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Home My WebLink About1000-97.-3-2 3'-W - 3e'-VS S-W T-IP - , 2 Ca 13 • .. S_I0-Y.- 11 7y MARK SCHWARTZ tlilf ARCHrrECr 5tae doo. al.� 5tan dorn. 25495.MAIN ROAD _..... yl R NEWYO�IIIC�1198 b I x f oor curcH b Wemv� V R6Tf• "Vo ~ A. el V o U GCe.ar WA •'� � b 2rd four '-C 3-1/2.}1/2 p-ft ><•2j C� . ... .. .. Gea.a.W.I8 off - c a5' z-9f T-y5• c r . Is'-I u4. le•-r - 19-I✓t- 3e-US' • . FIRST FLOOR PLAN EXISTING- SECOND FLOOR PLAN - EXISTING I Cy O �?� 3 �`+..I z • Scale:Yl- I'-O' Scale:Y:� I'-0' � Fi Uzi o 3e.-LW Pond r1 Rur POrc4. Re P P. 5'•7K• 13•-Or C•3' S"J?- T-I P rL�^f. vr 1 L .LLLL � ---.:��W.a i� S w WIC Kitchen 3•-P 00 Bathroorti A Bedroom I b 1><ibor ' - t--•[e��.d.a w,a 2668 Aibc T �avls[oNe a �' i n fuorne fl.a.Pls- IL I.a I. Off=Imnq Room _ wa samAcfz • Bedroom 2 0I'J seAia_ sma[trna AS-Built V U-.0 Cry W-den Nev Ei6Y I N �•, �' � Floor Plans C.V¢ 5'.1• C.3i- 2-6i• 2-1p¢ 3'�:• 3'-3Y.- 4'-1�• 4•-7Y- Iy._I uf• Ie•-r 3e'-IY' s 3e•-1Y.• ~ FIRST FLOOR PLAN - PROPOSED SECOND FLOOR PLAN - PROPOSED A - 1. 5 V . Scale:lq I'-0' Scale:A,n P-0• • � MARK SCHWARTZ AIA AYQff1ECr 11f9i MAM ROAD curaiocvs NRWYORICI1513S P:631-73"IM 3e•lyi• � 2 . C a U a _ cst .y_- ce-- Crawlspa = F.y,a.y O Baxmcntwy N 59.a r- FTy V. z U z C.b 51x4 19'_I lyi• - IB'•2 FOUNDATION PLAN — EXISTING . BRAN CA76 Rr4wx3m • 1 0 1 lla:flw meoedw /ClMAi3Z Af Np7® USAwtl sr rte SME fTMA As-Built Basement a . 1 - T - 1 12 4 1 z 1 z i z MARK ALA _ ie--•aP it-�o ARCRr ECG h. . u 2m9s MAIN ROAD _ - Cu7CH000E NEW YORK 1195 ro eaernes w rac ao> R 471-)]441as Ica• c— r Genxfe Bt eprWzon Wpbr Ft_ - - 2M Pgar f fa4nor Waa _�- - - 112oC-121.mo ' cy,a 8anw Wm - Q2A'o.e S if FOUNDATION PLAN - EXISTING FIRST FLOOR PLAN - EXISTING SECOND FLOOR PLAN - EXISTING w p �?� " scale:r.-_ I•-u- Scale:r.•� I•-o- sale:r,•- I•-a Q Q 3 1-4Ow � C4z wza I x In V M r� _ cv WP vAc rvtchcn NBiFhroom 3'O — Bedroom I xc.�cwca i ad. _ran eo..• Sc»m.� 26ir8 �-K . 2668 NORrx a:e9 etwd pore exvwoNs . k a 2668 pp a a p.�ets Lwrg Room d of— Bed . ............. 22 ma room 2 � Na 5a�'e ap �N LE A9 NpfFp ' m2M Mr DWWN ea: N6 E Lccm ea: L t sxtt'rlaraa: ml 9 As-Built .....-. .............. S ERGZ;;QE�� Lr Floor Plans 3 s 4 5 p Scale:Y-- r-c- Top d PrraMd 909. . ..—.........................-.............. �_._. ®SecaN Rcor E— 19•-7 e._ _...._.. ��y lYIArA SCHWARTZ AIA AsaFrEcr Sewrd Floor Top d K—wa 20*OMMN ROAD ®_5era+e noor_ C%(70bGUE �109& _ lMEWIM 11935 H Top d Pagncd Pbor - 0.02PRwass - ele..tee•<-_ E—wj° Flne Fbor X•3*p—d .®z+•ac. Top d rr.rva Pb ' ®fsy.Flcor . —�Elcv.WO Topd c ,ccrc 51 Q n BUILDING SECTION - EXISTING BUILDING 5ECTION - PROP05ED a Z Z,CD [><]� O InvT aaKwje a Poor M1 TwT®fotd lac T M1pPe-lo pa]eora�r P P Ulutc _. z A ...._ Tod gl—R ,L3®esTT®+zQ•o+f X•haM�oder ffx.prC l[,Oo o.pfFl Psr�co n noEw:doeu ar w. o Fle dx�qP l rerowr rt Race 2DIII1: m Tope) d ......... ....................... Afs� @MV6f11AOtPSa ........ .................................. 1. `` d .` Crawbpace '•,' .,s+.ec Tsvw¢ri 'v � "%. v. ♦r' r v. `:'/,� aft �:�',. �. � S SlcXias� 1 } ; n BUILDING 5ECTION - EXISTING BUILDING SECTION - PROPOSED x e :: MARK 5 _.:jC ;�_.- SCHWARTZ AIA ARCHf7ECT 29495 MN Rowo a MAIN r' eureeroeue NEWYORK 779E ':: ] __ ^L';'...�§!".' , ;£x- - -7344105 -- - — 1 %i r- K - _ rr� :: : ,•_•. .:l.,ib:-i.'t,:::.r.?�:.:..4...i."v.i:.;t-a:,.-]..:::.:f.bi_:].:.c.< - _ -- Y. EXI5TING FRONT ELEVATION - NORTH EXISTING RIGHT SIDE ELEVATION -_WEST w Scale:Y..—:•-O' 7 'Y' 4.4 s sy - O. Ln FFFfl J. :.a .nJ:. rtr.-w -w�ti4-.v - . .... ... .._ ... ..::' � .wig-.-.+-c�a,+,. :f -,.•.. :...a. ..... ..,.-< ..,.. •--. .'. ].try=.::�+->:, ,::..:,.:..::.::_., .�„ Y .r : ... -.vY �'-...: .tit.ia-.......c-.r.a....rJr.'.�i'.i":.:.i• -�'::"v _ - - ..._ _. .......... ..... ..... ... .. :.:.. : :: ... ._:....-.:.F ;,;- EM _ - iY NOr:7N CR/UN ®r - DAT! CEV 610N5 2 Do .0 ... '.... .. :.... .....: ... ...................... ... ..... ..... ......... CODA N6: wle ]CI7 • � warrnm ' piANN Ch. A6 G EQ(FOR _ t NEEf TIRE gProgress Elevations PROPOSED FRONT ELEVATION - NORTH PROPOSED RIGHT SIDE ELEVATION " Scale:Y.'— I'-0- Scale:Y'— I'-0, 3 i a A - 3 e MARK _ SCHWARTZ Fvv.%+-'"£ _ 1L1 ARCHRECT ey"s.i�=s�.:^f"T�:,-kx.4�;�,,,�:a sa.:f.:.Y+`:: k=•t:L.3.:-::5`��rau,3.-. '-^:^" 6�<.� r ..ml+x�•-,..5.�'�w+..��,L�'y^n n'♦��♦�—w.> - - T?__' i'" ...r +k, :Yr't1•'_x wt - _ --__ 2%9S MAIN ROAD CUPGiOGUE �`!- .F=- .P_i3=� -_-'a.'�•��:�%^��S•'-FTs35_ •` _ - NEW PORK ll915 it»` :,i_ :,irswwi,: .,7o4 ±wv:-;,F`r. '_`j'•q _ 1'.631-73HI8S _..::wiC_.e:r<,y..,:.•..-E.a^�f•_-.�.>_..r�::.i..:?:,. :;.:L�.-.:.z::+•`--i:-.�?73;i�-S.-Y..'::pert-ry_T•e�«„/s `::�•?�:s'n♦F:;z«p.. : + .:>., -;ds -max- t s. ....r:....a•.....- s ..x - = '�-�•'`�� — r�. ... _ _ ::r': "=1�:•,r_� .e<_3',..�� .,{ ?3.;�-'fir.., -- - - - - - - - Y:i l+H - dzal ,..ems-..-r.-.<-. EffEMI - ® ® - - - .K - w n EXISTING REAR ELEVATION - SOUTH n EXISTING LEFT SIDE ELEVATION - EAST u Scale:Y,'a i'-O' Scale:Y,'- I'-O• �i �n^ Q - ce. z g�grwza ....... .'x'._a.:..r iw,=':i fir..:a?..-..._.•/ .:[f ....^..+ e--, _ - _ At er. erl ...... . ..-.. W ti �{ < ;:.• -mow,. - . ..- ... . .. -3 -: ...... N�iil •tY nwK :v wA. i✓ V1R1 S fb' f' :i ..♦.; .,.ww:-:+.:w-w+v.->::.ti.vi%,:/.-i„i:-.i /� - Cd1Al lIR SpIMART2 . xRnMNR M9 Fj ERED an C xrsrmte 9 Progress PROPOSED REAR ELEVATION - SOUTH n PROPOSED LEFT SIDE ELEVATION - EAST Elevations � _ s X o A A - 4 0 L LIU J T III tF-IT T , I IT �7 Rr"POSED NORTH ELEVATION 'SCALF.-,�i/4" JE UE "N' EXISTING NORTH EELEVATION , 7 7, SEWAGE SYSTEM DESIGN SCDHS REF # C10-14-0002 CAL COLA TIONS TOTAL AREA = 10,644 SF SURVEY OF PROPERTY TOTAL BUILDING AREA = 1262 SF NON MEDICAL OMCE — 380 sq.ft. A T CUTCHOG UE 380sq2.ft.GP x 0.06 = 22.8 GPD/sq.ft. TOWN OF SO UTHOLD p F�477 sq. x 2 = 954 sq �� .ft.= 2 55 ,� SUFFOLK COUNTY N. Y. GARAGE — 281 sq.ft. x 0.08 = 17 GPD sq.ft. R°10 S�0 "3�� TOTAL GPD = 265 GPD s°0 o spy 1SCALE.• 1'-202 265 GPD = 300 GPD ��QE��P��°F pa p `a \G / c i�P��e��P��5 �v ry�9 J,��'\� NOVEMBER 1, 2012 SEPTIC TANK 265 X 2 = 530 GAL 2 DAY FLOW ��S p� FDR � JULY 3, 2013 (BOARD OF HEALTH SURVEY) 0 & yl ��, MARCH 27, 2014 (REVISIONS) PROVIDE 1 PRECAST SEPTIC TANK 1200 GAL 4' LIQUID DEPTH RED EES p�g�J �� MAY 6, 2014 (REVISIONS) MAY 28, 2014 (REVISIONS) LEACHING POOL 265 GPD = 26511.5 sq.ft. SW 177 sq.ft. pSo0 \�sc� 610,� ,�o�o.� JULY 23, 2014 (REVISIONS) PROVIDE I LEACHING POOL 1010 X 12 DEEP �tL c 6/�� a 4a e�tie AUG. 13, 2015 (REVISIONS) SEPTIC TANK AND LEACHING POOLS g,P cy�P P�� Se�P e FO;TcPJe pIS ;J NOV. 9, 2015 (ADDITIONS) TO HAVE TRAFFIC BEARING COVERS `eJoy of e P 10.°y ®ti �G le, MARCH. 4, 2016 (REVISIONS) 0 c 5�5 MARCH 14, 2016 (REVISIONS) oy:%; ,� ��e OCTOBER 6, 2016 (REVISIONS) EXISTING SEPTIC SYSTEM TO BE ° �y �'��y tJ� FEBRUARY 2, 2017 (REVISIONS) ° , �0' y°ti MARCH 1, 2017 REVISIONS f7LLED IN TO SCDHS. SPECS p, \!� Q, (REVISIONS) WELL TO BE ABANDONED �k , \°0® °�,r`° JULY 12, 2017 ( REAR SETBACK) 4 �0 s PARKING APT—(2) SPACES o�o�' f &yG� s ® `�•,� �6 a�0 4`� 0MCE — 4 SPACES ,� ` �° lea•*� ' " P�� e� 0 SPACE/100 SF) e c 366. SF — 4 REQUIRED (6 SPACES PROVIDED) \ z�o��{ �E 9�° �PeP R'6, 5 A� P, PARKING PERTAINING TO BUSINESS IN REAR OF BUILDING �\� ® � ,�" e P�s� \ o�`�P R®,y ° �oSco�S 3 pµ6 19p % •a° \�\ 9qA c P`�o 2 h TRENCH DRAIN CAL CULA TONS Q�°�o �G c '9�, �� ; ��o 11� �P$�, o PO, 15 WIDE PAVEMENT = 360 SQ.FT cR �P o o�y �°e s�� o"•<8��iti`� �oc e 360 x 0.6 x 0.17 — 37 CU.FT. 10 5 �eGy % ��° i0" e °A �Y o -' " PROVIDE (1) DW 610 x 2' DEEP '%� �'� r� it V'St `� yI I i 92 COMMERCIAL �PG y ° �,d�. ;,� i P�59, SEPTIC SYSTEM DETAIL ®� 'o. 2 �e s to NOT TO SCALE RAIN RUNOFF CONTAINMENT ; HEAVY DUTY LOCKING BUILDING AND GARAGE 1262 S.F. y y o o F.F. Ei. 26.2' HEAVY DUTY LOCKING n� rn. —� oyl ti ' 1� TRAFFIC BEARING COVERS TO GRADE TRAFFIC BEARING COVERS TO GRADE 1262 X 1.0 X 0.17 = 216 C.F. y y �� r'� AND CAST IRON FRAMES ��_,, y AND CAST IRON FRAMES 216122.3 - 9.7 VF v o, ,�. a o �! CLEANOUT FINISHED GRADE PROVIDE 2 DWs. 60 X 5' DEEP �F �`� �E y�I 1�2- OPG� 2T FACE OF OF CA IRON INC 2 5 24. 