February 14, 2027 Reviewed by: Board of Trustees Project Description: To construct a 6'4"x10'2" second floor dormer addition onto the landward side of existing 1.5 story, 1,882sq.ft. single-family dwelling with 81 sq.ft. attached deck; 312sq.ft. enclosed patio; and 135sq.ft. covered stoop; verify and upgrade stormwater drainage system for existing dwelling; and to establish and perpetually maintain a 10' wide, approximately 1,860sq.ft. non-turf buffer to be planted with native vegetation along the landward edge of the top crest of the bluff. 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 Frederick Robert Weber, Architect, received on January 31, 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. 41�_ 4471i�-Wx Glenn Goldsmith, President Board of Trustees SITE DRAINAGE: DR# AREA VOLUME (Required) DRAINAGE STRUCTURES VOLUME (Provided) r\• F� ', �`, 'mr�BER _.. .. _ . ._. .._ . FREDERICK A, B HOUSE, PORCHES 2362 sF x .166' Ram = 392 cf (2) 8' Dia. x 5' Deep w/ 422.5 cf 5 \NG '\ ` ` ' '\ '\ 1\��,►.\ Oo —� ROBERT Traffic Bearing Top SELL \ \ _ _ . . ; ! WEBER ` OI \ Co JAN 3 1 2024 v� House and Porch Roofs to have Gutters t Leaders Connected to Underground Drainage Structures (Typ.) ' 1` '� \' ' ' ' I I ARCHITECT l \ \ I 1 \ ' I ` \ \ ®® Os 8'0 Ring: 42.25 cF/Ft of Heighti''1 +, 1�1 +�I \ \\ \\ ,., __ ..... CONCRETE C.I. GRAVER TE \ 6 311 ,\�5��:::•::I::. '\ `\ ��`\\\\` \ \\\\\;\ `\\\ .\ \\ \\ �r `,` F"�I TRAFFIC BEARING m .....:. ::. SLAB PRECAST TO \ \\\,\\\\\\ `�,� `� \ \ \\ \,\ �� CONCRETE OR \\ CHIMNEY 0 t 5. P \ \\`�\\\�\\`�\�1 \ 1 'i 1\ \ `\ \`\ `� ( ter✓ DRAINAGE N LOT 3) \+�\ \\\ \\ \ r _/ / i PIPE i -- '+�1 �, � I\\ \\ \ �L\ \�,\\\\ I\ �� APPROVED B Q IS b� -� �p\L / :\:;:: t \`\\\\\\\\\ \\ \�\\\\ `\ \\ '+ �\ `� o BOARD OF RUSTEES I---I TYPICAL O w 1 �O GONG / / 'C�:3�•_••;•:• \� `\ \ \ \�\\ \\ \ \ \� `� \ \ \\ eo �< ycn �`_� TOWN OF SOUTHOLD W DRAINAGE % 'y �o RING >1 58 ��ro :::: :: :. \ \ \ 1 \ ` \ \ �� 'o --�/ DATE � ' Fed ruo,rY El ........ \ ` \ \ 2 CLEAN SAND t I / / '\ ` ` \ \ \ \ ` \ ` GRAVEL FILL / l \ \ \ .......... ----------__----------J / .......... CID TYPICAL SECTION DRAINAGE RING ���°3 --� ��� ,I 1 `\ \ \ \\ \\ \\ :.:.off.:..:.:.}. \ \ \ \ Q C) Aa41.2 O` 8 ''' w. \ \ \ \ \ \ \ \ \ \ \ \\ \ \\ ` \\ \ \ 100, moo `....: o ~j Rep\at`qced \\_�JI _- - 0. \` ` \ 60A, k It ko ll�O lb A X\5�`NC`( IR��9 0• S VFui,4 \ SOT 33 Rev \ /?' \�\ fA a+ \ \ \\ \\ \ � O�� � :•:cat`::�:•:�. \\ \ \\\ ENO F+� s \ . �\ \ _ — ....r.. \ \ \ \ \ I 1 ` 4'�' \ ONc• +` o�\ ::` ::':: :. \ \ \ \ I o DRAWING TITLE. e� SITE PLAN 00 6 . \ I I , \ I @ r �, •i PAP \ \ \ \ M Cv sT 4� p JOB: ° i '1 \ `� �o�_=� ' 320 DORMER ADDITION �e\\ (2ND FLOOR) 4495 NASSAU POINT ROAD 1 CUTCHOGUE. NY TOWN OF SOUTHOLD SCTM# 1000—III-09—II PROPERTY OWNER: \ \ _ S8 6 \\ ` ��` J 3a "GROSS g FLOOR AREA" MATTHEW GLASSMAN t TR,ACEY HELLER LOT SITUATE: CUTCHOGUE (NASSAU POINT) ARCHITECT: BUILDABLE LAND: 49,441 SF TOWN OK COUNTY,NEW PORK LOTS 40,000 TO 80,000 SF: 5100 SF FREDERICK R. WEBER LOT AREA IN EXCESS OF SURVEY INFORMATION: 41 EAST MAPLE ROAD 40,000 SF = 9441 SF x 5%) 412 SF KENNETH WOYCHUK GREENLAWN, NY 11140 TOTAL GFA ALLOWED: 5512 SF AQUEBOGUE, NY 52 NOYAC PATH SURVEYED: JUNE 3, 2023 WATER MILL, NY 1191L +O 0'LAST REVISED: ELEVATIONS REFERENCED TO NAVD of 1988 TEL +L31 154-5555 1 \\ "GROSS FLOOR AREA" SCTM# 1000—III-09-11 fweberarchitecteyahoo.com i 70 �ZO 036 LOT AREA: 63,421.2 S.F. 0.46 ACRES) SEAL: S�$ \ IST FLOOR LIVING: 1850 SF . ='"•'= :•.. SUN PORCH: UPLAND AREA: 49,441 SF (1.14 ACRES) .. 294 SF (LANDWARD OF BLUFF) IST (Greater than IS ): 88 SF r. • is . '•. ," s ' \ >-\ ZONING: R40 Arr±w A, \ \ 2ND (Greater than 6 ): 596 SF c' {hYr \ 3 \\ OEGK \\ TOTAL EXISTING: 2828 SF YARDS: (PRINCIPAL SETBACKS) .s.._ \ \ + FRONT 50' \3.3 �> ADDITIONAL w/ DORMER: 31 SF SIDE (ONE): 15' \, ,� . . TOTAL PROPOSED: 2865 SF SIDE R: 50'H>: 35 DORMER SETBACK NORµ \� {aP� \\\ LOT COVERAGE (ALLOWED): 20% (MAX.) SITE PLAN \ EXISTING HOUSE: 1882 SF COVERED STOOP: 135 SF ENCLOSED PATIO: 312 SF 1" = 20'—0" \`\ NOTE: EXISTING HOUSE HAS GUTTERS DECK: 81 SF JAN 24. 2024 -' AND LEADERS CONNECTED TO BLUFF DECK: 165 SF REV.: OCT. 10. 2023 UNDERGROUND DRYWELLS,. CONFIRM COTTAGE: 188 SF CAPACITY, (REPAIR, REPLACE, COTTAGE DECK: 644 SF DATE: SEPT 21. 