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HomeMy WebLinkAboutRacz, Michael & Dessimoz, Gail E-X S�( l n P � I M � S �` f WA1 Permit No.: 9251A CAD Date of Receipt of Application: May 21, 2018 Applicant: Michael Racz & Gail Dessimoz SCTM#: 1000-112-1-4.1 Project Location: 4255 Hallock Lane, Laurel C Date of Resolution/issuance: June 20, 20_18 Date of Expiration: June 20, 2020 Reviewed by: Board of Trustees Project Description: Install an additional 309 feet of fencing along the bluff, along the easterly side yard, and up to the sides of the dwelling in order to enclose the waterside yard. Sf/q sAst2 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 plan prepared by , received on , 2018 and stamped approved on , 2018. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the i CftE Administrative Permit set forth in Chapter DlS'U�SS Wetland Permit will be required. MO- Z� �� I>� This is not a determination from any other,- lu +Te-0 Michael J. Domino, President Board of Trustees '1 1 -_ (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A MOLA71ON OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL T 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 IN;TITUTION.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSE2UENT OWNERS(5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)g CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR COPY. OBTAINED`FROCERTIFICATION M OTHERS. uI/0Pj-O %'3(0 1 f 4IM 4�t o pL p3"� N ��02 400 Ostrander Avenue �L ; W4 E Riverhead, New York IIQOI � X\� 11 to I. 631.'12'12303 fax. 631.12'i.0144 D admin®youngengineering.com ,11 Ttti y\� H\Prp, 11 ---_ - __ Howard W. Young, Land Surveyor M o�$� --I It-------- Thomas G. WPol ert Professional Engineer S Robert G. Tost, Architect _-- It ItIt Douglas E. Adorns, Professlonal Engineer \ 11 1' ' VJ SITE DATA 1 , , AREA = 2.Q5aq ACRES OR 128,935 50. FT. 1 \ * RICvHT OF WAY FROM SUBJECT PARCEL TO SOUND AVENUE NOT 5HOWN HEREON. 9 0 * NEW, AS OF MAY Icl, 2008, STONE WALLS, WALKS AND DRIVEWAY NOT LOCATED AND SHOWN HEREON. \ It '1 O O WOOD STAIRS ; (� 1 \ O _ \ 1L, � r " 1 •I 1 1 \ ` MAY 2 1 2M 1 11 CHAIN LIMO ` FENCE 11 1 1 S TOP OF BLUFF \ ----_- 1m 1 � APPROXIMATE \ ° ���►��..����1�� ♦♦♦ , \��--�� �� LOCATION OF \ ♦ OLOC �'" SANITARY SYSTEM 5- KALL \ COASTAL E705ION HAZARD— LINE 25'FROM TOP OF BLUFF I STORY FRAME \ O GOTTA6E b' 0 \ r FEEL-115.1 a + PATIO. 4 pAhp u Ira' 2 STORY 92 SURVEYOR'S CERTIFICATION .cF 0 5T0T� MA•ONRY HOUSE- U 0.7' u gaa' SUN Jp N 0 \\ �O b P �1�\ VA O i y z \ z ` NE 9 \ s P� %\ cowl. W co .coven ��� Y O CO ry LOCATION o� i 0 o OF W3L 42A' I i \ POOL 2 5 � O wrw- \ eu.TSR 11 9 u ` HOWARD W. YOUN(5, N.Y.5. L.S. NO. 45893 \ 9 G SURREY FOR �w OHAr-L RAGZ RAGZ \ PAN at Laure I, Town of Southold `_� Suffolk .county, New York :A ram" 1 Q � S � FRAME N ' g �1 90 6ARA&E j - F I NAL SURREY Q / \ / County Tax Map District IOOO Section 112 Block OI Lot 4.1 \ // ����\\, MAP PREPARED JAN. 20, I`�95 \ o LG Record of Revisions O RECORD OF REVISIONS DATE MAR 21, laaF5 os 3p `` MAY 25 IaGS `\ \� ° � �� \ APR- 01,2004 \ GJ�p MAY 06 20D4 Krc9� �gM►� \ FINAL SURLY MAY IQ, nor) N \ \o �ti� o m \� G � t y� \\ 50 O 25 50 100 150 i""/' `�rock p� \�vG� � �` Scale: I" = 50' a 05 J05 NO. 2008-015a El = MONUMENT SET ■= MONUMENT FOUND = 5TACE 5ET = 57AKE FOUND ``a� DWG. 199x\RAGZ-3\2008_0159_fs.dwg ( OF I I I I I O O N� Young &' Young, Land Surveyors a , N��o SouNu 400 Ostrander Avenue, Riverhead, New York 11901 v" J,NOw A p igaunIg 'CI N 631-727-2303 a a SONG » E � ~ 6 �«<o Howard W. Young, Land Surveyor xY�g IIuni +ZFj E Thomas C. Wolpert, Professional Engineer i r 2 -7 5 Robert C. Tast, Architect Ronald uhl, Landscape Architect Tannin 7a Adams,.2o,03„ E N 5$ OZ Doug E. A, fms, Professional Engineer � e N (j�.25 ;Engittrrrittg �T\E \NE\MPOEG RK '` —4 3111 / ', pPPR wpSER MP 1; / / i �7ururging 10M OF BWFF ' � O $OT ,I — _ _ - - - — -- 3 — — —10325 ==ti=-10 = =— =_30_= =___ MAY 2 1 2018 — — GOD_ST AM Um 8 \ \ 1 Oz 21 � \ All ttWK\NO E ' i � � \ \ \ \ \ � �\ `L �o o',c � p507\ zoo Z 104.04 t9 oa A'f043z i \'s TUN BLZ`JF 104.