1,M/N. EL 23.5' 24' MASONARY CHIMNEYS 2'MAX. DRIVEWAY PARKING S F <:��5 tiro• ; va � EXTENDING MAX „ 25' �` F 0 THROUGH FOUNDATION 6, "12" 8 INCH 7RAF/C SLAB TO 1124-1� 2'MAX. 4588 SF >► y� �o° 1�.�' lF� I I � % �� IN�2. � ID GRADE — — � a INCH TRAFiC SLtib 4588 X 1.0 X 0.17 = 779 C.F. �a � '� I� 1/4'PER FOOT 21.7 B. TNu. ®®®®� _ 779142.2 — 18VF 0O 9O P r'�� $ MINIMUM PITCH 21.2' INVEL. ®®®� Jll �- MIN.4' DIA. PIPE 1/8'PER FOOT _ MINIMUM PITCH 21.0' CO PROVIDE 2 DWS 80 X 9' DP <�<<� 91J R�'y ` e °� A.p MINA'DIA. PIPE ®r c�, i.. L..•+ WITH GRATE v `� �� QO QO o� ALL P35 PTO VC E tm4 DRAINAGE STRUCTURE TO HAVE y� y 9� TRAFFIC BEARING COVERS F`� S-V �� \\.o `o. 9 J F y 0 S.� ° !, �T �.� \rr, � .6 s� 300 S.F. l�� `� yc BMINIMUM c" is.�'�. 5 ®� i �i y SIDE WALL v o NO PUBLIC GAS SERVICE TO HOUSE '�l F F1°kj>�\\ cIti�' ;°% °F Tj� qa9 AREA 712 SQ.FT. OF CONCRETE TO BE REMOVED y2 '� �, o, o — tom 3 FOOT MIN. SEPERATION LOT COVERAGE �9 c� �` ?� � C�9 r0 S Q FROM SEASONAL HIGH GROUNDWATER o c4` tP o BUILDING-1262 S.F. �9 ,op- �9� �'� epee 1262110664 = 11.89 LANDSCAPED AREA N, 4410 S.F.110664 = 41X •r,�, "'- 6 A 1SN'�yc eKEP I P E °lh9T° 'rp FRP < <� ® =MONUMENT ,A%1 1.'��o ♦ = BUILDING LIGHT FIXTURE (PROPOSED) `'$ • = 2" CALIPER TREE (RED MAPLE) (PROPOSED) ® ROWO 0 CENTER H EVERGREENS t�a = 3-4' HIGH BOXWOOD HEDGE ' � 1 = LINE OF HAYBALES & SILT FENCE TEST HOLE DATA BY McDONALD GEOSCIENCE. C)F NL,V � FEMA FLOOD ZONE X 7/5/13 � r� � > �j- C� BROWN SILTY SAND SM v.{__ ?4"-1 ELEVATIONS REFERENCED TO AN ASSUMED DATUM _ 3• The location of wells, cesspools & public water shown hereon are PALE BROWN FINE TO MEDIUM SAND SP MARK K. SCHWAR7Z, A/A ARCHITECT from field observations and or from data obtained from others. < - r P.O. BOX 933 4S�`7ti r�. ,G' W ANY ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA770M CUTCHOGUE, N.Y. 11935 �� N.Y.S. LIC. NO. 49618 OF SEC77ON 7209OF THE NEW YORK STATE EDUCATION LAW. 17, 1022339 PECONIC 'SCIRVEYORS, P.C. EXCEPT AS PER SECTION 7209—SUBDlNS/ON 2. ALL CERAf1CAT10NS NO WATER ENCOUNTERED (631 765-5020 FAX 631 765-1797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF �• SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF F 1 THE SURVEYOR AREA=10,664 SO. . P.O. BOX 909 WHOSE SIGNATURE APPEARS HEREON. 230 TRAVELER 1197E STREET 12-274 BOARD MEMBER" �� Town Hall.Annex Leslie Kanes Weisman,Chairperson 53095 Route 25,Main Road Patricia Acampora P.O.Box 1179 Eric Dantes Southold,NY 11971 Robert Lehnert Jr. 631 hone Tele p ( )7 5-18 09 Nicholas Planamento a; ` Fax631)765-9064 http:Hs o utho i dto wn ny.gov ZONING G BOARD OF APPEALS .......... TOWN OF SOUTHOLD 2 4 2 0'°" il ....... 0 �m p^v tl qA 4 MEMORANDUM Plarinfllg Board To: Heather Lanza, Planning Director Southold Town Planning Board From.. Kim Fuentes, ZBA. Beard.Assistant Date: February 22, 2021 RE; Z A.#74 3 --Mattituck 2012, LLC 36230 NYS Route 25, Cutchogue, SCTM No. 1000-97-3-2 Please find a copy of the Full Environmental Assessment Form submitted by :Michael Kimack on behalf of his client, Mattituck 2012, LLC, for proposed construction of a new single-family dwelling with a business office (pest control) located in Limited Business (LB) Zoning District. This application was originally referred to the Planning Board on February 16, 2021. Enclosures: FEA.F received February 22, 2021 cc: bark Terry Full Environment( Assessment.far .......... f Part I -.Project and Vetting j ` ""° 21 rLi i � FEBI Instructions ►r Completing Pert 1 f Part I is to be completed by the applicant or project sponsor. Responses become part of the a.pplicatid �kw.��p are subject to public review,and may be subject to further verification, Complete Part l based on information ieurrently 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; indicate whether missing information does not exist, or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to update or fully develop that information. Applicants/sponsors must complete all items in Sections A &B. In Sections C,D&E,most items contain an initial question that must be answered Blither"Yes"or"No". If the answer to the initial question i "Yes",complete the sub-questions that follow, if the answer to the initial question i "'No",proceed to the next question. Section F allows the project sponsor to identify and attach any additional information. Section G requires the name and signature of the project sponsor to verify that the information contained in Part I is accurate and complete, A. Project and Sponsor Information, Name of Action or Project: Nlattituck 2012 LL �m Project Location(describe,and attach a general location map): 36570 Route 25,Cutchogue,N.Y. 11935 Brief Description of Proposed Action include purpose or need): ..� Demolish an existing fc*imily dwelling with business office and construct a nE)W single family dwelling with business office Name of Applicant/Sponsor: Telephone: 516-658-6807 Michael A.Kimack E-Mail mkimack2@verizon.net Address:P.O.Box 1047 City/PO: . Southold State: N.Y Zip Code:11971 Project Contact(if not same as sponson, give name and title/role): Telephone: E-Mail: �H. Address: City/po: State; Zip Code: Property Owner (if not same a sponsor), Telephone:.631-875-8725 Ma tituck 2012,LLC F-Mail: norman@norrnankeilnurseries.com Address: 1854 Major,Path City/Po: State: dip Code: Southhampton on N�'��0 1198 Page I. of 1 B. Government Approvals B. Government Approvals,Funding,or Sponsorship, ("Funding"includes grants, loans,tax relief,and any other forms of financial assistance.) Government Entity If Yes: Identify Agency and Approval(s) Application Date Required (Actual or projected) a. City Council,Town Board, [:]YesEZ]No Southold Planning Board:Approved for extension or Village Board of Trustees to permit 9/10/19 to 3/8/20:21 b. City,Town or Village [, YesMNo Planning Board or Commission c. City Council,Town or [ ]YesE:]No Prior approval ZBA File#7098 New application:February 2012 Village Zoning Board of Appeals d, Other local agencies E]Yes WINo e, County agencies F-lYes&Z]No f. Regional agencies E:1Yes1Z1No g. State agencies E]Yes ONo h,Federal agencies E]Yes 21No L Coastal Resources. i. Is the project site within a Coastal Area,or the waterfront area,of a Designated Inland Waterway? F-lYesWINo ii, Is the project site located in a community with an approved Local Waterfront Revitalization Program.? 0 YesEDNo iii. Is the project site within a Coastal Erosion Hazard Area? M Yes[Z]No C. Planning and Zoning C.I. Planning and zoning actions, MOWN Will administrative or legislative adoption,or amendment of a plan, local law,ordinance,rule or regulation be the FlYesoNo only approval(s)which must be granted to enable the proposed action to proceed? 0 If Yes,complete sections C, F and G, 0 If No,proceed to question C.2 and complete all remaining sections and questions in Part I C.2. Adopted land use plans. a. Do any municipally-adopted (city,town, village or county)comprehensive, land use plan(s)include the site E]Yesg]No where the proposed action would be located? If Yes,does the comprehensive plan include specific recommend ati ons for the-,site where the proposed action [:]YesONo would be located? b. Is the site of the proposed action within any local or regional special planning district(for example: Greenway E]Yes[Z]No Brownfield Opportunity Area(BOA); designated State or Federal heritage area;watershed management plan-, or other?) If Yes, identify the plan(s): c. Is the proposed action located wholly or partially within an area listed in an municipal open space plan, [:]Yes2]No, or an adopted municipal farmland protection plan? If Yes, identify the plan(s): ..................... ......................... Page 2. of 1'13 ft C,3. Zoning a. Is the site of the proposed action located in a municipality with an adopted zonionl*g law or ordinance. 0 Y e s F-1-No If Yes,what is the zoning classifications} including any applicable overlay district? LB-.........Zone b. Is the use permitted or allowed by a special or conditional use permit? 