2023 INSTALL AS NEEDED) TOTAL: 4001 SF SCALE: In = 20' LOT COVERAGE (EXISTING): 8.1% JOB NO: w202305 YARDS: (ACCESSORY SETBACKS) (LOT SIZE: 60,000 TO 19,999 SF) SIDE t REAR: 20' DRAWING NO. FRONT (WATERFRONT): 50' MAXIMUM HEIGHT: 22' MAXIMUM AREA (63,621 x 3%): 1908.E SF A I OEG� OF A4 2 S.C.T.M.# DISTRICT 1000 SECTION 111--BLOCK 9 LOT 11 1 1 1 1 1 11 0 1 1 1 1 --1 r 1 1 1 1 1 CJ 2 STY FIRM. 1 1 DWELLING F1 1 J ZONE X, , 1 1 ZONE VE(EL 11) I I I j 1 ► 1 'TIMBER 1 `� 1 WALL It rn o t ;; DWELLINGS WITH �� O 1 ip; 1, to I i \ 6.#2 I o1 OPUBLIC WATER III I1I 1i I 150, LOT 31 317.50, # II 1 Il111, 1 111 , 111 \\ I 8 , 1 d BWyI. 1 I 1\►I,�II1� 1 \ \ \►\ 1 1 ' ^`/ ea6. �\` � " # CON## #•#` Welt. ,t �,,\�`\�\\\` � �` �\ � 1 C t \ 78°36120 t 6 SW # ew5a.5 V111 ` 1)�! 1��(,, `j`; 1 , 1i ; �v '��✓ 12"MAPLETV t }� � (I (( I l 1 1 PI \. � � -- � / •• __ _� 1�� 1`\, 16"OAK r� 16'MAPLE 54 ( ►\ ► `t 1 \ \ \ 1 1 4r ♦\ �♦ 1 14"MAPLE 12"MAPLE `1} 1 1 I! 1 ► 1 1� I 11 ` 1 F \ 6 GJ ►1 \\ ; { I I 1 1 I 1 t` ► 1_^ Cf 1 ` `\ \\WELL It12'MAPLE N 1, ►1 I t 1 t ' 111 � f'12'pAK Q E'ti",�i,,,9� 12'OAK1111II1♦ \ 16"OAK 16" t 1 \ � O ♦ . \ w � tn!;i ,=11111�11\,` It� 1►i 1 1 i 1 I � o '�� n N \\ Z \ \ 1 Oz�AK o 1 I I t l 111 ;11 I + 1 1 11 I j l ( 1 1O7^ ` 12.OAK \` B ♦\♦ DRAIN 6"° I `AK ► I 11►;11 II 1 11 `♦`c 12"PINE 4 ♦ ZONE X I ► kill 11'WI I 1 , 11 1 1 ; t� \ /� ,\ LOT 32 1 , \ Ot,\ 1 ' 1 \ 1 + 1 ^� 1 12"PINE ► 1 1 + ► 1 1 1 ► I I o f �\ \♦ `CFO \ \ ` 11iI `���\ i \Oi�� \ R/ ♦ EL 52.5 45' , t + v + g \ ` \\ \ \ `>..;a' `t•;�Y EL 52.9 39 2� ` 1 1 1 i 1 1 i' %i 1 �1� i 66 �\ qY\` 16.OAK m t , t 1 ;l 1 , I I ; 1 ; '1 1 ► 5.5 *0 A 41.5' A 24' :` 1 11 1' 1 1 ► i 1 \\ ' ` 11 12'OAK` \ ♦♦ \ 8 32.5' i18.2' m y UTILITY CONNECTIONS C/� \\ ~\ \ o:::{:::' •b? $ i ' 1 i 1\ \ \ ► 11 .' a TO COTTAGE HAVE 65 \ I ` 1 BEEN DISCONNECTED �\ \ \♦ �♦ \ -- SANITARY'� I —j'Z^I Q, I 1 ! 1 t ` t 1 1 �' .'.'': b0 N E—i_ \ R� LOT33 DWELLINGS WITH E i `1 —# E 1 �1 12 STY;:'.:: L 1 t ► 1 , 1 1 f I 1 1 � ; •...,� . /'`' PUBLIC WATER O ` -'�. {.':'•;:'•:�:FRM. :'r,.:,,:. ti 1 11 i i i 1 � ' I I I i t 1 1 '- 150' 7, U.P. GUY % /1z^oAK� ) �E�E.zEE =E oG `v'DWELLING:;•': \ ,1 1 1 1 1 1 11 1 ► ► 1 , 1 I / i ' BF �.E_E�. :: .#4995;•;•'::'• \ I I i t 11 ' I i 1 1 1 1 i i 1 1! ,z e1>< / % , ! Ems, :at "' ♦ 1► , 1 I ► 1 1 I ; 1 1 1 WOOD 11 E�.E \ :..''•::•.,:.::':::..::•:'' 41' \;1 ,; I , 1 i 1 , 1 ► 11 ► DECK111 E` . . i ,► , ' 1 I 1 I 1 1 1 ( i.� E1.15. 1 A ::.COT�. ` 1 1 ► 1 I t ; t \ 1 1 12'OAK// DRAIN P �'G METER' 'i;;:::.::::':::::::: A ; I I ; I 1 1 , \ 1 1 1 14.3 6.1 11 .6' Jr2 1 I i{ ` i 1 1 ; 1 1 \ ~� x I 12'O / % �GF 1 M.M. Irz' ro t 1 1 1 '0) 1 ) I 1 30'oAK t s�o2� °zP "'•':''`:.".` .'.` . =;, 11 li ; I 11 t 1 I 1 1 ► i j"'1 ( \ \\.-...� 5- ' � i � � `�`� \��\ � } •.��R� — ; �� :'.Zp.4'•'�••'•`•�''• coNc w � � ► II li 1 1(�11 ZONE VE(EL 11) EL52.3 � $ ` , 1 1 1 1 1 O 1 1s•oAK ip EL 52.3 N ` I I , 1 1 ' HONE X It►1 ,t I � 1 1 ` \�\ \ �\ ♦`��.� N �� 1 '' FEMA FLOOD ZONE BOUNDARY 12"OAK [. ' 15*0 Or-''� \ \ � 66 �♦� �\ \ ♦ \ i W.M. /�^� 1510 `\ \ . ♦` \ LOT 34 O 6' ` S 7g°36 20 "t 12•oAK \ `2' ACCESSORY STRUCTURE NO SEPTIC/NOWATER �. \. U.P. 1roAK 100, 12•oaK DWELLINGS WITH PUBLIC WATER 1550' LOT COVERAGE T BUILDABLE LAND(LANDWARD OF TOP OF BLUFF):49,441 S.F.or 1.14 ACRES DWELLING: 1882 S.F. COVERED STOOP: 135 S.F. DECK: 81 S.F. I DECK ELEV. 52.0 ENCLOSED PATIO: 312 S.F. I BLUFF DECK: 165 S.F. I 2 STY FRM. I MIXED SAND COTTAGE: 788 S.F. GARAGE r & LOAM 2, COTTAGE DECK: 644 S.F. I TOTAL: 4007 S.F. or 8.1% SP PALE BROWN FINE SAND NO WATER )7' JAN 3 1 2024 i 1 I ' �--\ AUG. 15, 2023 1Ibm McDONALD GEOSERVICES , 2 STY FRM. i pECKI of Eya<'"c1 I DWELLING r 1 FEMA MAP#36103CO164H I r— THE WA7FR SUPPLY, WELLS, DRYWELLS AND CESSPOOL ` J LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS. I—' BUILDABLE LAND(LANDWARD OF TOP OF BLUFF):49,441 S.F.or 1.14ACRES AREA: 63,621.2 SQ.FT. or 1.46ACRES ELEVA7701V DATUM: NAVD88 UNAUTHORIZED ALTERATION OR ADD17ION TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA770N LAW. COPIES OF THIS SURVEY MAP NOT BEARING 774E LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. GUARAN7EF IV 7FD HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU770M LISTED HEREON, AND TO 774E ASSIGNEES OF THE LENDING INS71TU770N, GUARANTEES ARE NOT TRANSFERABLE. 