}5 _ \ 1f*53 1075Y 1 +i1��� \ � ]] ` , �� 11595*\\ APPROXIMATE r" ova ��--� — LOCATION OF W �`F 10504 i - `uwNa \ �+ 10196 f ; 0605 �o ♦ ;i To70 \ BLOCK — / 10535 SANITARY SYSTEM o c't o * 1 WALL _ )8 27 10550 t OA�t - -'t'06 96 \ 7 + _ J Un 104 8 + 960 1� 18 1L2 111,09 9,lY'''18' DI �� i 99 \ 2_- _ oast 105.67 h -��' I TREE 24'°DIA.I ��" TREE \ COASTAL EROSION HAZARD No 05.66 17.7 m 11 1 _ I �o \ LINE 25• FROM TOP OF BLUFF x 1 1 o I 1108 }111 �q+10758 10707 t� n IOF,B / Q 'O T. ` Ito 20 1 STORY 10858* Z `"\ �11 f ` FRAME��OLLKOE J s 18'.DIA. t 5 0 \ Z \ O m. r \ F.F.LrL-113.1 toe 86 0 o TRE[ 0 0 r O c' O ` 2.fi 2.7 ,n ��' 1 a PATIO 108.17 + N J 4. 50906 \� j115867 \\ J +108 24 243 2.7 t3 0665 18' DIA. 3 105� — > 2 STORY 3.. J TRE� 0 29�= 0567 \ \ FRAME HOUSE J 117 _ 10832 10�55-) 106.9 F.F.EL= oe 7 195 53 53�E PArO 10541 238• \ 107 84 . J / \10350\ �. O 05\\to 27.5 .0 \ +05 30 ,t 22 0' /+107 83 _ P. +107 33 __ \ CP t� +\ \ \ '} O \ 104I66 \ 106 78 `1 +1')R,6 52 O W N Q +\ / + 1 0823 35 \\ 10663 +111 3P 11,9 103 + 1os 0° D IA `110— EE 36' Q +102 z-4� 706 LpSS E / \ +405 73 a 7 56 \ g o ,L G C HOUS +103 19 /y 4 COVER O \ \ POO D� R8 \ w O _ �w 104 42 I°4 21 6 PROX4Q" 1 10463 99 90 a �} /LOCATION\ 36 o DtA 06 x TREE2.B' 3. EPS o OF WELL O Oc 10398 \ 54POOL >.t ¢w \ o FILTER �A`�k 103i � N 2 STOtnAOE WOOD WALL zz, `L \ 7 + 71, ? GARAGE tQO 3 K +10007 02 roe94 G.F.EL=104'a P1N UN \ _ \ G• w o a \ N fENE FENCE \ +02.79 ' 1054t5 0 �O'26 NOTE: Dodo 06 \ (D• 08 \ \ PN eocK\ `�N p 2. o = STAKE SET FOUND N \ +10016 +loo4s 10+99 EVCUR \ `` 3. o = LATH SET \ 0 01 4. R.O.W. FROM SUBJECT PARCEL TO SOUND AVE \ -1001-1 \ \ NOT SHOWN HEREON. \ \ \\ 5. ELEVATIONS SHOWN HEREON ARE FROM ACTUAL SURVEY CA p 10016 \ W AND ARE REFERENCED TO N.G.V.D. (MSL 1929). o r` +9967 6. AREA = 2.9599 ACRES OR 128,935 SQ. FT. o, \\ \ \ i \ +9981 \ RCH p0 99 5+ +99 36 \ \ \ \ PORCH 7 0 1?E \ FRAME w ja +9941 90 \ \ GARAGE\ _V =owe \ o \ 61 \ \ +9 09 \ .o SURVEY FOR APPROXIMATE \ PO >a \ LOCATION +99}7 \ OF WELL \\ \� MICHAEL RACZ & GAIL DESSIMOZ = m � +97 79 \ QJ� 0070CL\ \ w i o \\ LO+ I R` 9 59 97�o CK 953N���C, \ \ \ W I 9745 9721 R,NOP\�. '\ \ \ At: LAUREL Town of: SOUTHOLD \ +99.22 A 973 3 97M \\ \ Suffolk County, New York ES'jt M G, 010060 \ 98 18 / 0 6 J 96 84 WELL � +96,°�, ,p 1000 112 01 4.1 \ 737 S o�nne Suff. Co. Tax Map: N�S 32+1 PSPH P�Z 9704 vOCy� District Section Block Lot O \ oO / 1 , 96 30 2 O 95 \ 96 55 O 50 0 25 510 100 NE tF Q� W. Y Ci MAY 6, 2004 is /--/ {O((Oe<�(� \'�- �( $ �► * APR. 1, 2004 �,"-t O( F O MAY 23, 1995 <�g: 00\N �><vG MAR. 21, 1995 � Sl -MO CHOP O DATE JAN. 20, 1995 N ax gybes `F1e�d �' 3 SCALE :1"= 50' No sax � `\Q� JOB N0. :95-0025 a F> Sv �a LAND =.a= O SHEET N0. :1 OF 1 O 5� 199X\RACZ-3\RACZ-2.dwg 60370 Board of Trustees 11 June 20, 2018 TRUSTEE DOMINO: All in favor? (ALL AYES). TRUSTEE BREDEMEYER: The next application, number 15, MICHAEL RACZ & GAIL DESSIMOZ request an Administrative Permit to install an additional 309 feet of fencing along the bluff, along the easterly side yard, and up to the sides of the dwelling in order to enclose the waterside yard. Located: 4255 Hallock Lane, Laurel. SCTM# 1000-112-1-4.1 This project was reviewed by the Board of Trustees as well as a separate field inspection by Trustee Glenn Goldsmith. Based on the survey stamped in the Trustee office, May 