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HomeMy WebLinkAboutTR-5914 Michael J.Domino,President OQF S0(��yOl Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 O P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams a0 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 19, 2019 Eileen Wingate 2805 West Mill Road Mattituck, NY 11952 RE: JOHN DiBARI 2000 GLENN ROAD, SOUTHOLD SCTM# 1000-78-2-37 Dear Ms. Wingate: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, June 19, 2019: RESOLVED, that the Southold Town Board of Trustees APPROVE the request-for a Transfer of Wetland Permit#5914 from Edward L. Kavanagh, as issued on May 26, 2004 and Amended on January 19, 2005; and BE IT FURTHER RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland #5914 to reconfigure existing deck by removing the 9'x5' first step; raising 105sq.ft. deck; installation of four (4) new treads at each end of deck, for a total of 30 sq. ft.; and as indicated on the site plan prepared by Condon Engineering, P.C., received on June 13, 2019 and stamped approved on June 19, 2019. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Michael J. Domino, President Board of Trustees MJD/dd $ � OF©(,���,� I` �, Michael J. Domino, Presider OosSC0�$� Town Hall Annex John M. Bredemeyer III,Vice-Presluent ��, - 54375 Route 25 Glenn Goldsmith y z:. P.O.Box 1179 ze A.Nicholas Krupski 0 ;>. . Southold,NY 11971 Greg Williams '�� ® p! ( Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: 14 Eileen Wingate on behalf of JOHN DiBARI requests an Administrative Permit to reconfigure existing deck by removing the 9'x5' first step; raising 105sq.ft. deck; installation of four (4) new treads at each end of deck, for a total of 30 sq. ft. Located: 2000 Glenn Road, Southold. SCTM#: 1000-78-2-37 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool); 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: �- If I have read & acknowl d� ged the foregoing Tr stees comments: �/ �. Agent/Owner: Present were: J. Bredemeyer t'___/M. Domino G. Goldsmith N. Krupski G. Williams Other ! L� 1 3 2019 BUILDER'S JOB NO. TITLE NO. REV. DAt TOTAL PLOT AREA: 24,353 t 1.S.F. 1. 2/13 Boy«Sof it a°'�°$ �.-•. z. s/zD � �ti9y I • ,,yQ' t�40'�N� Cog e1 ppt\ 6° QQ, R010 .f 1QQ' 1 yy 1 �?b �QQ wki !A,{ ;1 1 0 1 0.6� 197051 � '00° • 1 Ian � I N �{J 1 2G j 17d < � � I 0 N CP* 1 1 O � I N 1\\\ DFbVE 20' GARA(£ 1 Ld01 7 x 47' 41' 1 TT`` 8 t J Q 31' \ b � I X19 m CP _i 26' ��\ wv a z; Z \4 1-24'_w 18.5\\1 0 21.5 Q \\ii ��s \ 2 STORY FRAYS 13.4' REDDOILE _ F FLELV 16 01 o, GFLELY.14.17 57.9' lDT 21 t' " \17.0' 22.9' .. •OE4: DE CDYDEOI FtDCES SSTEPS T'EP'S I ' -- - - - - -- - _ ----_"`-` - ---IDT ZO - -- - - --- - - IDT 19 W O 4 O M N O to 0 0 O OF iOIL'E rtGt N. SUFFOLK � 99 MONUMENT — r.�ll\_.I. ,,,Y,��YR • PIPE 5,v,5' CREEK Date JUL 2 6 2006 The semage d!?p0 -I nd V."I'CT Inspe"�t�:d and/or carVuO!*,%,i':. i:8;.'`T, ' THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, 7F ANY, N07 SHOWN ARE NOT GUARANTEED. be satisfactory 1700.1"k THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE EXISTING CGDE OF PRACTICE FOR LAND SURVEYORS ADOPTED BY THE NEW YOR STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES THtS SURVEY �' ''1• � h •'%T MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. ND iiCIAL OF (�I'Ii-i(�; ,. ':t'• THIS STATE, OR OF ANY CITY,COUNTY, TOWN OR VILLAGE THEREIN, CHARGED WITH THE ENFORCEMENT OF LAWS, ORDINANCES OR REGULIITIONS SHALL ACCEPT OR APPROVE ANY PLANS OR SPECIFICATIONS THAT ARE NOT STAMPED, CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO FRE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITL£ COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS DR SUBSERUENT OWNERS. SUFFOLK COUNTY TAX MAP DIST: 1000 SECT: 078 SLK: 02 LOT: 37 BURTON MAP NO: 3848 AUGUST 19, 1963 LOT 20 BEHRENDT MAP OF WEST CREEK ESTATES SMITH PC LOCATION: SOUTHOLD ENGINEERS TOWN OF SOUTHOLD. SUFFOLK COUNTY, NEW YORK ARCHITECTS SURVEYORS 1 SURVEYED: JANUARY 18, 2006 f 244 EAST MAIN ST. CERTIFIED TO: MANZI HOMES PATCHOGUE, N.Y. 11772 (631) 475-0349 SCALE: 1 "=30' FILE NO: 05- 150 FAX 475-0361 EXISTING HOUSE - ---- ---- ---- ---- ❑ ❑ I I I I EXISTING DECK i EXISTING COVERED PORCH I I I I I ❑ ================= ❑ ========______=== ❑ 1 1 I I I I i I f 1 1 1 3 1 I 1 1 1 I 1 I I i i 1 i I I 1 1 i 1 1 I I 1 I I I 1 1 I 1 1 i I I 1 1 I I I I 1 1 i I 1 1 1 I 1 1 1 1 t I i i I I 1 1 1 1 1 I 1 1 1 1 1 1 I 1 3.. Lit i i I RUP REMOVE EXISTING STAIRS " i 1 I i I i I i I i i I I i I 1 1------------------------_ - - "'�S -m-=--==a-----;:-: -1=�------------------- 12'-8" 26'-1" EXISTING DECK PLAN EXISTING HOUSE JUN 1 3 2019 ,_.r APf BOARr TOWN STEES �'�� � DATE �-IrHOI.D ---- ----- ---- - piI I _ I EXISTING DECK EXISTING COVERED PORCH I I MATCH EXT'G HEIGHT I ❑ ❑ ❑ EXTENDED DECK EXISTING STAIRS: 8 RISERS AT 72'HIGH R U W/ NEW STAIRS R 7 TREADS AT 112'DEEP • . PROPOSED STAIRS: RAIL PER CODE 9 RISERS AT 72HIGH 8 TREADS AT 112 DEEP -T-B" - - 20'-9" X16 4� SCALE: PROPOSED DECK PLAN Condon Engineering, P.C. ill = 1 1.011 1755 Sigsbee Road DWG. No. DEBARI RESIDENCE Mattituck, NY 11952 2000 GLENN ROAD SOUTHOLD, NY 11971 300.01 EXISTING FOUNDATION AREA a � d da d EXT'G DECK PROP. DECK (2)2"x 8"DECK GIRDER BOLTED WITH 2'LAG BOLTS EXISTING DECK STAGGERED 16"O.C. 4" d JOIST HANGER ���—DECK SKIRT - __ _____________________=====n "x6"C.C.A.POST EXT'G(2)2"x 8"GIRDER i. = 00 I I h 011 E - I I I OST ANCHOR XIII 00 (p III x —� x «v�l r I _ i� c14 F" I NEW(2)2"x 8"GIRDER I L———J L——— 12"SONOTUBE N 24"x 24"x 12" ------ --- --9'-4' P.C.FOOTING 12"SONOTUBE N 24"x 24"x 12" P.C. FOOTING(TYP.) FOUNDATION PLAN SECTION PLAN I i E E r__� ,----i REMOVE EXISTING DECK t-.