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HomeMy WebLinkAboutTR-5900John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee # 1151C BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Date: August 10, 2015 THIS CERTIFIES that the construction of additions and renovations to the existing single-family dwelling regrading of existing lawn installation of new septic system with the condition of dn!ivells and gutters to contain the roof run-off with a line of hay bales being placed down prior to construction-, and for the as -built rock retaining wall and drywell with the condition of a 5' "no -mow" area along the landward side of the rock retaining wall At Madeline Avenue, Fishers Island Suffolk County Tax Map #6-7-12 Conforms to the application for a Trustees Permit -heretofore filed -in -this office Dated January 30, 2004 pursuant to which Trustees Wetland Permit #5900 Dated April 21, 2004, was issued and Amended on September 21, 2011 and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of additions and renovations to the existing single-family dwellin regrading of existing lawn installation of new septic system with the condition of drywells and getters to contain the roof run-off with a line of hay bales being placed down prior to construction,• and for the as -built rock retaining wall and drywell with the condition of a 5' "no -mow" area along the landward side of the rock retaining wall. The certificate is issued to STEPHEN BURNHAM owner of the aforesaid property. Authorized Signature John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders DATE OF INSPECTION: Ch. 275 d`/_J� /T Ch. 111 INSPECTION SCHEDULE Pre -construction, silt fence 1 st day of construction % constructed Project complete, compliance inspection. Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (63 1) 765-6641 INSPECTED BY: COMMENTS: /� ✓ C, CERTIFICATE OF COMPLIANCE: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. III INSPECTION SCHEDULE Pre -construction, hay bale line/silt boom/silt curtain 1 sf day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: �! l ��� �d� �« ��"/ �✓`��' COMMENTS: ,rid 17S� �. -0 l/✓ %9' b 57-1 CERTIFICATE OF COMPLIANCE: John M. Bredemeyer lll, President ZAf1`01 Town Hall, 53095 Main Rd_ Michael J- Domino, Vice -President C ,��� <9Gy P_O- Box 1179 James F. King Southold, NY 11971 Dave Bergen z w n, �� Telephone (63 1) 765-1892 Charles J. Sanders l ,V, ��� Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. III INSPECTION SCHEDULE Pre -construction, hay bale line/silt boom/silt curtain 1 sf day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: �! l ��� �d� �« ��"/ �✓`��' COMMENTS: ,rid 17S� �. -0 l/✓ %9' b 57-1 CERTIFICATE OF COMPLIANCE: .. �� . �. pI Lam''=..i �, � � �'`, � �r �y1' , • y - x �� � ;: { .:Stephen Burnham R—OMadeline Avenue, Fishers Island — 10/28/14 I . -44 . � -� � • � ' �Y '( x�.i�'�'�a EBF K��... i ��. !� �.%, ,K,i �-�� � _ ,;�j7' ,�' - •._ ! .. rid., wy��'.��+"11 •E� 'prL..,�•� -�' i"_'�'� * i'�.i _.\ � �4£�'t . �Y� .12'29 �� v {fit• • • 3 b Yt- Burnham Madeline Avenue, Fishers Island JT •• ' ♦ ,.w 1 _ , r ���RRR •• t . '� Y v• ..gip ' •' .+Re'- e y ' ' I AR Nw AM t.� �' �• •%"tel - _f i. - �� +4. � i'.s+ v_ _ ,� R Y �A- A �' ` 1• - s.Y � -_ ��t� k �•E' � r �.}}�• aR' • , y *M ,. y H"1 J 2 8, ? 01. � 2 31 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 pF Sopjyol T 0 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: September 21, 2011 Re: Proposed Wetland Permit for STEPHEN & CORNELIA BURNHAM SCTM#1000-6-7-12 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed as built is INCONSISTENT with LWRP Policy 6.3 (below) and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The rock retaining wall was built without the benefit of Board of Trustee review and the issuance of a permit. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney 0 0 August 4, 2011 Board of Town Trustees PO Box 1179 Southold, New York 11971-0959 Ref: Permit Application for Addition on Madeline Avenue, Fishers Island, NY. Section 006, Block 7, Lot 12 Dear Trustees: �TIT AUG 15 P. u You have requested that I send you new sets of plans and new application documents. I enclose: 1. Two sets of plans showing: a. The position of the new rock wall (marked 1) b. The position of the new drywell capturing roof runoff from the front of the house (marked 2) c. The position of the existing drywell in the rear of the house (marked 3) 2. Two color photographs showing the gutter entering the ground on the way to the new drywell 3. Two drawings from the drywell contractor showing the size and position of the new drywell 4. Two signed copies of a completed "Application for an Amendment to a Wetland Permit" 5. One signed and notarized "Board of Trustees Application" page 6. Two copies of my letter to you dated November 10, 2010. 7. A check for 100 dollars made out to the "Town of Southold". I hope that my application is now complete. Please let me know if there is anything more that you need. Sincerely, Stephen rnham 118 Parker Street Newton, MA 02459 (617) 899 0304 stephenburnham@gmail.com November 14, 2010 Board of Town Trustees PO Box 1179 Southold, New York 11971-0959 Ref: Permit Application for Addition on Madeline Avenue, Fishers Island, NY. Section 006, Block 7, Lot 12 Dear Trustees: In line with my conversation with Mr. King and in line with his requests, I enclose the following items: 1. A copy of my original permit application with amendments, marked each with an asterisk, detailing that a line of boulders was placed on the rear lawn in order to act as a retaining wall. The fill excavated from my new basement was placed behind the boulders so that the fill would not wash into the wetlands. Additionally this minimized the slope of the lawn allowing us to place the septic rings a little higher in the ground thereby maximizing the separation from the level of ground water. There is no effect on the wetland as I installed these boulders over my existing lawn. 2. A drawing showing the location of a new drywell installed on the front left side of my house. The purpose of this drywell is to contain the roof runoff from the gutters on the older part of the building. In addition, I wish to advise you that I have extended several of my roof gutters on the right side of my house so that the roof runoff from there will be directed to my previously installed drywell in the rear of my house. Sincerely, Stephen Burnham 118 Parker Street Newton, MA 02459 (617) 899 0304 stephenburnham@gmail.com James F. King, President Jill M. Doherty, Vice -President Peggy A. Dickerson Dave Bergen John Holzapfel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A E Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 AUG 15 2011 DATE �1111�/ IS,o)o II OWNER f" d� Onc k " PHONE (o ADDRESS I IT Q_cker S NP ftA f MA- o-zys I AGENT PHONE ADDRESS JS� i 06390 PROPERTY LOCATION I ko1Q I,re 4de"" z -, K ��j� AJ TAX MAP NO. 10 0 0 R VW request an Amendment to Permit # noo to Signed By: I�t Jill M. Doherty, President Bob Ghosio, Jr. , Vice -President James F. King Dave Bergen John Bredemeyer BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of STEPHEN & CORNELIA BURNHAM COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I J1eph2v �UIK�Q Nl , residing at /fid I1Y c1(ef S� M&Otclt., M k being duly sworn, depose and say: 0 Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone(631)765-1892 Fax(631)765-6641 That on the 3t4 day of Septeµ��,rI2011, I personally posted t e property known as i3vrs6^ - Pc.�.({a..�oP {iv�ise I t�dcl �4e /dam-., Fi614it1 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed. September 21; 2011 on or about 6:00 PM. Dated: (signat Sworn to before me this (Domestic Mry; Unly; No Insurance coverage For delivery information visit our website at www.us 1 " ru Certified Fee $2.85 09 O r3 Rehm Receipt Fee (Endorsement Required) $2.30 Postmark Here 1-3 Restdoted Delivery Fee (Endorsement required) $0,00 O ,n Total Postage 8 Fees $ $5.59 09/14/2011 r9 Sent To r.R.S.J.....__-__5...!_C�.I�.U.-___�!14__._____. Q M1 rree( t No .; Po orBox No. P.b (( 77 �� rr uprl bd��- City,Sfafe,ZlPa4 --------------------....... �S la PS Form ,r August 2006 _ kfy G 639D See Revers P tees Coue %tctw� -,T- 31 kudty 00yes vaPemann STATE OF NEW YORK COUNTY OF SUFFOLK MAILING OF NOTICE TIFIED MAIL RECEIPTS Address: P.O . Q d , 6as Ems ve F;s[,aMTS1r~.d"YUP (54390 po is�rsl's�Ql.d� It) i GG3�'a 146 I Ccro 6� `��e Vpa f A-,ke� s c �q Fo � PQ e 6 516 — Y"OKAo Fi64% 2-sla4 /-) LC 64396 -3 S Ae- 9 e0a,( W.l+C"�IC7 15 GF'F� S+epLeu,i�urt�9r1 ,residing at I14 Oc,c6r�4. Nee,9+6...,rfA , being duly sworn, deposes and says that on the t44k day of , 20 it , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the,current assessment roll of the Town of S uthold; that said Notices were mailed at.the United States Post Of i CeK r h , that said Notices were mailed each of said persons by (certified) (i e�isteredj mail. 0D /t4 Sworn to before me this _ A Day of < ,� 20__Ij— Public fir'"�ssio .:•Ir 'Otr MB�ElrRRE' .; Y AGO .ice `0 0 WN:* 0 0 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: 1 f YOU ARE HEREBY GIVEN NOTICE: !mt &. csbA 1. That it is the intention of the undersig d to request Permit from the Board fof G Trustees to: 3u, 4,x. c�� �l ( 'v, Kk bnc� yrzn cv,A c+o (eVe( +- (awh a vvrt p recto,..