21 st, 2018, Young &Young Surveyors, last dated May 19th, 2008, the Board had extensive discussions with, among ourselves during the course of work session, and the inconsistency for this project draws from the fact the proposed fence is extending seaward of the top of the bluff and is deemed to be a heavily vegetated area, so the Board of Trustees is concerned that a fence placement in that area would be contrary to good conservation practice, as well as the report of the LWRP coordinator. After discussion and reviewing the plans, the Board feels it would be appropriate that the fence placement would be better placed near the topographical crest of the bluff, and the exact distance from the top of the bluff, I would defer to Trustee Goldsmith because I don't believe we specified the distance from the top of the bluff. TRUSTEE GOLDSMITH: No, it's pretty well delineated with the vegetation. So when the lawn ends at the top of the bluff. TRUSTEE BREDEMEYER: Okay, thank you. Accordingly, to bring this project into consistency with the concerns of the LWRP coordinator, I would move to approve this application with the stipulation that the fence shall be landward of the topographical crest of the bluff in an area where the lawn ends, and that bluff be also on the plan of Young & Young Surveyors last dated May 19th, 2008, and inspected by Trustee Goldsmith on June 18th, thereby bringing this into consistency with the LWRP. That's my motion. TRUSTEE GOLDSMITH: Second. TRUSTEE DOMINO: All in favor? (ALL AYES). VI. APPLICATIONS FOR EXTENSIONS/TRANSFERS/ADMINISTRATIVE AMENDMENTS: TRUSTEE DOMINO: Under Roman numeral VI, Application for Extensions, Transfers, Administrative Amendments. Again, in order to simplify our meetings, the Board of Trustees regularly groups together actions that are deemed minor or similar in nature. Accordingly, I make a motion to approve as a group items one through nine. They are listed as follows: Number one, GEORGE & CATHRYN WILLIAMS request a Transfer of Wetland Permit#481 from Edouard Beaugard to George & Cathryn Michael J.Domino, President ��OF so yo Town Hall Annex John M. Bredemeyer III,Vice-President �� l0. 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski G _ Telephone (631) 765-1892 Greg Williams �OOU Fax(631) 765-6641 � NTI,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Storm Water Runoff With recent heavy rainfalls, we are reminded once again of the problems Southold Town has with storm water runoff. With over 100 road ends terminating at creeks, bays, inlets, or Long Island Sound, as well as all of the lawns and homes lining our miles of shoreline, 100's of thousands of gallons of storm water runoff enters our wetlands*every year. Carrying sediment that prevents sunlight from reaching aquatic plants,nutrients from animal waste and lawn fertilizers that promote algae blooms detrimental to shellfish;and bacteria and other biologicals that in high doses can be harmful to swimmers, storm water runoff is one of the Trustees main public safety concerns. So important, in fact,that Southold has a Storm Water Management Code. Southold Town's Chapter 236 provides an outline for how people need to deal with storm water runoff from their properties. For example,new construction or renovation is required to contain any potential runoff to the*wetlands from the construction by installing hay bales and silt fencing. This acts as a barrier and keeps our wetlands clean. Another example in Chapter 236 is that every building must have provisions to collect and disperse, ON-SITE,at least a 2 inch rainfall. This is usually handled by installing gutters, leaders and drywells to the home. The Trustees also have-a standing