--1 E E E i E 1 XISTING DECK .iv, x �. :.' PROPOSED.40 DECK JUN 1 3 2019 Soll.li",iL ic'vgi ELEVATION ` SCALE: Condon Engineering, P.C. ill = 11-091 4 DEBARI RESIDENCE 1755 Sigsbee Road DWG. No. Mattituck, NY 11952 2000 GLENN ROAD SOUTHOLD, NY 11971 300.02 Michael J. Domino, President o�oSUFFO(�coGy Town Hall Annex John M. Bredemeyer, III, Vice-President o 54375 Route 25 Glenn Goldsmith N ,x P.O. Box 1179 A Nicholas Krupski y o� Southold, NY 11971 Greg Williams dol , �a Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS SCTM#: Property Owner Name: D c PEAR.I py 15 2Q1� s T. Date Sent to Bldg. Dept: �5Y a � The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered a Demolition as described under Town Code? COMMENTS: Iq AignaWture o Reviewer Date ®F �00- Town Hall Annex Michael J.Domino,President John M.Bredeme er III Vice-President °`� r4 54375 Route 25 Y �� FhY�"�`� �'� P.O.Box 1179 Glenn Goldsmith `. 'r, - Southold,New York 11971 A.Nicholas Krupski ? _ t�'i Telephone(631) 765-1892 Greg WilliamseC ,y•�( Fax(631) 765-6641 ou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit ;',; 1 Amendment/Transfer/ExtensionMY 019 - Received Application: Received Fee: $ 1OD.DD _ Completed Application: Incomplete: (If"k SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: �Coordination:(date sent): 6.71R LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: !0.12.1 Receipt of CAC Report: :t: Technical Review: Public Hearing Held Resolution: Owner(s) Legal Name of Property (as shown on Deed): Mailing Address: 'Q V� �`��� A Phone Number: "Jl 904Q�- Suffolk County Tax Map Number: 1000 - 1'�_ — 2 Property Location: 9mo (If necessary, provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): akl_ Ir Mailing Address: w12A W R Phone Number: �� Q1 P I ` Michael J. Domino,President �*0f S0UTjyO Town Hall Annex John M.Bredemeyer III,Vice-President �O l0 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski G • Q Telephone (631) 765-1892 Greg WilliamsycOU 'O Fax(631) 765-6641 � NTY,�� E ^ LEI VE BOARD OF TOWN TRUSTEES MAY 13 TOWN OF SOUTHOLD 2Q�9 Sotltticrd Town Board of Trustees APPLICATION FOR A TRANSFER OF A WETLAND PERMIT DATE I II "l OWNER - PHONE 9 I 1 _6,9 3 MAILING ADDRESS SDI "Sa&UD AGENT WMArk PHONE "5I(0 , st sj ADDRESS PROPERTY LOCATIONle►� Cl��i V"`G : AA- V y. TAX MAP NO. ODD UWe '( 6 request a Transfer of Permit# from fl U Signed B Board of Trustees- Application —� GENERAL DATA Land Area(in square feet): _ (�► i Area Zoning: Previous use of property: Sin &Ale Y) Intended use of property: Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes eK No If"Yes", please provide copy of decision. Will this project requi e y demolition as per Town Code or as determined by the Building Dept.? Yes o Does the structure (s) on property have a valid Certificate of Occupancy? 1S Yes No Prior permits/approvals for site improvements: Agency Date F)Q&D 0V (M &� I I \ 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): , ��V_S-n �A Ln t)PICK � ISTT�Ap_s TO B05R C�P-(D\DLaj � ' ° u k 0 _ t ` 1�t SSU� ��� � � J��'i 1�I i� � �I[�L.a�1 �V 1-�� 's �����•�. Board of Trustees Appli�a,.ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: the E)WM 61 L.�DECK RN5- I —SIEP DCUM W MA N-W-1q,0A-BD LD j t0 to - BF-C 4 I(Aa ILAI 101t� SIS FEATURE , BUT REQUIRE -WE fWAIDU OF SE6Mb- 1 ) t- r-T I epy-116 DI -Ec-nnu -- -f- W S W Area of wetlands on lot: x(04 square feet Percent coverage of lot: ( % j nC, odd or Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No .>< Yes (1(l,5 If yes, how much material will be excavated? cubic yards J How much material will be filled? cubic yards I u �Depth of which material will be removed or deposited: �j feet y-[() o�'If1 J Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: ��( Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): A ����s 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 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 R Name of Action or Project: \ QOM G l ►n Project Location(describe,and attach a location map): Brief Description of Proposed Action: RewC)�1 ll�e ��lS�i 61� G��2C -� (�IY1 cJL� �S v) Mine.. yy4ecs4fp� Oec+' tor� of CGLI� kx'l neq u�'C-,e 4kr�� A 3 +ceedt:> i n eoL, Name of Applicant t oQr SSponsor. �p Telephone: b t q-75(( �kll �i� \ wt at _ E-Mail:_ -�t`��(� Address: a� i � Q. C City/PO: s State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that 0 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 finding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: ❑ lc n peen`� 3.a.Total acreage of the site oWe proposed action? _j _acres b Total acreage to be physically disturbed? acres SQ, JFI , c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? y acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural (non-agriculture) [:]Industrial ❑Commercial t55Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ 7?!�r ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action loclted in,or does it adjoin,a state li ted Critical Environ rental Area? NO YES If Yes,identify: Q �' Wt�_!—'0{��. W estc(-eeK ❑ ❑ 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 technologies: ❑ 2 10. Will the proposed action connect to an existing public/private water supply? C� NO YES If No,describe method for providing potable water: � � j R ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b. Is the proposed action located in an archeological sensitive area? ❑ ❑ 13.a.,Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO 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? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban 19suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ Ela.Will storm water discharges flow to adjacent properties? \17, NO ❑YES b.Will storm,water discharges be directed to established conveyance system (run f and storm drains)? If Yes,briefly describe: JSLNO '❑YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: _ _ _� ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: _� ❑ AFFIRM THAT THE INFOR ION PRO IDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor e: _ / U _ Date: Signature: Part 2-1pact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning El Elregulations? 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? ❑ LJ- 4. 4. Will the proposed action have an impact on the environmental characteristics that caused the El establishment of Ciitical Environmental Area(CEA)? S. Will the proposed action result in an adverse change in the existing level of traffic or El F1affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ a. public/private water supplies? b.public/private wastewater treatment utilities? ❑ ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural iesouices(e.g.,wetlands, 1:1 Elwaterbodies,groundwater,air quality, flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage a ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? E Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the 'proposed action may result in one or more,potentially large or significant adverse'impacts and an environmental impact statement is required. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date ^� President Print or"Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature or Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Pa-e 4 of Board of Trustees Applic- ion AUTHORIZATION (Where the applicant is not the owner) I/We, M-� owners of the property identified as SCTM# 1000- �— — �� , (� in the town of New York, hereby authorizes A /le_ to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. *PropertOwner'sSignature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF MOA 20_LL_, CONNIE D.BUNCH Notary Public,State of New York Notary Public No.016196185050 Qualified in Suffolk County Commission Expires April 14,2 U Board of Trustees Appls.o-_.—on AUTHORIZATION (Where the applicant is not the owner) UWe, owners of the,property identified as SCTM# 1000- �— _ 3� . ()- in the town of , New York,hereby authorizes V� r to act as any agent and handle all ' necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for,this property,, Prope Owner's Signature Property Owner's Signature -SWORN TO BEFORE ME THIS ! DAY OF �,20 of New Notary D.eoy Public,State®f New 1'art Notary Public No.01S196185050 Qualified in Suffolk County pp���,,�� Commission Expires April 14,2�J Board of Trustees Applin:- V;:ion AUTHORIZATION (Where the applicant isnot the owner) owners of the property identified as SCTM# 1000- L - - `.v ;in the town of ,-New York, hereby authorizes _ to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property: roperty Owner s Signa a Pr perry Owner's Signature SWORN TO BEFORE ME THIS s+ DAY OF h) Notary Public DIANE LEACH NOTARY PUBLIC OF NEW JERSEY Comm. # 2357040 My-commission Expires 31912022 Board •of, Trustees Appli-,- ;ion AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED.TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. r Signature of Property Owner S gna a of Property Owner SWORN TO-BEFORE ME THIS _ __DAY DAY OF, ,, 14 Notary Public DIANE LEACH NOTA YPUBLIC OF 235 040 JERSEYComm. # J My,Commission Expires 31912022 ; - APPLICANT/AGENURE PRE'SENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town ofSouthold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The numose 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 neces_sary to avoid same. YOUR NAME: Ek I 1 (Last name,ft st name,.gtiddl tial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than,5°r'o o he shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSI41P Submitted thi 1-day f 200 Signature Print Name Form TS 1 APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emolovecti The purpose of 7 this form is to rovide 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: c n ` �✓� 1 ) .�� ( o_l I (Last name,first name,.grtddle mutual,unless you are applying to the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the'1'own of Southold? "Relationship"includes by blood,ntarriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee h.as 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 XS / 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 iclationship 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 npplicant is a corporation); B)the legal orbeneficinl 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 th s / d f /� 20 Signature Print Name Form TS ] Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of-Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt .minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its siu'ficant 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 shill not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# _ _--� — PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board ElBuilding Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: R Location of action: 0000 ll ,(m c aGal6dEfA Site acreage: d � L Present land use: � ` Q�,1� 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: An te, (b) Mailing address: c e�tc (c) Telephone number: Area Code( ) �U21 J e)i Q -745q (d) Application number,if any: /V11 Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ NoT4 If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LW12P Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ Nok 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 K 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 ❑ NA 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 Ei Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not 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 X Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes 1:1 No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No)ZNot 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 54 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 ❑ Nou 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--IMk,,j Not Applicable PREPARED BYW l C TITLEI�� (DATE 4( � James F. King, President Jill M. Doherty, Vice-President Pl~ggy A. Dickerson Dave Bergen John Holzapfel 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 CERTIFICATE OF COMPLIANCE # 0155C THIS CERTIFIES that the Date September 21. 