0 Yes2l No c. Is a zoning change requested as part of the proposed action? MYesONo If Yes, i. What is the proposed new zoning for the site? C.4. Existing community services. a. In what school district is the project site located? Cutho Lle School District Mm b, What police or other public,protection forces sente the projectsite? Solilb-OA1 ,PPIJ-gg QqP c. Which fire protection and emergency medical services serve the,project situ?` Southold Fire.jqqpa�trnefij,and EMS d What parks serve the project site? D. Project Details D.I. Proposed and Potential Development a. What is the general nature of the proposed action(e.g.,residential, industrial, commercial, recreational; if mixed, include ail components)? Commercial b. a, Total acreage of the site of the proposed action.? 0.244 acres b. Total acreage to be physically disturbed? 0.105 acres c. Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.244 acres c. Is the proposed action an expansion of an existing project or use? El YesV1 No i, If Yes,what is the approximate percentage of the proposed expansion and identify the units(e.g., acres,miles,housing units, square feet)? Units: d. Is the proposed action a subd ivision, 01,does it include a subdivision? E]Yes ONo If Yes, i. Purpose or type of subdivision? (e.g,,residential, industrial,commercial; if mixed,specify types) i Is......... .................. a cluster/conservation layout proposed? E]Yes ONo iii. Number of lots proposed? iv. Minimum and maximum proposed lot sizes? Minimum Maximum ............. el Will proposed action be constructed in multiple phafses? E3YesONo i. If No, anticipated period of construction: 9 months ii, If Yes: 0 Total number of phases anticiptited 1 0 Anticipated commencement date of phase I (including demolition) April month 2021 year Anticipated completion date of final phase Jan month 202 eat- Genet-ally describe connections or relationships among phases, including any'-contingencies where progress of one phase may determine timing or duration of future phases-, ............ Page .3 of 13 it Describe how the proposed action would affect that waterbod �etlar or w id,,e.g. excavation,fill,placement of structures,or alteration of channels, bards and shorelines. Indicate extent of activities,alterations and additions in square feet or acres. ,u �„ mwm�. mmwm .mm.mmmmm.... www�.�mm�wL�w. iri. Will proposed action cause or result in disturbance to bottom e ,.�, m.... . diments �Yes[:]No If`"des,describe: iv. Will proposed r in he 0 action cause or result destruction or removal of p p T t aquatic vegetation? [_lYesF�I►lo If Yes; • acres of aquatic vegetation proposed to be r move after project .�m.m.m. . expected acreage of aquatic vegetation remaining p eject completion purpose of proposed removal el . beach clearing,invasive species control, boat access); / mmmmmwwwwww.w.wm .� ,� r _. �m wwwww proposed -nethod of plant removal, • if chemicaAerbicide treatment will be used specify roduct s , mwwwwwwww mm �w :,:, . .. 11. Describe any proposed reclamation/mitigation following disturbance; .. m m �mmmmmm�mmm�mmmm.....�mm mm�m�mwwwwmmwwmwv� �, c. i l l the proposed action use or cr�eat:e a new derr�� ? p p � sand for water? � 'e If Yes: Total anticipated water usa e/ errar�cl i, "ot. per day. .m 247.E gallons/day ii. ill the proposed action o t iri t°er, from an existing public water supply? If 'es [Z]Yes�jlJo f Name of district or service area: Suffolk La Water Authg t � mmmmm nnnnnmmm mwwiuww mmmmwmmieirvm. Does the existing public water supply have capacity to serve the proposal? Y esEl No • Is the project site in the existing district? V1 Yes No Is expansion of the district needed? El es[Z 1` o Do existing lines serve the project site? Z 'esF_1 No w. Will line extension within(an existing district be necessary to supply the project? M es WJNo If Yes: Describe extensions or capacity expansions proposed to serve this project; Source(s)of supply for the district; iv. Is a new water supply district or service area.... to be farmed tc �m.w.w.m proposed serve the project site? 0 YesWJNo If,'des; ' Applicant/sponsor for new district: Date application submitted or anticipated; Proposed source(s) w district: stri c • es)of supply fcir new �t: „n.�mmwwwwwwwwww . . � _._ m mm� wwwwwwwwwww v. If a public water supply will not be used,describe plans to provide water supply for theproject: u maximum mmm vi, If water supply will be from wells(public 1'private),), pumping capacity; gallons/minute. d. Will the proposed p p action generate liquid wastes? El"des WINo If Yes-, i. "Dotal anlicipated liquid waste generation per day: , gallons/day ai, Nature of li 'ddc wastes to be generated e.g._,sanitary wastewater, industri-Cal; if combination,describe all components and app�roxtin te� oltin es o,r propo�ilifons ofeach�� p wwwww�._�wwwwwm�w, , �m�mwwwwwwww .�, m .:__�m '�+.+�n m ,,•,,.... M... mn , mmea nym uwni mmmm nnnmmmm nmtmmmmmmimuwxmx.m .mwme.v art. Will the proposed action use . � � p p' any existing public wastewater treatment facilities. El Yes WIN o �wm If Yes: Name of wastewater treatment plant to be used; Name of district; Does the existingwastewater treatment pianm ... ,�. - . o t have capacity to serve the project? El Yes Olio Is the project site in the existing district? Yes MNo Is expansion of the district needed? [I`des[:]No Page 5 of 1 f oM Do existing sewer lines serve the project site? E]Y s O'No lei Will line extension within an existing district be necessary to serve the project? MYesONo If Yes; • Describe extensions or capacity expansions proposc�cl to serve this project: i�. will 11 a new wastewater(sewage)treatment district�i t be formed to serve the� project site? E] es Rio If Yes: Applicant/sponsor for new district; Date application pplrcation submitted or anticipated: the wastewater discharge?' -,� What is the receiving water for v. If public facilities will not be used describe plans to provide w,Ctstewa"—e � �p p � ter treatment for the project, including specifying proposed receiving water(name and classification if surface discharge, or describe subsurface disposal plans); p designs to capture, recycle or r vi, Describe an 1 p , y ease liquid waste: rvrvrvrvry AWW� WON e. Will the proposed action disturb more than one acre and create sftormwater f runoff,either from new point E]Yes "No sources(i,e,#,ditches, pipes,rwales,curbs,gutters or other concentrated lows of stormvwrater)or non-point source(ire.sheet flow)during construction or past construction? If Yeswi i. How much impervious surface will the project create in relation to total size of project parcel' �Square feet or acres(impervious surface) Square feet or acres(parcel size) iir Describe types of new point sources.. iii, where will the s .,� . .w directed i«. site Stc7r� ,-�._.. � ...�.� ,� —, tormwater runoff b(3 ( e.on-site ��water management facility/structures,adjacent properties, groundwater,on-site surface water or off-site surface waters)? N/A If surface titers, identify receivii g titer- �.. �,fm� �.m.m .. .. „��...._ ,.,.�..... ..� _. � �wn «< .�.._..... ' dies or wetlands: Will storrnwater runoff flow to adjacent properties? El Yes No iv. Does proposed plan minimize impervious surfaces, use pervious materials or collect and re-use sto water? El Yes I` o f, Does the action include or will it use on-site.proposed r ,one or rn ore sources of air emissions, including fuel Yes o 0 combustion,waste incineration,or other processes.or operations` If Yes, identify: iA Mobile sources during project operations(e.g.,heavy equipment,fleet or delivery vehicles ir, Stationary sours f ... ., .... ...... ....mom uuuu es during construction (e.g.,power-generation, sotructura.l heating, batch plant,crushers) ris. tationa "sources m....... ,---a `, ,roce5s e��issions l-«mm.� u es Burin o erations e g p' ( g, , arge bailers, electric generation) ..rvrvrvrvry ..m .� . will air air emission sources named in Dr2, ( ),require g y A . f above re urre a. N1Y State Air Registration,Air Facility Permit, [3Yes 2] o or Federal dean Air Act Title IV or Tale V Permit? If Yes: project located in tii Air qu�ilit�iron-attai11MC11tt area/ (Area routinely or periodicallyfails to r�neet Yes t, is tlii ro et site No ambient nt it quality standairids, t",or all or some;pants oftile year) ii, In ad,ditiotl to eiil*tsslolls as,ea er-rlated in the apl°flication,the pro ect will ger era.te: To,r s/year°(short tans)of Carbon Dioxide(C 02) ,'— ..