HomeMy WebLinkAboutTR-10761A �l
Town Hall Annex
v�®� S®U�,y® 54375 Route 25
Glenn Goldsmith, President 4r® P.O. Box 1179
A. Nicholas Krupski, Vice President Southold, New York 11971
Eric Sepenoski :
y � � Telephone (631) 765-1892
Liz Gillool
�® Fax (631) 765-6641
Elizabeth Peeples
COUNTi,�
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SOUTHOLD TOWN BOARD OF TRUSTEES
YOU
ARE REQUIRED TO CONTACT THE OFFICE OF THE ES BOARD
OF TRUST OFFEES
72 HOURS PRIOR TO COMMENCEMENT OF THE ACTT
BELOW
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1 sc day of construction
'/2 constructed
When project complete, call for compliance inspection;
Glenn Goldsmith, President s®(B�y Town Hall Annex
A. Nicholas Krupski,Vice President ,`O� ®�® 5 Route 25
P..O.O. Box 1179
Eric Sepenoski l Southold, New York 11971
Liz Gillooly Telephone(631) 765-1892
Elizabeth Peeples • a0 Fax(631) 765-6641
UN'TY,��
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 10761A
Date of Receipt of Application: January 22, 2025
Applicant: Hufflepuff LLC
SCTM#: 1000-70-12-33.2
Project Location: 1380 North Bayview Road, Southold
Date of Resolution/issuance: March 19, 2025
Date of Expiration: March 19, 2028
Reviewed by: Board of Trustees
Project Description: For trees already cleared as well as further removal of
existing Leyland Cypress; replant with 25-7' to 8' tall Green Giant Arborvitaes;
with the condition to establish and perpetually maintain a 10' vegetated non-turf
buffer along the edge of the wetlands.
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 Young Associates, received on April 9, 2025, and stamped
approved on April 21, 2025.
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.
Glenn Goldsmith, President
Board of Trustees
f,)wwmnYap Ymunw w,mnw ro na swKv rs.w.m•a s[cnw nw w>K M m saII FWunw w.1�)amuas 9.ar qtw 1M mapn ues m[nsnc ewucvcs"x rw."ewi[R.woII+lo w[W*m![us(a m m.av enwpxr u[5 a rw"¢cnw w ra,m U1 aw6 w m5 SL•Kv•✓rod R/wiG M S1wK'mvT..[a s[.w w O.0Y0 s[k swu q.a r.1.)memt�nox
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400 Ostrander Avenue,Riverhead,New York 11-101
OD DRIVE tel.6SI.T2-7.2303 fax.631.121.0144
-O A y1 •,O --- admineyoungenglneering com
Howard W.Young,Land Surveyor
Thomas O.Wolpert,Professional Engineer
Douglas E.Adams,Professional Engineer
I '1 Daniel A.Weaver,Land Surveyor
W E SITE DATA
® + AREA=28,337 5Q.FT.
On I
'DU
S ' VERTICAL DATUM =NAVD(1988)
6.42
p 9 2025 `
Southold Town ti 1 6. Existing Leyland Cypress
Board of Trustees 0 -�y" ', t be removed.
BLKHD/aF ,
1.3•N 25/7-8'Green Giant Arborvitaes
Z�? +4.43 78 to be planted in place of Leyland
S Cypress.
1 v
s
8•3
R �
436
Proposed 10'vegetation buffer "N �? 67
with 3"American Cape Beach °� \
grass. Rp
To be planted 1'o/c APPROXM�ATALONS ra°l`° i ����, q�
Approx.1290 plugs WATERMARK 2 4.1E Q� '" - \
TAMp 6y�r 600 SURVEYOR'S CERTIFICATION
9 LOT COVERAGE �p �'� ° "� S •WE HEREBY CERTIFY TO C AR O LI N E 8 U RTO N THAT THIS SURVEY
00° --Ct WAS PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND
8 EXISTING N38.20'I8"E 3'O' d / SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF
FRAME HOUSE 6 RO =2,409 SQ.FT. =8.5% 6.15' PROFESSIONAL LAND SURVEYORS.