2006 sing1e-fami1v dwelling, covered porch & deck At 2000 Glenn Rd., Southo1d Suffolk County Tax Map # 78-2-37 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/28/04 pursuant to which Trustees Permit # 5914 Dated 5/26/04 Was issued, 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 a sing1e-fami1v dwelling, covered porch & deck owner of the The certificate is issued to EDWARD KAVANAGH aforesaid property. ~o<~ Authorized Signature J IN I 77, / r gin FIT r i f � 3 . • � . 11 • � n t1 _ 1 • 1\ 1 : ! � /'� r. t l,.ya, n,,.!'rS� �-�j ,� A, ♦ -`•r�� y�•-r •^ r-y r,J�, ) . . ;.~ ,-.-.-,-.--.----.-.~-.~,~.-.--.~,"'_____.__.__._,~......__._.-._____.__,'~<t. . , . . TERMS and CONDIl1QNS 'l1le PetmiUee Edward L. Kavanagh ,"",I-.g at 740 Glen Cove Ave.. Glenn Head " . N. Y.. IS fU'C' of the coasideradOll lor the ....~ of <<he PUmk cIocs ~bood and r-xD>e co the fol. ao.wu.,: 1. That the Nid .Poud 01 Trustees aod the T_ 01 SouchoId ate releNed, ffOlD any aod all cIaauges. << dalms f<< cIaauges. 01 .... ~,ditecd, << IDdirec:dJ IS .. ~ of any opec- dIG.prfoaoed p'.-..ntco.Jbls I""""t. aod 'eM. Ri!I. ~~ MIJIs orber owne.rease. delead.atlJ aod all...m adts'lnltl.ced"" dlhd.,.me.. aod the Ri!I P I IUee a" ,.... faI1llahmtJ wIch reSpect cheRto. co the ~1-esduslOCl of the Baud 01 Tnslees of <<he T_ 01 SoacbllId z. That chis I'e.aDlt Is ftJid f<< .. pedod of 24 : -. wbkh is cIO'ns/Ife~~ co be the "";-e-I time' required co --omplete the wod: ln~wcI, bIt.ihoaJd ~ -. request . for ... exleIISiOll -mal be IIIIde CO <<he Poatd at .. later ~ . 3. That chis PerJnit should be RIalned lndefloltel,. or as Ioag IS <<he aid Pc:aDktec ..ubCs co . ....I....ln the _ or ptQject ~ved, to proYide nidcaoe co anyoae ClOIIOet1Ied chat IDIh- ~oo was CJrislaaI11 _tne-!. 4. That <<he wod: ~~ will be Illbject to the ~lIoa aod appronl of the Board << /no agents, aod ~Il....... with the ptorisioas 01 the ,...flng appIIacioa, ....,.be cause f<< rewaaon of chis Peauit ..,. ,...,.~tlon 01 the said Board. S. That theft will be DO __""'e faterf_ with Dftigadoo IS a result of the wod: IIerela ...~, . . 6. That theft sbaI1 be DO lnterfereoce w/ch the rlgbt 01 the pubIlc co pus aad repass daag the beach het..~ bJsh aod low water .-:b. ' 7. That if fucure op-tL- 01 the Town of ~ relfIlre che.-.1I1111/<< a1~r'll-ll" fa the ~ 01 the wod: herein...., , . r \ or tf, In the T- ol6e JloU'd 01 n-. the, Wlllkahal1 cause _.......lde omu- co flee ...~ the add ~- wID be nlJUlalI. ..-_ GOCke, co _ or alter chis wod: << proJect bereln swed "1dlo.4 ~ .., CO the Town' , ol SoPchoId. ' , , 8. That the aid Board will be DOClfled ..,. the P. ",,1_ lit the ~: Of the wod: IDIh- orbed. 9. That the 'p.;.rrnt_ wID GbcalA all ocher peaa/lI aod (~.~ ..~ 6It ..., be nqaIre4 ...p; 1"_'" co chis permit ~ ....,. 'be ~ to Ieftl!re ...- fallam co .. -. • gUFFO(,� Albert J.Krupski,President ��0 CQ Town Hall James King,Vice-President �� � 53095 Route 25 Artie Foster - P.O. Box 1179 Ken Poliwoda • Southold,New York 11971-0969 Peggy A. Dickerson A aTelephone(631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 19, 2005 Mr. Jeffrey T. Butler P.O. Box 634 Shoreham, NY 11786 RE: EDWARD KAVANAGH 2000 GLENN RD., SOUTHOLD SCTM#78-2-37 Dear Mr. Butler: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., January 19, 2005: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#5914 for an expansion of the deck and covered porch, and as depicted on the plan prepared by Jeffrey T. Butler, P.E. dated December 11, 2003. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, I. . Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims Ne N rk State Department of Environmental Conservation AM sio of Environmental Permits, Region One Bul ling? 0 -SUNY, Stony Brook, New York 11790-2356 Ph e: 31)444-0365 • FAX: (631)444-0360 _ We site www.dec.state.ny.us Erin M.Crotty Commissioner ERMIT MODIFICATION ward Kavanagh November 30, 2 JAN 1 92005 � 0 Gle venue NY 11545 Southold Town Glen Head, Board of Trustees Re: Permit# 1-4738-03317/00001 Dear Mr. Kavanagh: Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR Part 621 (Uniform Procedures Regulations). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is modified to authorize: Addition of a covered porch and an uncovered porch to south side of proposed dwelling as shown on plans prepared by Jeffrey T. Butler, P.E., stamped NYSDEC approved on 11/30/04. This letter is a modification to the original permit, and as such, shall be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. Sincerely, �G Mark Carrara Permit Administrator f cc: MHP J. T. Butler File ( I SUBDIVISION MAP OF "WEST CREEK ESTATES" FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON e.r1 CU�MoD 031 / ) AUGUST 19, 1963 AS FILE N0. 