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES 70 THE S7RUC7URES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE 7HEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC770M OF FE7VCES, ADD1770MAL STRUCTURES OR AND 07HER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY ENDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF:LOTS 32&33 INCL. CERTIFIED TO: MATTHEW GLASSMAN; MAP OF:AMENDED MAP OF NASSAU POINT TRACEY HELLER; EMINENT ABSTRACT, INC.; FILED:AUGUST 16, 1922 No.156 WESTCOR LAND TITLE INSURANCE COMPANY; SITUATED AT: NASSAU POINT CITIBANK,N.A. ►SAGA,ATIMA; TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Boa 153 Aquebogue, New York 11931 FILE # 223-84 SCALE:1"=30' DATE:JUNE 3,2023 N.Y.S. LISC. NO. 050882 PHONE (631)298-1588 FAX (631) 298-1588 SOUTH OLD ST.EES . Issued Date a J /a q AddresS-,Y"-T-A&m" kogi)s, THIS: Pl07'ICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE OWN OF SOUTHOLD SOiJ7°FIOLD, N.Ya 11971 TEL.: 765-1 892 Glenn Goldsmith,President sS�FF©IkC�G Town Hall Annex A.Nicholas Krupski,Vice President �a y<� 54375 Route 25 CO Eric Sepenoski W ? P.O.Box 1179 Liz Gillooly �y • O��n Southold,NY 11971 Elizabeth PeeplesOl � ,� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed in field by: En-Consultants on behalf of MATTHEW GLASSMAN & TRACY HELLER requests an Administrative Permit to construct a 6'4"x10'2" second floor dormer addition onto the landward side of existing 1.5 story, 1,882sq.ft. single-family dwelling with 81sq.ft. attached deck; 312sq.ft. enclosed patio; and 135sq.ft. covered stoop; verify and upgrade stormwater drainage system for existing dwelling; and to establish and perpetually maintain a 10' wide, approximately 1,860sq.ft. non-turf buffer to be planted with native vegetation along the landward edge of the top crest of the bluff. Located: 4995 Nassau Point Road, Cutchogue. SCTM# 1000-111-9-11 Typ of area to be impacted: Saltwater 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 Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No `'" Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: G. Goldsmith 1/ N. Krupski E. Sepenoski L. Gillooly E. Peeples _ Adv -!�`'� 1 1E.,s � fir►' ,.�. WWI10 rtunt.r. ■ I �•.r.-�;y _ mil. , fl a n �\' rjl 0 141( C4 4', omitrwis� ZV,, 12 11a2 Ti C2 m 4, 4 17- to A p toaea! kph. % arm 12 - Irae iti Vl�vm N' IN, w !21918 06 08 "1"', 14�l 41 41 12t0 to T o (5) ID 77,it IIA e, .� be @ A -P , d g, q tw A I 4 'o % 12 lk Ie 14 % VVF TA s C'll 90 IV N SFC.— COUNTY OF SUFFOLK(D rn a Real Property TiA Service Age—Y r7 IN t2l) OFFICE LOCATION: ������ SI�(/ryQl MAILING ADDRESS: Town Hall Annex O P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) va Southold, NY 11971 �Q Telephone: 631 765-1938 lrouff I,� 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 13, 2024 Re: LWRP Coastal Consistency Review for MATTHEW GLASSMAN &TRACY HELLER SCTM# 1000-111-9-11 En-Consultants on behalf of MATTHEW GLASSMAN &TRACY HELLER requests an Administrative Permit to construct a 6'4"x10'2" second floor dormer addition onto the landward side of existing 1.5 story, 1,882sq.ft. single-family dwelling with 81sq.ft. attached deck; 312sq.ft. enclosed patio; and 135sq.ft. covered stoop; verify and upgrade stormwater drainage system for existing dwelling; and to establish and perpetually maintain a 10' wide, approximately 1,860sq.ft. non-turf buffer to be planted with native vegetation along the landward edge of the top crest of the bluff. Located: 4995 Nassau Point Road, Cutchogue. SCTM# 1000-111-9-11 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 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 { 1 Glenn Goldsmith,President ��of So+Uj� `� ? Town Hall Annex �`� d� A.Nicholas Krupski,Vice President D X\ 54375 Route 25 P.O.Box 1179 Eric Sepenoskii Southold,New York 11971 Liz Gillooly __,;c, Telephone(631) 765-1892 Elizabeth Peeples ,�O Fax(631) 765-6641 jAA IDl�J U E BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD JAN 3 1 2024 This Section For Office Use Only _ Southold Town Coastal Erosion Permit Application Board of Trustees Wetland Permit Application Administrative