- ecbs, oA ..6 l,rz+�aJs m cQc{LteA i^ Ae- Sc -yah +»tle p,Q {» Cc-�nti �wf ruav�, 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: 17-10 You may contact the Trustees Office at 765-1892 or in writing. The above -referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME: S+e Len f t l pu MAILING ADDRESS: P U. 4 o%L Q w ,2 r PHONE#: (P1)-894 o3ov I �,) �4 z:^,,r AGENT: MAILING PHONE Enc: Copy of sketch or plan showing proposal for your convenience. I Rik of 0 0 0 0 0 4' � O OI �I vr)d eco cky we I] Mie Town of Southold 0 • LWRP CONSISTENCY ASSESSMENT FORM INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non - supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# !nOO -S�L•00J- - EGA %- W Q PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. 1Z Board of Trustees 19 Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: PL'4 Location of action: I,\ a� /demur✓ �-1 S�+S w I � 1 Site acreage: 2-�c 4xKS Present land use: S - t4e- q -a , L S C Present zoning 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 (b) Mailing address: (c) Telephone number: Area Code ( ) &I 7- ?"- 030 (d) Application number, if any: 2 Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes MNo ❑ If yes, which state or federal agency? Ili 1(S "C C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LV -/RP Section III - Policies; Page 2 for evaluation criteria. ❑ Yes ❑ No 6Q Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 13 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III — Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III — Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III — Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No Not Applicable 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 HI — Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Appale to l k zs CC4.C..- w ,1) l+,. aro,w- 4t#- 40r.1. , 14_Tm.M 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 K] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. 1:1 Yes ❑ No 1= Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III — Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No IN Not Applicable Attach additional sheets if necessary WORKING COAST POLICIA 11 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 9 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III — Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III — Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PREPARED BY_ :5+aDL . 2, ik,� TITLE 0L.t1Y10-(— DATElJ J 14 /S 9 0 Town of Southold /g Erosion, Sedimentation & Storm -Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. e: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A t9e o O o 4 % 1 STORM -WATER, GRADING DRAINAGE AND EROSION CONTROL PLAN ° a -S cii'n "g�-�To'i�- CERTIFIt30 Rv a nrerru SCOPE OF WORK -PROPOSED CONSTRUCTION a. What is the Total Area of the Project Parcels? (include Total Area of all Parcels located within r"1 •t� the Scope of Work for Proposed Construction) �S •C b- What is the Total Area of Land Clearing and/or Ground Disturbance for the proposed construction activity? Y,00-0 ITEM # / WORK ASSESSMENT I Yes No PROVIDE BRIEF PROJECT DESCRIPTION (Pm kkfleuna Pp .s N..I.M 2 cr, Pfm-4 lul. Submission of a SWPPP is required for all Constmctton activities involving sou disturbances of one (1) or more acres; Including disturbances of leas than one acre that are part of a larger common plan that will ultimately disturb one or more acres of land; Including Construction activities Involving sod disturbances of less than one (1) acre where the DEC has deterrtdned that a SPDES pennit is required for stomn water discharges. ( SWPPP•s Shall meet the Minimum Requirements of the SPDES General Permit for Storm Water Discharges from Construction activity - Permit No. GP -0.10-001.) 1. The SWPPP shall be prepared prior to the subrNttal of the Not. The Not shad be submitted to the Department prior to the Commencement of censaudion adiray, 2. The SWPPP shag describe the erosion and sediment control practices and where required, post-consWdlon atom water management practices that will be used and/or constructed to reduce the pollutants In storm water discharges and to assure compliance with the team and conditions of this pernaL In addition, One SWPPP shall Identify potential sources of pollution which may reasonably be expected to affect the quality of stoma water discharges. 3. AN SWPPPs that require the PostT nstmdton storm water management practice component shag be prepared by a qualified Design Professional Licensed In New York Mat b knowledgeable In the Principles and practices of Storm Water Management STATE OF NEW YORK, COUNTYOF ..............`............................. SS 1Ttat I, ...S.,P�,e V rin V 0 ✓✓� (Name of intlividual sigNng Document)""""""' bel Ad And that he/she is the..............................................Im Owner and/or representative of the Owner or O make and file this application; that all statements . ta.4d that the work will be performed in the manner set Swom to before me this: ................... day of ..............14 '�... Notary Public:..........., 3 Will this Project Retain All Storm -Water Run -Off Generated by a Two (2') Inch Rainfall on Site? (This item will include all runoff created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of Impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This Item shall Include all Proposed Grade Changes and Slopes Controlling Surface Water Flow. Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to control site erosion and stone water discharges. This item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling, Grading or Excavation where there Is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (I Do') feet of a Welland or Beach? WIII there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? — V 8 Will Driveways, Parking Areas or other Impervious IDv Surfaces be Sloped to Direct Stone -Water Run -Off Into and/or In the direction of a Town right-of-way? 9 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any El/ Item Within the Town Rightof-Way or Road Shoulder V Area? (Ia41bm win NOTlridub 1M ImYeelimh of OrMway Doane.) NOTE: I/ Any Answer to questions One through Nine is Answered with a Check Mark In a Box and the construction alta disturbance Is between 5,000 S.F. 6 I Am in ease, a Storm -Water, Grading, Drainage S Erosion Control Plan Is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Sulking Permit. deposes and says that he/she is the applicant for Permit, perform or have performed the said work and to true to the best of his knowledge and belief; and (Signature d Applicant) FORM - 06/10 0 0 Board of Trustees Application County of Suffolk State of New York �tep�ein I n�a vV\ 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 TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERIvGT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS__DAY OF —&jq�ZO_ jL �P�ssio'MiTS �-,..� �H,BthE1�R •� O, .i.` `'oma tary Publi 0 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM YOUR NAME: (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 I a ' I_ p t (If "Other',name the activity.) �l4,NGi� Cavi tr'Ue,t--c... ape^t 4C. ,,LO 1-3 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 Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non -corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this y -G uJ ` 2< Signature__-� Print Name Q i'onn TS 1 AUG 15 i$n„thhc�;i Town �J Sfi�Y�N Ball I��'---k y' ) ` Pat NSF PIRATE 'COVE MARINE COMMERCIALUSE MUNI CIPAL . W'ATPR ON 'SITE SEPTIC SYSTEM N/F .MICHAEL LAUD SINGLE FAMILY RE. MUNICIPAL WA -ON SITE SEPTIC m n rtisl�L.L) ARD ­ OP iR,V'1�5S TQbb'N OF S®UTNOlD �JATc ��al�llll —_ 1:)`eURVEY,MAP,±PRERARED FOR GEORGE',W PACKARD, LOUI$E`r,BU_RNH d61(FKARD STEP.NEN T. "BURNHAM CORNEUA B. BURNHAM MADELINF AC GU51 11,, 1999; SCALET 1'"-40'p SHEET 7 OF 1 "f! J4 1IS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED HEREON. ANY EXTENSION OF; THE USE BEYOND THE' PURPOSED'AGREED TO BE=TWEEN THE CLIENT AND THE SURVEYOR'EXCEEDS THE SCOPEIOF THE ENGAGEMENT. - " 2'� IT IS A VIOLATION OFI-THE STATE EDUCATION LAW FOR -ANY ' PERSON, UNLESS ACTING UNDER HE DIRECTION OF A ,LICENSED LAND SURVEYOR, TO ALTER' AN ITEM "IN ANY WAY. - 3;) ONLY COPIES OF THIS SURVEY MAR KED WITH THE LAND SURVEYOR'S SIGNATURE AND"AN ORIGINAL 'EMBOSSED OR, -INK' SEAL ARE THE PRODUCT OF THE LAND SURVEYOR, 44COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC SURVEY TRIANGULATION STATION "PROS". 5'.);, SIS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000, SECTIONITE 006, BLOCK 7, LOT 12, 6.),ITOTAL AREA = 2,261 ACRES. 