3848 ELEVATIONS IN N.G.V. DATUM (MSL 1929) N/F ROBERT & CAMILLE WILSON EXISTING RESIDENCE PUBLIC WATER 16 4 TIE LINE ALONG APPROXIMATE HIGH I PR X WATER MARK VE PORC D 95 11 -` N 115'_11" 0 n my p V j Z 123,8 m r-731 o Np Np 0 Z O O iOs Z Z N P1rn y O '� '. o��` 6 A Ln PORCH C Zr AtC PROPOSED Z�, y s CPORCHD PROPOSED NO Z� DI RBANCE BUFFER Ef Ln 0 00 ton N \�, 2 0 N to � I ¢•t , 8 6 10 � 6 * t0 SITE PLAN DOLS 300 ■■�■ = ■ ■ NG AREA 20 10 0 20 40 60 80 100 GRAPHIC SCALE 1" = 20'-0" 17/00001 S..C.D.H.S. REF. NO. RIO-04-0006 SITE PLAN JEFFREY T. BUTLER, P.E. QED SINGLE FAMILY RESIDENCE 1 GLENN ROAD, SOUTHOLD, NY P.O. BOX 634 S.C.T.M. 1000-078-02-37 SHOREHAM, NEW YORK .\TER BODY: WEST CREEK TEL.: 631 .208.8850 FAX: 631 .727.8033 SUFFOLK TOWN OF SOUTHOLD I DATE PREPARED: 12/11 /03 .... - - tOT AREA = 24,353.13 SQ.FT. FLOOD ZONE = AE BASE FLOOD ELEVATION = 8.0 --tft UTILITY POL.E o #Hi ~ ~ Z ~ b GRA PALE BROWN SANDY LOAM (OL) PALE BROWN . SIL TV SAND (SM) PALE BROWN FINE TO MEDIUM SAND (SP) WATER IN PALE BROWN FINE TO MEDIUM SAND (SP) TEST HOLE BY MC DONALD GEOSCIENCE 8/7/01 LOT AREA (ADJACENT TO WETLANDS) = 22,355.36 SO.FT. PROPOSED RESIDENCE = 2415.72 SO. FT. PROPOSED COVERED FRONT PORCH - 105.8 SO.FT. PROPOSED COVERED REAR PORCH - 270 SO. FT. PROPOSED UNCOVERED REAR PORCH - 180 SO.FT. . TOTAL - 2971.52 SO.FT. - 13.30" LOT COVERAGE S 0~'30'OO" E .~~@ o G.F.=12'6" o N PROPOSED 2 STORY RESIDENCE F.F.=15'9" ,. . ... i<i , " N ~ N PROPOSED ~ PROPOSED DRYWELL FOR COVERED ROOF RUNOFF t\. PORCH . G\'I."'I OO~OS~~'I'l" '< ~": 0\'1.'''.... . o i-'l ~ -~ 1.5' ~ .r___ LpRO~SED SANITARY SYSTEM 3 L.P. 8'., 4' DEE~ N/F FERUCIO FRANKOLA EXiSTING RESIDENCE PUBLIC WATER 3' ) N02'30'OO" W 250.21' UTIUTY POLE 0#14 8.3' 4'x25 sa.FT.x. sa. FT. LE" NYSDEC 1-4738-0 -15' PROPERTY OWNER: EDWARD L. KAVANAGH A~ 740 GLEN COVE AVENUE ''7'''1/11, GLENN HEAD, NY 11545 'V S TEL.: 516-674-0707 ~o~h ~() l?~11-- COUNTY ( PROF 2( O��SUfFO(,��0 Telephone p Tour Hall (63 1)765-1892 - 53095 Route 25 O P.O. Box 1179 Southold.New York 1 1971-095 9 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD TO: Southold Town Board of Trustees FROM: Southold Town Conservation Advisory Council DATE: January 11, 2005 RE: Recommendations A meeting of the Southold Town Conservation Advisory Council was held Tues., January 11, 2005. The following recommendations were made: DISCUSSION AND RECOMMENDATION OF APPLICATIONS TO AMEND PERMITS Moved by William Cook, seconded by Jack McGreevy, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the application of EDWARD KAVANAGH to Amend Permit #5914 for an expansion of the deck and covered porch. Located: 2000 Glenn Rd., Southold. SCTM#78-2-37 The CAC recommends Approval of the application with the Condition there is a limit to the number of trees being removed on the property. Vote of Council: Ayes: All Motion Carried 0 0 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 Erin M.Crotty Commissioner PERMIT MODIFICATION Edward Kavanagh November 30, 2004 740 Glen Cove Avenue Glen Head, NY 11545 Re: Permit # 1-4738-03317/00001 Dear Mr. Kavanagh: Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR Part 621 (Uniform Procedures Regulations). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is modified to authorize: Addition of a covered porch and an uncovered porch to south side of proposed dwelling as shown on plans prepared by Jeffrey T. Butler, P.E., stamped NYSDEC approved on 11/30/04. This letter is a modification to the original permit, and as such, shall be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. Sincerely, �G Mark Carrara Permit Administrator cc: MHP J. T. Butler f� 2 n� File E D rC is .� V DEC1 4 D 3 200 .. Smdhold Town efPP.$ Albert J.Krupski,President p/ Town Hall James King,Vice-President ,QS�FF�A'C 53096 Route 25 Artie Foster �O" ¢j P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 Peggy A. Dickerson aiD Z Telephone(631) 766-1892 ap Fax(631) 765-1366 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. V'e . a INSPECTION SCHEDULE Pre-construction, hay bale line 1 at day of construction % constructed 'Project complete, compliance inspection. _pgUFFO(,� Albert J. Krupski, President OV' CQ Town Hall James King, Vice-President = � 53095 Route 25 Artie Foster o P.O. Box 1179 Ken Poliwoda = Southold, New York 11971-0959 Peggy A. Dickerson 'y.�Q �Q� Telephone(631) 765-1892 Fax(631) 765.1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 26, 2004 Jeffrey T. Butler, P.E. P.O. Box 634 Shoreham, NY 11786 RE: EDWARD L. KAVANAGH 2000 GLENN RD., SOUTHOLD SCTM#78-2-37 Dear Mr. Butler: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 26, 2004 regarding the above matter: WHEREAS, Jeffrey T. Butler, P.E. on behalf of EDWARD L. KAVANAGH 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 April 28, 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 May 26, 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, 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 the Board of Trustees approve the application of EDWARD L. KAVANAGH to construct a two-story, single-family dwelling with related improvements, and all as depicted on the site plan prepared by Jeffrey T. Butler, P.E. dated December 11, 2003. 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: $100.