Permit Amendment/Transfer/Ex ensio Received Application: I X 4 Received Fee: $ Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): 4`LWRP Consistency Assessment Form Sent: a- CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: aJ 1 N 5E Resolution: Name of Applicant Tracy Heller and Matthew Glassman 18 Vanderbilt Avenue Address Brooklyn,NY 11205 Phone Number: 214 536-1375 Suffolk County Tax Map Number: 1000 - 111 -9- 11 Property Location: 4995 Nassau Point Road,Cutchouge (located on east side of Nassau Point Road,+/-1328'north of Wunneweta Road) (provide LILCO Pole #, distance to cross streets, and location)' AGENT: En-Consultants (If applicable) Address: 1319 North Sea Road, Southampton,NY 11968 Phone:631-283-6360 Board of Trustees Applio'. ;Lori GENERAL DATA Land Area (in square feet): 63,621 sf Area Zoning: R-40 Previous use of property: Residential, 1.5-sty,one-family dwelling and accessory frame building Intended use of property:Same,with 2nd floor dormer addition to dwelling Covenants and Restrictions: Yes X No If"Yes", please provide copy. Will this project require a Building Permit as per Town Code? X yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals X Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by Building Dept. Yes X No Does the structure(s)on property have a valid Certificate of Occupancy X Yes No Prior permits/approvals for site improvements: Agency Date Southold Trustees Wetlands Permit#6519 January 24,2007,amended July 24,2007 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): Construct 64"x 10'-2"second-floor dormer addition to existing 1.5-story, 1882 sf single-family dwelling(with 81 sf attached deck, 312 sf enclosed patio,and 135 sf covered stoop);verify and/or upgrade stormwater drainage system for existing dwelling;and establish along top of bluff a 10-ft wide,approximately 1,860 sf non-turf buffer to be planted with native vegetation,all as depicted on the site plan prepared by Frederick Robert Weber,Architect, last dated January 26,2024. I bard of Trustees Applicatl WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Renovation and expansion of existing 2nd floor bathroom to create modernized bathroom with adequate headroom. Area of wetlands on lot: -0- square feet Percent coverage of lot: -0- °% Closest distance between nearest existing structure and upland edge of wetlands: > 100 feet (to existing dwelling) Closest distance between nearest proposed structure and upland edge of wetlands: > 100 feet (to proposed dormer) Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: Standard construction practices. 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): The project consists only of the construction of a second-floor dormer addition to the existing single-family dwelling for the purpose of renovating and expanding an existing bathroom to create a modernized bathroom with adequate headroom. The addition,whose area constitutes approximately 3 percent of the existing dwelling footprint,will be constructed entirely within the existing dwelling footprint and thus cause no change to existing bluff setbacks or lot coverage. In fact, because it will be constructed onto the landward side of the house,the addition will be located almost 29 feet farther from the bluff than the closest point of the existing house. Both the dwelling and addition are located more than 100 feet from wetlands. However,to mitigate any potential impacts associated with the project, a stormwater drainage system is proposed to collect and recharge roof runoff from the entire dwelling,and a 10-ft wide,approximately 1,860 sf non-turf buffer to be planted with native vegetation will be established along the top of bluff. Thus,while the addition would not cause any adverse environmental impacts even without such mitigation,these mitigation measures will result in net beneficial impacts on the adjacent bluff ecosystem and tidal waters of Great Peconic Bay. i 617.20 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 I 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 I-Project and Sponsor Information Name of Action or Project: Heller&Glassman Additions Project Location(describe, and attach a location map): 4995 Nassau Point