74) SITE IS LOCATED IN R-80- ZONE. 8,) 'BASE FOR LEVELS: 'NGVO 1929. I j' I''',1G 15 2011 20 10 0 20 iiiia GRAPHIC SCALE IN FEET OF 0 I" 611�4 1 ^1 0.. G �E Q C Q w Z 8 m of W a O m L) W d N afm r E If w 2 W W� h = m 0 U p a �o '3 Q U ~ a m OV } O U Z Q 0 9 a o W z W m = 0 _ w ir_ a N� J m 9 U =n Ld cn N N Nm OF 0 I" 611�4 1 ^1 0.. SHEET 1 OF 1 I 1 1 G Q C Q w Z W a O L) W J W UI u)a a <1 2 W Q z = U Q a m W z W 0 _ ir_ a W Ld cn m to Z 2 a O _ N w o N W � w 0 0 it Q tt U al Q 0 ry o rn m o 0 � a Z o W z o W W Y U <Z Y DATE: 03/11/2009 SCALE: 1" = 20' SHEET 1 OF 1 I 1 1 • Jill M. Doherty, President Bob Ghosio, Jr., Vice -President James F. King Dave Bergen John Bredemeyer BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD September 21, 2011 Mr. Stephen Burnham 118 Parker St. Newton, MA 02459 RE: MADELINE AVE., FISHERS ISLAND SCTM#6-7-12 Dear Mr. Burnham: C� Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., September 21, 2011: WHEREAS, STEPHEN BURNHAM applied to the Southold Town Trustees for an Amendment to Wetland Permit #4173 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 15, 2011, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: the 5' area landward of stone wall will remain as a "no mow" area, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, 0 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, BE IT FURTHER, RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #5900 for the as -built rock retaining wall and drywell with the Condition of a 5' "no -mow" area along the landward side of the rock retaining wall, and as depicted on the survey received on August 15, 2011 and stamped approved on September 21, 2011. This is not a determination from any other agency. Sincerely, Jill . Doherty, �eside Boa of Trustees JMD:Ims �g�►FFOt,�C • Peter Young, Chairman Lauren Standish, Secretary Z y�i # Baa Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax(631)765-6641 At the meeting of the Southold Town Conservation Advisory Council held Wed., September 14, 2011, the following recommendation was made: STEPHEN & CORNELIA BURNHAM to Amend Wetland Permit #5900 for the as -built rock retaining wall and drywell. Located: Madeline Ave., Fishers Island. SCTM#6-7-12 The CAC did not make an inspection, therefore no recommendation was made. 0 0 Jill M. Doheily. President QVV- CO P.O. Box 1179 Bob Ghosio, Jr.. Vice -President �� GZ Southold, NY 11971 James F. King Telephone (631 765-1892 Dave Bergen 1r Fax (63 1) 765-6641 John Bredemeyer yyoe * �ao� Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: �- /`/- // STEPHEN & CORNELIA BURNHAM request an Amendment to Wetland Permit #5900 for the as -built rock retaining wall and drywell. Located: Madeline Ave., Fishers Island. SCTM#6-7-12 Type of area to be impacte _Saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland PartTown Code proposed work falls under: hapt.275 _Chapt. 111 _other Type of Application: ''Wetland _Coastal Erosion _Amendment _Ad min istrative_Emergency _Pre -Submission Violation Info needed:,_ WIN= CREW 14�0 n - Modifications: Conditions: Present erev J. Doherty Ghosio �ing Bergen, redemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: N/F PIRATE COVE MARINE COMMERCIAL USE MUNICIPAL WATER ON SITE SEPTIC SYSTEM N/F MICHAEL LAUGHLIN SINGLE FAMILY RESIDENCE MUNICIPAL WATER ON SITE SEPTIC SYSTEM NY I, MESHw/,TER KERM10 BWNONY AS R/GCEO EI c R N S,olux. 3/15/OE POLL AREA= 2.261 ACRES E OEC1( IDISMS ORAE LO llm Mm SINGLE FAMILY RESIDENCE MUNICIPAL WATER ON SUE SEPTIC SYSTEM N/F PATRICIA DOWNEY SCHIESTL SINGLE FAMILY RESIDE MUNICIPAL WATER ON SITE SEPTIC SYSI ➢RYRFIL MR' ...Rocs LE"' RIMOIT SHE E3PN6bN ftCP3ED 1%O ORRAM SFPIM MI( Ism CEPL) AXIOM /-PNIX+OSrtD OELR I PROPOSED LERCH G. RING (SEE DEPART) N 91?y A 6f 6 BOUNDARY MAP SWE 1'~ NNISxm W l SUET 1A N rk v o E o�� nl$ NOR SEIsoNne 4ACVND. 'm LEACHING RING CROSS SECTION . TO Sf E 0 E TEST HOLE EATA W. R. SIROUSE P.E,LS 10/31/02 D'-15' TOPSpL 15'-36' SRWY SUB W-12' SANDY nu 1.) SURrEY MAP PREPN$D FOR GEORGE W. PNx . LOUISE Ekgt N '.AAO, STEPHEN T. EURW141, CpWEW U. BURNNW; MADEUNE A4ENUE: FISHERS. ISLAND. HER tt ; "HAN LER, PAINER ! HHG: IYMWICH. CT: DATE AUGUST 11. 1999: SME: 1"..0': SHEET 1 OF 1 NOTES I.) TNS. SURVEY WAS PREPARED FOR ME. PARTIES MN PURPOSE WpCATED (EREM.. ANY IXTE M OF MC USE WOONO THE PWGOSM / NEEL TO BEM'EEN THE CLIENT Mn ME. SURJEYfR EXCEEDS ME SCOPE OF. ME.iIMAfEMENT. 2) N 1.4.-0 VIOLATION OF THE SEATS EGJCATION U FOR N PENSXi. UNLESS ACTING WAER ME ONRE01011 OF A LRXN5EO LANE SURVEYOR, 70' &TER M RE11 IN ANY NAY.' 3.) ONLY COPIES OF THIS SURTY NARXED WITH ME LWD SUZY MS SWNATUK AND AH MORAL EMBOSSED OR INN SVL ME ME PWOUCT OF NE LAN $NMYDR. t,) COOROWATE DR`LWES NE MEASURED M. ILS,Po T AND GEOOETC SURVEY TRMNGUTAIION STATION 'PROS' 5.) WE IS W THE TORN Of SWTHCLD. WVMY OF SUF`OLR TM DAP ICO2, SECDON W6, OL G ], LOT 12 6.) TOTT1 AREA " 2,261 ACRES. T) STE IS LO TEO W R-80 ZONE. R.) NE', T.Nt: I IEPRAR T. KROFTM NE OR NA STREET NE'ML%N, 0 502459 8 81]-]95-0908 9.) SITE 6 SER ED BY MUNICIPAL WATER ANO ON SIZE SERUK UWOS& SITTEG, 10.) OAK FOR LEYEM HGW 1929. .070 MR SERNC SYSIEM- 1.) USE ME (1) 1500 GL. SEPTIC TANK 2.) USE SX (6) 8 R. CMNEIER, 2 R. HICH %RECAST CONCRETE LEACHING RINGS, 3.) USE . NCH WNEIER. APPROIEO KKR ME THRWGNUR. {.)ME WASTE ONES FROM ME SEPTIC TAM 9NMHD EMER ME WCOLE RN4 AS HIM AS Po39NLE. 6.) USE A CR OSS -OVER. PIPE RIPIEEN THE WODLE RINGS ANO THE FOUR OUMD RINGS, 8 ACHES ADWE ME BORON. 6J BYXFlLL WMRAL SHAL SE COARSE SAND AND GRAVEL. ].) SUBS SHAUL BE BEIWEEN 10' AND IV SELOR GRADE. 8.) SOLID ISMOR E COVER SHALL BE WOREEN 6" AND 12' BELOW OWE. 9.) BOTTOM OF POOLS SHALL BE A NNIMUM OF'2 FF£T AERM HIGH 10.0 NAN. IZE MEWATEN. 10,0 M0.UMIZE 11E pSTNICE BETFEEN DE FOUR (OUTER) SVELLRE FDD N/F IqW OR FORMERLY N/F SQUARE FEET —RIO — ALFRED R. GREBE, JR. —10— PROPOSED WNTWR —I— 'VACANT LAND" N 86M'M" E N2E0" N F i u� PIRATE COVE n+ _ +' .N, - N/F MARINE ': o PATRICIA DOWNEY a SCHIESTL NI/F s". �o MICHAEL LAUGHLIN IOU 5 BT36'pY N 22.80' j 3.T14'10' N BOUNDARY MAP SWE 1'~ NNISxm W l SUET 1A N rk v o E o�� nl$ NOR SEIsoNne 4ACVND. 'm LEACHING RING CROSS SECTION . TO Sf E 0 E TEST HOLE EATA W. R. SIROUSE P.E,LS 10/31/02 D'-15' TOPSpL 15'-36' SRWY SUB W-12' SANDY nu 1.) SURrEY MAP PREPN$D FOR GEORGE W. PNx . LOUISE Ekgt N '.AAO, STEPHEN T. EURW141, CpWEW U. BURNNW; MADEUNE A4ENUE: FISHERS. ISLAND. HER tt ; "HAN LER, PAINER ! HHG: IYMWICH. CT: DATE AUGUST 11. 1999: SME: 1"..0': SHEET 1 OF 1 NOTES I.) TNS. SURVEY WAS PREPARED FOR ME. PARTIES MN PURPOSE WpCATED (EREM.. ANY IXTE M OF MC USE WOONO THE PWGOSM / NEEL TO BEM'EEN THE CLIENT Mn ME. SURJEYfR EXCEEDS ME SCOPE OF. ME.iIMAfEMENT. 2) N 1.4.-0 VIOLATION OF THE SEATS EGJCATION U FOR N PENSXi. UNLESS ACTING WAER ME ONRE01011 OF A LRXN5EO LANE SURVEYOR, 70' &TER M RE11 IN ANY NAY.' 3.) ONLY COPIES OF THIS SURTY NARXED WITH ME LWD SUZY MS SWNATUK AND AH MORAL EMBOSSED OR INN SVL ME ME PWOUCT OF NE LAN $NMYDR. t,) COOROWATE DR`LWES NE MEASURED M. ILS,Po T AND GEOOETC SURVEY TRMNGUTAIION STATION 'PROS' 5.) WE IS W THE TORN Of SWTHCLD. WVMY OF SUF`OLR TM DAP ICO2, SECDON W6, OL G ], LOT 12 6.) TOTT1 AREA " 2,261 ACRES. T) STE IS LO TEO W R-80 ZONE. R.) NE', T.Nt: I IEPRAR T. KROFTM NE OR NA STREET NE'ML%N, 0 502459 8 81]-]95-0908 9.) SITE 6 SER ED BY MUNICIPAL WATER ANO ON SIZE SERUK UWOS& SITTEG, 10.) OAK FOR LEYEM HGW 1929. .070 MR SERNC SYSIEM- 1.) USE ME (1) 1500 GL. SEPTIC TANK 2.) USE SX (6) 8 R. CMNEIER, 2 R. HICH %RECAST CONCRETE LEACHING RINGS, 3.) USE . NCH WNEIER. APPROIEO KKR ME THRWGNUR. {.)ME WASTE ONES FROM ME SEPTIC TAM 9NMHD EMER ME WCOLE RN4 AS HIM AS Po39NLE. 6.) USE A CR OSS -OVER. PIPE RIPIEEN THE WODLE RINGS ANO THE FOUR OUMD RINGS, 8 ACHES ADWE ME BORON. 6J BYXFlLL WMRAL SHAL SE COARSE SAND AND GRAVEL. ].) SUBS SHAUL BE BEIWEEN 10' AND IV SELOR GRADE. 8.) SOLID ISMOR E COVER SHALL BE WOREEN 6" AND 12' BELOW OWE. 9.) BOTTOM OF POOLS SHALL BE A NNIMUM OF'2 FF£T AERM HIGH 10.0 NAN. IZE MEWATEN. 10,0 M0.UMIZE 11E pSTNICE BETFEEN DE FOUR (OUTER) SVELLRE FDD N/F IqW OR FORMERLY SF SQUARE FEET —RIO — EXISONG CONTOUR —10— PROPOSED WNTWR —I— WRONG SE18pCK LINE KQ � Y Z U Z Elf aED 2 m x J x =)w p m Z W Y oW�b� O SoNvya yIQOJ '42� F 7N N _ a l7¢6� QQ Z Y W C am 3~ Z W CL (W7 CL � N 5 6 8 GATE: 06/08/2003 SCALE: 1" - 20' SHEET I OF 1 N/F PIRATE COVE MARINE COMMERCIAL USE MUNICIPAL WATER ON SITE SEP77C SYSTEM N/F MICHAEL lAUGHLIN SINGLE FAMILY RESIDENCE MUNICIPAL WATER ON SITE SEP77C SYSTEM C. 9.LLK NXS,D.Lc. 3/15/00� AREA= 2.26± ACRES N/F PATRICIA DOWNEY - SCHIESTL SINGLE FAMILY RESIDENCE ' N/F - _ "- g----------- ALFRED R. GREBE, JR. 6r36'N' rAm' uRTWEi� wR WNF.LrADFn R1W9MW 'VACANT LAND" EYPN6WN I N E6H'M" E _ SiFlO TANK om DETK) 24260' O 0 Z N F 9 m Q J EKISTING REPaK, PIRATE COVE yyyyyy���4aAV/ AWA`: `s3d4'� __ v N/F MARINE = w 8 PATRIC14 DOWNEY t ATE: Au . u, 1999: SC : 1•.40': SHEET 1 OF 1 SCHIESTL 7.) ME IS LO as IN R-&1 ZONE. YpgONT . • SINGLE FAMILY RESIDENCE 6.) A,,MKANT: 3/ STEWEIi T. BIRtNWJ.I P 118 PORKER STREET NEWTON. W 02,59 MICHAEL LAUGHLIN $� V, N 9.1 SHE IS SERYT M RY MwKPAL WATER .0 ON SITE SEWPGE CISMSK _ ON SITE SEPTIC SYSTEM SYSTEM. n eG• f 3.r u9a• n NOTES FOR SEPIK SYSTEN- • � .q, E%IST«c `�\`r` EI£/. 9]6 �;� MUNICIPAL MUNICIPAL WATER - _ "- g----------- ON SITE SEPTIC SYSTEM 6r36'N' rAm' uRTWEi� wR WNF.LrADFn R1W9MW STING FLUOR EYPN6WN - ISN EMLw M'-12' SMOY RLL SiFlO TANK om DETK) r O 0 Z RIX I 1( ) Q J EKISTING REPaK, E1EYA710N t6.90 yyyyyy���4aAV/ AWA`: `s3d4'� __ v \ / f FNM "ITTOR ,f.i�ROPoSfD CEGK • � .q, E%IST«c `�\`r` EI£/. 