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims • SOFfO(,� • Albert J. Krupski,President �� CO Town Hall James King,Vice-President ,V'1` 53095 Route 25 Artie Foster o �'! P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 Peggy A. Dickerson �.f�o aO�`F Telephone(631)765-1892 `1 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: W-6 it, Please be advised that your application dated S��aB�ay has been reviewed by this Board at the regular meeting of a(010f and the following action was taken: (_Application Approved (see below) �) Application Denied (see below) L_) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: a ( "/ucZc41„, —(&e't atrar had) TOTAL FEES DUE: $ /OD, QD -SIGNED: PRESIDENT, BOARD OF TRUSTEES �o��►fF0(,�co Telephone Town Hall (631)765-1892 Z 53095 Route 25 W P.O.Box 1179 O'y • ��� Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, May 11, 2004, the following recommendation was made: Moved by William Cook, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of EDWARD L. KAVANAGH to construct a two-story, single-family dwelling with related improvements. Located: 2000 Glenn Rd., Southold. SCTM#78-2-37 Vote of Council: Ayes: All Motion Carried NEW YORSATE DEPARTMENT OF ENVIRONMENTAL CCISRVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738.03317/00001 A ri119,2004 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental April 19,2009 Conservation Law TYPE OF PERMIT■New ❑ Renewal ❑Modification❑Permit to Construct ❑Permit to Operate ❑ Article 15,Title 5:Protection of Waters ❑ Article 17,Titles 7,8: SPDES ❑ Article 27,Title 9; 6NYCRR 373: Hazardous Waste Management ❑ Article 15,Tide 15:Water Supply ❑ Article 19:Air Pollution Control ❑ Article 34: Coastal Erosion ❑ Article 15,Title 15:Water Transport Cl Article 23,Title 27: Mined Land Management Reclamation ❑ Article 15,Title 15: Long Island Wells ❑ Article 36: Floodplain Management D Article 24: Freshwater Wetlands ❑ Article 15,Title 27: Wild, Scenic and ❑ Articles 1,3, 17, 19, 27,37;6NYCRR Recreational Rivers ■ Article 25:Tidal Wetlands 380: Radiation Control ❑6NYCRR 608:Water Quality Certifica- ❑ Article 27,Title 7: 6NYCRR 360: tion Solid Waste Management PERMIT ISSUED TO TELEPHONE NUMBER Edward Kavanagh 516) 674-0707 ADDRESS OF PERMITTEE 740 Glen Cove Avenue, Glen Head, NY 11545 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Jeffrey T. Butler, P.O. Box 634, Shoreham, NY 11786 631 208-8850 NAME AND ADDRESS OF PROJECT/FACILITY Kavanagh property, 2000 Glenn Road, Southold SCTM #1000-78-2-37 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk I Southold I West Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a single family dwelling with porches, septic system and drive. All work must be done in accordance with the attached plans stamped NYSDEC approved o rAp n T Southold town By acceptance of this permit, the permittee agrees that the permit isLntinqe ° e with the ECL, all applicable regulations, the General Conditions specified (see page 2 8r 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS John A. ' land CKW Region 1 Hea uarters, Bldg. #40, SUNY, Stony Brook, NY 11790-2356 H ZED SIGNATURE DATE l Page 1 of 4 April 19, 2004 • 0 lylao �� gUPFO(,� Albert J. Krupski, President O�0 CC Town Hall James King,Vice-President rd � 53095 Route 25 Artie Foster pO P.O. Box 1179 Ken Poliwoda Southold, New York 11971-0959 Peggy A. Dickerson Oifr 0�� Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A PE - _ DATE _ a , 3004 �J i Beard ri Tri.°�_ __ OWNER I _a lckrno,* PHONE ADDRESSr9OpO 'knr' Y)d . C1`A�1ht�\c AGENT:a�yaj;,A\g�- PHONE lo3\ - SOB ��SO ADDRESS��x 1p3u Stiov-g hom . tJY k 1-j F) n PROPERTY LOCATION c�\PrlCl cCS`,-A"C)j 6 TAX MAP NO. 1000 - (�)`T 8 - UQ - -,2Y7 I/We sfe7i T o7ziu request an Amendment to Permit #!E:Q1_ �o z E'.t 0A ✓SiiJ nJ rS f- �•e6 l�iv1l,�_/9O�/¢a,�-/J 1JEz ic, j Signed By: Albert J.Krupaki,President g�►FFO(,��� C�!' Town Hall James King,Vice-President Th 53095 Route 25 Artie Foster ::2tt P.O.Box 1179 Z Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson ap � Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application �GGctiand Permit Application Major —Minor Waiver/Amend nt/ n es oreceived Application: N Received Fee:$ r8oard ETrustees Completed Application_Incomplete _SEQRA Classification: Type IType II_Unlisted_Coordwation:(date sent).•CAC Referral Sent: !/abate of Inspection: / AV_Receipt of CAC Report: _Lead Agency Determination: _Technical Review: �_ ublic Hearing Held: Resolution: Name of Applicant 1Fc)k1AQfl L• �fl�Auati+ 1 Address 7-41) ( pert (oyE AyENos , CiL tow ACXC- , ,NY 11545 Phone Number:(51r4 Ln-7-4- 030-7 Suffolk County Tax Map dumber: 1000- D143 -()'2 - 3-7 Property Location: SDUI H S 1 OC- UC— �LEt, , R,oA p 19-70,S-1 EAST nr -t?�R-IVlfryl2otat� 1�CT�JEEti krtLrrti EbL-F -4 1¢ArJN # 15 (provide LILCO Pole#, distance to cross streets, and location) AGENT: -�EFFI'—E4 T. E (If applicable) Address: ''•L Lox b34-F S1ic ecHAri Ny 11'7 (0 } Phone: Board of Trustees Application GENERAL DATA Land Area(in square feet): 24 , S53, 13 SQ FT. Area Zoning: Previous use of property: V q c P rjT L,oT Intended use of property: S 1 r c,L-f FA o--I i L-/ Prior permits/approvals for site improvements: Agency Date NYSoEC I-4-738-o3317-00001 4119104 SC��--15 QEF t.lo, �fD"O�-Doi)b �£n,�itJC� No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description(use attachments if necessary): 1?::-U)L p r* TW n jTD� 1 SING LC �AMILy �csin � r`ct " kTra !�� La-��� 1 M'PQodt�ErsTs. Board of Trustees Application WETLANDfrRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: tom,,,Lj�!, A --rw n Srp,z j SlNy _FAwi �Y i2f%iOFl-1cr- W 114A CSE t RTES IMPrzov r M� �S. Area of wetlands on lot: Ig X1-1- S square feet Percent coverage of lot: `L . Closest distance between nearest existing structure and upland edge of wetlands: p-� feet Closest distance between nearest proposed structure and upland edge of wetlands: R 5 ' l 1 " feet Does the project involve excavation or filling? NoYes If yes, how much material will be excavated? 244 cubic yards How much material will be filled? 