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622 Church Lane LLC
Cantrell, Elizabeth From: Cantrell, Elizabeth Sent: Tuesday,June 27, 2023 4:19 PM To: gjmstl02l5@aol.com Cc: Goldsmith, Glenn Subject: 622 Church Lane LLC; SCTM# 1000-99-4-18 application Hi Glenn, Regarding the application referenced above,the review of the project has begun and at this time it has been deemed incomplete and at this time will not be added to a public hearing agenda for a number of reasons which are listed below. Please be advised that the requested information is a preliminary review. The Board of Trustees may request additional information after further review. 1. Four sets of full N.Y.S. licensed certified construction plans and detailed elevations must be submitted (one full size set and three 11"x17"sets are acceptable). 2. The construction plans and the existing& proposed elevations must include all measurements and details that contain all required information for both the Board of Trustees and the Town's Building Dept. regulations for review. 3. The current site plan submitted with the application is incomplete. • It is not certified by a N.Y.S. licensed professional • It does not have any measurements from proposed to top of bank/bluff, property lines and edge of vegetated wetlands. • It does not contain any dimensions other than the proposed pool (every proposed structure requires a dimension including spa, on grade patios and walkways,steps to ground). • -All retaining walls need to have material to be used, length, width and height of each with elevations for each drawn up;and added to the written project description. • Is the pool/patio/bbq area partially on grade,completely raised? More detail needs to be given in elevations and in the written project description. • The site plan states sanitary system on the plan, but does not depict it nor state that it is to be an I/A OWTS system. Please update the site plan. 4. The written project description is incomplete. • How many stories is the proposed dwelling? • Is the sq.ft.of the proposed dwelling the footprint or combined levels of the proposed? This office only needs the footprint of said dwelling(not including decks/patios/etc.). • For the retaining walls please give details for each—material, length,width, height/varying height. • How much fill is being added to create a new grade around the dwelling,only the amount being excavated (350cy)? Please explain further in the written project description. • What is the size of the proposed service parking oil&stone area? • What is-the size of the proposed motor court oil &stone area? • Please add the installation of stepping stones in the various areas to the written project description. • Please include details of the spa within the pool. • Please include details of the bbq area. • Please include dimensions of each set of steps to ground. • If there are any second-story balconies/decks please depict on the plans and include the dimensions both on the plans and in the written project description. i 1 5. Please inquire with the Town Building Dept.on driveway regulations and whether two driveways are permissible. 6. Please be advised that this Board may require a "Pier Line"site plan (as defined under Definitions in Ch.275-2 of the Town Code) be submitted fortheir review. Please submit the requested paperwork at your earliest convenience in order to proceed with said application. Sincerely, 5*P,etl (,curficeQ2 Senior Office Assistant Town of Southold Board of Trustees Office: 631-765-1892 Email: elizabethc@southoldtownny.gov 2 OPT OOp S g1°1131; \ F NO \ .91 �\ Q \ \.. \..,• aT ov- E K' 12021 ,.. \ \. ``' \ \\ \ \ \\ \\ PROJECT DATA: �\ EXISTING CONDITIONS BASED ON S 72 18 9_ \ \ r \ \ \ SURVEY DATA FROM: 275.40' M� \\ L.K. McLEAN ASSOCIATES, P.C. 4°30'29E CONSULTING ENGINEERS& P�vCP-x LAND SURVEYORS WNo, 437 S0. COUNTRY ROAD BROOKHAVEN NY, DATED: JUNE 17, 2021 AMHW A "H / I / ~o �\ \\ a \ uNE FOR REVIEW & FILING INa,\TfN NOT FOR CONSTRUCTION � G /�<, � - / / EG TO AUNDI JN/ �-- , \ S / }. •., - /j PROF.