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HomeMy WebLinkAboutTR-6364 James F. King, President Jill M. Doherty, Vice-President Peggy A~ Dickerson Dave Bergen Bob Ghosio~ Jr. 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 (REVISED 10/10/08) # 0331C Date October 10, 2008 THIS CERTIFIES that the removal of the existing residence, cottage and garage, and construction of a new residence, pool, terraces and sanitary system At 5704 Indian Neck Lane, Peconic Suffolk County Tax Map #98-5-14.3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 3/17/06 pursuant to which Trustees Wetland Permit #6364 Dated 5/17/06 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 the removal of the existing residence, cottage and garage, and construction of a new residence, pool, terraces and sanitary system. The certificate is issued to GEORGE & SANDRA ENGELKE owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 # 0331C Date: July 8, 2008 THIS CERTIFIES that the remove existing residence, cottage and garage, and construct new residence, pool, terraces and sanitary system, and renovate existing house into a beach house At 5704 Indian Neck Lane, Peconic, New York Suffolk County Tax Map # 98-5-14.3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 03/17/06 pursuant to which Trustees Permit # 6364 Dated 05/17/06. 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 the remove existing residence, cottage and garage, and construct new residence, pool, terraces and sanitary system, and renovate existing house into a beach house The certificate is issued to GEORGE & SANDRA ENGELKE owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John HolzapfeJ_ Town Hall 53095Route 25 P.O. Box 1179 Southold, NewYork 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 v// Pre-construction, hay bale line I/~0'~ 1st day of construction ¼ constructed v/ Project complete, compliance inspection. ,1f5/~:~ 0 ~./.~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 April 16, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Nancy Steelman Samuels & Steelman Architects 25235 Main Rd. Cutchogue, NY 11935 RE: GEORGE & SANDRA ENGELKE 5704 INDIAN NECK LANE, PECONIC SCTM#98-5-14.3 Dear Ms. Steelman: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., April 16, 2008: RESOLVED, that the Southold Town Board of Trustees grants a One-Year Extension to Permit #6364, as issued on May 17, 2006. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, President, Board of Trustees JFK:lms 3u! 02 08 05:44p B~ ~ni Buildeps ~31~916 po1 John Bertani Builder Inc. 1380 Oakwood Drive Southold, N,Y. 11971 (631) 765-1594 FAX (631) 76,5-3916 July 2, 20O8 Sanc~'a Engelke - Pen'nit no. 6364 Mr. J~nes King, President 80ubhold T~w~ Trustees P.O. Box 1 ~ 79 SoL, thoM, NY 11971 We are requesting a project complete, compliance inspection for the San~a Engelke Residence, 5704 Indian Neck Lane, Peconic, pe~nit # 6364. Vice President March 11, 2008 S A M U E L S & S T E E L M A N Board of Trustees Southold Town Town Hall Annex Main Road Southold, NY 11971 Re: Engelke Residence 5704 Indian Neck Road Peconic, NY 11958 SCTM # 1000-98-5-14.3 Dear Trustees, We are requesting a one year extension for Trustees Permit #6364 which was issued on May 17, 2006. We have enclosed a check for $50.00 Please call us with any questions or concerns. Sincerely, SAMUELS & S~T~ELMAN ARCHITECTS ARCHITECTS 25235 MAIN ROAD CUTCHOGUE, NEWYORK 11935 (631) 734-6405 FAX (631) 734-6407 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095Route 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 REQ01RED TO CONTACT THE OFFICE OF THE BOARD OF TROSTEES 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 v// Pre-construction, hay bale line 1st day of construction ½ constructed v/' Project complete, compliance inspection. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO....~3~.d~ ........ DATE: .~..~.. ~.~. ~..-.'~9.g.6 ISSUED TO GEORGE AND SANDRA ENGELKE Pursuant to the provisions of Chapter 615 of the Laws of the State of New YorE, 1893; and Chapter 404 of the ~ws of the State of New Yore 1952; and the Southold To*n Ordinance en- titled ."REGULATING AND THE PLACING OF: OBSTRUC:~[LONS IN AND ON TOWN WATERS AND PUBLIC LANDS and'-the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS.FJLOM LANDS .UNDER TOWN WATERS;~L and in a~:cordance wi~ 'the Resolution of The Board adopted at a meeting held on .~Y...J~7~L ...... ~.9.~, and ~n conslderatio, of the sum of $.~f0...~ ........ paid by George and Sandra Engelke _ . of l%conic ... N. Y. and. subject to the Terms and Conditions listed on the reverse slde hereof, of Southold Town Trustees authorizes and permlH the folJow~ng: $~muels end $tee~man Architects revised rvl~y 30, 200&. all' in accordance with the detai~ed SPedfi~ations as presented in . the odglnatlng application. IN WITNESS WHEREOF, l~e seld Board Of Trustees here- by causes its Corporate Seal So be a~x. ed, an~ these pres?n? to be ,ubscribed .by ;al. majority of the sa~d Board .as of .thls aal'e. TERMS ~ncl CONDITIONS ~~ Sandra an~ George Engelke .~ Peconic ., .... · t. That the sald .~mvd o~ Trustees and the Town of f~thold ate tele~ed ~totn any and aH ,~.,~,~ oc _~,~-,~ ~c~ chtaa~ of ~ s~ing div0ctly oc lndtte~.v ns · result of say oloe~- for sm ex-t,.~-lon may be nmde to the I~ at a !-~_~ ~. Tlmt this Pe,~ should be '+'!,,ed indefinitely, or as long ts the said p,,~,,~o~e wtshe, ' ~ 'm.~.~.~n the st~-ccu~e ot project involved, to pmvtde evtden~ ~o anyone exhumed that 4. 'ilar dze wo~ l~volved will be subject to t~e lns~ecXloa m~! q~l~o~al e~ d:t Bottxl its agents, ~ non-oom~'~, with the provisions of d~e o~,~ application, naybe csuse t~x~cadon of thls p,-~t by resolution of tl~ saLd Bo~d. . ~. That there will be no untexsonable interference with ntvtgttion as s te~lt of the world.. ?. That if future OlW"~iocs of the To~n o~ ~ teq~e th~ mnovsl and/or upon'due nod~ to temo~e o~ dtet this wodc ot projec~ beton ~._~_ ~ 4~lX~eS to the Tom:~ otMd. James F. I~ing, President Jill M. Doherty, Vice-President Peggs~ 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 May 17, 2006 BOARD O~ TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Nancy Steelman Samuels & Steelman Architects 25235 Main Rd. Cutchogue, NY 11935 RE: GEORGE & SANDRA ENGELKE 5704 INDIAN NECK LANE, PECONIC SCTM#98-5-14.3 Dear Ms. Steelman: The Board of Town. Trustees took the following action during its regular meeting held on May 17, 2006 regarding the above matter: WHEREAS, Samuels & Steelman Architects on behalf of GEORGE & SANDRA ENGELKE 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 March 17, 2006, 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, a Public Hearing was held by the Town Trustees with respect to said application on May 17, 2006, 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 proposal complies with the standards set forth in Chapter 97 of the Southold Town Code, 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 GEORGE & SANDRA ENGELKE to remove an existing residence, cottage and garage. Construct new residence, pool, terraces and sanitary system, and renovate the existing house into a beach house and all as depicted on the plans prepared by Samuels and Steelman Architects revised May 30, 2006. 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.) This is not a determination from any other agency. Fees:S100.00 James F. King President, Board of Trustees JFK/hkc James F. King, President Jill M. Dohe~y, Vice-President Peggy 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 Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: has been and the ( '")Application Approved (see below) (__.)Application Denied (see below) (__.) 