Road,Cutchouge; SCTM#1000-111-9-11;located on east side of Nassau Point Road,+/- 1328' north of Wunneweta Road(map provided). Brief Description of Proposed Action: Construct 6'-4"x 10'-2"second-floor dormer addition to existing 1.5-story, 1882 sf single-family dwelling(with 81 sf attached deck, 312 sf enclosed patio,and 135 sf covered stoop);verify and/or upgrade stormwater drainage system for existing dwelling;and establish along top of bluff a 10-ft wide,approximately 1,860 sf non-turf buffer to be planted with native vegetation,all as depicted on the site plan prepared by Frederick Robert Weber,Architect,last dated January 26,2024. Name of Applicant or Sponsor: Telephone: 214-536-1375 Tracy Heller&Matthew Glassman E-Mail: tracyheller3@gmail.com Address: 18 Vanderbilt Avenue City/PO: State: Zip Code: Brooklyn NY 11205 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. X 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: NYS DEC X 3.a.Total acreage of the site of the proposed action? 1.46 acres b.Total acreage to be physically disturbed? <5,000 sf acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1.46 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 U , 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? X b. Consistent with the adopted comprehensive plan? X 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? X 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: Name: Peconic Bay&Environs,Reason: Protect public health,water,vegetation& scenic beauty, gency: SUM-1k County,SUM- Date:7- 2- X 8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: X 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: X 11.Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment: X 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? X X 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? X b. Would the proposed action physically alter, or encroach into,any existing wetland or waterbody? X If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply. ® Shoreline ❑Forest ❑Agricultural/grasslands ❑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? X 16. Is the project site located in the 100 year flood plain? NO YES X 17. Will the proposed action create storm water discharge,either from point or non-point sources? 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: ❑NO❑YES Page 2 of 4 c 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: X 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: X 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: X I AFFIRM THAT THE INFOR ZAION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Roarm,Coastal Management Specialist Date: January 29,2024 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 I 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 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)? Page 3 of 4 c � No,or Moderate small to large impact impact may may occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11. Will the proposed action create a hazard to environmental resources or human health? 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 I Part 3 should,in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude.Also consider the potential for short-term,long-term and cumulative impacts. ❑ Check this box if you have determined,based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 '�oCree. OWTA�tu P'r C. . 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I Wunnewe$a ae o n d �] 517�<ACC�55 VIA Ni BPS PyIpTER N t Ep [LEPRWATER !; Ilf�� l yl .. A i' tngaon ° �LA AO�P I.' I I %Fdk Ca*q Nagstran Map 29 11, G +3000' Nassau Point i 1 1 I L L I T T L E P E C '0 N I C I I ©H�gstrom Map CPmpany,Inc. ' 40 41 aa � Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Q� 1000 111 9 11 STORM-WATER,GRADING,DRAINAGE AMP EROSION CONTROL PLAN II3 sFFRT Section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM#/WORK ASSESSMENT Yes No a.What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm-Water Run-Off (include Total Area of all Parcels located within 1.46 Acres Generated by a Two(2")Inch Rainfall on Site? ❑ the Scope of work for Proposed Construction) (S.F./Acres)) (This item will include all run-off created by site b,What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed <5,000 