policy of requiring pervious non-turf buffers along bulkheads and at tops of bluffs that help keep run off from entering the wetlands and prevents erosion to bluffs. These are important measures to keep our wetlands safe and clean! Before deciding to renovate or build, the Town Trustees urge you to check our website and the other department's websites to make sure what you are planning to do meet the Town's Code. These codes have been developed for the good of all citizens. And the wildlife all around us too! Michael J. Domino, President � c0�,y Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith H P.O. Box 1179 A Nicholas Krupski �y • �� Southold, NY 11971 Greg Williams 0( ,� �a� Telephone (631) 765-1892 Fax (631) 765-6641 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 / % constructed V Project complete, compliance inspection; Michael J.Domino, President O`� Ol Town Hall Annex 0 John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders CA Southold,New York 11971 i�iGlenn Goldsmith • �� Telephone(631) 765-1892 A.Nicholas Krupski lif'COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 1Zticc�fA�G- RA-c� � GALL. Dt✓Sst�.o� TO: • Please be advised that your application dated AV 211 has been.reviewed by this Board at the regular meeting of 1/ , &, ;Mg and your application has been approved pending the completion of the follovAng items checked off below. RaeckTW6-FVc� (,�-�vPWAaD 0r TDP Cagt'ol~ Revised Plans for proposed project AJt06 C t09 Wk AAA Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1' Day of Construction ($50.00) -Y2 Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement(complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ ` BY: , Michael J. Domino, President Board of Trustees Michael J. Domino,Preside ) o�QS�FFU(kIroG Town Hall Annex John M. Bredemeyer III,Vice-President V_ ? 54375 Route 25 Glenn Goldsmith y z P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams ?� ® p� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: f�ISA T Completed in field by: G• Go 1 a�S M ��� MICHAEL RACZ & GAIL DESSIMOZ request an Administrative Permit to install an additional 309 feet of fencing along the bluff, along the easterly side yard, and up to the sides of the dwelling in order to enclose the waterside yard. Located: 4255 Hallock Lane, Laurel. SCTM# 1000-112-1-4.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5_ Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type:/1 II Unlisted Action Type of Application: Pre-Submission \/ Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: Fance placevne 1 rdn na► f�e S lojpg o A'e w&A SecAwo yA o 6oi� o- Wu K. I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other �. 4 At, lot } it ^ 0A el}y,� .�ZTI Y TW.yF4a p yxi.$; it yqv CA y ' t EF,t f 2 ' i. 7 .. .+ S •'.}t ii.w�{.x�a�� ^*� �, } .Mi �� 'fie c t E� � �� _, r;rlf} Imo' �`. ;, .. • # Lyu. 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Main Rd. &Youngs Ave.) va Southold, NY 11971 r1hpQ Telephone: 631 765-1938 O Fax: 631 765-3136 �y00UNTY,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President. Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: June 14, 2018 Re: Local Waterfront Coastal Consistency Review for MICHAEL RACZ & GAIL DESSIMOZ SCTM# 1000-112-1-4.1 MICHAEL RACZ & GAIL DESSIMOZ request an Administrative Permit to install an additional 309 feet of fencing along the bluff, along the easterly side yard, and up to the sides of the dwelling in order to enclose the waterside yard. Located: 4255 Hallock Lane, Laurel. SCTM# 1000-112-1-4.1 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 INCONSISTENT with the Policy Standards and therefore is INCONSISTENT with the LWRP. The proposed fence extends seaward of the top of bluff. The reason for the fence located within this area is not identified. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Michael J.Domino,President ,*QF SO!/j Town Hall Annex John M.Bredemeyer III,Vice-President h�� �lQ 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G � � Telephone (631) 765-1892 Greg Williams O 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 Amendment/Transfer/Extension Received Application: S21.18 Received Fee: $ 100,00 Fri IQ 522• fZ�Completed Application: � "° `' Incomplete: MAY 2 1 201 ; SEQRA Classification. Type I_ Type H Unlisted 8 Lead Agency Determination: -/Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: — I�l Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Legal Name of Property Owner(s): M r C 0 19 E L R NC 2- Mailing Address: A- ( g s M A-TT`T rr vC (< N Y 1 Phone Number: b ( _ S,57-3 -S 3 Z3 O Suffolk County Tax Map Number: 1000 - f -j- o I — L4 ` Property Location: Lf '3—S 5 t4 &LL q C(K (If necessary,provide LILCO Pole#, distance to cross streets, and location) 'AGENT(If applicable): Mailing Address: Phone Number: Board of Trustees Appl�' Ltion GENERAL DATA Land Area(in square feet): ��9 A C 12 D 2 12 $ r Q 3 Ss!z) FT_ Area Zoning: ! D E-tffT !,A Previous use of property: S A " E- Intended use of property: S A-1-1 E7- Covenants and Restrictions on property? Yes ✓No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes '--�No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes V�N0 Does the structure(s) on property have a valid Certificate of Occupancy? Y es No Prior permits/approvals for site improvements: Agency Date 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): E YT-rw ! 0 d F t Y, f 'STI dLJ C— S A F r-rz 3 0 ��v Board of Trustees Apple _Ation WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: —1-0 F t2 y V 1 ACr_— A--D 1 `t f 0 &.� 6 L -- Area of wetlands on lot: square feet Percent coverage of lot: A® % Closest distance between nearest existing structure and upland edge of wetlands: 306 feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? L,�No Yes If yes,how much material will be excavated? d" 14 cubic yards How much material will be filled? N 114 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 6I7.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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: k:)cfi61—jS ( 0kJ E) F Fkq F_t-I.JC. tF_ Project Location(describe,and attach a location map): LL© C N E h-tAT 7-ITU y I q Brief Description of Proposed Action: A iTr0 1-- A L. 0 -TG—C`/ 04J F� ( S A F LET-Y �_j fl 0 LF-&-/Z C ® pLj-'4z_(3 L_ Name of Applicant or Sponsor:: Telephone: (�3 ' '5-53 S3 d K) Address:�I G M 1-ico A-17cT cJ C(2 ,LJ y City/PO: State: Zip Code: �' ® • o S MKTT(TUC l . l� Y f tqs-.)-- 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: 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? Mo N Lracres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2-o[ acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban . ❑Rural(non-agriculture) ❑Industrial ❑Commercial sidential(suburban) El Forest [R.Kgriculture ❑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: Er ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation services)available at or near the site of the proposed action? 19- ❑ 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: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: "❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ 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 ES 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: 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 [I 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? Eff❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? NO [:]YES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: -90' OYES 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 IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: VDate: / 7 l 0 Signature: to dC _9L CZ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1.and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. 