9]6 �;� ae 1t.o L aoAr ROFOSFA LF.YJENG.101G a (SEE OETMIj <' Ww NOPE MEREsiwE 6r36'N' rAm' f ewpIMAREc O'- T 7 W o m Z > - \ M'-12' SMOY RLL P.k NNL APPROX. LOCATION O 0 Z 3 Q J EKISTING REPaK, E1EYA710N t6.90 1.) SURvEY MM FAEPARED FOR GEORGE W. PHMAQO; LWLSE WRHN41 ¢� Y SYSTEM J� MHER5. 6WID. NEW YORK: C DER, P/LLIER a KUNG: NORWICH, CT: . LE /T57 ATE: Au . u, 1999: SC : 1•.40': SHEET 1 OF 1 Q a 7.) ME IS LO as IN R-&1 ZONE. YpgONT . • SINGLE FAMILY RESIDENCE 6.) A,,MKANT: 3/ STEWEIi T. BIRtNWJ.I P 118 PORKER STREET NEWTON. W 02,59 BOUNDARY MAP w5HE0 4AOOE '4 KO a � I PnLET �1� xcx sFwwwu GM UFUNKRR LEACHING RING CROSS SECTION NGF TO .G 0 TEST HOLE MTA \' W. R. STROME, P.EL.S 10/31/02 5 WaCATED IERMIC ANY E%TENSON OF ME USE BEYOND ME PtQMSM f ewpIMAREc O'- T 7 W o m Z > - \ M'-12' SMOY RLL P.k NNL WATER O 12, SEEPAGE O 90' O 0 Z 3 Q J // E1EYA710N t6.90 1.) SURvEY MM FAEPARED FOR GEORGE W. PHMAQO; LWLSE WRHN41 ¢� Y PACI%.40, STEPHEN T. WFNWW. C ELM B. B.RNWAI; W DINE A9ENUE: J� MHER5. 6WID. NEW YORK: C DER, P/LLIER a KUNG: NORWICH, CT: U ATE: Au . u, 1999: SC : 1•.40': SHEET 1 OF 1 Q a 7.) ME IS LO as IN R-&1 ZONE. m SINGLE FAMILY RESIDENCE 6.) A,,MKANT: 0 S STEWEIi T. BIRtNWJ.I P 118 PORKER STREET NEWTON. W 02,59 MUNICIPALWATER 617-795-OSW V, N 9.1 SHE IS SERYT M RY MwKPAL WATER .0 ON SITE SEWPGE CISMSK / ON SITE SEPTIC SYSTEM SYSTEM. I0.) SIK FOR LEVEIS. NCN 1929. NOTES FOR SEPIK SYSTEN- _N I.) USE CNE 1 M. SEPTIC FOUR E 2.) USE 51% (6) 6) FT. 8 ET. OWIETEfl, 2 R. HIGH PRECAST NNCRETE LEAGANG a n RUNGS. IN 3.) VSE 4 NCH ES MPROJED SEWER PIPE THROUGR ERM. THE WABTE LINER INE SEPTK TANK $XOAD ENTER ME MIDDLE q i MRS ESN IS" R SSP R PI.E 5.) U OVER RPE [EMEEN THE NIp01E PBIc9 M'0 THE FOUR 5.) USE A CR9, POLE 3 / BOUNDARY MAP w5HE0 4AOOE '4 KO a � I PnLET �1� xcx sFwwwu GM UFUNKRR LEACHING RING CROSS SECTION NGF TO .G 0 TEST HOLE MTA \' W. R. STROME, P.EL.S 10/31/02 Z Q WaCATED IERMIC ANY E%TENSON OF ME USE BEYOND ME PtQMSM d' 7 p O'- T 7 W o m Z > 15'-30'6. SY1vl0Y SU8500. w' 22 M'-12' SMOY RLL a p.' .. a WATER O 12, SEEPAGE O 90' O 0 Z W➢ RETIItQCEs Q J SIGNAFF E M0 M ORIGNAT EMROSSM OR INK SEAL ME ME PROWCT C£ ME WN SIMvEYOR. Z 1.) SURvEY MM FAEPARED FOR GEORGE W. PHMAQO; LWLSE WRHN41 ¢� Y PACI%.40, STEPHEN T. WFNWW. C ELM B. B.RNWAI; W DINE A9ENUE: Z MHER5. 6WID. NEW YORK: C DER, P/LLIER a KUNG: NORWICH, CT: U ATE: Au . u, 1999: SC : 1•.40': SHEET 1 OF 1 Q a 7.) ME IS LO as IN R-&1 ZONE. m Q NOTES = m I.) TIS SUWEY WAS PREPAREO NR RIE PIRURS Aro PURPOSE Z Q WaCATED IERMIC ANY E%TENSON OF ME USE BEYOND ME PtQMSM d' 7 p AGREED TO BETWEEN TIE CHEM AHD THE SURVEYOR EXCEEDS THE SCOPE CP ME EHWCEUENi 7 W o m Z > UN R 1,4 A VOUNDER THE 5(ATI ED F AI%1H UW FDR D RUFNRSON UNLESS MTMG wOEft ME gRECTN)N OF ALICENSEO IANO SUNEMOR TO w' 22 ILTER µ REIT IN ANY OAT. - a p.' .. a O 0 Z 3.) ONLY CWIET OF THIS SURVEY MNMED WIRI ME WN SUR cYOR'S Q J SIGNAFF E M0 M ORIGNAT EMROSSM OR INK SEAL ME ME PROWCT C£ ME WN SIMvEYOR. LL ] O Q{wQ{ KK LLc; 4.) CWROIMIE MSTANCES EFf MEASUREO FRw U.S. COAST A1C GEOOERt 50RYET TPoWGUTAROK STATION 'PROS" K Q Z 4 YEi 5.) SITE a N THE TOWN OF S .MU, GOUNTF M SUNT. TALK. 7 Iq%1, SECTON COU. BLOCK T, LOT 12a M G) TOTKL MEA _ 2.201 ACRES. F; 7.) ME IS LO as IN R-&1 ZONE. Z w Ed 6.) A,,MKANT: 0 S STEWEIi T. BIRtNWJ.I w 118 PORKER STREET NEWTON. W 02,59 Q a- W 617-795-OSW V, N 9.1 SHE IS SERYT M RY MwKPAL WATER .0 ON SITE SEWPGE CISMSK SYSTEM. I0.) SIK FOR LEVEIS. NCN 1929. NOTES FOR SEPIK SYSTEN- _N I.) USE CNE 1 M. SEPTIC FOUR E 2.) USE 51% (6) 6) FT. 8 ET. OWIETEfl, 2 R. HIGH PRECAST NNCRETE LEAGANG a n RUNGS. IN 3.) VSE 4 NCH ES MPROJED SEWER PIPE THROUGR ERM. THE WABTE LINER INE SEPTK TANK $XOAD ENTER ME MIDDLE q i MRS ESN IS" R SSP R PI.E 5.) U OVER RPE [EMEEN THE NIp01E PBIc9 M'0 THE FOUR 5.) USE A CR9, 3 a WTSOE RINDS. 0 LACHES ABOJE ME BGTTW. b.) MCNFILL WIERVL5WL1 BE CMRSE YND MO CIUVEt. R 7.)5LN6 SWILL BE BETWEEN aY MC 14' SELOM fPPOE. E 'o 6.) SOLID Q`NCRFR CPIER SHALL OR BEMEEN 6' NC 12' BELtlN ORUUX. 9.) MINN. OF MCI" SHNI. BE A WNIMUM OF 2 FEET I HIGH =NDMATER. g YASOUIL IDA WKIMIZE ME DISTANCE BETWEEN ME FOUR (OUTER) SATELLITEPOOLS. EGEND N/f NOW OR MaNERLY SF SQNN FEET —10— E%ISMIG CONTOUR —10— PROPOSED CONTOUR —I— OuNANG KTRACK ..E a 8 DATE: 06/08/2003 SCALE: 1' 20' SHEET 1 OF i Y 3 1 � tit i+. .L jo J� v w m. * e 1 -v � '141 t y . • �.:. James F. King, President Jill A Doherty, Vice -President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. to Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631)765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE -CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre -construction, hay bale line 1 sc day of construction /2 constructed ZProject complete, compliance inspection. G 77 -I l" i LEs�o�/L f 7a 1�)-914 #PAW f '6(1167- ",�� y,�P< /? ,Dje,;P'c✓FzGLs /iF/COy9�LLs %7= 81 J"104 F, (OCL u.fa-el- DEC 10wi'on.� 0 James F. King, President Jill M. Doherty, Vice -President Peggy A. Dickerson Dave Bergen John Holzapfel March 22, 2006 Mr. Stephen Burnham 118 Parker St. Newton, MA 02459 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD RE: MADELINE AVE., FISHERS ISLAND SCTM#6-7-12 Dear Mr. Burnham: Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax(631)765-6641 The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 22, 2006: RESOLVED that the Southold Town Board of Trustees grants a One -Year Extension to Permit #5900, as issued on April 21, 2004. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, James F. Kmg President, Board of Trustees JFK:Ims Board Of Southold Town Trustees SOUTHOLD. NEW YORK PERMIT NO.. SIX. - STEPHEN BURNHAM ISSUEDTO ...................................................... DATE:. 4p't-S-t..21,.... 2.004 Aut4orizativn Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;'.'. and in accordance with the Resolution of The Board adopted at a meeting held on Ain c e 21. 2004 and in consideration of the sum of =..50.00 ... paid by Stephen Burnham ........... ........ ........... ...... ................. ...... ......... _..........._...._................................,..................... of ... ..._Ni6hem,.._I32and....... ............... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to construct additions and renovations to the existing single-family dwelling, re - grade existing lawn, and install a new septic system, with the condition drywalls and gutters are Installed to contain the roof run-off and a line of hay bales is placed down prior to construction, and all as depicted on the site plan prepared by Richard H. Strouse last dated September 12, 2004. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and theseBents to be subscribed by a majority of the said Board .as of is date. The Permittee TERMS and CONDITIONS Stephei Bututharn residing at MadeP pie Ave., Fi,5heu I.seand N. Y, as {tart of the consideration for the issuance of the Permit does understand and prescribe to the fol- : i. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly Of indirectly As a result of any open. atom performed pursuant to this permit, and the said Petmiaee will, at his or her own expense, Wend any and all sucii suits initiated by third :parties, and the said Permittee Assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 abs. which is ta'nsideted to be the estimated time required to complete die work involved, but should circumstances ws rsmt, request for An extension may be made to the Board at a later dace. 3. That this Permit should be retained indefinitely, or as long as the Bald Permittee wishes to maintain the structure or project involved, to provide evidence ro anyone concerned that suth- orizatiou was originally obtained 4. Tbat the work involved will be subject to the inspection And approval of cite Board Of its agents, and n000umplianee with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. S. That there will be no unreasonable interference with navigation, As a result of the work herein addtotized. G That these shall be no interference with the right of the .public to pass And repass along the beach between -l* and low water marks. 