--—Ton (,short tons)of Nitrous Oxide(1`20) —Tons/year(short tons)of.Pero uorocarbons(PI'Cs) —Tons/year(short tons)of Sulfur Hexafluorid(�(SF6) —Tons/year(short tons)of Carbon trioxide equivalent offiydrofZourocarbons(HFCs) —Tons/year(short tons)of Hazardous Air Pollutants(HAPs) Page ) of 1 3 fW. m, h. Will the proposed_osed action generate or g, t , g � p g emit methane(including, but not limited to sewage treatment plants, ]Yesw o landfills,composting facilities)? If Yes: i. Estimate methane generation in tons/year(metric)., _ ��in cl _ m�wwwww to generate heat or ...... ii"Describe any methane capture,control or elimination rxreasurt';s m u Jed in project design(e.g., combustion electricity,flaring): wwwww — mmmmmmm Wwwwr i Y ill the ro.....used action result i n the release of air pollutants open-air proposed p r operations or processes,such as [:]Y'eso No quarry or landfill operations? If 'es: Describe operations and nature of emissions(e.g,,diesel exhaust,rock particulates/dust):° j. i proposed increase i traffic above re Will l l the ro osed action result substantial rn�.rease in Y � present levels or generate substantial 'es2]No new demand for transportation facilities or services? If`des: i. i the peak traffic I tod Check allEvening, andonl]y betweeti hours of to ii. For cone e�rcial activities 0'r ly, pr �ec`Ied n wry l �°of s i�'trailer truck trips/day; iii Parking t l it spaces'. ExiStin " � �mmmm propo ��.d 1" et incream��e/decrease proposed y p �. ivY does tl�e °��o ose action i,�rcl�rdc� r�u slaved use parking*.?, es o v, If the proposed,action includes,any ino di,f"i cat ion of existing roads,creation of new roads or cli,,ange in existing access desct,i,�he: mwwwmrr �. rr m-.... .�mmmmmrrrrrr- "...... vt. Are ubl w- 1c rrvate trans ortatron ser° r or fa cilit res available within �:mile of the proposed site? [�'`�es,�Ilo vu Will the proposed action include access to,public transportation or accommodations for use ofhybrid,electric fes I to or other alternative fueled vehicles? viia, Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing [ Yes,'{]No pedestrian or bicycle routes? kY Will the proposed _ projects generate p p action (for commercial or industrial ro ects only ge ate new or additional demand Yes2]No for energy? If Yes: iY Estimate annual electricity demand during operation of the proposed action; N/A m om b,us,tra�rc on-site renewable,le via grid/local oa.l m� ww � ,,� ii, Anticipated sources/suppliers of electricity for the project(e.g.,ion-sits ` ' Y other): ' � g utility,ot- N' iiiY.Y „w-mumwwruuvnyrwc ,mmmmm� '� mmmnemmmmmmmmmmm m ....... wwwww []�,'esE]Norn ........,.rnnr . ' Will the ro osed action require a new, or an upgrade to,an existing substation?�wwwwwwwwww w:r 1. Hours of 0,l e ation. Answer all items which apply. iY During Corm"struction: U. During Operations: Monday- r rrda 7:00 AM to S:Co PM it :AMonday-Friday: �8,00AM to 5:00 PM, Business) 0 Saturday:_ 7:00 AM to 5:00 PM �* Saturday*' 8:00 AM to 5:00 P (Business m w�r m.m m� Sunday" �� Sunday" " Holidays: --- wwww��.m ----- mmmmmmmmmmwwwwwwwwwwmm�w.w � mmHolidays: Page 7 of 1 10 .........--------- Will the proposed action produce noise that will exceed existing ambient noise levels during constructii. on, F1 Yes 0 No operation,or both? If Yes: i. Provide details including sources, time of day and dUration: ........................................ �. ............... ii. Will proposed action remove existing natural barriers that could act as a noise barrier or screen? 11 Yes�No Describe:,-,,. ...................... vv wmmm �4*04,* ................mR n.. Will the proposed action have outdoor ll&diting? 0 Yes E3 No If Yes: i. Describe source(s), location(s), height of fixture(s),direction/aim,and proximity to nearest occupied structures: F rqn1po E qh1ervif 1�I wp g. Apgnill0sA@ ?-o— serv1qgjA"o �Ln!120-1041b-ta�rtkyj)pp nc pk rch ............. ii, Will proposed action remove existing natural ba`j'--i--i`ers` y D e s c r i be: could act as a I ight barrier or screen.9 es No o. Does the proposed action have the,potential to produce odors for more than one hour per day? n Yes ONo If Yes,describe possible sources, potential frequency and duration of odor emissions, and proximity to nearest occupied structures: .................... ................. P. Will the proposed action .'Include any bulk storage of petroleum((,.1ombined capacity of over 1,100 ga I I ons) C3 Yes 21 No or cherni"cal I)roducts 185 gallons in above ground storage or any amount in utidergrourid storage? 'If Yes: i. Product(s)to be stored U. Volume(s) per unit time (e.g., month,year) W. Generally describe proposed storage facilities: ............ MW� q,� Will the proposed action(commercial,Industrial and only use pesticides herbicides, 4 01 (i e. D Yes ONo 11tisecticides)during construction or operation? If Yes: i. Describe proposed treatment(s): ——----- ..... ....... ....... ii. Will the proposed action use Int2am"ated Pest Man, e1iient Practi.ces? Yes No r. Will the proposed action(commercial or industrial projects only) involvr� or require the m-a"nagement or disposal Yes ONo of solid waste(excluding hazardous materials)? If Yes: i. Describe any solid waste(s)to be generated during Construction or opel,ation of the facility: Construction: tons (unit of time Operation toils ii. Describe any proposals for on-site minimization (unit of tim,e) Construction: recycling or rase of),:naterials to avoid disposal as solid waste: mmmm.m Operation: ...... iii. Proposed disposal method s/ficici�Iiti es for solid waste generated on-site: -——-------- Construction., .............................. rvrvrvrvry Operation-, .................................................. OWN Page 8 of13 c. Is the project site_presently used by members of communr; ty for pr.rblre�recreation? _ i. If Yes: explain: Y s El No -�ry � mmrvrvrvry w dY Are there any facilities serving children,the elderly, disabilities i / daycare centers, y people with disa.l�llrtres (e.g,,schools,hospitals, ,licensed Yes 1J ter ,or group homes)within 1500 fe' of the ro'c;c�t site? � [''� ° If Yes, p J i. Identify Facilities- wm mmmm.�.�mmm-n�nrvrvrvry www e Does the project site contain an e Y{ tr ng dam 9 . .......... If Yes; ElyeSONo ri. Dimensions of the dam and impoundment: 9 Darn height: . �mnmmmmm f cet Dam length: wwwww mmmm, wwww feet Surface m , � ce area: rvm - acres Volume impounded, gallons �l �... m�mmmmm � g acre-feet W. Dam's existing hazard clan ificatiorr�° ii r. Provide date �� and summarize result's f last...inspection-, mww , rvry �. mm�nnnnmw �mmmmmm. ry �rvrvry m �..�nnrvrvrvrvry mrvry f.Has the project site ever been used as a municipal,commercial«r industrial -. solid waste management facility; ❑Yes[ or does the project site adjoin property which i now,or was at one time u�>ed as . . 1 No If Yes: a solid waste management facility? in Has the facility been formally closed? dyes,cite,sources/documentation: � CesD No �n i. Describe thethe boundaries rvrvrvry location of the project site relative to ndaries of solid w _ w m ante r�nanagcment facility: �wwwwwnmmmn �rvrvrvry ,�rvry .....mmmm f Y. y '.... r wWw�-mnnn uumn t®......,.:.+,�mnmmmnry ".......�.+.nm�m�mmmmomvw�rvrvwau.�+..mm�nninnnn�rewwwumu trrn Describe an developmentt tl� rro d y constraints due e o solid y1[wry activities: rye v i[e.��wwwww�m t �`soli waste�4�t�r�tdV Vt immm�wwwww ..,,,,,,,, nnwwwwww.�.