-- i ��— � -- `_ =- -� --- -- \ \ E/i," \�� � J \\\ / g`OGK MpR tlfdE ei� = = _ _ WOC3Dfi_At@S3� \ STAMP: RED• I / -SIt-I�F N��'�-T1�AI� REM�-tl0NTAZT_,\� \ F ' E \ ,,A �. � � � _ ,.�.. 061 \\ \ e \ FEN ( If 1. \ a 50 -- C \ PROVIDED DEC / FtE� W P ( JURISDICTIONAL LINE00 / 1 7 / Al IVE I \ �ISHED6R \ \ v jN000 SR) 6 ' 29 _ _ T T I 1 I I I I I I ( ADJACENT AREA COVERAGE WITHIN PROVIDE .2 ` v � � I I � � � \ �•. L ++ 3 4 \ \ I I I �. C1pP' DEC JURISDICTIONAL LINE) / 4t . NYS DEC / +tF I /r �� \ \ 1 / \ TOTAL ADJACENT AREA ON SITE 72,473 SF POOL TERRACE / DECK � / \ / 3 5 \ \ \ 1 I \fl I, ( MAX ALLOW. AA COVERAGE (20%) 14,495 SF 13. 13:5+ •. B 26. 5 \ BREAKLINE FOR LOWER I ) ° ERRA .*` ' LEVEL FFE: 25.50 / I EXISTING AA COVERAGE (1.00%) 717 SF ERYICEI I* PLANTER WALLS / / / / / ' PARrIN.G . M _ �p `OIL &)S,TONE - \� * � I ,�"' �` 5 / / / / / / y• / / / / / ,/ / �/ 6 / // f s / TOTAL OF EXISTING STRUC TO REMAIN (1.00%) 7 17 SF .1 4 14.5+ 11 2 / / / / / / / / / I / / / / / / PROP GARAGE 40 SF / E I) / / / LOWER LEVEL / / / , , // /� � / I / / PROP. RETAINING WALL 15 SF 5 / WALKOUT TERRACE 15 v -yTw 2[i 5— ` 1 I I ( _ 7 / / / / / 15 ,. �f• 5 + / / / / // // / / / I / FtYPNNE PROPOSED TOTAL AA COVERAGE (1.070/) 772 SF EY — + l ! ! 0 opLpNCyS�7'�,�n ) I 13e1 M�KENNP PROPOSED TOTAL DISTURBANCE IN AA 574 SF / PROJECT DESCRIPTION: 37 (TO PLANTER WALL)' ._ uPNp 20 XIS'f / x / MOTOR 58�_7^(TO LIMIT OF GRADING) \ /.j / IN THE ADJACENT AREA TO THE TIDAL WETLANDS: / r' / � 1, I OF Rp 4 I r TRF,E I I l I ra • P I 57'-0"(TO SILT FENCE) � ,may EON / / OIL & ST.bNE 35• . I I INSTALL(21) LF OF UPLAND RETAINING WALL(8"THICK SESSP �; NSA / 11' R I I i o I I / \\\ / I I ( ( \ ° �rl / DEC COVERAGE (WITHIN 300' WALL CAP) TO 10 ELEVATION OR TOP OF HILL) -INSTALL 45 SQ FT OF GARAGE I _ / / // // / /� LP ` — I k•I 11" ` I I I I I I I )pNR ��� ` \\ r / / NYS DEC \ � � / ( -RE-GRADE(574) SQ FT OF UPLAND AREA 0 20' 40' /� 1/-- — _' I I I I ( ( ' ( ( ( J TOTAL ADJACENT AREA ON SITE 65135 SF MAX ALLOW. AA COVERAGE (20%) 13,027 SF SCALE: 1/20" = V-0° __ I I III � EXISTING AA COVERAGE 1.25% 815 SF I / Nil I I - I I E e1 1, 1 1`C`I i 1 \ \ Foy \ ( ) 1. �r REVISIONS/RELEASE DATES:1 / \I I ( I 6.0 I I I I I I I� C I ' �I , ' \ \ cc � -08/07/22 1 FOR PERMIT "I�TlN III I I I�\ \ \ \ \ \ o SITE PLAN KEY: -09/06/221 FOR PERMIT � P � � TOTAL OF EXISTING STRUC.TO BE REMOVED(0.15ro) 98 SF - 12/29/22 1 WALL LAYOUTS PER ENG. / T I I 3 I IL, I I I I W 60 �s TQI I I \ \�\ \ \ \ \ s / - - I O� I I E A �I�T�A�T TOTAL OF EXISTING STRUC TO REMAIN (1.10%) 717 SF PROPERTY BOUNDARY -01/03/23 1 DEC UPDATES 30 O ( TT d,' I I ` \ o -01/09/23 1 TRUSTEE UPDATES IUR`I VA I6G,/ 1 r \ E ` \ , \ , 1 \ \ \� �O�p PROP. MAIN HOUSE+TERRACES (0.27%) 180 SF BUILDING SETBACKS -03/07/23 1 DEC UPDATES ENVIRONMENTAL SETBACKS ON I / 2 \\ \ \\ \\ \ 1 \ i %W ~ \ \ PROP. POOL + TERRACE (0.84%) 546 SF — — — : , _ 6. 1-1 HAMILTON e` ( /3� * / \ \ \ PROP. GARAGE 0.98/° 640 SF RE w j� \ / / t ,t \ \ \ \ ( ) EXISTING TOPO / \ \ \\ - PROP. LOWER LVL TERRACE+STEP 0 28/0 185 SF 25 _ LANDSCAPE ARCHITECTURE, P.L.L.C;. n PROJECT NAME: 35 � �-�-.- . I / / 40 ,,. . � \ \ \ \\ \\ \\ \\ \\ \\ \\\\\\ \ , ` \ \ \ \ \ \ \\- - - - - � '° � ) - PROPOSED TOPO PROP. FRONT WALKWAYS (0.15/°) 96 SF 1625 NAUGLES DRIVE I 41 x ' x,. 7 \ \ \ \ \\ \\ \ \\ \ \ \\ \\\ \ ` \ \ ` \ — — PROP. PAVED MOTOR COURT 0.05% + 45.5 EXISTING SPOT GRADE MATTITUCK NY o I - LAer ( 42.5. 4 \ \ \ \ \ \\\ / PROP. OIL & STONE MAIN DRIVE (0.0%) o SF --._X x--- EXISTING FENCE DATE: MARCH 07,2023 j OQLAN© _ + ?• \\ \ \ \ \\\\\ \\ \\ \\\ \\�EXI$TIN� - - -^ PROP. OIL&STONE SERVICE DRIVE 0 0% 0 / 1.