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 Chapter 97 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees MaylO, 2006 April 12, 2006 Field Insp~on April 12, 2006 Field !nspe~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Diekers0n ])ave Bergen John Holzapfel Town Hall 53095 Route 25 P,O. Bbx ~179 $outhold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ~ ~ [ 2.. - 0 ~ NameofAppticant: ~/5~ ~ ~;~c~ Name of Agent: ~ ~*~'-c~ ~- Property Location: SCTM# & Street Brief Description of proposed action: Type o£ area to be impacted: Saltwater Wetland Freshwater Wetland __Sound Front Bay Front Distance of proposed work to edge of above: ~cof Town Code proposed work falls under: __Chapt.97 Chapt 37 __other Type of Application: /Wetland __Coastal Erosion__ __Emergency Info needed: Amendment __Administrative Conditions: Present Were: %~/King ~/' __J.Doherty ~P,Dickerson Other: D. Bergen__J.Holzapfet Mai!ed/Faxed to: Date: Telephone (631j 765-1892 Town Hall 53095 Route 25 P~O Box 1179 South old. New York 1 1971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., April 12, 2006, the following recommendation was made: Moved by Don Wilder, seconded by Jack McGreevy, to TABLE the Wetland Permit application of GEORGE & SANDRA ENGELKE to remove an existing residence, cottage,and garage. Construct new residence, pool, terraces and sanitary system, and renovate the existing house into a beach house. Located: 5704 Indian Neck Lane, Peconic. SCTM#98-5-14.3 The CAC Tables the application because the project wasn't staked, however all land seaward of the wall should be left natural, drywells and gutters installed to contain all rumoff and pool backwash, and all walkways and driveway should be pervious. The CAC further recommends the proposed pool be set back 50' from the bluff. Vote of Council: Ayes: All Motion Carried May 26, 2006 S A M U E L S & S T E E L M A N Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 RE: Engelke Residence 5704 Indian Neck Lane Peconic, New York SCTM # 1000-98-5-14.3 Dear Trustees: Enclosed, please find four (4) revised Site Plans dated May 26, 2006. Please note the following revisions as per the Board of Trustees meeting on May 17, 2006: 1. Relocated the Pool an additional 10' from the bluff line. 2. Relocatd the Pool 7' towards the west property line. 3. Removed most of the 4' high stone wall and substituted a 2' high wall with 2' high fence in the area of the Pool only. Please call us with any questions or concerns. Sincerely, Nancy/S,t'e~lman Princi~zl Architect ARCHITECTS 25235 MAIN ROAD CUTCH©GUE, NEWYORK 11935 (631) 734-6405 FAX (631) 734-6407 PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON JOSEPH L. TOWNSEND To: PLANNING BOARD OFFICE TOWN OF SOUTHOLD James King, President Town of Southold Board of Trustees MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 From: Mark Terry, Senior Environmental Planner ~' ('~ MAY LWRP Coordinator Date: May 17, 2006 · Proposed Wetland Permit George and Sandra Engelke SCTM#1000-98-5-14.3 Samuels & Steelman Architects on behalf of GEORGE & SANDRA ENGELKE request a Wetland Permit to remove an existing residence, cottage and garage. Construct new residence, pool, terraces and sanitary system, and renovate the existing house into a beach house. Located: 5704 Indian Neck Lane, Peconic. SCTM#98-5-14.3 The proposed action has been reviewed to Chai~ter 95, 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 action is INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. I Policy 6 Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. 