FRAME GARAGE =519 SQ.FT. =1.8%
FRAME SHEDS =204 SQ.FT. =0.7% +5.82 FFL
"g WOOD DECKS =1,063 SQ.FT. =3.8%
R TOTAL=4,195 SQ.FT. =14.8% ��T�e + �" b 0 6� `
4.78
PROPOSED
FRAME HOUSE&RO =2,409 SQ.FT. =8.5% x? �/b' �J ati 11-41 d V
c FFL
FRAME GARAGE =519 SQ.FT. =1.8%
ry '
Y FRAME SHEDS =204 SQ.FT. =0.7% O 6.08 6. \o° 4 HOWARD W.YOUNG,N.Y.S.LS.NO.45893
WOOD DECKS =1,063 SQ.FT. =3.8% O / 29,-- +a3 0 4�m ' DANIEL A.WEAVER,N.Y.S.L.S.NO.50771
POOL =91 SQ.FT. =0.3% - e's. '??r
DECK =390 SQ.FT. =1.4%
>� 6.5 ":0 44 ,p +ems '" 'o• $ +. SURVEY FOR
TOTAL=4,676 SQ.FT. = I65% 6 4.9 �Q z �'`A, B9 0, r3 I CAROLINE BURTON
m
'6.0' w 8 of Southold,Town of Southold
° 4, Suffolk County,New York
3 S 4.5z PROPOSED +o, 7.29 Vs• PROPOSED c y
TIE LV*ALOM ✓ DECK �b. a z3.a, POOL ;.'�+-
WOODeULKYEAD J PROPOSED "^ EQUIPMENT g�3 BUILDING PERMIT SURVEY
K LEGEND > POOL S 3 a low 70 12 33.1
APPROVED BY 1000 70 12 33.2
County Tax Mop
BBC =BELGIAN BLOCK CURB �� oti o�so-��i 1000 s«eo„ 70 ei-k 12 La' 34
` BSW =BRICK SIDEWALK FLASPOLE
CLF =CHAIN ONUMELINK� BOARD OF 1RUSTEES MAPPREP"�`°" 'ED All12:20z'
CMF =CONCRETE MONUMENT FOUND
CM5 =CONCRETE MONUMENT SET
EOP =EDGE OFPGVEMENIT TOWN OF SOUTHOLD Record of Revisions
REVISION DATE
IPF IRON PIPE FOUND o� q,F. PRnPOun Pr1rM FQUIPMFNT APR 16 2o24
MLF =METAL FENCE O �' L +4.15 4 LOT CnVFRAGF....._ _ ¢PT 13 M23
PRF =ON RAIL FENCE DATE
RO =ROOF OVER _
S W F WOO STANCE FOUND N78 1.35, -
h WSS =WOOD STAKE SET W
m =UTILITY POLE _. .. _....--.__.
4� =LIGHT POLE ---- -- -, - 30 0 15 30 60 90
• =END OF DIRECTION/DISTANCE ! _
Scale:1"- 30
JOB NO.2024-0023
DWG.2024_0023j)p 1 OF 1
SO
UT. H0- 'L0 . TRUsTEAES
Iss u e d. To- 1 !�►��1tQ��F L� Date 3/1�1a5
_ Addross � 11.0. ,
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHO.LD, N.Y. 11971
TEL.: 765.1892
Glenn Goldsm;.,.;'resident Town Hall Annex
A.Nicholas Krupski,Vice President �� y:4 54375 Route 25
Eric Sepenoski ? P.O.Box 1179
Liz Gillooly �y • 0�� Southold,NY 11971
Elizabeth Peeples �1 Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time:Mo.rc h ►l,Zb 25 Completed in field by; bn-,I L CA-1 P-"PIE�
Absolute Property Care LLC on behalf of HUFFLEPUFF LLC requests an
Administrative Permit for trees already cleared as well as further removal of existing
Leyland Cypress; replant with 25 7"-8" Green Giant Arborvitaes. Located: 1380 North
Bayview Road, Southold. SCTM# 1000-70-12-33.2
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland Sound Bay
Part of Town Code proposed work falls under: Chapt. 275 Chapt. 111 other
T79 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.:
P101 0ddrGSSMV1 o 1o.'�cN.S �O r rcnla>nfi" $MCS • Con aMO-A a IWO' v eaa6►.�
"0 A-itiY� bU RC.f .