�• TO-P-EMAt \ \ \ \ \ \\\\ \\�WINO\COI A DS�T� 16 - - - ( ) 0 S F � I , — — — — ° PROPOSED FENCE SHEET: SITE PLAN ®® ,ALL PROP. RETAINING WALL CAPS (0.48/°) 314 SF STON Lo SERV►C \\ \ \ \ \ \\\\ �,' - - - DRAWING: DRI ' \\\\\\\\\\ \\\\ \\ \\\ \\\\ �~ i ~�'2 - - - / PROPOSED TOTAL AA COVERAGE (4.17%) 2,71 SF N \\\ \ \ \\ \\ \\� - -1 2 * 1 ONE m � \ \\\\\��2� \ \\ \�� � � ��-�� \ �o�' _ / 0 20' �,1, z wIDE> \ \\ \\ \ sY -- N MAY 2 3 2023 / / �. _ — _.._. � \ �\\\\\ -'-•\\ ,�,�-`e'�C�-cam--'' \ � — --�` SCALE: 1" =20'-0,; Board of Trustees Road • • 1 2022 1215 to 1245 Applicant vo r r r ' j+r I ■ • +c.v xa�iL 1•e •�a look �T��r' .r t� .�,rtl � T�' .."�r.�� r. • '. 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'i� 'ice + 'f J.!P y�.� .+t .� �.•.� Page 23 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC fit � Y s'�.. .f� .w•S t ►-^SNP ; �:. � 1�M °F A , v� • r�,,� � +Y a- i 1, .�114� X c t .,,r'K'° V.?t ,r to. "! � �� °'". � r%�.'�,�''�''�.� � .-+R► ""` � ., ���,+ sY�y .. ^r a�'^')� " "" w'�'.''ram. .4 �' +e•yj.'vy, _ , .r'Y• .ter 4 �, �'.t ,a v �y'hy } °,; bF. ZAP Page 24 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC s �JJJ ail L `rr rr TIV..,,. . L � r • •. Page 25 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC t r' ,4 xT -Aw Y ray' - y Page 13 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC 77 Page 14 Fes. _��c - �'"� �`- N'` ,t' \ qad' ♦' �'...�.. `` .-��; a b. �ti��f� artx: �j',': q' ,t. •�j\ � 'e; U,a• i �� a+.��` t` ' ? (#', '�;i J � • - y' n, r 1, �• • • OtOF J n \ _ # S1 I .• ; t ((Ry^y"i4'. M... �..Y•.ice H t.--. � �Y. � � .�T+.. > y. 7*7 LIP me YY +, 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC i • •it - VW It "got < r we iY'.it " ... . ' •- .`yam - i 1 M l Page 3 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC rim, low r ,G — -- t s ' a. _ ;. • 0.h VA 1�4 ..'.�•,sl7r' I:'.'w' r i '� d.,r�lG� Page 4 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC IF a i e fir . y� r Ahern { ` Page 5 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC f w . A row 44 r, 4 +. F •ter .iBA { f, ,�4�- �Y ,� Page 6 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC �-- 'yam' '�`►' * ' � � �, � . . a s� ? • Sl M ' a R • ♦p Page 7 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC a e' Page 8 1625 Naugles Road Mattituck NY Photos taken August 10, 2022 1215 to 1245 Applicant 622 Church Lane LLC Page 9 corn azna, eDW 1 TOp / tasW /J T1aT K' 1.01 i WWW �_ rT7 m n.Tot6 ,9 /. ^• 41 Tw(<I 5 °y • JC% nWn � -ytr '� J�i� WTTrtUGIt MIEt ,SI 1p' \ \ i/' gSTNICT - I 2M i .�1 °, ,r.aHc1 \ a er T.or rcwrp� .'°. WTLrtrtCK FMTO(gSTRICT � m � \ ,S .p U .I •y.'Its /�C° O /^,pe�F � 1s 2� - /�1 OF l4) Iv uIc raR Pn No. { "• `- ,� — —_ --•'— �•°• --^-- nonce COUNTY OF SUFFOLK © x a aamnn SECTM]N NO Real Property Tax Service Agenq v t Prwc,xo 1�M PROPERTY YN + I o�Og�FFQt�.coG , John G. Stein,Chairperson y Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 • `F Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held on Wed., July 12, 2023, the following recommendation was made: Moved by Caroline Burghardt, seconded by John Stein, it was RESOLVED to SUPPORT the application of 622 CHURCH LANE LLC to remove a block shed, one-story frame building, frame shed, and a residence; construct a new single- family dwelling (2,420 sf.); install a new I/A OWTS system; pool (592 sf.); pool fence (150'); garage (455.2 sf.); retaining walls (289'); drive and motor court. All new structures and terraces shall be a min. of 75' landward of the tidal wetlands boundary. Located: 1625 Naugles Rd., Mattituck. SCTM#99-4-18 Inspected by: John Stein, Caroline Burghardt, Maggie Merrill The CAC Supports the application with the condition fertilizers are not used on the existing lawn path. Vote of Council: Ayes: All Motion Carried r' Town Hall Annex Glenn Goldsmith,President r 54375 Route 25 A.Nicholas Krupski,Vice President �� �' P.O.Box 1179 Eric Sepenoski [ Southold,New York 11971 Liz Gillooly ' Telephone(631) 765-1892 Elizabeth Peeples �Q Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only D Coastal Erosion Permit Application X Wetland Permit Application VAY 2 3 2023 Administrative Permit —Amendment/Transfer/Extension X Received Application: S•L3Z3 Southold Town �—Received Fee: $ 1'2S0 Board of Trustees Completed Application: S-,2 •Z -- Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): �`- X LWRP Consistency Assessment Form Sent: X CAC Referral Sent: Date of Inspection: Z Z i Receipt of CAC Report: _ Technical Review: 1 J Public Hearing Hel25 — �q(Zp � Resolution: �' ftA'RhGS I Owner(s) Legal Name of Property (as shown on Deed): 622 Church Lane LLC. _ Mailing Address: P.O. Box 961, Mattituck, NY 11952-0961 Phone Number: 631-275-3031 Suffolk County Tax Map Number: 1000- 99-4-18 Property Location: 1625 Naugles Read, Mattituck (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): JMO Environmental Consulting Mailing Address: P.O. Box 447, Quogue, NY 11959-0447 Phone Number: 631-653-0607 Email: Eharbes@gmail.com Board of Trustees Application GENERAL DATA Land Area,(in square feet) 129800. Area Zonin R 80 g Previous use of property Single family dwelling, boat house, sheds, etc 9 Intended use of property New_sin le family dwelling Covenants and Restrictions on-property? Yes _E�LNo If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? > Yes ,_❑TNo 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. W�Whis project re any 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 Town Trustees#0215 4/18/18 . Town Trustees#9214 7/14/22 N.Y.S.D.E.C. 3/15/23 ❑ 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).:.,,Please see.-attached. . Applicant proposes to remove a block shed (87.4 SF), a one story frame building (362 SF), a frame shed (51.8 SF) and a residence (842 SF); construct a new single family dwelling (2,420 SF); install a new I/A OWTS system; pool (592 SF); pool fence (150'); garage (658 SF); front deck.(93 SF); main terrace (1,121 SF); steps (455.2 SF); retaining walls (289'); drive and motor court. All new structures and terraces shall be a minimum of 75' landward of the tidal wetlands boundary. Proposed setbacks from the tidal wetlands boundary: Single family dwelling 86'2" Garage 75'4" EAST planter retaining wall 70' to 58' Pool terrace deck 81'10" East planter retaining wall 87' to 73'6" Board of Trustees ;Application WETLAND/TRUSTEE:LANDS:APPLICATION:DATA Purpose of the proposed operations: New $;;111g1e fa17111y: dwelling Area of wetlands on lot: .square feet 3,600 Percent coverage of lot <20 0 Closest distance between nearest existing structure and upland edge of wetlands:.`14 l.Beet Closest distance.between nearest proposed.structure.and upland edge of:wetlands 70 feet. Does the project.involve excavation or filling? No Yes If yes,how much material will be excavated? 350` cubic yards How much material will be`filled? 350 cubic.yards Depth,of which material will be removed or deposited:.4 feet Proposed slope throughout the.area of operations Backhoe and a oader Manner in which material will be removed.or.deposited: P y 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): As proposed there should.be be negative impacts upon the wetlands or tidal waters of the town . APPLICANT/AGENT/REPRESENTATIVE 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. YOUR NAME: LC LLC- (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 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 br 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): E,A)the owner of greater than 5%of the shares of the corporate stock of the applicant _n (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-coiporate 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 a day of I a-y-h 20 o13 Signature_ Print Nam Form TS ] — -- Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, L'V�-CV\ CO-41-L—L�--C owners of the property identified as SCTM# 1000-99-4-18 _ in the town of Mattituck —New York, hereby authorizes JMO Environmental Consulting to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature rop rty Owner's Signature SWORN TO BEFORE ME THIS_p� _ DAY OF , 20 aj 3 Notary Public