�,�nirvrvrvry ,. nrvnry ......wrvuww�mmnn�^- �rmnmminnnmi '+mnmmmm�mmi mmmmmmmnmmiw .... mmmmnvmmmnuwu�.,rvrsmmnwuuu .vree ~4rmawmuimwewwwwwww ... w g, Have hazardous wastes been generated,treated and/or w. g disposed of the site., or does the project site adjoin des No Property which is now or was at one time used to cor�►rner4cial! meat store y t ore and/or dispose of hazardous ? If Yes: p us waste. rf. Describe waste(s)handled and waste management activities, including approximate . . g time when activities occurred: rvrvrv� mmm�,�Y�n��,,,,,�m,�� Into _ .m .ry ht Potential contamination h' Has there been a r' reported spill at the proposed ------- remedial actions been conducted p p p project site,or have any 'Yes� No at or adjacent to the proposed site? If Yes: i. Is any portion of the site listed on the NYSDEC Spills i p s Incidents database or Environmental Site El Yeses'No emediation database? Check all that apply: y d Yes--spills Incidents database DECt Provide E II)number(s): �] Yes--Environmental Site Remediation databaseProvide DECDI��C IIInumber(s)- 0 Neither database i[ If site has been subject of I .0 A correcItive activities,describe control measures', mmm �wm-mmmm ...m.wrvm .�mmw �, rvwwwwnww � mm �Y n �� rv.wwmwwwwm .., ww ,wrvrvry M. Is the � i � rvnnnnn.��,�rvrvrvrvry project within 20+00 feet of any Bite in the NYSDEC Environmental Site P..emediation database's ... If yes,provide DEC ID number( ): OYesONo describe � iv. If , c rr� }yes to ., r ,0 or Iii above u ent status ofsite s e -. .-rvrvrvry wwwww www �� mmmmmmwww, mmmnmm,w ,nmm,m m.., �� 'age 10 of 1 v. Is the project site subject to an institutional control limiting p�roperty_ uses? DYesONo 0 If yes,DEC site ID number: 0 Describe the type of institutional control (e,g,deed resti-iction or easement)., 0 Describe any use Iii-nitations: ............ 0 Describe any engineering controls-, ....... 0 Will the project affect the institutional or engineering controls Yes Explain: .......... .............— E,2. Natural Resources On or Near Project Site ........... a. What is the average depth to bedrock on the project�site? UnknLo_wn feet b. Are there bedrock outcroppings on the project site? El Yes,ONo ,If Yes,what proportion of the site is comprised of bedrock outcroppings? C. Predominant soil type(s)present on project site......' brown fine'—to—med"Turn sand 100 d. What is the average depth to the water table on the project site. Aver-cage: > 17 feet -—-------- e, Drainage status of project site soils:O—W—ell�Drai�ned-, _'_` 1 CIO%of site Moderately Well Drained: of site Poorly Drained %of site f.Approximate proportion of propoiWaction site with slopes.- [Z) 0-100/(), 100 %of site 0 10-15(Vo: %of site 0 Ej 15%or greater: Vo of site g. Are there any unique geologic features on the project site? If Yes,describe: 0'Yes .............. ............ h. Surface water features. i. Does an portion of the project site contain wetlands or other waterbodies(Includin streams, E]YesW]No y 9 rivers ponds or lakes)? ii. Do any wetlands or other waterbodies adjoin the project site? El Y es W1 N o If Yes to either i or ii,continue. If No,:skip to E.2.i. iii. Are any of the wetlands or waterbodies within or adjoining the, project sits;reg u fated by any federal, MYesMNo state or local agency? J iv, For each identified regulated wetland and waterbody on the project site, provide the following information-, 0 Streams: Name Classification # Lakes or Ponds: Name Classification 0 Wetlands: Name .......... Approximate§Tz_� Wetland No. if re gulated by DEC) ir. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired E]Yes E]No waterbodies? If yes,name of impaired water body/bodies and basis for listing as impair d, i. Is the project site in a designated Floodway? 9 []Yes W]No j, Is the project site in the 100 year Flooc iplain 9. �Yes EZ]No k. Is the project site in the 500 year Floodplain? []Yes No 1. Is the project site located over,or imm(_,diately adjoining,a primary, principal or sole source aquifer? D'Yes 21No If Yes: i. Name of aquifer: Page 1 [ of 13 ............... e. Does the project site contain, or is it substantially contiguous to, a building, archaeological site,or district Yes[Z No which is listed on,or has been nominated by the NY S Board of Historic Preservation for inclusion on, the State or National Register of Historl'(,,,Places? If Yes: i, Nature of historic/archaeological resource: El Archaeological Site ElHistoric Building or District U. Name: iii. Brief description of attributes on which listing is based: f. Is the project site,or any portion of it, located in or adjacent to an area designated as sensitive for El Yes V]No archaeological sites on the NY State Historic Preservation Office(SMIO)archaeological site inventory? g. Have additional archaeological or historic site(s)of resources been identified on the project site? []Yes 2]No If Yes: i.. Describe possible resource(s): ii, Basis for identification: h. Is the project site within fives miles of any officially designated and publicly accessible federal,state,or local E]Yes W]No scenic or aesthetic resource? If Yes: i. Identify resource: 1i. Nature of,or basis for, designation(e.g,,established highway overlook,state or local park,state historic trail or scenic byway, etc.): iii. Distance between project and resource; miles, i. Is the project site located within a designated river corridor under the Wild, Genic and Recreational Rivers n Yes 2]No Program 6 NYCRR 666? If Yes: L Identify the name of the river and its designation: cc. Is the activi•ty consistent with development restrictions contained in 6NYCRR Part 666? n Yes F�No K Additional Inrormation Attach any additional information which may be needed to clarify your project, If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any measures which you propose to avoid or minimize.them, G. Vetiffication I certify that the information provided is true to the best of my knowledge. Applicant/Sponsor Name Michael A.Kimack D at e 06, ir Tifle PRINT FORM Page 13 of 13 `w BOARD MEMBERS Southold Town Mall im Leslie Kanes Weisman,Chairperson 61, ;W 53095 Main Road e P.O.Box 1179 �� t � � Southold,NY 11971-0959 Patricia Acarnpora2 Office Location: Eric Dantes Town Annex/First Floor Ca ital One Bank 1 i P Gerard P.Goehnn er N 54375 Main Road at Youngs Avenue) Nicholas Planamento prep r Southold,NY 11971 f http://southoldtownny.gov �- r ZONING BOARD OF APPEALS ! � TOWN of SOUTHOLD .W T+ l. i1 76 -1809 Fax f 31 75-9064 I 211,017 MEMO Soijlfiold Town Planning Bowl TO Plannln Board FROM: Leslie K. Weisman, ZBA Chairperson DATE: July 14, 2017 SUBJECT: Request for Comments ZBA # 7098 Mattituck 2012, LLC (East End Tick Control) The ZBA is reviewing the following application. Enclosed are copies of Building Department's Notice of Disapproval, ZBA application, current map on file. Your review and comments are requested at this time. The file is available for review of additional documentation at your convenience for reference if needed. AP.P'LICANT TA X# SBA# HEARING CODE DATE OF PREPP R ZONE DATE SECTION STAMPED of SURVEY DIT SURVEY/SITE PLAN Mattituck 1000- 70 8 November Art I Sec July 12, 2017 John T. 2012 LLC ' 7-3-2 2, 2017 280-42A Metzger (East End Tick Control Your comments are requested 1 week prior to hearing date., Thank you. Encls. MATCH L1j1 SEE SEC NCJ.CfBS �� CH UNIE —___ _- _ 1 p t,1� FOR PCL NO � ��„� � � G� � SI SEE SEC NO „ 13 � 3,1 , 1 1„4A41011 m, rTtvn,O.F SP° W Ole ON;OfTO ° 1106t°rw " � bra 1 A M° 18Nil t 9 2A(G) 6roQ`l p 1 6AM „Jw A 1,11A 0, Oo T , to �. � •'�, jo 14 13.1 -)1 e 2.ti E61 12-10 VA ji..�„ 3 2.61k(c) 4 Z4, 11.4 63 1 22,1 23 ^1'1 21,5A(C) 17.4q 2L OA UNION FREE SCHOOL DIST NO 9 °�� AS III's 10 6.5A 3AAf 1f1 ` IXA i �r Alt 12.1 ° 1 - 13,2 13,E 1.9A 13.4 4,,6q VA(C) , w 31.E ` 21 19 1.81 � 2 16.15 16.4 16.3 V 31.5 2 1.8A to d 4 ' 1 ku 31 22 DEC V1 Cn o".w M *"� 1 �v ►,'+ter++ 0" t,*1 LA- 41 A 13 �rM+► .� t MATCH —q SEE SEC.N i 1 «v " OF SUFFOLK LINE ALLPRC3f ER"E5 hIC7TfC� �� COUNTY C1T'titF15M5E,: arau[uu tyra5 -- W H .. m tProperty y�y p ray ice � w Ag Sd,w..,W.,.wu,�+ °.�. ARE V*114NIVIFFOLLOAANGCrSTRICTS Real'Propert'Ta �rvf4rG Fnc C7�sr.ca Lino -- p nWusr bgjAd Lim ------P _ SCE Sri SEVuEp r�ur�TENANGE"AJ..TFRATtac+,SALE OR r ,� C)Wrkl Lim �N . WET DISTRIBUTION OF ANY PORTION��Tr�F ; � �°�� County Center Riverhead,N Y 11901 02F _.....w—-- r+war+c�+ ...."`_""`�T......�.. SCALE IN FEE IKa�wrpminYatLme —" COUNTY��, S T. A LIGMT mmm m�mmm r�EFLERSE wl � ► €! 2CIU L�.