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 proposed setback from pool to the top of bluff is 13 feetI a minimum separation distance of 50' is required pursuant to Chapter 97. Please require that the applicant amend the application to meet the above policy to the greatest extent possible~ Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Albert J. Krupski, President James King, Vice-President Henry Smith A~tie Foster Ken Poliwoda Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~etland Permit Application jMajor Waiver/Amendment/Changes ,,...-Received Application: 3/Iq/0 ~-~Received Fee:$o2~'O/ ' "~C-omplet ed Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date scm) .~AC Referral Scm:' .Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ---Public Hearing Held: ql Iq !Ob Resolution: Minor Name of Applicant George & Sandra Enqelke Address 83 Chelsea Rd., Garden City, NY 11530 Phone Number:( ) 516-741-2864 Suffolk County Tax Map Number: 1000 - 9 @- 05-14.3 Property Location: 5704 Indian Neck Rd. Peconic, NY (provide LILCO Pole #, distance ~o cross streets, and location) AGENT: Samuels & Steelman Architects (If applicable) Address: 25235 Main Rd., Cutchoque, NY 11935 Phone: 734-6405 Board of Trustees Application Land Area (in square feet): Area Zoning: R- 8 0 Previous use of property: Intended use of property: GENERAL DATA 130,414 S.F. Residential Residential Prior permits/approvals for site improvements: Agency None Date × No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary): Remove e~:is['i nq residence (partially), cottage & garage. Construct new residence, pool, terraces, & sanitary system Renovations to remaining house into beach house (permit) PROJECT I.D. NUMBER 617.21 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 sponsor) ! 1. APPLICANT /SPONSOR i 2. PROJECT NAME Samuels & Steelman Architects I Engelke Residence SEc 3. PROJECT LOCATION; Mu~ic~pamy Peconic (Southold Town) County Suffolk 5704 Indian Neck Lane Peconic, NY 5. IS PROPOSED ACTION: ~' DESCRISEPROJECTSRIEPLY:Remove (partially) existing residence, cottage & garage, construct new residence with attached garage, pool, terraces & sanitary system. Renovations to remaining existing house into beach house. 7 AMOUNT OP LAND AFFECTED: WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~ Yes [] NO I! NO. describe brieily 9. WHAT IS PRESENT LAND USE iN VICINITY DP PROJECT? ~, Residenltal Q,!ndustrial [] Commercial DOES ACTION INVOLVE A PERMit APPROVAL OR FUNDING. NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (PEDERAL, STATE OR LOCAL)? [] No ~f yes. Jist agency(s) and pecmi~lapprovais Town of South'old Trustees- Permit. Suffolk county Health- Sanitary system DOES ANY ASPECT OF THE ACTIOt4 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~'~Yes' liND if yes, Jist agency name and permJUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMit/APPROVAL REQUIRE MODIFICATION? IS TRUE TO THE EEST OF MY KNOWLEDGE [] Yes [~NO If the action is in the CoGstal Area, and you are a state acency, complete the ~ Coastal Assessment Form before t~s proceeding with a.~$ess merit OVER PART [[--EN ! SSESSMEHT PART III--OETERMINAT1ON OF SiGNIFiCANCE [To be completed by Agency) INSTRUCTIONS: For escn adverse etfect identified acove, determine wneU~er it is suDstantfai, Jarge. important or odlerwiee signi f ~3.c~ .