Present Were: G. Goldsmith N. Krupski E. Sepenoski
L. Gillooly __V_E. Peeples
OOD �RZVE 4oD Ostra d.r Aw ,Rl—hood,Non Ypk 119OI
bl.651.17272"5 fax.651.T1TA144
—O AKW — -—- admMya Axn K�N..rhgrgm
—_—— a. N O�ttt�1k550Ctctf 45
'I Hor+ord K Ypmg,O/se Land 9..dyor
I Thomas G.YVolpert,FYsbnal 6;gineer
Do�gim E.I I A. Ihoressbnd Erglry-
/.� � Daniel1 A A..Weaver,Land 5wveyor
} i w E _ SITE DATA
11 t�
I I 4 AREA:26,337 SQ.FT.
I
I
�{ t
E
s VERTICAL DATUM =NAVD(1996)
�o<d O•,� eAx
Existing Leyland Cypress
t be removed.
25/7-8'Green Giant Arborvitaes
to be planted in place of Leyland
QP, Cypress.
SURVEATION
LOTCOVERAGE c� sq�� °00 CERTIFY
ROLtNEBUR ONTHA
P •WE HEREBY CERTIFY TO CARD LINE BURTON THAT THIS SIMVEY
WAS PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND
FRAME HOUSE 6 RO 2,409 54.FT BS7:NG N38°20'18•E d' \ SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF
FRAME = . : PROFESSIONAL LAND SURVEYORS,
8 FRAME GARAGE =519 SQ.FT. =1.6% 6.15'
FRAME SHEDS =204 SQ.Fr. =0.7%
"g WOOD DECKS =IA63 SQ FT. =35%
TOTAL=4,195 SCy FT. =141x
R�
PROPOSED
FRAME HOUSE 6 Ro :2.409 SQ.FT. =B.DX
FRAME GARAGE z 519 54.FT. =Id%
FRAME SHEDS =20e 7V` °4 �6 fir'
SQ.FT. =0.77E 'L• e. e. p' y I HOWARD W.YOUNG.N.Y.S.LS.NO.45M
WOOD DECKS =1A63 Sq.FT =9A% DANIEL A WEAVER,N.Y.S.L.S.NO.50771 _.
POOL =91 SQ.FT. =05t O J4r
DECK =390 SQ.FT. =3.4% aeMem s r
mRp° e. ,+ ; '`• ; P SURVEY FOR
TOTAL=4.676 SQ Fr. •163% ' u' �? 'V' Ar
CAROLINE BURTON
at Southold,Town of Southold
e� D tl Suffolk County,New York
4- FROPOSEb« wMwo�NI— i oEC% 'y. �p 41. PooL �
j PROPO
� EQUIPMENT y BUILDI46 PERWT SURVEY
LEGEND '' roaL P 3 T 1000 70 12 33.1
d $ 1000 70 12 33.2
KIM CURB ,►� j4 C—ty 70 - 12 �_� 34
9 BSW --=BRICK r MOP 1000 -.CK SIDEWALK_.._. '� ..
0.F =LNAIN LINK FENLE-- ('� `, N.aaF y MAP PREPARED FrEL SURVEY COMPLETED MARi2.2024
2024
CMF CONCRETE MONUMENT FO11FlJl-. ' v E °
or -coNaEIEMOFu a Record of Revisions
DI =d/AIIJA6E
EDP =EDGE OF PA P _ REVISION DATE
IPF :IRON PIPE
1 ��f Q PROPOSED POE.EquIP11Q�lT APO to-211t.