BARBARA H.TANDY Notary Public,State Of New York No. 01 TA6086001 Qualified In Suffolk County �� Commission Expires 01/13/20___1 Board of Trustees Application AFFIDAVIT (0z-Z-Cy\urCvX L-t-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 Sig of Property Owner SWORN TO BEFORE ME THIS al _ DAY OF &t1Y1C-1 ,20 p"1� 9"V . Notary Public BARBARA H.TANDY Notary Public,State Of New York No. 01 TA6086001 Oualified In Suffolk County Commission Expires 01/13/20 APPLICANT/AGENT/REPRESENTATIVE. TRANSACTIONAL DISCLOSURE FORM The:;Town of Southold's Code of Eth[cs'orohibifs conflicts afanterest onYhe part of to*" icers and employees The pornose of thts;form is to provide mfornrauon which can alert the town of possible ea if acts of interest and alfaw�t to take whzteyer acttori is ngcessarvto a_ void ame YOURNAME: .Just,.Glenn, E. name;'.first name,ipiddle initial,upless you are applying°to the name of. someone else,,or other entity;:such as a company,_Ifso,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 Ezemptioti from plat or official map. Planning :Other (if:"Other!,name the activity:.) Do you personally(or'through;your.company,spouse,.sililing>parent;orchild)have a rslat�otiship with any ofheer or employee of the Town.of.Southoid?:"Relationship"mclt des by:blood,rnarriage,or kiustness Interest -"Bstsmess interest"means a bus►ness, including a partnershi in which the town officer or employce has every a pattral ownership of(oremployment`by}a coporation . In,which the,town officer or:employee owns.more than S°Lo of:the shares, YES NO n If you answered°`YES",:complete the'balance:of this form and date and sign where indicated. Naive 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 officeror 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,'ot child is(check all that apply) �A)the owner of greater than 5%:6f the shares of the corporate stock:of the app1'. t:. f: (when the applieartis a corpQrat�on); B)theaegal or:beneficial'owner of any interest in;a non.corporate entity(wh`en 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 `d zoo.: $tgnature. Form TS I.. . �- Print.Name.. . 61 Z20 Appendix B Short Environmental Assessment Form Instructions t6r Cam,nletinli Part 1 -Project Information. The applicant or project sponsor is,responsible for the completion.of Part L Responses become.part of the application for approval or funding,are subject to public,review,and may be subject to further verifications. Complete Part. 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.supplementany item Part 1. Project and'Sponsor Information Name of Action or Project: I.Proposed.single family dwelling Project Location(describe,and attach a location map): 1625 Naugles.Drive, Mattituck Brief Description`ofProposed Action Please see attached Name of Applicant or Sponsor Telephone:631 275-3031 .622.Church Lane' LLC. E Mali:Eha 'rbes@gMajl.com ..:..... ... Address: P.O. Box 961 City/PO.c State: Zip Code: Mattituck .: NY 11052-0961 1.Does tli`e'proposed actscti o y involve the legislative.adoption ofa'plan,local law,ordinance, NO. .. YES>..' administrative rule,.or regulation? IfYes,attach.a narrative description of the intent of the proposed,action and the:environmental resources.that .spay be affected in the municipality and proceed to.Part2. If no,continue to question 2.. 2. Does the proposed action require a permit;approval or funding from any other`governmental Agency? NO Yl✓S If Yes, list agency(s)name and permit or approval: N.Y.S.D.E.C. �✓ 3.a.Total acreage,of the site of the proposed action? 3.1 acres b.Total acreage to be physically disturbed? 0 02. acres C.Total acreage(project site and.any contiguous properties)owned or controlled by the applicant of project sponsor? 