S.F. Site improvements and the permanent creation of construction activity? (S.F./Acres) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed ❑ PROVIDE BRIEF PROJECT DESCRIPTION(Provide Additional Pages as Needed)) Drainage structures Indicating Size&Location?This item shall include all proposed Grade Changes and Construct 6'4"x 10'-2"second-floor dormer addition to existing Slopes Controlling Surface Water Flow, 1.5-story, 1882 sf single-family dwelling(with 81 sf attached 3 Does the Site Plan and/or Survey describe the erosion X deck,312 sf enclosed patio,and 135 sf covered stoop);verify and sediment control practices that will be used to and/or upgrade stormwater drainage system for existing control site erosion and storm water discharger.This dwelling;and establish along top of bluff a 10-ft wide, Item must be maintained throughout the Entire Construction Period. approximately 1,860 sf non-turf buffer to be planted with native vegetation,all as depicted on the site plan prepared by Frederick 4 Will this Project Require any Land Filling,Grading or ❑ Excavation where t ere is a change tot a Natural Robert Weber,Architect,last dated January 26,2024. Existing Grade involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities X ❑ Encompassing an Area in Excess of Five Tousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site?Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres:including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes Elare part of a larger common plan that will ultimately disturb one or more acres of lands; which Exceed Fifteen(15)feet of Vertical Rise to Including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges_ Q (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit O Will Driveways,Parking Areas or other impervious for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off ❑ 1.The SWPPP shall be prepared prior to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, ❑ required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit. In addition,the SWPPP shall Area?(This item will NOT include the installation of Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE:If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SW PPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. that is knowledgeable in the principles and practices of Storm Water Management. (NOTE: A Check Mark(x)and/or Answer for each Question is Require for a Completed Application). STATE OF NEW YORK, COUNTY OF Suffolk SS That I, Robert E.Herrmann ___ ____ _ ___ _____ being duty sworn,deposes and says that he/she is the applicant for Permit, -------------------ingD Document) (Name of individual signing Document) And that he/she is the ---Agent - ----------------------------- ----------------------------------------------------------------------------------------- (Owner,Contractor,Agent,Corporate Officer,etc. Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the bes f his knowledge and belief;and that the work will be performed.in the manners set forth in the application filed herewith. Sworn to before me this; 29th o ary ----------------- -2024 ::;� Notary Publi f �} S T E P-RE-H-�------- ( gnat of pplicant) FORM - 06/10 STATE OF NEW Y 0 R K COMMISSION N0 . 5015931 QUALIFIED IN SUFFOLK COUNTY EXPIRES AUGUST Z, 2025 oard of Trustees A,pplicat: .L AUTHORIZATION (Where the applicant is not the owner) I/We, Tracy Heller owners of the property identified as SCTM# 1000-. 111.-9-11 in the town of Southold New York, hereby authorizes En-Consultants 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. N/A Prop rty wn rs S gnature Property Owner's Signature Tracy Heller SWORN TO BEFORE ME THIS / c� �h DAY OF � � , 20� MONAALISWIM P!;. MY PUBLIC OF NEW JOW Notary Public 'Offadulon# 50127766 4-1y Cainkwm ETON 06118f2025 f 't Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, Matthew J. Glassman owners of the property identified as SCTM# 1000-. 111.