MLF -METAL i -'q1 ,�.tS LOI rnVco.cF_
OPL
RO _POST 6 RAA 4'F J AN 2 2 2025
WIF =WIRE 21.i
WSF =WOOD STAKE F ' �6'48sw
W55 =WOOD STAKE
`II, =UTILITY
``ISTAN'E Southold Town 30 0 15 30 60
LIGHT
90
=END OF OIRECTIO [E
Board of Trustees Scale:1"_ 30'
JOB
23
DWG..2024_00230023_bp 1 Of 1
(1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 72D9 OF THE NEW YORK STATE ED!CATION 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 ERECT"OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIOERED TO BE A VALID TRUE COPY.(4)CERTIFICATION
INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTPUTIONS OR SUBSEQUENT OWNERS. (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)k CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS.
400 Ostrander Avenue, Riverhead, New York IIr-f01
tel. 651.727.2505 fax. 651.121.0144
ODpRI� admin®younge ee nginring.com
O A KW O _ _ —� — CMF O"q
I Howard W. Young, Land Surveyor
Thomas 0. Wolpert, Professional Engineer
1 I Douglas E. Adams, Professional Engineer
I I , Daniel A. Weaver, Land Surveyor
01 3�
<�N W '� E SITE DATA
n��nAT�
t AREA = 28,337 SQ. FT.
I
I '
1
ko��2ok S VERTICAL DATUM =NAVD(1988)
o�o��apok� 6.42
t` �o off,• og CMF
63 l N +6.63 \\
°1P OR)
d�0 9�T ,,2 P- -19-7 W \
00 G �F PNE II 6.58 \
BLKHD/CLF
1.3'N 1
I \�DOu� 1
+4.43
s sr, i v 6.78
(_ ..
COVER
/tt �
O
R
1
.67
P \
GVI O `
TIE LINE ALONG OF OFRglC 1 O \
APPROXIMATE HIGH $9 �0 ter`
WATERMARK 9;
CP
+6.30 \ \ �
Q ,� \ / \ ti ,� •�' �. 1�116 FOP
\ 8.09 '
\ � 0-IN" OF �\���
\ PROPANE BRr SURVEYOR'S CERTIFICATION
3 TANK O �P� PT4 EVFRGR 6.00 go mqn soriales
IPF * WE HEREBY CERTIFY TO CAR D LI N E B U RTO N THAT THI5 SURVEY
WAS PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND
<� N38020'18'�E `'e' 8� SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF
N �y PROFESSIONAL LAND SURVEYORS.
N 6.15'
` 8.98
+5.82 FFL
N h'O �.• •. Y`V� .'�Y
8 TA
-:jr -
m oLOXtitil F�1°o S a 1 t1 !
C4 S0 4.78 `o��� 30 Sb 48e IPF
1P. 1148 ti
O` b S r6 9�F FFL p 1 w L-e�— ," mot/►-�^c r
O tL 6 08 /6 48 0° °� HOWARD W.YOUNG,N. .5.L.S.N .45893
g + <io sF ;
0 oosr I DANIEL A.WEAVER,N. .S.L.S.NO.50771
f ^ �
V= c 0 c000 9 5.0' ti� J�ti g 3T N \ 1
�1 woo�°`K 6.54 ro 4 A- '6�. PG Sl m, ' k ' SURVEY FOR
89, PRR �3 CAROLINE BURTON
0 4.9' ry
o p 6.56 r `'�h ��'k, ��,�
C
oO +6.01 6
N 6.7 at Southold, Town of Southold
TA 7.29 ' p Suffolk County, New York
m 4.52 PROPOSED 2f o IS9 o k
TIE LTNE ALONG DECK
WOOD BULKHEAD Q tip' 2
N PROPOSED BUILDING PERMIT SURVEY
N LEGEND P00L 1000 70 12 33.1
Dmly 0�401a b 1000 70 12 33.2
BBC =BELGIAN BLOCK CURB b0� °ti County Tax Map District 1000 Section 70 Block 12 Lot 34
BSW =BRICK SIDEWALK ^'
CLF =CHAIN LINK FENCE OFLAGPOLE FIELD SURVEY COMPLETED MAR.06,2024
a CMF =CONCRETE MONUMENT FOUND MAP PREPARED MAR.12,2024
CM5 =CONCRETE MONUMENT SET _
DI = DRAINAGE INLET R� �� '' � i. Record of Revisions
EOP = EDGE OF PAVEMENT REVISION DATE
IPF =IRON PIPE FOUND ��So�96 QFoc I'
MLF =METAL FENCE +4,15 L,
OL =ON PROPERTY LINE J A�1 2 2 2025
PRF =POST&RAIL FENCE �L
PO =ROOF OVER 21 Southold Tovm
NO WIF WIPE FENCE GL° WSF =WOOD STAKE FOUND
N78°46 48„w E?3ardofhust�es
WSS = WOOD STAKE SET
C, =UTILITY POLE