3.1 acres 4. Che 11 land uspg at occur'on,ad oinin Urban ✓ Rural(non-agriculture) lndustrial Comm an ar the ro action. ercial ❑.. Res,idential (suburban) Forest. ❑Agriculture Aquatic ❑Other(specify) Parkland Page 1 of 4 Applicant proposes to remove a block shed (87.4 SF), a one story frame building (362 SF), a frame shed (51.8 SF) and a residence (842 SF); construct a new single family dwelling (2,420 SF); install a new I/A OWTS system; pool (592 SF); pool fence (150'); garage (658 SF); front deck (93 SF); main terrace (1,121 SF); steps (455.2 SF); retaining walls (289'); drive and motor court. All new structures and terraces shall be a minimum of 75' landward of the tidal wetlands boundary. Proposed setbacks from the tidal wetlands boundary: Single family dwelling 86'2" Garage 75'4" EAST planter retaining wall 70' to 58' Pool terrace deck 81'10" East planter retaining wall 87' to 73'6" 5.`1s the proposed action, NO `::YES :N/A a. A'permitted use under the zoning regulations? b.Consistent with the•adopted com rehensive lam? 6. Is.the proposed action consistent with the predominant character of the existing:built or natural NO. landscape? 7.-,17the site ofthe proposed actton.located in,or does it adjoin,a state listed Critical Environmental Area? NO `::YES If Yes,identify:Ipn�.Island Sound joi .� 8. a.Will the proposed action result in a substantial`increase in traffic above present levels? NO i ✓ b.Are public transportation service(s)available at or near the site of the proposed.action? c.Are any pedestrian accommodations or bicycle routes available on or near.site ofthe.proposed action? 9.Does the proposed action meet-or exceed.ihe state energy code.requirements? If the proposed action will exceed requirements,describe design features and technologies Of n ..� 10. Will the proposed action connect to an existing public/private water supply? NO :`YES.. If No,describe method for providing.potable water: El n 11:'Will the proposed action connect to existing wastewater utilities? NO. ,''.YES , If No,describe method for providing wastewater treatment:. n LJ ' 12. a.Does the site contain a structure that is Misted on.either the.State or National Register of Historic NO .. YES Places?. ✓ b: Is the proposed action located in an archeological sensitive area? - ✓ 13.a.Does any portion ofthe site of the proposed action,or lands'adjommg 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 waterl ody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:. 14.VWetl'; ntfy the typic bitat types that oc n,or are likely to be found on t roject site. Check all that apply:. Shoreline Forest Agricultural/grasslands Early mid=successionalnd Urban Suburban 15..Does the site of the proposed action contain any species of animal,or associated habitats, listed. NO YES .. by the State or Federal government as threatened or endangered? ✓ 16':is the project site.located.in the 100 year flood plain?' NO YES ]7.Will the proposed action create`stone water discharge;eitherfrom.point or non=poihf sources? NO... If Yes a. Will storm water discharges,flow to adjacent properties?. -[]NO DYES ❑✓ ❑ b. Will storm water discharges be directed to established conveyance systems ff an m drains)? If Yes,,briefly describe: N0 �1'ES, Rage 2 of 4 . 18.Does.fhe proposed action include consfruction or'other activitiesthat result m the.impoundment of NO VES water or other liquids(e.g:_retention pond,waste lagoon, dam)? If Yes,explain purpose and,size ❑✓ . ❑ 14 P P adjoining P y 99..Has the site of the ro osed action or an ad'oinin ro ert 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 remediadon(ongoing or NO. YES corn eied):for hazardous waste? If Yes,describe i AFFIRM:THAT THE INFORMATI PROVIDED ABOVE IS TRUE AND AMMATIE TO THE BEST OFAV1. ' KNOWLEDGE Applicant/sponsor name.:G 1:e .. JU, Date: Signature: Part 2-Impact Assessmen . The end Agency is responsible for the completion of Part!