—-- Amdula +oftand Lone-- wu�tK WTHOUT WRITTEN PERMISSION OF THE pwkLighl I.3a?ridLkw vvaSTEvtiaTEt1 REAL PROPERTY TAX.SERVIOEAGENGY, ; Palk C,krl+ici Lino 1'WJ(fiMr!dniiuy'MMm FORM NO. 3 , TOWN OF S OUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.T. NOTICE OF DISAPPROVAL DATE: December 18, 2014 RENEWED: May 11, 2015 RENEWED: January 11, 2016 AMENDED :March 305 2016 RENEWED &AMENDED: June 19, 2017 TO: Mattituck, 2012 LLO 36230 Route 25 Cutchogue,NY 11935 Please take notice that your request dated December 2, 20,t For permit to Tape additions and alterations to an existing� � ��le f ra.h dw�elli� T�th�business�o ee pcst control)at Location of property: 3 23Rute 25,Cute County Tax Map No. 1000—Section.97 Bloch 3 Lot 2, Is returned herewith and disapproved on the following grounds: Tl e ro ose coast u.ctio on,,t ii �cel n e u�;nc L Tone not e it:t r :.t to Art1c1,g-jM,, Sect o w 42 * Vi c h,s�ta ems. E ce s,,ott er ise woyidcd,herei,:,n ao uild o pre. s s'hall,lie used and u l ,n, or, t ,.l* 1 . , � t conforms runs to the Bulk Schedule an tl�er�eo � l� l� e ereete or altr�d � t� L Tstrt ule�� lie sae �.�. a � .._ Parking and Load* Schedules into �ate it otltlii er °t referenee vjti tle sane force and, effect as if such re ulationswere set forth herein in full.". '45 ul� schedule req�uj a inn�Tu � sin ode a d set c, o ��eet � :..0 u c� � e �F set"'backe M feet nd . a. �i:n nr rear and setback Of 75 fl et. fll aye eedyt u t re , et back, f i l Leqt,_a tot side e rc ion;,, t e and setback of+l-25.2 feet and a rear and seth�c :of+l�ed construct 60 feet. , , s r .res site a rov , ire t w c Sout.,� ld T n � � repose _. 'You mlay appl, M t �s�cn,c dirt uhori ,z e � all „tm , This notice of disapproval was amended on March 30, 2016 to include the need far setback variances and on June 19, 2017 to correct an error. Cc: File, planning, ZBA Fee:S, Filed By: Assignment No., APPLICATION TO THE SOUTHOLD TOWN BOARD 01F APPEALS AREA VARIANCE House No. Street Ilamlet SCTM 1000 Section _Block_a. Lot(s) Lot Size -Zone I(WE)APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED BASED ON SURVEY/SITE PLAN DATED Owner(s): f z 7 IJ ot Z L C; Mailing Address- W''Ally. 11968 Telep hone:&03/ .7 r_._/7?;Vax: Email:m ur/Cof C 6 N rje 0 0,00-1 NOTE:In addition to the a please complete below if application is signed by applicant's attorney,agent,architect, builder,contract vendee,etc.and name of person who agent represents: Name of Representative: �� ' , '! �fortod Owner )Other: ''40 �64?9.1 Address: Roll iz......... ............ 40' le-5 Telephone: wetvv;�ax: Email: �'�'1' �c''1 ` ''`"''` . 'j / 1� - Please check to specify who you wish correspondence to be mailed to,from the above names: ( )Applicant/Owner(s), Authorized Representative, Other Name/Address below. 'E -EVIEWED SURVIEWSIT'E.PLAN WHEREBY T ILD1',NG INSPECTOR R D 14 i d 47 ATED N and DEN IED AN APPLICATION DATED,- FOR* in ermi gP , Ruildi Certificate of Occupancy Pre-Certificate of Occupancy Change of Use r( ) Permit for As-Built Construction O Other: Provision of the Zoning Ordinance Appealed. (indicate Article,Section,Subsection of Zoning Ordinance by numbers.Do not quote the code.)Nrtiicle. /Y Section,:, Subsectioll; Type of A peal. An Appeal is made for: 7A Variance to the Zoning Code or Zoning Map. A Variance due to lack of access required by New York Town Law-Section 280-A. Interpretation of the Town Code, Article Section O Reversal or they A pri[or appeal has 911as, not been qua,de,at any time)),ri,th res �ect to this pLo,lwr UNDER ' 1C, Appeal,'N,o(s)., Year 0AI (Please be sure to research before cwnptethtg,�M uqttestion,or,call our oj fee fibr a.,s,, istan,(e, Name of Owner: ZBA File# ........................... REASONS FOR APPEAL (Please be specific, additional sheets may be usew with preparer's ,signature notarized): 1.An undesirable change will not be produced in the CHARACTER of the neighbc+r,or,a detrarnent to nearby properties if granted,because: ;WovR /f j�,tl �Xl-j'1��'�.% �`�J7�✓ .� �� ZE&O VA 7ZP -rA1j6` 1APP1 77 0& 000!::# 04' �Ale PZP& A AIP AM 7;V005 09 -'tj �v6lr tom°" 2.The benefit soug t by the app1icanx7 Or 7A5 Ao(674 IN 7-A/4':0' CST e achieved by some m�tlaocA/ �feasible fir the appli u , other than an area variance,because: r�� L Q C��-��1�(/' (,�,,0C 411A' �j?C�l'J'"f/��' OoI44ZIIl�C� POo4:3* ce ,�" ��1, !',�� c4wiovc I V/ Aw, IV CP'45 V46: 44&Y' AZ r. 460 77441S* V 3.The amount of relief requested is��t subsR�ntial because: 4AIAP � 7; 25 kPA ��f..� )A�eo 01 'V�� ,p, ,�749/;r/jq OV 19 OA65Y /v or ro�5 Y "1114r ,ls, 1I&Ae5e 4.T'he variance will NOT'have an adverse effect or impact an the physical or envrrtanmenta) conditions in the neighborhood or district because: 771-Ze ,*P�j�'dI'/�� APP1,7—ls .�',,,.'�'� P O /Vb 7 Cl��il�G� �� 's�Y!eAG 0e �N Y!�'a�V�'N�� C a�✓/JlP�'a�-�' IAI rjV9 "I&A�e4>RAo46AV 5.Has the alleged difficulty been self-created? { Yes,or { } No Why: Are there any Covenants or Restrictions concerning this land? X No { } Yes(please furnish a copy) This is the MINIMUM that is necessary and adequate,and at the same time preserve and protect the character of the neighborhood and the health;safety and welfare of the community. or Signature of Applicant or Authorized Agent (Agent must submit written Authorization from Owner) LJr Swnm to bcFarc me this day, t ph 3 A Notary Publi TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 OUAUFIED IN SUFFC7LK COUNTY COMMISSION EXPVRESJUNE 30,2Q�,� APPLICANT'S PROJECT DESCRIPTION APPLICANT: �" � 4 DATE PREPARED: 1.For Demolition of Existing Building Areas Please describe areas being removed II.New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of first floor extension: Dimensions of new second floor: Ar Dimensions of floor above second level: Height(from finished ound to top of ridge)g � Is basement or lowest floor area being constructed? If yes,please provide height(above ground) measured from natural existing grade to first floor: 0 111.Proposed Construction Description (Alterations or Structural Changes) (Attach extra sheet if necessary). Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: Number of Floors and Changes WITH Alterations:, _)V,�a IV. Calculations of building areas and lot coverage (from survc or) Existing square footage of buildings on your property: Proposed increase of building coverage: Square footage of your lot: f � �Percentage coves e o g of your lot by buil,din area: V. Purpose of New Construction. ` 4 I VI. Please describe the land contours (flat, slope %, heavily wooded, marsh area, etc.) on your land and how it relates to the difficulty in meeting the code requirement (s): 01",?40�, ,z:tct jX 01111 jewt, ow.owl Z2,16tal r_ vl_.,?�, �. Please submit 8 sets of photos, labeled to show different angles of yard areas after staking corners for new construction, and photos of building area to be altered with yard view. 4/2012 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION A. Is the subject premises listed on the real estate market for sale? -Yes . X No B. Are there any pi-oposals to change or alter land contours? No _'Yes please explain on attached sheet. C. 1.) Are there areas that contain sand or wetland grasses? A10 2.) Are those areas shown on the survey submitted with this application.� 3.) Is the property bu ll'k1headed between the wetlands area and the upland building area? 4.) If your property contains wetlands or and area�,I 'have you, contacted the Office of the Town trustees for its determination of jurisd.itie ?" ,ea,se con irmn status, of your,inquiry or application with the Trustees:, and if issued, please attach copies of permit with conditions and approved survey. D. Is there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level?,_----A/0 E. Are there any patios, concrete barriers,bulkheads or fences that exist that are not shown on the survey that you are submitt-ing"?' 0 Please show area of the structures on a diagram if any exist or state none on the above line. F. Do you have any construction taking place at this time concerning your premises? &0 If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking, please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. H. Do you or any co-owner also own other land adjoining or close to this parcel?