244 cubic yards Depth of which material will be removed or deposited:_feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: M RTF 2 I A L EXCAvA-rr=i) 'F(LdM FOUNDf1 rtorl w LL-L- fgE �c)c K- LC f CSN SITE fcr2 F(NpkL- G, 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: —Tw a STciz Y St ry c,Li- -� rte„ y l�cS��JEtice w�i H r�A-c� D � rv1P�eor� nn��r.��S Are wetlands present within 100 feet of the proposed activity? No�Yes Does the project involve excavation or filling? No__>c- Yes If Yes, how much material will be excavated? 2-4-4 (cubic yards) How much material will be filled? 24-4 (cubic yards) Manner in which material will be removed or deposited: Mia re—i Ac -EKCRvATEI> IFt2oc-i FovNDFati r� t� ,L� Be STocr— RL-ED Drs StTt f�tvrJ t>SEn Fc72 Fl " Al._ C� �E . Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 617.20 SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT I SPONSOR 2.PROJECT NAME E1wiAeo L. H �ZESIL>�NCE 3.PROJECT LOCATION: > JJ c�J �1 F F O L-ICMunicipality 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide mao 20oo C-IL£NN RoR17. Soo-rH SS IOE of [7LFnN FZo Pc, Iq JLC.67 EAST OF MP SPti v,FW _�oPO. '�BtTwEC" ('T ILIT`I POLE # 14 4 UTIL_1Ty "�,.,Le 41S 5.IS PROPOSED ACTION: fli New ❑Expansion ❑Modification I alteration 6.DESCRIBE PROJECT BRIEFLY: 1:�2c GobEO -Two STCpe `( S1N4LC FP4A%Ly '1:ZESiDCt�CC WITH RCL-A-rC.D "PV20vEMC NT S . 7.AMOUNT OF LAND AFFECTED: Initially 14 353.131jecres ,S10 INC. Ultimately 2A S5-&Q, acres .Sto AC. 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Eyes ❑ No If no,describe briefly: 9. W/HAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as appy.) I)(1 Residential ❑Industrial Commercial Agriculture ❑Park I Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Ayes El No if yes, list agency name and permit I approval: py$pCC I-4'7312>-03�1—I ID0001 .41 Iq)D4- �v SCS _VIDN" OF SOLTHOLL� t?>01 1� Nc 1�c T IST 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes El No If yes, list agency name and permit / approval: N\(SI)FC1-473c`3-oo311 10C�001 41tq104 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature If the action Is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART If- IMPACT ASSESSMENT o be completed by Lead Agency) A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. ❑Yes E]No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? It No,a negative declaration may be superseded by another involved agency. E] Yes [:]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,raise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shetiflsh or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as oflicialty,adopted,or a change In use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be Induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy? Explain brie . I alas D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? (Nyes,explain ❑ Yes E]No E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: FI Yes [—]No PART 111-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance mustevaluale the potential impact of the proposed action on the environmental characteristics of the CFA. Check this box if you have identified one or more potentially large orsignificant adverse Impacts which MAY occur.Then proceed directly to the FUL EAF anti/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Nam-orffe—sponsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparerdifferent from respond o cer) NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES,TOWN OF SOUTHOLD In the matter of applicant: kl>wP27 L. SCTM# IODD - D-78-02-31 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: T1 01L_o A Two V\r,TN RELATtO MP!2cVEMfNTS . 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: Sour H SI De o K C7 L,-t,N XOA t�, fc)10. 5-1 ' FPST OF MAi" t3AYVIE" I�oA� �eTweEa� Urtiu7y I��E \4 i, Ll I ry pp�_F -4 15 . 3. 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. OWNERSNAME: OWArto L, V_AvA� pc," MAILINGADDRESS: '740 6iLCQ Core AVtNUE CLCJn1 HC Ap NY IIS4CZ_ PHONE #: 51 lc - In 1 A - !�5-1 O r Enc: Copy of sketch or plan showing proposal for your convenience. IT 04/21/2004 15:22 5317_ 33 BUTLER THa4A5 PACE 01 Hoard of ftuetees AWli.oatian ADTHOQIY.A'1'SD� (where the applicant is not the owner) z, 6Vk19AIVV residing at 7V49u ln'2� A� (print owner of property 1ma1 ng a sss ,,/ l,,T�fA0 ,, A _do hereby authorits n (Agent) to apply for permit from the Southold d of own Trustees on my behalf. (Owaex a gna ure A Albert J. Krupski,President o�S►FFO[,�co Town Hall James King,Vice-President 53095 Route 25 Artie Foster P.O.Box 1179 Ken Poliwoda = Southold, New York 11971-0959 W � Peggy A. Dickerson j. `� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of -- '^0�` h ----------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING J Z b, residing at -)p �GasC,ytls�. x being duly sworn, depose and say: That on the/ f day ofmi , 200 , I personally posted the property known as /QU a - 0-703'- - oa-3�7 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 e1 bra 0-& f7 too Dated: �)6h sign e Swom to before me this "-dayo / 200 / Notary 11c MARY NOTARY POBL C.State NAGH ot New" NO.30-4912015inn Nassau Cau Conan Qualified QualiExpires November 18,Z��� PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: .Sovnrrr�o /1-� l( 97/ D�vA'TA'Q++/ K �ULr f'/YGGt'/� TE S7Dit-L STATE OF NEW YORKT��- COUNTY OF SUFFOLK T^,Wj2j T, cEr if residing at ;s oye2NI,L SJr't+tdyiy m being duly swom, deposes and says that on the / 9 day of�,20o4 deponent mailed a true copy of the Notice set forth in the Board of rustees 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 Southold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (certified)(registered)mail. Swom to before me this �G Y�— Day