7. Thu if future operations of the Town of Southold require theremoval and/or Alterations in the location of the work terein authorized, or if, In the opinion of $ere Bard of Trustees, the. work shall am unreasonable obstruction to free navigation, the sold Permittee will be requited, upon toe notice, to remove or niter this work or project herein staid without expenses to the Town of Southold. . e. That the aid Board will be notified by the Permitter a the completion. of the work auth- ori ed. 9. That the Permittee will obtain all other permits aced consents 6a mg be required sup- plemental to this permit which tray be subject to revoke upon faihtte to obtain same. • �gUFFO(�- c Albert J. Krupski, President QG James King, Vice -President 'y� Artie Foster N ' Z Ken Poliwoda Peggy A. Dickerson . BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 21, 2004 Mr. Stephen Burnham 228 Parker St. Newtown, MA 02459 RE: MADELINE AVE., FISHERS ISLAND SCTM#6-7-12 Dear Mr. Burnham: Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (63 1) 765-1892 Fax (63 1) 765-1366 The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 21, 2004 regarding the above matter: WHEREAS, STEPHEN BURNHAM applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 30, 2004, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 21, 2004, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, E WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of STEPHEN BURNHAM to construct additions and renovations to the existing single-family dwelling, re -grade existing lawn, and install a new septic system, with the condition drywells and gutters are installed to contain the roof run-off and a line of hay bales is placed down prior to construction, and all as depicted on the site plan prepared by Richard H. Strouse last dated September 12, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: None Very truly yours, d&'W-a '0 4 0'r Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims • New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 Phone: (631) 444-0365 • FAX: (631) 444-0360 Website: www.dec.state.ny.us Januar'8,2004 Stephen Tyler Burnham 1 l8 Parker Street Newton, Mass 02459 Re: 1-4738-03278/00001 Addition and septic replacement - Fishers Island Dear Mr Burnham, v Erin M. Crotty Commissioner The New fork State Department of Environmental Conservation has reviewed the application listed above, which was submitted on October 3, 2003 and has the following comments: 1. The Department has no objection to the proposed addition. ?. Septic systems are required to be a minimum of 100 linear feet from freshwater wetlands. The replacement system proposed in this application is only 63.5 feet from the wetland. The plan must be revised to maximize the setback between the wetland and the leaching rings. Can rings be relocated toward the area of the maple tree to be removed ? ? 3. The site plan must be revised to show a line labeled "limit of clearing, grading and ground disturbance". If you have questions concerning this matter, please contact me at (63 1) 444-0357. Sincerelti, Susan -Ackerman Environmental Analyst I F�StiERs M1 •O T ... w t ' W _ ro1[F C"TY OF SIhFOLK © E ••• Ked Property Iwke Y ME September 27, 2004 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY 11971-0959 Ref: Madeline Avenue ✓"� D t5���� I5 LU V`F D Addition and Septic Replacement — Fishers Island Dear Trustees: On January 27, 2004 I applied for a wetland permit for my property on Fishers Island, NY. Based on your comments by phone and those of the NYSDEC and the Suffolk County Department of Health Services, I asked Dick Strouse of CPK to redo the plans for my new septic system and addition and I enclose 3 copies of these plans. The DEC asked that we remove the 36 -inch maple tree and place the septic system in this position. They also asked that we mark the limit of clearing, grading and ground disturbance. The Department of Health Services asked that the plans show the location of the existing system, note that the adjacent properties use municipal water and have on site septic systems, show a different installation of leeching rings per their recommended design and show a place for a possible 50 pct expansion of the system in the future. You asked for a line of hay bales to be placed at the marked limit of grading and ground disturbance, and that we install a dry well to contain roof runoff. The new plans show all of these changes. Having answered the concerns of yourselves and the other regulatory agencies involved, we hope that you will grant us your permission to proceed with getting our construction permit from the Town of Southold Building Department so that we can begin this project. Sincerel , Stephe urnham 118 Parker Street Newton, MA. 02459 Tel: 617 795 0988 N/F PIRATE COVE MARINE COMMERCIAL USE MUNICIPAL WATER ON SITE SEPTIC SYSTEM N/F MICHAEL UUGHLIN SINGLE FAMILY RESIDENCE MUNICIPAL WATER ON SITE SEPTIC SYSTEM AREA= 2.26± ACRES BOUNDARY MAP . 1 -.IOM 1MSXTD CA. • run /uRL[T n� � 0 9 o r. •� �Ir MM suuNw GwOxWMrm LEACHING RING CROSS SECTION MOT m rut m TEST MOTE LATA BY: R. MOUSE, P.CLS 10/31/02 0--15- T (N, 36' SWOT SUBSOIL M'-IzSWOY BLL NATER O 12'. SEEPAGE O 90' wa RElFRENCES 1 I SUFOAY MAP MEPNRD FOR GEOF? F W. PACAAM. LWI^.E WRMWJL PACKMO,STEAMER T. @NBHM. CpWELIA B. EAR10WA. WARMF AWNUL, FIFILAS 5LW0. NET, RTRR; CHmOuER. PNYER a KMC; MCFNICM. Cl; DATE: MIGUST 11, 1999. SCALE 1'-10'; SHEET 1 OF I PATES I.) THS SURJEY WAS MMAKO MIT TME PMn[S AM) PURMSE WpGTED MREOM. ANY METYMN OF THE USE BELOW) THC PEO AGREED TO BETN£EN THC CUM MIO NE SIIT2YOR EFCCE)S ML SCOFF OF TME FMOACYMM. 2) M LS P VgIA OF THE STATE EVOATOW LAW FOR MY KITSON. UNLESS ACTING UNDER ME VREC)ON OF A UCEMSE) U D SLXMYOR. TO MTCR FN OEM, IT, .1 WAY. J I ONLY CMICS M mR 5UFMY M UD wHM mL LWO SURYEIC6I J IIFF M) m ORPTM3 EMBOSSED )R WK SfM AHE mC PRODUCT Of TIE LAM1 9AMTOR. A) COOROUNTE LNSTMICES ARE MC URED FROM U.S. COAST Mq GEODETIC SURVEY TT6WGINATIXI STAMM 'PROS' 5.) WE R N THE TORN OF SWM)L0. COLAh OF WFi0.K TM IMP IOW, SCGImM OD6. OLOCIL 3. 10, 12 fi) )) TOiu IS sAEA - 2 26 , i ALRCS. 91E LOCATE) M R -W IOM. AT MPUCANT: srzP11u1 T B1WMMm IIB PAMER STREET MCNTOM. MA OMIT .12-295-0988 9.T RITE R SEMYE) BY MUNICIPAL NATER MD CN LR SCMOLE CISPOSM SYSTEM. IO) fikE FOR LEVEL^: NPD 1929 MOTES I OR SEPTIC SYSTEM - 1.T USE (WE (1) I!IM CA- SEPTIC TMK 2) U5L SX (6) B R. EARLIER. 2 FT. Hq PRLCA5T CONCRETE LEACHING RINGS J) USE A PCH COWS R. APPRMED SEMFft NINE THRWCHCM UTA AS �IUXES�OLTIR' SEPTIC TMK ER THE EATMMUF S.) USC A COOS—FIFE CLN TIME MIWIE RWGS MM TME FAIR MWF 'MGs, 8 INCHES ABDVE THE BJROM. ,) BACKFILL MAFTRW SHALL BE COAR. SME, MD GRAVEL. 3) STABS SHALL 8C IITMEEN TO- MO TI' KL01Y GRADE. 8.) !xRZ CIXICRETE COVER $INCL ME FEIWCEN 6' AND 12' BELM GRADE 9) MTTOM OF POIXS AINL BE A WYMUM Of 3 FEET ABOVE HWTI SLIKWAL C.1iaNPYATfA. 100 WAMHC TMC WANCE H.IVICFN THE FOUR LOWER) SATELLITE POOLS Qom Y Q U Z R' am S m z¢ Df J x m Z W O oW C)z N U a z 6oa1W K Q¢QSsw Y0Qn N am 3~ Z LAI U O F CB � N/F ALFRED R. GREBE, JR. XFAC fNESNAS 'VACANT LAND' ewxuwr .Ep IF, x IISAfAo' [ C flLLx Y.S.DECC 3/15 W /IS/00 N/F a rr PIRATE COVE u - NIP Ste'_ • .- \1 N/F PATRICIA DOWNEY SCHIESTL - - MICHAEL LAUGHLIN SINGLE FAMILY RESIDENCE MUNICIPAL WATER • DATE: 06/08/2003 .,-x4n" -- ON SITE SEPTIC SYSTEM M4-10- x' _ —10— IMIRll 1'W _ T'� ` SHEET flJC£ IPlIQt MNOfT M.WG SETB^CK UNf 1 F%ISTW aOW 1\ 5oT, DPAINpI FIEv.-30Ire 50 Cmm TAN( Ls¢ TAV9) oEa j 11 1 o � r 1A - '_- - POSm APoIIFN • '� t1:'4: (: 'tib 61N0 NITIMME `= ' - QIP,•:; ; r ro � eE Fra).w _ • ••,alsrlxc .a9 o REPOSE) MAFJuc RIxc v _- � EILV •.. L M. i (SFE ECIFU • . . ,Y,, 5.e ENx PPE ,4 .•- BTJfi'W - 72.W .,Rn e' 2 Ter P U • ESYSRM APIK LC /l53 f YWAM Q BENCHMARK • 3 / P.K. JFV EL / EVATTR) ION 16.90 r / h J� SINGLE FAMILY RESIDENCE • F MUNICIPAL WATER / ON SITE SEPTIC SYSTEM • NINE / / Pula / BOUNDARY MAP . 1 -.IOM 1MSXTD CA. • run /uRL[T n� � 0 9 o r. •� �Ir MM suuNw GwOxWMrm LEACHING RING CROSS SECTION MOT m rut m TEST MOTE LATA BY: R. MOUSE, P.CLS 10/31/02 0--15- T (N, 36' SWOT SUBSOIL M'-IzSWOY BLL NATER O 12'. SEEPAGE O 90' wa RElFRENCES 1 I SUFOAY MAP MEPNRD FOR GEOF? F W. PACAAM. LWI^.E WRMWJL PACKMO,STEAMER T. @NBHM. CpWELIA B. EAR10WA. WARMF AWNUL, FIFILAS 5LW0. NET, RTRR; CHmOuER. PNYER a KMC; MCFNICM. Cl; DATE: MIGUST 11, 1999. SCALE 1'-10'; SHEET 1 OF I PATES I.) THS SURJEY WAS MMAKO MIT TME PMn[S AM) PURMSE WpGTED MREOM. ANY METYMN OF THE USE BELOW) THC PEO AGREED TO BETN£EN THC CUM MIO NE SIIT2YOR EFCCE)S ML SCOFF OF TME FMOACYMM. 2) M LS P VgIA OF THE STATE EVOATOW LAW FOR MY KITSON. UNLESS ACTING UNDER ME VREC)ON OF A UCEMSE) U D SLXMYOR. TO MTCR FN OEM, IT, .1 WAY. J I ONLY CMICS M mR 5UFMY M UD wHM mL LWO SURYEIC6I J IIFF M) m ORPTM3 EMBOSSED )R WK SfM AHE mC PRODUCT Of TIE LAM1 9AMTOR. A) COOROUNTE LNSTMICES ARE MC URED FROM U.S. COAST Mq GEODETIC SURVEY TT6WGINATIXI STAMM 'PROS' 5.) WE R N THE TORN OF SWM)L0. COLAh OF WFi0.K TM IMP IOW, SCGImM OD6. OLOCIL 3. 10, 12 fi) )) TOiu IS sAEA - 2 26 , i ALRCS. 91E LOCATE) M R -W IOM. AT MPUCANT: srzP11u1 T B1WMMm IIB PAMER STREET MCNTOM. MA OMIT .12-295-0988 9.T RITE R SEMYE) BY MUNICIPAL NATER MD CN LR SCMOLE CISPOSM SYSTEM. IO) fikE FOR LEVEL^: NPD 1929 MOTES I OR SEPTIC SYSTEM - 1.T USE (WE (1) I!IM CA- SEPTIC TMK 2) U5L SX (6) B R. EARLIER. 2 FT. Hq PRLCA5T CONCRETE LEACHING RINGS J) USE A PCH COWS R. APPRMED SEMFft NINE THRWCHCM UTA AS �IUXES�OLTIR' SEPTIC TMK ER THE EATMMUF S.) USC A COOS—FIFE CLN TIME MIWIE RWGS MM TME FAIR MWF 'MGs, 8 INCHES ABDVE THE BJROM. ,) BACKFILL MAFTRW SHALL BE COAR. SME, MD GRAVEL. 3) STABS SHALL 8C IITMEEN TO- MO TI' KL01Y GRADE. 8.) !xRZ CIXICRETE COVER $INCL ME FEIWCEN 6' AND 12' BELM GRADE 9) MTTOM OF POIXS AINL BE A WYMUM Of 3 FEET ABOVE HWTI SLIKWAL C.1iaNPYATfA. 100 WAMHC TMC WANCE H.IVICFN THE FOUR LOWER) SATELLITE POOLS Qom Y Q U Z R' am S m z¢ Df J x m Z W O oW C)z N U a z 6oa1W K Q¢QSsw Y0Qn N am 3~ Z LAI U O F CB � N/F ALFRED R. GREBE, JR. 'VACANT LAND' x IISAfAo' [ 2Azm' N/F a PIRATE COVE u - NIP MARINE PATRICIA DOWNEY SCHIESTL \1 I S N/F - - MICHAEL LAUGHLIN 4'. I BTM'W'• DATE: 06/08/2003 3390' RUW OR FORMERLY M4-10- x' 5T ;QUARE FEET —10— BOUNDARY MAP . 