-Answer all of the:following questions in.Part 2 using th info ation contained in Part l and other materials submitted by the project sponsoro 'otherwise available to;the r vi er. When answering the questions the reviewer should be guided by the concept"Have my responses:been reasonable nsidering the scale,and context of the proposed action?" `No,or r4oderate 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 of affect.existing infrastructure for mass transit, biking orwalkway?. ❑: 6. Will the proposed action cause an increase in the use of energy and it fails:to incorporate reasonably available energy conservation orrenewable energy op ortunities? ❑' �� 7. Will the proposed action-impact existing a.public/private.weer 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.9.,wetlands waterbodies,.groundwater,air quality,flora and fauna)? ❑> Page 3 of 4 No;or: 'model ate 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 t 11. Will the proposed.nfion,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 mayor 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-terinr and cumulative impacts: TOCheck.this iiox if you have determined,based:on the information and analysis above,and any.supporttng documentation, that the proposed action may result in one or more potentially large orsignificant 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 Sig nature.of Responsible Officer in Lead Agency Signat re of Preparer(if different from Responsible Offior) PRINT Page 4.of 4 Town of Southold LWRP CONSISTENCY ASSESSMENT F.ORIVI A. INSTRUCTIONS All applicants for,permits* including Town of Southold agencies, shall.,complete ahis 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 n. 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 prepares of this form should.review the::exempt. minor action`list policies and explanations of.each polcycontauied in the Town:of.Southold Local- Waterfront Revitalization Program. A 'proposed action wall be evaluated as to its. s� ign f cant :. benefieial:and adverse effects:;upon;the coastal.area(which includes'all of Southold`l'ownj: 3 , if any,question in:.Section.0 on this form is answered..'.yes" or, "no", then,the proposed action will affect the Achievement of.the`LWRP policy standards and conditions contained`'the consistency' . review law Thus, each answer must be ex lain in detail, hstuts both sunporttng and non. supnortina facts If an action cannot be certified as consistent v�nth.the LWRP policy,standards and con d tioris,rtshall 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#;994 1:8 .PROJECT NAME.New single family dwelling The Appliication has been submitted to (check appropriaterespon se) :: Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees . ✓ 1. Category of Town:of Southold agency action(cheek.appropriate'response): (a) Action undertaken directly by.Town agency(e.g.capital construction,planning activity;agency regulation,land iansaction) a (b)` Financial assistance(e g.grant, oan,subsidy) (c) Permit,approval,license;certification: Nature and extent of action: Please see.attachgd . I 1 Applicant proposes to remove a block shed (87.4 SF), a one story frame building (362 SF), a frame shed (51.8 SF) and a residence (842 SF); construct a new single family dwelling (2,420 SF); install a new I/A OWTS system; pool (592 SF); pool fence (150'); garage (658 SF); front deck (93 SF); main terrace (1,121 SF); steps (455.2 SF); retaining walls (289'); drive and motor court. All new structures and terraces shall be a minimum of 75' landward of the tidal wetlands boundary. Proposed setbacks from the tidal wetlands boundary: Single family dwelling 86'2" Garage 75'4" EAST planter retaining wall 70' to 58' Pool terrace deck 81'10" East planter retaining wall 87' to 73'6" Location.of action: 1.625 Naugles.Road; Mattituck Site acreage: 3.1 Sin le.famil dwelling, boat house; sheds, etc.. Present land.use: . . 