-9-11 in the town of Southold .New York, hereby authorizes En-Consultants 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. I ' N/A Property Owner's Signature Property Owner's Signature i Matthew J. Glassman SWORN TO BEFORE ME THIS "1 n7H DAY OF ;J Akl-U N �,.20 Z 4;otarvy Public LAWANNA MELVIN Notary Public,state of New York No.01 ME6410689 Commission� �fExpi es November county,2024 zoard of Trustees Applicatioka- ` AFFIDAVIT Matthew J. Glassman BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. N/A Signature of Property Owner Signature of Property Owner Matthew J. Glassman SWORN TO BEFORE ME THIS DAY OF ,..20 Notary Public i Board of Trustees Applicatmon AFFIDAVIT Tracy Heller BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. N/A L-zzw I Sigrd6e of roperty Owner Signature of Property Owner Tracy Heller SWORN TO BEFORE ME THIS DAY OF3R N1 a ,,20 Notary Public LAWANNA MELVNN Notary Public,State of New York No.01MErW0Co my ,2024 ouaimed m tang Conlml5sion Expires November 2 Board of Trustees Application AUTHORIZATION (Where the applicant.is not the owner) I/We, Tracy Heller owners of the property identified as SCTM# 1000-. 111.-9-11 in the town of Southold .New York, hereby authorizes En-Consultants Y 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. ' 3 I 1 i N/A Property Owner's Signature Property Owner's Signature Tracy Heller SWORN TO BEFORE ME THIS . DAY OF ,.20_ Notary Public i ,Ioard of Trustees Applicai _i AFFIDAVIT Matthew J. Glassman BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET-FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES: THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. -�� N/A Signature of Property Owner Signature of Property Owner Matthew J. Glassman SWORN TO BEFORE ME THIS 42 DAY OF { 0 , 20—J-4 MONA ALIBRAIiN NOTARY PUBLIC OF MEW JERSEY C,o whdon 0 M27756 My Com nbft E)0=05MV M25 Notary u lic i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'.s Code of Ethics prohibits conflicts of intereston the part oftown officers'and,emalovees.The purpose of .this form is to movide information which can alert the town of possible conflicts of interest and allow it to take whatever action is. necessary to avoid same. YOURNAME: Heller, Tracy (Last name,first name,griddle 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 X Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally'(or•through your company,spouse;sibling,parent,or child)have&relationship with any officer or employee. of the Town of Southold? "Relationship"includes by blood,.rharriage,.or business interest.."Business interest'means a business, including a partnership,in which the town officer or employee,has,even a partial ownership of(or employment•by)a corporation in which the town officer or employee owns more than.5%ofthe shares. YES F-1 NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the 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): _nA)the owner of greater than S%of the shares of the corporate stock of the applicgrit � (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 hulgl 20,ZY Signature 0,Ila _ Print Name Tracy Hell Form TS 1 C I ; APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold''s Code of Ethics prohibit§conflicts of interest on the partof town officers and employees.The pumose of .this form is'to provide inforination which can alert the,town_of possible conflicts of interest and allow it to,take whatever action is necessary to avoid same. YOURNAME: Glassman, Matthew J. (Last name,first name,middle 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 X Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse;sibling,parent;or child)have a relationship,with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,.or business interest.."Business interest'means.a business, including a partnership,in which the town officer or employee.has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than,5%of the shares. YES F-1 NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the 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): _nA)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); 14Q an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Type Submitted this 1'-_day of T-- 20 q Signature _ Print Name Matthew J.Glassman Fonn TS 1 APPLICANT/OWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emplovees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME : Herrmann, Robert E. (Last name,first name,middle 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.