1 -.IOM 1MSXTD CA. • run /uRL[T n� � 0 9 o r. •� �Ir MM suuNw GwOxWMrm LEACHING RING CROSS SECTION MOT m rut m TEST MOTE LATA BY: R. MOUSE, P.CLS 10/31/02 0--15- T (N, 36' SWOT SUBSOIL M'-IzSWOY BLL NATER O 12'. SEEPAGE O 90' wa RElFRENCES 1 I SUFOAY MAP MEPNRD FOR GEOF? F W. PACAAM. LWI^.E WRMWJL PACKMO,STEAMER T. @NBHM. CpWELIA B. EAR10WA. WARMF AWNUL, FIFILAS 5LW0. NET, RTRR; CHmOuER. PNYER a KMC; MCFNICM. Cl; DATE: MIGUST 11, 1999. SCALE 1'-10'; SHEET 1 OF I PATES I.) THS SURJEY WAS MMAKO MIT TME PMn[S AM) PURMSE WpGTED MREOM. ANY METYMN OF THE USE BELOW) THC PEO AGREED TO BETN£EN THC CUM MIO NE SIIT2YOR EFCCE)S ML SCOFF OF TME FMOACYMM. 2) M LS P VgIA OF THE STATE EVOATOW LAW FOR MY KITSON. UNLESS ACTING UNDER ME VREC)ON OF A UCEMSE) U D SLXMYOR. TO MTCR FN OEM, IT, .1 WAY. J I ONLY CMICS M mR 5UFMY M UD wHM mL LWO SURYEIC6I J IIFF M) m ORPTM3 EMBOSSED )R WK SfM AHE mC PRODUCT Of TIE LAM1 9AMTOR. A) COOROUNTE LNSTMICES ARE MC URED FROM U.S. COAST Mq GEODETIC SURVEY TT6WGINATIXI STAMM 'PROS' 5.) WE R N THE TORN OF SWM)L0. COLAh OF WFi0.K TM IMP IOW, SCGImM OD6. OLOCIL 3. 10, 12 fi) )) TOiu IS sAEA - 2 26 , i ALRCS. 91E LOCATE) M R -W IOM. AT MPUCANT: srzP11u1 T B1WMMm IIB PAMER STREET MCNTOM. MA OMIT .12-295-0988 9.T RITE R SEMYE) BY MUNICIPAL NATER MD CN LR SCMOLE CISPOSM SYSTEM. IO) fikE FOR LEVEL^: NPD 1929 MOTES I OR SEPTIC SYSTEM - 1.T USE (WE (1) I!IM CA- SEPTIC TMK 2) U5L SX (6) B R. EARLIER. 2 FT. Hq PRLCA5T CONCRETE LEACHING RINGS J) USE A PCH COWS R. APPRMED SEMFft NINE THRWCHCM UTA AS �IUXES�OLTIR' SEPTIC TMK ER THE EATMMUF S.) USC A COOS—FIFE CLN TIME MIWIE RWGS MM TME FAIR MWF 'MGs, 8 INCHES ABDVE THE BJROM. ,) BACKFILL MAFTRW SHALL BE COAR. SME, MD GRAVEL. 3) STABS SHALL 8C IITMEEN TO- MO TI' KL01Y GRADE. 8.) !xRZ CIXICRETE COVER $INCL ME FEIWCEN 6' AND 12' BELM GRADE 9) MTTOM OF POIXS AINL BE A WYMUM Of 3 FEET ABOVE HWTI SLIKWAL C.1iaNPYATfA. 100 WAMHC TMC WANCE H.IVICFN THE FOUR LOWER) SATELLITE POOLS Qom Y Q U Z R' am S m z¢ Df J x m Z W O oW C)z N U a z 6oa1W K Q¢QSsw Y0Qn N am 3~ Z LAI U O F CB � � a o m R£ a I S c DATE: 06/08/2003 MEMO N/F RUW OR FORMERLY SCALE: 1' 20' 5T ;QUARE FEET —10— EAIRTWC CONTOUR —ID— PROPOSED COM. SHEET —e— M.WG SETB^CK UNf 1 OF 1 N/F PIRATE COVE MARINE COMMERCIAL USE MUNICIPAL WATER ON SITE SEPRC SYSTEM N/F MICHAEL LAUGHLIN SINGLE FAMILY RESIDENCE MUNICIPAL WATER ON SITE SEPTIC SYSTEM AREA= 2.26t ACRES NrsDEC Fv.FsmvA1[N nrlL.xo R UNUM, AS RAGGED RF c B4rc S..I.C. 3/I5/M, ' Qhs. I N/F PATRICIA DOWNEY SCHIESTL SINGLE FAMILY RESIDENCE 7 -MUNICIPAL WATER ON SITE SEPTIC SYSTEM BOUNDARY MAP C4f 1• ,RR' FmrFm w.DC •� 1 • F6L1 N-, n� .��• o 0 6 o n • rvl' N. Scl"o:aL IAaImMMER LEACHING RING CROSS SECTION .1 O SCM( Pm • •Aa .IM •L .u. TEST HaE DIA BY. R. SIROUSE, PELS 10/31/03 0'-15" MYSOL 15•-]6' SURE, SUBSM ]6'-12' iWOY TIM NATER O 12'• SEEPAGE 0 9U• MIP REFERENCES 1 ) SURVEY NM MEPMED FOR GEORGE W. PIIXMiD. LOOSE EURNN4( PACAMO. STEPHEN r BURMLAAI. CgMELW B BUWWM: NMMMNF AWNOE, Fly ,. FSLZ0. NEW YORK: CNNIOIER. PALMER ! NYIG: HCRWICN, Ci: WE AUGUST 11. 1599. SQNE1'-40•: SHEET I OF 1 RDra I.) THIS SUTMn WAS FRrIMfl, TUR ME HOMES MD PORWSE WUWTED IERECH. ANY EIRENSON OF THE USE BEYOND MC P SFSLD AGREED r0 BETWEEN ME CUENr NTD ME SURITYM EXCEEDS MC BCOFY M ME INSw CHEM 3 ) II L`• 0 vKILATKFN OF ME STATE EMICTION U MR MY PERSON. UNUSS KNNG UNDER THE DIRECTION OF A LMENSED LMN SUFNTMRL TO .TCR . DEM IN ANY NPT, 3 ) ONLY COILS OF THIS SURVEY MMSLU WITH ME VMO SUTRE OR S SICNAIIR[ AND OM O KI EMBOSSED OR INH SEA ME MC PRODUCT OF ME VNI SMETOR N ) COUR)MME TMTMM NNE MEASURED FROM U.S. COAST MN CLWETIC SURVEY 1PoPNGUIROH STITCH'PRUS' 5) SITE IS M THE OWN OF SWIHOLD. COUNTY OF SUFFOLK TNI MM IOW. SECTOR W6. DUDCK ]. LOT li 6.) TOT. NCA - 2.265 ACRES ]I SHE r UO IEC IN R -BO ZONE B) APR 1. STEPHEIj T. SUNNI. IB PIAHM SINAI NEW ICN.. ON59 61]-]9$-.S. 9.) STE E 1ER 10 BY MMICM. WATER MD ON SIR SEWAGE NSPOY4 SYSTEM 0.) .5 FDO (INt.. HR9 1939. NOTES I OR SEPW SYSTEM - 1. ) USE ME (1) ISM GFT. SEPTIC TMH Z) USF SIX (6) B FT. MMVER. 2 Fl. HIGH MUDK51 WKREYE LEFGPNG PoNGS. 3.) USC N KH MMRQN. M%NWED SEINER PWE FIRWCMDUf. 4 HI WASTE LnFS FROM ME SEPTIC TMH ENOL➢ ENIEA MF MIDDLE .GS IS MON FS FHS"RE. 5.) LIE A CROSS-WER HPE W.INEEN THE MIDDLE PANGS ME THE FOUR DU151DE WNGS. 0 MCHES FBNS ME BOTTOM. 6) BACgTLL WRRML SHIM BE OYL`.,E SAD MID PUVR. ]J SIAflS $ BE BETWEEN 10' MD II' ULM GR1DE. B) SOILED CONCRETE G SHALL EF dI M .' AM 12' BLLINI GRADE. 9.) BOTTOM OF POOLS SW4L BE A MINIMUM OF 2 FEET A HCH BFAXNK 4S.g11NONATER. 10.0 MWMIZE THE MTMCE BETWEEN THE FOUR (OUTER) S4RLLDE POOLS N @ H/F 1 BY ALFRED R. GREBE, JR. — 10— EK TSTI COMMON VACANT LAND" PRIM M (MHOMR � A PosED ADDmox l - 2ALW GDH N/F 9 SINGLE FAMILY RESIDENCE PIRATE COVEN MUNICIPAL WATER w $ TO BE REMOED ON SITE SEPTIC SYSTEM • . • (tel I` L` 7 a -,ir (FN]K RING EIEV.... IRON (MAL) S Be mx rw[ '. •_�,10TM MCI �APPROII. :A' I MATICW EgSRND 5[PM S i i' III.N• SSIEM IF /152 'ORMT BOUNDARY MAP C4f 1• ,RR' FmrFm w.DC •� 1 • F6L1 N-, n� .��• o 0 6 o n • rvl' N. Scl"o:aL IAaImMMER LEACHING RING CROSS SECTION .1 O SCM( Pm • •Aa .IM •L .u. TEST HaE DIA BY. R. SIROUSE, PELS 10/31/03 0'-15" MYSOL 15•-]6' SURE, SUBSM ]6'-12' iWOY TIM NATER O 12'• SEEPAGE 0 9U• MIP REFERENCES 1 ) SURVEY NM MEPMED FOR GEORGE W. PIIXMiD. LOOSE EURNN4( PACAMO. STEPHEN r BURMLAAI. CgMELW B BUWWM: NMMMNF AWNOE, Fly ,. FSLZ0. NEW YORK: CNNIOIER. PALMER ! NYIG: HCRWICN, Ci: WE AUGUST 11. 1599. SQNE1'-40•: SHEET I OF 1 RDra I.) THIS SUTMn WAS FRrIMfl, TUR ME HOMES MD PORWSE WUWTED IERECH. ANY EIRENSON OF THE USE BEYOND MC P SFSLD AGREED r0 BETWEEN ME CUENr NTD ME SURITYM EXCEEDS MC BCOFY M ME INSw CHEM 3 ) II L`• 0 vKILATKFN OF ME STATE EMICTION U MR MY PERSON. UNUSS KNNG UNDER THE DIRECTION OF A LMENSED LMN SUFNTMRL TO .TCR . DEM IN ANY NPT, 3 ) ONLY COILS OF THIS SURVEY MMSLU WITH ME VMO SUTRE OR S SICNAIIR[ AND OM O KI EMBOSSED OR INH SEA ME MC PRODUCT OF ME VNI SMETOR N ) COUR)MME TMTMM NNE MEASURED FROM U.S. COAST MN CLWETIC SURVEY 1PoPNGUIROH STITCH'PRUS' 5) SITE IS M THE OWN OF SWIHOLD. COUNTY OF SUFFOLK TNI MM IOW. SECTOR W6. DUDCK ]. LOT li 6.) TOT. NCA - 2.265 ACRES ]I SHE r UO IEC IN R -BO ZONE B) APR 1. STEPHEIj T. SUNNI. IB PIAHM SINAI NEW ICN.. ON59 61]-]9$-.S. 9.) STE E 1ER 10 BY MMICM. WATER MD ON SIR SEWAGE NSPOY4 SYSTEM 0.) .5 FDO (INt.. HR9 1939. NOTES I OR SEPW SYSTEM - 1. ) USE ME (1) ISM GFT. SEPTIC TMH Z) USF SIX (6) B FT. MMVER. 2 Fl. HIGH MUDK51 WKREYE LEFGPNG PoNGS. 3.) USC N KH MMRQN. M%NWED SEINER PWE FIRWCMDUf. 4 HI WASTE LnFS FROM ME SEPTIC TMH ENOL➢ ENIEA MF MIDDLE .GS IS MON FS FHS"RE. 5.) LIE A CROSS-WER HPE W.INEEN THE MIDDLE PANGS ME THE FOUR DU151DE WNGS. 0 MCHES FBNS ME BOTTOM. 6) BACgTLL WRRML SHIM BE OYL`.,E SAD MID PUVR. ]J SIAflS $ BE BETWEEN 10' MD II' ULM GR1DE. B) SOILED CONCRETE G SHALL EF dI M .' AM 12' BLLINI GRADE. 9.) BOTTOM OF POOLS SW4L BE A MINIMUM OF 2 FEET A HCH BFAXNK 4S.g11NONATER. 10.0 MWMIZE THE MTMCE BETWEEN THE FOUR (OUTER) S4RLLDE POOLS N @ H/F N/F BY ALFRED R. GREBE, JR. — 10— EK TSTI COMMON VACANT LAND" PRIM M (MHOMR ' E 2ALW N/F 9 SINGLE FAMILY RESIDENCE PIRATE COVEN MUNICIPAL WATER w $ / ON SITE SEPTIC SYSTEM • v / IRON NIF MICHAEL LAUGHLIN neo• j' 3n. la• N i i' III.N• / MLr / BOUNDARY MAP C4f 1• ,RR' FmrFm w.DC •� 1 • F6L1 N-, n� .��• o 0 6 o n • rvl' N. Scl"o:aL IAaImMMER LEACHING RING CROSS SECTION .1 O SCM( Pm • •Aa .IM •L .u. TEST HaE DIA BY. R. SIROUSE, PELS 10/31/03 0'-15" MYSOL 15•-]6' SURE, SUBSM ]6'-12' iWOY TIM NATER O 12'• SEEPAGE 0 9U• MIP REFERENCES 1 ) SURVEY NM MEPMED FOR GEORGE W. PIIXMiD. LOOSE EURNN4( PACAMO. STEPHEN r BURMLAAI. CgMELW B BUWWM: NMMMNF AWNOE, Fly ,. FSLZ0. NEW YORK: CNNIOIER. PALMER ! NYIG: HCRWICN, Ci: WE AUGUST 11. 1599. SQNE1'-40•: SHEET I OF 1 RDra I.) THIS SUTMn WAS FRrIMfl, TUR ME HOMES MD PORWSE WUWTED IERECH. ANY EIRENSON OF THE USE BEYOND MC P SFSLD AGREED r0 BETWEEN ME CUENr NTD ME SURITYM EXCEEDS MC BCOFY M ME INSw CHEM 3 ) II L`• 0 vKILATKFN OF ME STATE EMICTION U MR MY PERSON. UNUSS KNNG UNDER THE DIRECTION OF A LMENSED LMN SUFNTMRL TO .TCR . DEM IN ANY NPT, 3 ) ONLY COILS OF THIS SURVEY MMSLU WITH ME VMO SUTRE OR S SICNAIIR[ AND OM O KI EMBOSSED OR INH SEA ME MC PRODUCT OF ME VNI SMETOR N ) COUR)MME TMTMM NNE MEASURED FROM U.S. COAST MN CLWETIC SURVEY 1PoPNGUIROH STITCH'PRUS' 5) SITE IS M THE OWN OF SWIHOLD. COUNTY OF SUFFOLK TNI MM IOW. SECTOR W6. DUDCK ]. LOT li 6.) TOT. NCA - 2.265 ACRES ]I SHE r UO IEC IN R -BO ZONE B) APR 1. STEPHEIj T. SUNNI. IB PIAHM SINAI NEW ICN.. ON59 61]-]9$-.S. 9.) STE E 1ER 10 BY MMICM. WATER MD ON SIR SEWAGE NSPOY4 SYSTEM 0.) .5 FDO (INt.. HR9 1939. NOTES I OR SEPW SYSTEM - 1. ) USE ME (1) ISM GFT. SEPTIC TMH Z) USF SIX (6) B FT. MMVER. 2 Fl. HIGH MUDK51 WKREYE LEFGPNG PoNGS. 3.) USC N KH MMRQN. M%NWED SEINER PWE FIRWCMDUf. 4 HI WASTE LnFS FROM ME SEPTIC TMH ENOL➢ ENIEA MF MIDDLE .GS IS MON FS FHS"RE. 5.) LIE A CROSS-WER HPE W.INEEN THE MIDDLE PANGS ME THE FOUR DU151DE WNGS. 0 MCHES FBNS ME BOTTOM. 6) BACgTLL WRRML SHIM BE OYL`.,E SAD MID PUVR. ]J SIAflS $ BE BETWEEN 10' MD II' ULM GR1DE. B) SOILED CONCRETE G SHALL EF dI M .' AM 12' BLLINI GRADE. 9.) BOTTOM OF POOLS SW4L BE A MINIMUM OF 2 FEET A HCH BFAXNK 4S.g11NONATER. 10.0 MWMIZE THE MTMCE BETWEEN THE FOUR (OUTER) S4RLLDE POOLS N @ H/F N/F BY ALFRED R. GREBE, JR. — 10— EK TSTI COMMON VACANT LAND" PRIM M (MHOMR ' E 2ALW N/F 9 n PIRATE COVEN IF N/F w $ PATRICIA DOWNEY SCHIESTL NIF MICHAEL LAUGHLIN neo• j' 3n. la• N i i' III.N• BOUNDARY MAP C4f 1• ,RR' FmrFm w.DC •� 1 • F6L1 N-, n� .