of ,200 Notary Public' NOTARY PUBLIC.C Sta eNAGH of New York No 30-4912015 Qualified in Nassau County / Commission Expires November 18,Z SOS 04/27!2004 15:43 631733 BUTLER TH3WXS ^ PAGE 01 APPLICANTIAGBNT/R>:PRESENTATWE TRANSACTIONAL DISCLOSURE FORM Tlw Tewn of a..t,taeuy Code ePEddts pdta'+J otmPokts orielaaa o tbe, daflown sown omom ad®lavvut.7ttaes_ et ids dermis to mil isdaeodoa witch cat dart the tows of mAtihic maEiaat f RE sad Allo it to ake wheaoer sdnn L a®meav to avoid soar, YOUR NAM&; Aer3 L.._ t: Pow 4 4(Last malas,Em eeme,middle bend,tmWen y04 W* lyhq-W&C maw of "mow da or other andty,aech m a corn my.If m,iyditate the other petsm's or company's name.) NAME OF APPLICATION: (Check all the apply.) Tar Viavmce Varimc CMaje o[Zame A"Mal of pW Eaemphon Gam pW or omNd nep Other (If"Oem",came at udwb.) Do1S 7 w�oldt�o yaw OWMWY.o s by blood�co4 or child)bM a rvkdgodup v/A my officer or saWkya ofdwship" rsstY{e,or budtwe fatemA"BYgtmrs taarest"mortem•bodies, b doing a MINNOW in which the IOWA ame r or amicyse he oven a pow ammorshlp of(or aVlymem by)a oospwwm im which the town omoer or employa win more them 5%ofthe shale. YES NO x If you eaewared"YES".Compile the balaaco ofthit fom ad date and trip whore indicted. Nero of penes employed by the Town of Southold Tek orp odban eftbat penin Describe the mlatioaahip betwcon yaeself(the applim ollMeopmeptetestadvs)and tho tows oClcur oar omglym.Either Check the appropriYo hot A)thnwth D)mWor dewibe in the space psoNdsd The tom 001ca Of applOyee oar his or ba spoons,Wins,parent,or dAW Is(oheek all that applyy ___._A)the owner of Veda thin S%of the dine of the cerperAle sack of the appb mt (wha dee eppliaot is a aosporatim); B)the loo or betw0cmd owner of any interest in s sork4aporw entity(who the appiic"is not a corpumtiooJ ,C)m officer,diecar,patmer,a anploya of de appliwd;or _--P)dee scow appliomt. DB9C VHCN OF RELATIONSHIP Y� 9abm>olad 7'day of � 4� Sipe4ve priat Name9t/ i•-•�_• COUNTY OF SUFFOLI (i -i".. SG:aUIf xixx+xc H'WttiyTo Service Wexy [J` IW. 077 , wuoxMLI + Ol 14 MWI QF;� y I _ '�, � a �" � , � /� .f/`�'�.7r�(•'�. ,roti-0�l'�,`—�.f.I c� ® \ w" a +�. ._,� y`y >•X7� N°� 9aa. ��-� 4:(x`1 , I ("�'{�^•.,r�+ p-J j'�f_7. w .✓ h�._Y°c I LJ {�^-��--j{� 1 'a �\ 6� " `n � ",I/� r// . .7�e`�I •a +a, a yTx�, y/J� I 6/�` -{, 93 E�� rru O o-w —_ — ...... —_._ wrcc COUNTY OF S;V © i SOINIpID_T ttcnax w c"� ___ ___ _ __ _ m•,.�•a Ned heperty Tm Sarim WncY r �) • '/o seem LOT AREA = 24,353.13 SQ.FT. LOT AREA (ADJACENT TO WETLANDS) - 22,355.36 SQ.FT. SUBDIVISION MAP OF "WEST CREEK ESTATES" FILED IN FLOOD ZONE = X & AE PROPOSED RESIDENCE = 2415.72 SQ.FT. THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON BASE FLOOD ELEVATION = 8.0 AUGUST 19, 1963 AS FILE NO. 3848 PROPOSED COVERED FRONT PORCH 105.8 SQ.FT. PROPOSED COVERED REAR PORCH = 270 SQ.FT. ELEVATIONS IN N.G.V. DATUM (MSL 1929) —+4d0— PROPOSED UNCOVERED REAR PORCH = 180 SQ.FT. N/F ROBERT & CAMILLE WILSON TOTAL 2971.52 SQ.FT. 13.30X LOT COVERAGE EXISTING RESIDENCE UTILITY PUBLIC WATER POLE 1 S 02'30'00" E 15 16 4 TIE LINE ALONG 0 X115 250.68 v APPROXIMATE HIGH PR X WATER MARK 12 VE D95 11" Z 12 POR 67 115 _11" Cr2 0 123_8 v GZ 0 14 o G.F.=12'6" �^ y yo 0 o PROPOSED 2 A v ' a STORY �, on Z v rn " RESIDENCE $ v o N " F.F.=15'9" m r' �S� 0U150 � �{ 0 ri , Z 13 a PORCH Zz my 0 TEST O NPROPOSED GZ y HOLE PROPOSED NO p Q COVERED PRZ PROPOSEDtea• PORCH 04% DI RBANCE BUFFER PROPOSED �? o .o o+ Z DRYWELL FOR ROOF RUNOFF COVERED o �$ �'• � � ; RA = 14.0 O G?, ST oN �@ ! �� �n PALE BROWN PRO OR`�`W " 1 . ' _Z � 0 EO RD OF TRUE rL3 SANDY LOAMf 8, L LP P 11 °� v� T WN OF SOOT OLD 2 (OL) 1.5' $14 EP O MIN. O MIN. O . MIN. O 10 N N 8 6 PALE BROWN 14 12 0 SILTY SAND 2 N 02'30'00" WcO (SM) 250.21' PROPOSED II�p� 7 0. SANITARY SYSTEM PALE BROWN -3 Un LITY 3 3 L.P. 8'0, 4' DEEP Sl TE PLAN FINE TO POLE N FERUCIO FRANKOLA MEDIUM SAND 0 #14 EXISTING RESIDENCE 4'x25 SQ.FT.x3 POOLS = 300 (SP) PUBLIC WATER SQ.FT. LEACHING AREA 20 10 0 20 40 60 80 1 —8.3' (5.7) GRAPHIC SCALE 1'• o NYSDEC REF. NO. WATER IN PALE OWN FINE 1 -4738-03317 00001 D.H.S. REF. NO. R 10 TO MEDIUM PROPERTY OWNER: r SAND EDWARD L KAVANAGH SITE PLANFREY T. BUT (SP) 740 GLEN COVE AVENUE HT GLENN HEAD, NY 11545 PROPSIN FAMI Y R I o 034 -15' /�/ TEL.: 516-674-0707 2000 GLENN ROAD, SOUTH LD, NYS�Iof Nismn P.O. BOX 634 A�FESSI��P� MC DONALD HOLE �p�1'� S.C.T.M. 1000-078-0 - SHOREHAM, NEW YORK GEOSCIENCE '90 F�, WATER BODY: WEST CREEK TEL.: 631.208.+8850 FAX: 631 .727.8033 8/7/01 COUNTY OF SUFFOLK TOWN OF SOUTHOLD 06 PARED: 12/11/03 Z Z w It PROPOSED W w w a- RESIDENCE o o: 0: OL a 0 0FINISHED FLOOR15'9"- 0 14.0 8.08.0 8.0 2'0 SANITARY MEAN HIGH WATER SEASONAL GROUND WATER SYSTEM 20 10 0 20 40 60 80 100 GRAPHIC SCALE 1" = 20'-0" HOUSE, FF = 15.75' FINISH GRADE FINISH GRADE=14.2 V MIN' TC=13.2 1' MIN. 1000 GAL. MIN' 4• PIA. APPROVED plpE 13.0 PRECASTCONC. MIN. PITCH 1/4" 1 SEPTIC MIN. p� �{ 1 1 12.50 �_°• . COLLAR DRAM AGi RMZ: TANK LEACHING • b I7 NV. EL. NV. EL. 12.50 POOL ~ 1 OF 3 BOTTOM O x = 13.0 NV. EL. 12.00 08.7 INV. EL. 11.50 C • OO OOOOO $ 3' CLEAN 8.50 O O O O O O O O SAND COLLAR 8' DIA. z GRAVEL O O O O O O O = O O O O O O O O O O 5.70 O O O o O O O O O GROUND WATER 000000000 NYSDEC REF. NO. 11 -4738-03317/000011 S.C.D.H.S. REF. NO. RIO-04-0006 I>, I SITE PLAN JEFFREY T. BUTLER, P.E. tiH3ACIQFLL TO BE CEM GRAVE PROPOSED SINGLE FAMILY RESIDENCE 6' MN. PEhE7RAnaN GROUND WATER P.O. BOX 634 01 SAND.VIRGIN �A1� 2000 S.C.T.M. R1000-078TH00LD,7NY TYPICAL LEACHING POOL SHOREHAM, NEW YORK WATER BODY: WEST CREEK TEL.: 631 .208.8850 FAX: 631 .727.8033 NOT TO SCALE COUNTY OF SUFFOLK TOWN OF SOUTHOLD DATE PREPARED: 12/11 /03