7�X =LIGHT POLE 30 0 15 30 60 90
o • =END OF DIRECTION/DISTANCE Scale: 1�� ' 30'
J
a
JOB NO.2024-0023
DWG. 2024_0023_bp 1 OF 1
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E J COUNTY OF SUFFOL
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OFFICE LOCATION: _ ®`O MAILIN BoADDRESS:
Town Hall Annex
54375 State Route 25 Southold,NY 11971
(cor. Main Rd. &Youngs Ave.) tJA: .
Telephone:631765
Southold, NY 11971 +0 • _ �o
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
To: Glenn Goldsmith, President
Town of Southold Board of Trustees
From: Mark Terry, AICP
LWRP Coordinator
Date: March 17, 2025
Re: LWRP Coastal Consistency Review for HUFFLEPUFF LLC
SCTM# 1000-70-12-33.1 and 33.2
Absolute Property Care LLC on behalf of HUFFLEPUFF LLC requests an Administrative Permit for
trees already cleared as well as further removal of existing Leyland Cypress; replant with 25 T-8"
Green Giant Arborvitaes. Located: 1330 North Bayview Road, Southold. SCTM# 1000-70-12-33.1
Absolute Property Care LLC on behalf of HUFFLEPUFF LLC requests an Administrative Permit for
trees already cleared as well as further removal of existing Leyland Cypress; replant with 25 7"-8"
Green Giant Arborvitaes. Located: 1380 North Bayview Road, Southold. SCTM# 1000-70-12-33.2
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation that
the as-built is INCONSISTENT with LWRP Policy 6.3 and, therefore, INCONSISTENT with the
LWRP.
6.3 Protect and restore tidal and freshwater wetlands.
A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees
laws and regulations for all Andros Patent and other lands under their jurisdiction
1. Comply with Trustee regulations and recommendations as set forth in Trustee permit
conditions.
The trees were removed without a Board of Trustee review or permit.
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
Southold Town Police Departmnt POLICE
e
� F As of Mon Jan 06 09:40:39 EST 2025Qf �.
Incident Report
CC# Pct sector Car Incident Type Classification
SH25001092 SHPD 803 SHM3 Trustee Inspection Incident GEF
INCIDENT
Report Date Report Time Report Day ate((Occurred on/from) [rime DaY ate(Occurred to) Time
1/03I2025 12:13 Fri 1/0312025 12:13 Fri
Business name and type Town Code
TISOUTHOLD-5259
Incident address
1380 N BAYVIEW RD,SOUTHOLD,SUFFOLK NY USA 11971
OFFENSES
o. Law iName of offense eg Section Sub Cat tt
1 STC ISouthold Town-WETLANDS AND SHORELINE 275-5 Permit procedures. C
SSOCIATED PERSONS`
Person e:C=Coro lalnant V=Vlctlm E=Alded A=Arrested S=Sus ect 1111--illilssing Person W=Wltness P=Person Interviewed O=Other
er pe Name O.B. ex Race Manse
1 SOUTHOLD TOWN TRUSTEES
ddress Home Tel# Work Tel# all Tel#
(631)765-1892
er rrype Name O. exB. Race ffense
2 S;P IAN ZUHOSKI 01/05/1988 hiteNon-Hispanic
Address Home Tel# ork Tel# ell Tel#
23625 MIDDLE RD,CUTCHOGUE,New York,11935 (631)445-5952 631)445-5952
Per rpe Name O.B. ex IRace ffense
3 S CAROLINE BURTON 11/01/1979 hiteNon-Hispanic
ddress Home Tel# rk Tel# ll Tel#
544 BROADWAY,DOBBS FERRY,New York (917)520-5008 o ie 520-5008
NARRATIVE
Undersigned and HMII Kirincic responded to the above listed I/L regarding tree work being performed without a trustee permit.