��• o 0 6 o n • rvl' N. Scl"o:aL IAaImMMER LEACHING RING CROSS SECTION .1 O SCM( Pm • •Aa .IM •L .u. TEST HaE DIA BY. R. SIROUSE, PELS 10/31/03 0'-15" MYSOL 15•-]6' SURE, SUBSM ]6'-12' iWOY TIM NATER O 12'• SEEPAGE 0 9U• MIP REFERENCES 1 ) SURVEY NM MEPMED FOR GEORGE W. PIIXMiD. LOOSE EURNN4( PACAMO. STEPHEN r BURMLAAI. CgMELW B BUWWM: NMMMNF AWNOE, Fly ,. FSLZ0. NEW YORK: CNNIOIER. PALMER ! NYIG: HCRWICN, Ci: WE AUGUST 11. 1599. SQNE1'-40•: SHEET I OF 1 RDra I.) THIS SUTMn WAS FRrIMfl, TUR ME HOMES MD PORWSE WUWTED IERECH. ANY EIRENSON OF THE USE BEYOND MC P SFSLD AGREED r0 BETWEEN ME CUENr NTD ME SURITYM EXCEEDS MC BCOFY M ME INSw CHEM 3 ) II L`• 0 vKILATKFN OF ME STATE EMICTION U MR MY PERSON. UNUSS KNNG UNDER THE DIRECTION OF A LMENSED LMN SUFNTMRL TO .TCR . DEM IN ANY NPT, 3 ) ONLY COILS OF THIS SURVEY MMSLU WITH ME VMO SUTRE OR S SICNAIIR[ AND OM O KI EMBOSSED OR INH SEA ME MC PRODUCT OF ME VNI SMETOR N ) COUR)MME TMTMM NNE MEASURED FROM U.S. COAST MN CLWETIC SURVEY 1PoPNGUIROH STITCH'PRUS' 5) SITE IS M THE OWN OF SWIHOLD. COUNTY OF SUFFOLK TNI MM IOW. SECTOR W6. DUDCK ]. LOT li 6.) TOT. NCA - 2.265 ACRES ]I SHE r UO IEC IN R -BO ZONE B) APR 1. STEPHEIj T. SUNNI. IB PIAHM SINAI NEW ICN.. ON59 61]-]9$-.S. 9.) STE E 1ER 10 BY MMICM. WATER MD ON SIR SEWAGE NSPOY4 SYSTEM 0.) .5 FDO (INt.. HR9 1939. NOTES I OR SEPW SYSTEM - 1. ) USE ME (1) ISM GFT. SEPTIC TMH Z) USF SIX (6) B FT. MMVER. 2 Fl. HIGH MUDK51 WKREYE LEFGPNG PoNGS. 3.) USC N KH MMRQN. M%NWED SEINER PWE FIRWCMDUf. 4 HI WASTE LnFS FROM ME SEPTIC TMH ENOL➢ ENIEA MF MIDDLE .GS IS MON FS FHS"RE. 5.) LIE A CROSS-WER HPE W.INEEN THE MIDDLE PANGS ME THE FOUR DU151DE WNGS. 0 MCHES FBNS ME BOTTOM. 6) BACgTLL WRRML SHIM BE OYL`.,E SAD MID PUVR. ]J SIAflS $ BE BETWEEN 10' MD II' ULM GR1DE. B) SOILED CONCRETE G SHALL EF dI M .' AM 12' BLLINI GRADE. 9.) BOTTOM OF POOLS SW4L BE A MINIMUM OF 2 FEET A HCH BFAXNK 4S.g11NONATER. 10.0 MWMIZE THE MTMCE BETWEEN THE FOUR (OUTER) S4RLLDE POOLS N @ H/F NDW OR fOEMEFLY BY SOLIME FEET — 10— EK TSTI COMMON —IG— PRIM M (MHOMR —@— BUUNG ETB^CA UNE LQ] i Y < U Z K am m 2< m Z W Y 4 w WW SO�UVQ 4 0 W Z g N W m Q N Y (r G am 3~ Z OTE mcI- ow o In < P 8 DATE: 06/08/2003 G SCALE: 1' = 20' SHEET 1 OF 1 Albert J. Krupski, President James King, Vice -President Artie Foster Ken Poliwoda Peggy A. Dickerson y� o� y Z BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application .g000Wetland Permit Application Major ✓Minor —Waiver/Amend nt/C n es 4teceived Application: 0 _,eKeceived Fee:$ ' ,Coetnpleted Application _Incomplete SEQRA Classification: _ D Type IType IIUnlisted _Coordination:(date sent i . 7;CAC Referral Sent: `' �ftte of Inspection: _Receipt of CAC Report: Srut� _Lead Agency Determination: _Technical Review: ,wPublic Hearing Held: Resolution: Name of Applicant S fie' P� ✓� IJ U f n^0. M Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631)765-1892 Fax(631)765-1366 Address t14 O;z`/S� Number:( ) C/%� ` CIS-D'?7T_ Suffolk County Tax Map Number: 1000 - Soc 4, uvN oo 6 G loc % / Lo� I Property Location: T1SLar& �S t pole -#- 1�).1 11aC4 I;"t /o,,.trt_ C St (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: L • Board of Trustees Application GENERAL DATA Land Area (in square feet): C 6 aJ IOzv . O -ba S 5JVc rr hr=t V— Area Zoning: K - T. o 0 Previous use of property: S Ltiewtra Intended use of property: R o S , d l.; r i-oL ( Prior permits/approvals for site improvements: Agency 0 >z S0IJkOU GOAd;L, aoA Date 1990 a -WL -0 arm No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? K, No Yes If yes, provide explanation: Project Description (use attachments if necessary): tr"IJ Rot &�kdu- -2 3� la AA . vt e,J Sero S �IS4n on 0 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: i r c rCa "p— 1 ,U , w�AJXC'e r"()ravt SjeO�rt 5v5lelvt Area of wetlands on lot: 7O,CWV square feet Percent coverage of lot: 76 % Closest distance between nearest existing structure and upland edge of wetlands: US— feet Closest distance between nearest proposed structure and upland edge of wetlands: 6'0 feet Does the project involve excavation or filling? NoV--� Yes If yes, how much material will be excavated? G O cubic yards How much material will be filled? O cubic yards 3 o' L, Gin I'/ en � S �y YW 10W K Depth of which material will be removed or deposited: % Y o' feet Proposed slope throughout the area of operations:of Manner in which material will be removed or deposited: 6C -C- � hoe— 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): C sys" NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: t( J1 S I tt1_e P h e k:j ✓l 0 r-eX SCTM# I 00 �e4 006 YOU ARE HEREBY GIVEN NOTICE: Lo - I 1. That it is the intention of the undersigned toerequest a Permit from the Board of Trustees to: b J; I d a 5 iigoW add �, av,, and 0. Vlew Sep�� SyST e,►-� 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: QJ fin, 0_,., — Pac (a rA i l Act ►.t 4VC14 of That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: You may contact the Trustees Office at 765-1892 or in writing. The above -referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: S�fep�.e� 1Jvf.�l.a� MAILING ADDRESS: 1 i8 Pi 5'h Ne PHONE #: "/r) - Enc: /') - Enc: Copy of sketch or plan showing proposal for your convenience. 1A.16.4 067)-7ext 12 ' PROJECT I.D. NUMBER 617.21 SEC Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by ADplicant or Project soonsor) 1. APPLICANT ISPONSOR I2. PROJECT NAME e✓1 Jl kLLu 1n_�KG to( JjRCf'Y"01 3. PROJECT LOCATION. S. J / ofd C Municipality fUh County J V QI k a. PREC ISE -LOCATION (Street address and road intersections, prominent landmarks, etc., or rowee o) P t C cL ^e A -x✓ � r ✓1 e,,( tUct,� e+ m e 6 �&kid r t Le a Vs (a ✓4 5. IS PROPOSED ACTION: ❑ New xpa n ooificatlonralteration S. DESCRIBE PROJECT BRIEFLY: �/ QO,ICQ gMC,0 add � A�0^ w ; r� ham) loorCirerc»'), K✓0t/� k,fc� a..o( �C_k, r�„m , I n s�A view 7. AMOUNT OF LAND AFFECTED: Initially �' acres Ultimately • acres 3. WILL -PPROSED ACTION COMPLY WITH EXISTING ZONING OR CTHER EXISTING 'LAND USE RES7RIC71ONS? es j_ No If 40. describe Orieily 3. WHAT PRESENT L.AY.D USE IN VICINITY OF PROJECT? 9emdential E'naustnal ! Commercial L Agnculture '! Pam/Forest/Open soace L Diner Descnoe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. .NOW OR ULTIMAT ELY FROM ANY OTHER GOVERNMENT�AIL AGENCY (FEDERAL, STATEOCALI? ()RC ' OL eO I, CI'Zii— Yes V No If yes, list agencyts) and permdlaoorovals S o o Ui Gi , I J, De PqFer 11. DOES ANY ASPEPJ�-OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes LLV,4o if yes, list agency name and permd/aoproval 12. AS A RESULT OF PRQPOSED ACTION WILL EXISTING PERMITIAPPROVAL r7EOUIRE ..1OCIFICATICN? ❑Yes Lr7, N/o I CERTIFY THAT THE r.___...._. /INFORMATIONNPPROVIDED(AABOVE IS TRUE -O THE SES T OF MY KNCWL=OGE e:e-/AJ,-4 Applicant/sponsor nna Dale. �W ^ If the action is in the Coastal Area, and you are a state acency, complete the Coastal Assessment Form before proceeding with this assessment OVER 0 Board of Trustees Application County of Suffolk State of New York SfieyN�T ( �nrri�o rvi 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 TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS Z 6 f4 DAY OF JAA/ nr 20 ()`( otary Public NEIL GCDWIN Ndyry Public, MaasadkW is My Commission ExplresOc OW 22, 2010 Albert J. Krupski, President James King, Vice -President Artie Foster Ken Poliwoda Peggy A. Dickerson 0 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of -Saro.he-n--E.�rnhmm - COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING . LA Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 D E C E �r L MAR U Southold Town Board of Trustees I, 8�.aM ,residing at/A4.adehllP aut W=asher s ,1-</aA r Svc, o 63 90 being duly sworn, depose and say: That on theA day of I personally posted the property known by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held (1) od r Ri� ,as . a004 o� C) - � �'' Pm, Dated: 301t/ Sworn to before me this a dayof&t00y /0t!v,__ Public \'ERON'ICA HAMILTON NOT;,RY PUBLIC STkTE OF NEIN YORK NO. O7 HA6067785 QUALIFIED IN SUFFOLK COUNTY TERM EXPIRES... O BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of -Saro.he-n--E.�rnhmm - COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING . LA Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 D E C E �r L MAR U Southold Town Board of Trustees I, 8�.aM ,residing at/A4.adehllP aut W=asher s ,1-</aA r Svc, o 63 90 being duly sworn, depose and say: That on theA day of I personally posted the property known by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held (1) od r Ri� ,as . a004 o� C) - � �'' Pm, Dated: 301t/ Sworn to before me this a dayof&t00y /0t!v,__ Public \'ERON'ICA HAMILTON NOT;,RY PUBLIC STkTE OF NEIN YORK NO. O7 HA6067785 QUALIFIED IN SUFFOLK COUNTY TERM EXPIRES... 