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? Fc;r. EL 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? Er 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 jl reasonably available energy conservation or renewable energy opportunities? LUJ 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 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 I 1/ ❑ problems? u 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 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) PRINT Page 4 of 4 Board of Trustees Appl Ltion AFFIDAVIT I"1 I GhQ,c L � OC-Z— BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. xak Signature of Property Own e Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF Cl U 20 Notary Publi TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,201 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emnlovees.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. s YOUR NAME: / I /V �'�`� iL ✓ "V�i (Last name,first name,Viddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you 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 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 than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi / da of 20 Signature Print Nam Form TS I Board of Trustees App:' -,ation AFFIDAVIT 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 AGENTS) 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. i Si re of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS /` DAY OF 20 LINDA S. BAY NOTARY PUBLIC-STATE OF NEW YORK No.01 BA4962647 Qualified in Suffolk County - MY Commission Expires 02-28-2022 Notary Public 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form.should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which 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 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# IV D (� _ [ _ ® [ ��a PROJECT NAME A-C 2 F&:fiy F--L- .jC. `r7— YTE7 ev r 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: lam= -fcrts c a e,1 Location of action: C &,-!5 O A-u-o Ce_ 1-AW Lam, M A`fi 7-tT Ld< 1-J Y, I (f{ S Z Site acreage: Q (SS Present land use: Present zoning classification: rZ M t4 L 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: 4: E: (2 Of (b) Mailing address: P 0 . Q) D ( <6 -S (c) Telephone number: Area Code( ) l S S: (d) Application number,if any: ' 1 " Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No Eg*'� If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. ❑Yes ❑ No 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 El Yes ❑ No [=I 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 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 le;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 ❑ ro No U 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. F 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 ❑ No E 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. YeZ] No RNot Applicable Attach additional sheets if necessary • f ` WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See WRP 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 El No U 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 forzNot n criteria: ❑ Yes ❑ Nopplicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pa 65 through 68 for evaluation criteria. ElYes ElNo Not Applicable el'57 PREPARED BIA�AJ TITLE_/J/c.�/ � � DATE � �