9 Y 9 Present zoning classif cation: R 80 r 2.: 1f an application for the proposed action has been filed with the Town of Southold agency, the following information shall be:provided: x (a) Name of applicants 622 Church Lane LLC (b) Mailing address: P.O.Box 961 _ Mattituck,NY 11952-0961 (c) Telephone number: 631 275-3031 Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes'0 No❑ If yes;which state or federal agency?NS.D.E C: C.. Evaluate the project to the followingi policies by analyzing how the project.will farther support or noUsupport 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 coastaflocation,and minimizes adverse_effects of development. See.LWRP:Section III-Policies; Page 2 for evaluation criteria. ❑✓ Yes ❑ No ❑ Not Applicable. Project will not.have.a negative im act upon.the.character of the communitY or oP Pen's..ace. _ Attach additional sheets it necessary. Policy 2. Protect and preserve .historic .and archaeological resources. of the'Town of Southold. See LV MP Section III Policies Pages 3 through 6.for evaluation criteria R] Yes ❑ No 0 Not.Applicable Project will have.no impct upon any known historic or archaeological resorces. Attach addihonalsheets if necessary Policy, 3, Enhance visual quality and protect scenic resources throughout'the:.Town of Southold. See . LWRP Section III`—Policies Pages.6 through 1 for evaluation criteria Yes ❑ No Not Applicable . Project will have no.impact upon the visual quality of the Town or any scenic resources. Attach addihonal sheets if.necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—nnPolicies Pages 8 through 16 for evaluation criteria O. Yes 1 No .Not Applicable Project will not result.it the loss of life,structures or natural resources due to flooding or erosion. 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 R1 Yes 0 No. E]Not Applicable Project will not negatively impact water quality or water supply. th ad ihona s eets if nece tac ssary 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 11 through 32 for evaluation criteria. �/ Yes No Not Applicable Project will not:impact the quality or function of the TowWs ecosystems or Significant Coastal Fiah and Wildlife Habitats or wetlands: Attach additional sheets ifnecessary. Policy. 7.. Protect and :improve air quality in the Town ;of Southold.:See LWRP'Section III - Policies. . Pages 32 through 34 for evalnation criteria. ❑✓ Yes ❑,No Not Applicable The project will not impact the quality of the air: Attach additional;he ets.i€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 ;D No ❑� Not Applicable The project does not involve solid waste or.hazardous,substances and wastes. PUBLIC.COAST POLICIES Policy 9. Provide for public access to, and"recreational..use of,_coastal Waters, public lands, and public resources of-the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. Ye l Na 0 Not Applicable The project.will not impact:the public access to, or the recreational use of, coastal waters,:public lands or the public_.resouces of the Town. Attach additional sheets if necessary f' 1 WORIUNG COAST POLICIES Policy 10. Protect Southold's water-dependent uses-and promote siting of new water-dependent uses in suitable locations:' See LWRP Section III—Policies; Pages 47 through.56 for evaluation criteria. ✓ .Yes ❑ No .Not A licable ❑ PP , Pr: 'ect not ppact t.he To . `s` r- a .. �epetz ent rises in_s: Attach additional sheets if necessary Policy Sl. Promote sustainable.usc. of living .marine 'resources in Long Island .Sound, :the.Peconic Estuary altdr Town waters. See LWRP Section III--Policies; Pages 57 through 62 for evaluation criteria. ❑✓ Yes D No❑ Not Applicable , PCo'ect will:not:.irripactahe sustainable..use ofliving marine.resorces of,Mattituck.Creek.or.the adjacenfLong.Island.Sound.. .:. . Attach addifional.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 es I?roject:d.o .not involve agricultural lands... Attach additional sheets if necessary Policy 13 Promote appropriate use and development .of.:energy and mineral resources. See LWRP Section III-Policies;Pages 65 through 68 for evaluation criteria. ❑Yes ❑ NO Not Applicable Pro'ect.does not..involve the use of or..the develo. ment.of.ener or mineral.res.ources. PREPARED BYGlenn E. Just . . TITLE.A e--nt . DATE' �"