0 Board of Town Trustees Town of Southold Town Hall PO. Box 1179 Southold, NY 11971-0959 Dear Board of Town Trustees: r January 27, 2004 D ECE�°� JAN D Southold Torvn Pe: rd of Trustees Here is my completed application for changes to my property on Madeline Avenue, Fishers Island. I request permission to replace my gravel leaching field with a modem septic system, build a small addition onto my house and regrade my lawn. Most of this will take place in areas within 100 feet of wetlands (my entire property is within 100 feet of wetlands) but nothing will take place in the actual wetland area itself. My house (which I own together with my sister) has three bedrooms and two bathrooms. I plan to add a bedroom/sleeping porch, enlarge the kitchen and separate the laundry from the downstairs bathroom. I will excavate a new basement under the addition and I hope to use this fill in the regrading of my existing lawn. On October 0 2003 I applied to the NYS DEC and I have received the enclosed letter of approval but with several corrections and changes to be made. I intend to comply except that I will ask about not remove the nice maple tree unless absolutely necessary. Please let me know if you agree with the DEC or if you have other concerns. I will also need to get permits from the Suffolk County Health Department and the Southold building department. But I have received advice that the proper way to start is with the DEC and yourselves and then proceed with the others once I have received your approval. Please let me know if you have any advice to the contrary. Please also let me know if there is anything missing from my application which I will try to rectify in short order. All going well I hope to start this project this fall. Sincerely, Steve Burnham 118 Parker Street Newton, MA 02459 0 0 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: .3Ufn�G—7—(n 5�22�L'V\ l (Last time, 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 Variance Change of Zone Approval of plat Exemption from plat or official map Other (if "Other", name the activity.) la 'd s 4-'Z (' m 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 Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non -corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or _D) the actual applicant. FRn FMAR E� M E DESCRIPTION OF RELATIONSHIP ,1J D - 2 ��'�`� ' Board of Submitted this y of cbr_2! 200 Signature S Print Name S ted ^ u � r l,u .✓t AREA= 2.26± ACRES LIMIT OF CLEARING, GRADING & GROUND DISTURBANCE JOIE: A CONTINUOUS LINE OF HAYBALES SHALL BE PLACED AROUND THE PROPERTY AT THE EXTENT OF THE THE UMIT OF CLEARING, GRADING & GROUND DISTURBANCE N/F PIRATE COVE MARINE + COMMERCIAL USE NYSDEC FRESHWATER WETLAND MUNICIPAL WATERBOUNDARY AS FLAGGED BY + ON SITE SEPTIC SYSTEM C. BALK N.Y.S.D.E.C. 3/15/00 wF N _ _ + WF. /FPATRICIA DOWNEY +WK. SCHIESTL . SINGLE FAMILY RESIDENCE MUNICIPAL WATER ON SITE SEPTIC SYSTEM • �' ; PROPOSED ORYWELL FOR I ' ROOF LEADER RUNOFF . W. F. " •"�__� r FUTURE 50% • EXISTING FLOOR \ EXPANSION + . ELEW.=20.09 " (1 ROPOSED 1500 GALLON SEPTIC TANK (SEE DETAIL) DECK ) 11 ) W.F. ISO \ / v 19.9 PROPOSED ADDITION 111 ROPOSED DECK WF' I" EXISTING'" N/F HOUSE ; r y ISTING 36' MAPLE _ TO BE REMOVED MICHAEL LAUGHLIN % eP�?' w.F C o SINGLE FAMILY RESIDENCE + + w \ l MUNICIPAL WATER W.F. W.F.1 L � '' PROPOSED LEACHING RING ON SITE SEPTIC SYSTEM - - \ I EXISTING F OOR 0 o I66 ST y L eY (SEE DETAIL) ELEV.= 9.78 resr / W.F.HOLE " 110 J 1 / IRON PIPE 5 " + � � � •• �� I ( n � .8' N 4313.05 wr. EXISTING 3 g �� W 626.27 -- + DRIVE / — 87-36'00" Wi 72.80' -- + ` MERESTONE 5.8' 187 C) Z r' + W.F. APPROX, LOCATION Z o m EXISTING SEPTIC g NLr'm0, SYSTEM O POLE X152 - HYDRANT BENCHMARK . / P.K. NAIL ELEVATION 16.90 �o SINGLE FAMILY RESIDENCE MUNICIPAL WATER / ON SITE SEPTIC SYSTEM IRON PIPE/ QUALITY CONTROL CERTIFICATION GROUP REVIEWED I DATE PROJECT MANAGER 2 (H--_ 9•N1w / suwV 9•.2.. ENVIRONMENTAL CIVIL Ih--o STRUCTURAL POLE / ARCHITECTURAL A,., , FILE J4691 N/F ALFRED R. GREBE, JR. T: "VACANT LAND" N 86'44'40" E .--_-- 242,60' z N/F o PIRATE COVE ' w V n N/F 0 MARINE £ r6, o PATRICIA DOWNEY m SCHIESTL J N/F va ' � ..... - - MICHAEL LAUGHLIN N. a S 87"36'00" W 72,80' S 33' 14' 10" W 111.54' BOUNDARY MAP SCALE 11-100' FINISHED GRADE 4"0 INLET 61. , OU1 Utl ry o 0 0 0 0 0 0 0 d 0 0 0 0 0 C. 0 0 1 m z N � I HIGH SEASONAL GROUNDWATER LEACHING RING CROSS SECTION NOT TO SCALE KNOCKOUT INLET AND OUTLET OPENINGS r 30m iuT�l.'�iim CAST CONCRETE COVERS PLAN LOCKING CASTING TO GRADE rt 9n" r4A. WIRE ME zi 662.6/6 G4 WIRDI M SHSH LOCATION MAP SCALE 1"=400' TEST HOLE DATA BY: R. STROUSE, P.E,L.S 10/31/02 W-15" TOPSOIL 15"-36" SANDY SUBSOIL 36"-12' SANDY TILL WATER 0 12', SEEPAGE 0 90" MAP REFERENCES 1.) SURVEY MAP PREPARED FOR GEORGE W. PACKARD, LOUISE BURNHAM PACKARD, STEPHEN T. BURNHAM, CORNELIA B. BURNHAM; MADELINE AVENUE; FISHERS ISLAND, NEW YORK; CHANDLER, PALMER & KING; NORWICH, CT; DATE: AUGUST 11, 1999; SCALE: 1"=40'; SHEET 1 OF 1 NOTES 1,) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED HEREON, ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT, 2.) IT 15 A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. 3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF THE LAND SURVEYOR, 4.) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC SURVEY TRIANGULATION STATION "PROS" 5.) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000, SECTION 006, BLOCK 7, LOT 12 6,) TOTAL AREA = 2.26± ACRES. 7.) SITE IS LOCATED IN R-80 ZONE. 8.) APPLICANT: STEPHEN T. BURNHAM 118 PARKER STREET NEWTON, MA 02459 617-795-0988 9.) SITE IS SERVICED BY MUNICIPAL WATER AND ON SITE SEWAGE DISPOSAL SYSTEM. 10.) BASE FOR LEVELS: NGVD 1929. NOTES FOR SEPTIC SYSTEM - 1.) USE ONE (1) 1500 GAL. SEPTIC TANK 2.) USE SIX (6) 8 FT. DIAMETER, 2 FT, HIGH PRECAST CONCRETE LEACHING RINGS. 3.) USE 4 INCH DIAMETER, APPROVED SEWER PIPE THROUGHOUT. 4.)THE WASTE LINES FROM THE SEPTIC TANK SHOULD ENTER THE MIDDLE RINGS AS HIGH AS POSSIBLE. 5,) USE A CROSS-OVER PIPE BETWEEN THE MIDDLE RINGS AND THE FOUR OUTSIDE RINGS, 8 INCHES ABOVE THE BOTTOM. 6.) BACKFILL MATERIAL SHALL BE COARSE SAND AND GRAVEL, 7.) SLABS SHALL BE BETWEEN 10" AND 14" BELOW GRADE. 8.) SOLID CONCRETE COVER SHALL BE BETWEEN 6" AND 12" BELOW GRADE, 9.) BOTTOM OF POOLS SHALL BE A MINIMUM OF 2 FEET ABOVE HIGH SEASONAL GROUNDWATER. 10.0 MAXIMIZE THE DISTANCE BETWEEN THE FOUR (OUTER) SATELLITE POOLS. EL GEND N/F 1YLp1 FORMERLY - 3" VENT [, 3' VENT) 10 - 10 EXISTING CONTOUR LIQUID LEVEL ° PROPOSED CONTOUR —II— m SETBACK LINE a � C A DunEf 9AFRE 1 CONTINUOUS HOT ' E p , _ ASPHALT SEAL LINED WITH N > ,rT a a N C, va G v :r Ri 4' SCHEDULE f140 00 C, W J oLuO IN INLET BAFFLE I 1 en cls DEFl-ECTO I < > z � Z ✓ N ; Z m a�� Of0 ao wz 0 W. ✓"i� � W �� CROSS SECTION 1'l 1500 GALLON — 2 COMPARTMENT a SEPTIC TANK ro NOT TO SCALE V LOCATION MAP SCALE 1"=400' TEST HOLE DATA BY: R. STROUSE, P.E,L.S 10/31/02 W-15" TOPSOIL 15"-36" SANDY SUBSOIL 36"-12' SANDY TILL WATER 0 12', SEEPAGE 0 90" MAP REFERENCES 1.) SURVEY MAP PREPARED FOR GEORGE W. PACKARD, LOUISE BURNHAM PACKARD, STEPHEN T. BURNHAM, CORNELIA B. BURNHAM; MADELINE AVENUE; FISHERS ISLAND, NEW YORK; CHANDLER, PALMER & KING; NORWICH, CT; DATE: AUGUST 11, 1999; SCALE: 1"=40'; SHEET 1 OF 1 NOTES 1,) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED HEREON, ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT, 2.) IT 15 A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. 3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF THE LAND SURVEYOR, 4.) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC SURVEY TRIANGULATION STATION "PROS" 5.) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000, SECTION 006, BLOCK 7, LOT 12 6,) TOTAL AREA = 2.26± ACRES. 7.) SITE IS LOCATED IN R-80 ZONE. 8.) APPLICANT: STEPHEN T. BURNHAM 118 PARKER STREET NEWTON, MA 02459 617-795-0988 9.) SITE IS SERVICED BY MUNICIPAL WATER AND ON SITE SEWAGE DISPOSAL SYSTEM. 10.) BASE FOR LEVELS: NGVD 1929. NOTES FOR SEPTIC SYSTEM - 1.) USE ONE (1) 1500 GAL. SEPTIC TANK 2.) USE SIX (6) 8 FT. DIAMETER, 2 FT, HIGH PRECAST CONCRETE LEACHING RINGS. 3.) USE 4 INCH DIAMETER, APPROVED SEWER PIPE THROUGHOUT. 4.)THE WASTE LINES FROM THE SEPTIC TANK SHOULD ENTER THE MIDDLE RINGS AS HIGH AS POSSIBLE. 5,) USE A CROSS-OVER PIPE BETWEEN THE MIDDLE RINGS AND THE FOUR OUTSIDE RINGS, 8 INCHES ABOVE THE BOTTOM. 6.) BACKFILL MATERIAL SHALL BE COARSE SAND AND GRAVEL, 7.) SLABS SHALL BE BETWEEN 10" AND 14" BELOW GRADE. 8.) SOLID CONCRETE COVER SHALL BE BETWEEN 6" AND 12" BELOW GRADE, 9.) BOTTOM OF POOLS SHALL BE A MINIMUM OF 2 FEET ABOVE HIGH SEASONAL GROUNDWATER. 10.0 MAXIMIZE THE DISTANCE BETWEEN THE FOUR (OUTER) SATELLITE POOLS. EL GEND N/F NOW OR FORMERLY SF SQUARE FEET - 10 EXISTING CONTOUR _IO__ PROPOSED CONTOUR —II— BUILDING SETBACK LINE a � N 0 Z O Q Y = o 0 U Z ,R a � C 0 o H a E T _ m N > ,rT a a N C, va G v N O Ri Z¢ 00 C, W J oLuO IN N O 7) m Z LLl m > z � Z 0 L N ; Z m a�� Of0 ao wz 0 W. ✓"i� � W �� �g 1'l (nw a Of ro n V U DATE: 06/08/2003 QZ x N LI- I m bG W 010 x 'c ILIO � O W LLl ILII W IL 0 Lu LLI I�I�I W of W u W U N 0 Z O Q Y = o 0 U Z ,R Q 0' 0 0 o E _ m N > S m a N C, vi Z N O Ri Z¢ 00 C, W J oLuO IN N O 7) m Z LLl m > z � Z 0 L N ; Z m a�� Of0 ao wz 0 W. � aJ �g 0 (nw Of ��w(o CL _ Of N n V U DATE: 06/08/2003 QZ x N LI- I m Z W LLl om W IL 0 Lu LLI N o Z O a d U o 0 ,R 0 0 o E _ N > N O a N C, vi Z N O Ri N 00 C, IN N O 7) a � � N � 0 � m D Y 0 0 W. w 0 0 z6 z m N a F „ o o N N O N N C, vi Z N O Ri N G C, IN O 7) V o Z 0 Z 0 G D Y 0 0 W. w 00 0 2 m IC n V U DATE: 06/08/2003 SCALE: 1 " = 20' SHEET 1 OF 1