- A119 If yes, please label the proximity of your lands on your survey. I. Please list present use or operations conducted at this parcel, and the proposed use C/5 (ex: posed: same with garage, pool or other) rt 0000 o Atith,onized, signature and Date BOARD MEMBERS SO Southold Town Hall, � 530�95 Main:Road P.O.Box. 1179 Leslie Kanes Weisman,Chairperson Southold,NY 11971-0959 Eric Dantes 0 ee L • �; cnt��on. Gerard P.G oehringer Town Annex./First Floor,Capital One Bank. 54375 Main:Read at Youngs Avenue George Homing � � g ) r Southold, Y 11971 Kenneth Schneider 4 0 http://southoldtown.northfork.net R, IC, IVEI ZONING BOARD OF APPEALS CTD TOWN OF SOUTHOLD 2 3 2015 Tel,(631)765-18+09 9 Fax(631)-765-9064 uthold Town Clerk FIENDINGS,DELIEBERATIONS AND DETERAUNATION A ETING OF OCTOBER 155 2015 ZBA FILE: 6 8 8 5 NAME OF APPLICANT: Southold Town Planning Board r PROPERTY LOCATION: Town wide SE0 DETERMINM"A7171ON',*- The Zoning Board of App als has visited the Property" under consi deration in this application and deters nes gat t s,revs falls under the Type II category of State s List cif Apt.on , lthout further steps under SERA. IS OF, APPL1,CA1,%0N-. Planning Beard Town of Southold requests Town-Wide Interpretation under § 280- 146(D)(1)of the Town Code as to whether the Malon Decision#5383 applies to the LB Zone District as well as the General Business(-8)Zane District. lTl NA1 1 � T °N: The Beard of Appeals received a Memorandum dated July 24, 2015 from Southold Town Planner Brain Cummings, related to an application before the Planning Board in which he states that the Planning Board "is seeking clarification as to whether the Stanley Malon Decision (ZBA File #5383) applies to only the General Business B)Zoning District or was intended to apply in all Zoning Districts."This was followed by another Memorandum dated August 3, 2015 from!Donald Wilcens .i, Chairman of the Planning Board, seeking clarification as to whether the Stanley Malon Decision File# 5383 applies to the LB Zoning District, in which the subject property before the Planning Board is located, as well as the General Business (B) Zoning District." C The Malon decision was rendered by the ZBA on May 20, 2004 based on an application for a multiple-use building (proposed to contain up to 8 uses) on a 53,821 sq. ft. lot in the B-General Business Zone District. The Building Department issued a Notice of Disapproval on May 20, 2003 that cited the bulk schedule requirement of J0,000 sq.-ft• per use. The applicant requested an interpretation by the ZBA of Code Section 100- 102 to dete_,. ine if 30,000 sq. :ft, of land area per permitted use in the B-general Business Zone District was requ,lred.,In s decision the Beard stated that,"this re uire r ent is interpreted to apply to each building rather than to each use oceu ancy within the building area in the General,Business District." istrict." a� w h •1 FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this request for an interpretation on October 1,2015,at which time written and oral evidence were presented. Based upon all testimony, documentation,review of the minutes from the public hearings associated with Malon application#5383, and other evidence,the Zoning Board answers the question of,whether the Malon Decision#53 83 applies to the LB (Limited Business)Zone District as well as the B (Business)Zone District as follows: ........... Town of Southold Annex 9/21/2013 P.0,Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE O OCCUPANCY No: 36508 Date: 9/18/2013 THIS CERTIFIES that the building ACCESSORY GARAGE Location of Property: 36570 Route 25, Cutchogue, SCTM#: 473889 See/Block/Lot: 97.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore Med in this officed dated 12/11/2012 pursuant to which Building Permit No. 37683 dated 12/11/2012 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ace e ,so ly,ope,ear ggragg as or ected 9123113 fior.,appli"cation,date., The certificate is issued to Mattituck 2012 LLC (OWNER) of the aforesaid building. SUf OLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Autho-"' Ja rL FORM NO. 4 TOWN Of SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Date .................. East cdatoho THIS CERTIFIES that the building located atp/s MIA'A.Roady ladto',011.0.,, Street *we,pop 0*0*' a*0, W 10 4 0 0 0,0 0 1 a 5,6 4 6 A*,a 0 0,0 MapNo. ...am woo 50,10,44 Block No. Lot No. ad W*ON,OR,10 M 0, 6 **1*4*V A*•4, A*,*,* 0*,6*0 4 1,#M'Ir�am,*4, 4#0,0, conforms substantially to the Application for Building Permit heretofore filed in this office dated Jay, 3 19 .5-s� 0 104 1104,0#P 4,04 W*1 44*'WW's W004SAW111004IN091V got pursuont to which Building Permit No. *J* 4 19 was 'Issued and conforms to all of the requirements dated .......00000 0.0 0 0 6**W W W 0 9 0 0 0 0 0 4 *#a M#0 j of the applicable provisions of the low. The occupancy for which this certificate is issued is NOT ONVOR PRI 1, all OXE IPAXTILY IMSIDEXCE W 01"4m**'40 0* 0'*�**00 ff*40**'* yW1@1*'0"'JW $4 Ogg 6666 000*444*"' 0 WWI-****0*04*'*#**0# VnIo G* -6 Wall*&Wdsebo so aseakovabo*N4 woo***Obe*a*0 This certificate' is issued to (ownev, lessee or tenant) of the aforesaid- building. 13mild'ing Inispfect HOWARD M'v* TtAR' 'Y' Page 2 of 2—October 15,2015 ZBA#6885—Interpretation Town Wide 1. No, the"Malon Decision" does not apply to the LB Zone District, as said decision is only applicable to properties located in the B Zone District and no other zoning districts located within the Town of Southold. The Board finds that the plain reading of the "Malon Decision #5383" clearly memorializes the intent of the Board to limit the reach of the decision to the B Zone District exclusively. Furthermore, prior to rendering the "Malon Decision" there was a request to the Board during a public hearing to expand the subject scope to include all business districts and the Board refused such request in its decision, by restricting the interpretation solely to the B Zone District. 41 RESOLUTION OF THE BOARD: In considering all of the above factors, motion was offered by Member Schneider,seconded by Member Homing, and duly carried,to determine that The Stanley Malon Decision,File#5383 applies to the B (General Business Zone)District, and does not apply to the LB or any other Zoning District, Vote of the Board: Ayes: Members Weisman (Chairperson), Hornin& Dantes, Schneider. Absent was: Member IF * Goenrin en This Resolution was duly adopted(4-0). o Leslie Kanes Weisman,Chairperson Approved for filing /10 /2015 AuR.ICULT RAL DATA STATEMEN i ZONING BOARD of APPEALS TOWN of SOUTHOLD WHEN TO USE THIS FORM: This farm must be completed by the applicant for any special use permit, site plan approval, use variance, area variance or subdivision approval on property within an agricultural district OR within 500 feet of a farm operation located in an agricultural district. All applications requiring an agricultural data statement must be referred to the Suffolk County Department of Planning in accordance with Section 239m. and 239n of the General Municipal Law. 1. Name of Applicant. 4........... 2. Address ofA Applicant: pp ` 3. Name of Land Owner(if other than A � cant): I f 4. Address of Land Owner: �� ' 16? 5. Description of Proposed Project: . ..........1�41111111P 11111115 1 f. Location of Property:,":," (road and Tay.map number 01,11-1.1.1.1-1 _F Q 7. Is the parcel within. 500 feet of a farm op ° n? } Yes { No 8. Is this parcel actively farmed? f I Yes *No 9. Name and addresses of any owner(s) of land within the agricultural district containing; active farm operations. Suffolk. County Tay Lot numbers will be provided to you by the Zoning Board Staff, it is your responsibility to obtain the current names and mailing addresses from the Town Assessor's office (765-1937) or from the Real Property Tax office located in Riverhead. NAME and ADDRESS - 2f 0000-1, WN4 yJ1 110, ooe;/v 4. 5. F. (Please use the back of this page if there are additional property owners) 714� Signature of p c °° Date Note: 1. The local Beard will solicit comments from the owners of land identified above in order to consider the effect of the proposed action on their faun operation. Solicitations will be made by supplying a copy of this statement. 