Upon arrival,the undersigned observed construction workers actively cutting and removing trees on the property.
check with the Southold Town Trustee's office confirmed that permit#9808 was issued only for the adjacent lot,1580 N Bayview Road,
Southold.
Southold Town Trustee's Office confirmed there is no permit on file for the I/L.
The construction crew was identified as Coastal Plantings,owned by Zuhoski.
The undersigned spoked to Coastal Plantings and instructed them to cease work on the property until the appropriate permits were
obtained.
The homeowner,Burton,was also advised of the situation.
ummonses 0954 and 0955 were issued.
Victim did receive information on Victim's Rights and Services pursuant to NYS Law ❑Yes 5U No
FFICERS
ame iank adge# Classification
UTHILL,KELLY arbor Master M3 Reporting officer;Dispatched officer
am iank 3adge# Classification
SOUTHOLD PATROL Reporting unit
Name iank ad e# Classification
KIRINCIC,JOHN arbor Master M Assisting officer
ADMINISTRATIVE
Teletype No Connected CC#'s
Status IStatus Date Confidential ❑
Closed/cleared 1/03/2025
C# 110-70THILL,
I Investigating Officer upervisor
H25001092 KELLY SGT/132 HAASE,ROBERT Sergeant
[Electronically approved
' r
Glenn Goldsmith,President �QF S0 Town Hall Annex
A. Nicholas Krupski,Vice President ®� ®�® 54375 Route 25
P.O. Box 1179
Eric Sepenoski8 Southold, New York 11971
Liz Gillooly e�
Elizabeth Peeples ® Telephone(631) 765-1892
a Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
This Section For Office Use Only
Coastal Erosion Permit Application UD
Wetland Permit Application BAN 2 2 2025
Administrative Permit
Amendment/Transfer/Extension SoutholdTown
Received Application: Board of Trustees
Received Fee: $ S W d O
Completed Application:
Incomplete:
SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec.
Lead Agency Determination Date:
Coordination:(date sent):
LWRP Consistency Assessment Form Sent: 3 ✓ ��5
CAC Referral Sent:
Y Date of Inspection:
Receipt of CAC Report:
Technical Review:
Public Hearing Held: 3(`'V �3
Resolution:
�-
Owner(s) Legal Name of Property (as shown on Deed):
Mailing Address: '5 I 1 'V`� Dubb 5
Phone Number: 631 ✓16`? w
Suffolk County Tax Map Number: 1000 - u —1- 3. �—
Property Location: 13
(If necessary, provide LILCO Pole#, distance to cross streets, and location)
AGENT (If applicable): k6Jc(4— POP—
Mailing Address:
Phone Number: 631-A 7- 3! Email:
Ord of Trustees Applicatic,
�6 GENERAL DATA
Land Area(in square feet): I S z-(
Area Zoning: L q o
Previous use of property: � � V� ( cSl �'t � 1
NI-1 I CJ1!n4
Intended use of property:
Covenants and Restrictions on property? YesNo
If"Yes", please provide a copy.
Will this project require a Building Permit as per Town Code? Yes No
p J q g
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 ZNo
If"Yes", please provide copy of decision.
Will this project requirk6y demolition as per Town Code or as determined by the Building Dept.?