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit X X Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest.`Business interest" means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the 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 that 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 29th 4ay of January ,20 24 Signature A" Print Name Robert E. Herrmann r ' Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS l, 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 si nig f cant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both 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# 111 - 9 11 PROJECT NAME Tracy Heller&Matthew Glassman The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 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: Construct 64"x 10'-2"second-floor dormer addition to existing 1.5-story, 1882 sf single-family dwelling(with 81 sf attached deck, 312 sf enclosed patio,and 135 sf covered stoop);verify and/or upgrade stormwater drainage system for existing dwelling;and establish along top of bluff a 10-ft wide,approximately 1,860 sf non-turf buffer to be planted with native vegetation,all as depicted on the site plan prepared by Frederick Robert Weber,Architect,last dated January 26,2024. Pursuant to Southold Town Code§268-5 ("Review of Actions")and the corresponding definitions of"actions"and"minor actions"by §286-3 ("Definitions"),the proposed work meets the following definition of a minor action and should thus be determined to be exempt from waterfront consistency review: "II.Additions to an existing building or rebuilt residential structure which results in no net increase in ground area coverage,except where the parcel is located in a coastal erosion hazard area." Therefore, all policy responses herein are noted as"N/A." t 1 Location of action: 4995 Nassau Point Road,Cutchogue Site acreage: 1.46 acres Present land use: Residential, 1.5-sty,one-family dwelling and accessory frame building Present zoning classification: R-40 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Tracy Heller&Matthew Glassman (b) Mailing address: 18 Vanderbilt Avenue Brooklyn,NY 11205 (c) Telephone number: Area Code 214-536-1375 (d) Application number, if any: 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? New York State DEC C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No ® Not Applicable I Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ❑ 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 ® 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 Applicable 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 LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes FIN o ® Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ❑ Yes FIN o® Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold',., ::-Ater-de endent 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 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 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 Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PREPARED BY LECoastal Management Specialist DATEJanuary 29,202a Robert E. Herrman Amended on 811105 t EN CONSULTANTS EBoarrd 2024 January 29, 2024 wn tees REQUEST FOR AN ADMINISTRATIVE WETLANDS PERMIT Town of Southold Board of Trustees 54375 Main Road Post Office Box 1179 Southold,New York 11971 Re: Tracy Heller&Matthew Glassman 4995 Nassau Point Road, Cutchogue SCTM#1000-111-9-11 Dear Board of Trustees: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Four(4)Wetland Permit Applications including: a) Authorization&Disclosure Forms; b) Short Environmental Assessment Form; 2. Four(4)LWRP Consistency Assessment Form. 3. Four(4) site plans prepared by Frederick Robert Weber,Architect, last dated January 24, 2024. 4. Four(4) surveys prepared by Kenneth M. Woychuk Land Surveying, PLLC, dated June 3,2023. 5. Two(2)sets of site photographs. 6. Application fee of$250.00. I hope this information shall allow you to process our permit request. Should any additional information be required,please do not hesitate to contact our office. Sincer ly, Robert E. Herrmann r Coastal Management Specialist /khs ` Enc. 1319 North Sea Road I Southampton,New York 11968 p 631.283.6360 f 631.283.6136 www.enconsultants.com environmental consulting