2. Comments returned to the local Board will be taken into consideration as part as the overall review of this application. 3. Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners identified above. The cost for mailing shall be paid by the Applicant at the time the application is submitted for review. 617,20 Appendix B Short Environmental Assessment Form Instructions for CompItlLng 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: It'1001, oe 014? Project Location(describe,and attach a location map): Brief De�crlption of Pro posed,Aztion-,,�pFr 00 614 141W ,4001111-11zY 12 e1W � AP Name of Applicant or Sponsor: Tel eplione EA.,A Aft r-Iv- 4W, A, Address: City/PO: State: Zip Code: 1.Does the proposed action only imen1v the legislative adoption of a plan, local law, ordinance, administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that Ir MI-1% ES 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? NfJ YES If Yes,list agency(s)name and permit or approval: X csC ''`7T. A74�5.4 '14-oA AZWAIA11416 ,'ro OZP 3.a. Total acreage of the site of the proposed action? W—acres b.Total acreage to be physically disturbed? 0.ZQ�acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all ],and uses that occur on,adjolnlnlg and near the proposed action, 11 'U ran 0 Rural (nori-agricult'Licre) El Industrial esidential(suburban) 1:1 Forest 0 Agriculture 0 Aquatic El Other(specify): 1:1 Parkland .............J Page I of 4 ............ S. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b. Consistent with the adopted comprehensive plan? L 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�, v_ironmental Area? NO YES If Yes identify:, P& . X 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? 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 techriologgles: I I 1 11 A 11111111111111 11,11111, 1 00 in 1111 �AIIAIIUJI 11 oe V, 0� 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 od for pro,vidin be nietli g wastewater treatment: tZ 4F 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? X If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: 11 Shoreline 0 Forest 0 Agricultura 1/grass lands Cl Early mid-successional %-Ie Cl Wetland Cl Urban 29 Suburban 15. Does the site of the proposed action contain any species of animal,or associated habitats,listed F 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 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? JZNO 0 YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe; 0 NO)KYES ? Page 2 of,4 18.Does the proposed action include construction or other activities that result in the iiiipoundment of NO YES water or other liquids (e.g.retention pond,waste lagoon,darn)? 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 I'ILC3VLDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF ►fIY KNOWLEDGE Applicant/sponsor name: � Date: /_/........... ........... or Signature: FRI Part 2-Impact.Assessment. The Lead.Agency is responsible for the completion of Fart 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 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 reasonabl available enem conservation or renewable enelZy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? S. 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)? f 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 problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 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. 0 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. 0 Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Date ... ...................—-----------Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) ........... Page 4_of4 Board ofZoningiliNneals lcat , 14 AUTHORIZATION (Where the Applicant is not the Owner) 1 re sid 1ingat ,11 ?VA�, (Pri'rit,property owners name) (Mailing Address) 'do hereby authorize (Agent) " to apply for variances) on my behalf from the Southold Zoning Board of Appeals. (Owner's Signature) �IAV j!e,�ZZ r .,t Owner"s Name) AGENVREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of conflicts of,Interest on the part Of,town officers,and',eingLa2ges.17he hfs # t le,conflicts of interest and allow it to take whatever action is form is, Ito py yide in f6riin.a.tion witich can alert the town of twsswb necess-iAry to avoid's1*11MV. YOUR.NAME: koloz,H,04 (Last name,rirst name,middle initial,unless you are applying in the name of someone else or other entity,,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance ........... Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child) have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest" means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D) and/or describe in the space provided. The-town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) Q an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day of' --r 20 Signature, Print Name APPLICANVOWNER TRANSACTIONAL DISCLOSURE FORM i it, conflicts of interest oti,the �art,of town-offic, end The Town of Southold's Code s, Y1,an --mmkc st-lb ,ofth'is form is to provide inf6r,mation which can alert the town of possible conflicts of interest and allow it to take whatever 111lictionis flece&Saayto,mold same. YOUR NAME (Last name,fist nG"'j"�_0_!,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood, marriage,or business interest."Business interest" means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) Q an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this day,of' 20 Signature PW Z, Print Name Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I 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", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LMW policy standards and conditions, it obetindertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldto vn.northfork.net), the Board of Trustees Office, the Plannm* g Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# The Application has been submitted to (check appropriate response): Town Board [:d Planning Dept. E3 Building Dept. I Board of Trustees Category of Town of Southold agency action (check.appropriate response): (a) Action undertaken directly by Tovm 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: .J> XYD 4Z-%��IZ4 2$1- &41V,3 p~"0 '00 & "'IA16 1AA0 14 CW 1C.Ir 4V ap 1 2 J AF 1.0 J0 0`0............... .......... ,4:rX' 404e Location of action: 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: O/Z 1.11.1 I ',',,"I /1-Z.......................... (b) Mailing address: /Oe�, a 94 (c) Telephone number:Area Code (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes No If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, males efficient use of infrastructure, mares beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III --Policies; Page 2 for evaluation criteria. Yes No Y Not Applicable a Attach additional sheets if necessary Polio 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria Yes No Not.Applicable 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 0 No ] Not.Applicable 71viLlIz ,A00P ej**� 6&Z4— /V e),1 000 Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize lass of life, structures, and natural resources from flooding and erosion. See LWRP Section III--Policies Pages 8 through 16 for evaluation criteria Yes 1:1 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 XNot Applicable w 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 o xNot 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 f rl /z io !741 "AU .................... L-W41E..0, OR J4 )9& IDA Y15 r� or 4 1 m y I 1 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. Ld Yes No Not Applicable ........... �ALO_ _____z:eo _AJ ............. 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 LWR.P Section III--Policies; Pages 38 through 46 for evaluation criteria. Ye No Not Applicable Attach additional sheets if necessary WORKING 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 Applicable ........................ Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies* Pages 62 through 65 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. 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