Yes No
Does the structure (s) on property have a valid Certificate of Occupancy? /'Yes No
Prior permits/approvals for site improvements:
Agency .Date
J
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):
srd of Trustees Applicatic
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Z�( '` -eTuc--�
ELM-uVe- cS'fl�r\ L( 0. SS WOW0 -b
Eyloonil .s
Area of wetlands on lot: N square feet
Percent coverage of lot: Vx %
Closest distance between nearest existing structure and upland edge of wetlands: feet
Closest distance between nearest proposed structure and upland edge of wetlands: feet
Does the project involve excavation or filling? /Z'No Yes
If yes, how much material will be excavated? Acubic yards
How much material will be filled? cubic yards
Depth of which material will be removed or deposited: �7� feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited: _k"s I Gk'pad
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):
`O �� W 1 C VIC,
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part 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.1 -Project and Sponsor Information
Name of Action or Project: II �
Project Location(describe,and attach a location map):
Brief Description of Proposed Action:
oN
a -m
Nam of Applicant or Sponsor: Telephone:
1 U4 W E-Mail:
LLL �3� �-3
k&p � , Ccs17
Addres
City/PO: State: Zip Code:
( r, lcYG�
1.Does the proposed action only involve the legislative adoption of a plan,local law,oi•dinanc , NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and.the environmental resources that
FtSJ-
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? acres
c.Total acreage'(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) ❑Industrial [—]Commercial ❑Residential(suburban)
El Forest ❑Agriculture El 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:
L-P ❑
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
b.Are public transportation service(s)available at or near the site of the proposed action? r-;z:} ❑
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? M ❑
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: [NS ❑
11.Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment: Z" ❑
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? ® ❑
b.Is the proposed action located in an archeological sensitive area? ❑
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? ® ❑
b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? r,_.7-_" ❑
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: LL2i>
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑Shoreline ' El Forest ❑Agricultural/grass lands ❑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? � El
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: ❑NO ❑YES
Page 2 of 4
ti
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: �u!l ❑
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 6 ❑
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor e: Date:
Signature:
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑
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
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 1-1problems?
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
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner!
residing at
(Print property owner's name) (Mailing Address)
do hereby authorize CQY [rs
r \ (Agent)
to apply on my behalf to the
Southold Building Department.
day cC ?t
4wrier's Signature) (Date)
(Print Owner's Name)
trd of Trustees Applicati
AFFIDAVIT
�,o,r0�ktp_, 6vr+oo "-C—BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN
ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT
ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES
AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF
GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE
TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THE PERMIT.
Signature of Property Owner Signature of Property Owner
7r tV C>
"7:SWOPN T"EFORE ME THIS a g DAY OF,,'.s a 20 2
5tq
C K
Notary Public '
P. IUVAS
n5
i
State of flew Yt
6414697.
�� '
,46tches
r � nna
a
Cr
APPLICANUAGENUREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.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, (' �``-- II
\
YOUR NAME: 66 S�(' S, C741 e-t <5-,X
(Last name,first name,ipiddle initial,unless you are applying in the name of J
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"OtheC',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 ipteresL"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 this IZ day of 200:r?
Signature.
Print Name 315SC-1
Form TS 1 3
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# �6 - IZ - 722
PROJECT NAME Ay"V� f Pcn�� B -k
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 e ent of action:
mt) S ) voL e C
r-eZVA G i cw-f
Location of action: C
Site acreage:
Present land use:
Present zoning classification:
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:---5ve
(b) Mailing address: `9.-
fVA
1
(c) Telephone number: Area Code(4 i l r
(d) Application number,if any: N
Will the action be directly undertaken,/require funding, or approval by a state or federal agency?
Yes ❑ No LL1J 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
❑ Yes ❑ No d 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 Ap�`,,,,,�ble
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 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.
❑ Yef] No Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICII( ,.
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria.
❑ Yes ❑ No Not Applicable
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 D 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.
i
Yes 11 No KNot Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policie , Pages 65 through 68 for evaluation criteria.
❑ Yes El No of Applicable
PREPARED BY TITLE DATE