~Jfec', SnOUJC~ be assessed in connection wittl its (al setting (La. uriaan or rural); (b) probaDility of occ~,"-~g; (c) duratic irreversdaility; (e~ geogra[~nic Scope; and (l) magnitude. If necessary. ~d~ &[t~chments or reference supporting materials. Ensur: eXOlana(Jcns contain sufficient ~.exail to snow that all re!avant adverse impacts have been identified and adequately aCdresse, ChecX dais box if you hsve identified one or more potentially large or significant acverse imoacls which ;do occur. Then Jroceec3 direc:ly ~o ;ne FULL &AF eno/or ~regare ~ positiv~ declaration. ChecX :his box ~f you h~ve de,ermined, base~ on ~he in~orma[ion ~nd analysis ~0ove and any suooorth documen[a:ion, :hal :he proaoseo ac:ion WILL NOT result in.ny significant adverse envircnmemsl imcac AND provi6e on ~[~cnmen[s ~s necessary, (he re~sons su¢cordng [~is determinsdon: LETTER OF AUTHORIZATION Sandra & George Engelke 83 Chelsea Road Garden City, NY 11530 516 741-2864 Januaw 12,2006 We hereby authorize Nancy Steelman of SAMUELS & STEELMAN ARCHITECTS to act as our agent in obtaining all permits required by SOUTHOLD TOWN, SUFFOLK COUNTY and NEW YORK STATE for the construction of our residence at 5704 Indian Neck Lane in Peconic, NY Geoge Engelk~ Sandra Engelke Date Date James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095Route 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of .... COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~k) ~./].~. ~'~ ~. residing at ~' ¢~or~ ~ being duly sworn, depose and say: That on..Lthe tO day of/d/7.a'xa..~, 200~I personally_ posted t~e propeGy known a~ by placing thc Board of Trustees official poster where it can easily be seen, and~hat I have checked to bc sure thc poster has remained in place for eight days prior to the date of the public heating. Date of hearing noted thereon to be held ~t ]on/. ~ ] '9. ~1~)~ ~ Dated:~ [.~,/~)[4~ ~..~/~.~(~~~ Sworn to before me this ~at~e)~ ~.~ day of ~200 (~ pA'~-FIICIA RICHARDS Notary Public, State of New York No. 01RI6042467 Qualified in Suffolk County Commission Expires May 30, 209g.~- .~.~ Board of Trustees Application County of Suffolk State of New York ¢,~c_~ .~r-~z~r~ (,t~-,4-'h BEn,~G DraY swo~ DEPOSES~ ~F~S ~T ~/S~IS ~ ~PLIC~ FOR ~ ~O~ DESC~ED PE~T(S) ~ ~T ~L STA~S CO~ ~ ~ TR~ TO ~ BEST OF ~S~R ~O~EDGE ~ BEL~F, ~ ~T ~L WO~ ~L BE DO~ ~ ~ ~R SET FORTH ~ T~S ~PLICATION ~ AS MAY BE ~PRO~D BY ~ SOUTHOLD TO~ BO~ OF ~US~ES. ~ ~PLIC~T AGeS TO HOLD T~ TO~ OF SO--OLD ~ ~ TO~ TRUSTS ~ESS ~ ~E ~OM ~ ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY ~T~ OF S~ PE~T(S), ~ G~D. ~ CO~LET~G ~S ~PLICATION, I ~BY A~O~ ~ ~US~ES, ~ AGE~(S) OR ~P~SE~A~S(S), TO EN~R O~O ~ PROPERTY TO ~SPECT T~ P~SES ~ CON~CTIO~T~~W OFfS ~PLICATION. / ~ ~ig~ture ' swo~,o~vo~mms I¢ ~aYOF M~ ,200¢ Notary Public P~TR!Ci~ R~CHARDS Notary Public, State of New York Ne. (; l Rt6042467 Qualified in Suffolk County Commission Expires May 30, TRANSACTION/iL DISCLUSURE FORH The TOWn o~ S~u~hold~s Code of ~bhieo p~ohibl~s con~licbe oF intereab on bbs par~ o£ bo~n oEficeta and employees. The ~urpoee of bhia form is bo provide informabio~ ~hiCh aler~ bhe bo~n of possible conElicba o~ inbeteeb and allo~ ib bo bake whabavac acbion is necessary Bo avoid same. YOU~ N~Bt *'= ' ~ :~'~'~'* ' "~ (Lash na~,~ireb name~ m~dd.le in/bial, unless you are applying in ~he name o~ someone o~her en~i~g, such ps a company. IE eo~ indicate NRTURB O~ APPL~UR~ION~ (check all thab apply.) Tax grievance Variance change o~ ~on~ ' ~xatp~lon ~ro~ pla~ o~ o[~iclal map o~h~r parsee, cC ~hild) hnv~ a rela~tonship vLBh any og~ieer or eep~oyee ce the Town CE Souehold? 'Rela~lonehip- includes which 6he Sown of Eieer or employee has even a ps,Sial ownership oE (or employmenb by) a tofF,oration in which khe ~o~n officer or employee owns more ~han sh~res. If you answered "YE~,". complete Ehe balance OE ~h{. ~orm and dabs aud sign whore lndleaeedo Name oE person employed by khe To~n of Bou~hold TI~Ie or poslbion of bhab parson Describe the relationship be~ee~ FouraelE (~he applicant) and ~he born officer er employee. ~i~her cheek appropriate Xine ~} ehrough D) and/or describe in ~he apace provided, The bown oEfieer or employee Or hie or her epouae~ paren~ or child 1s {~heek all ~ha~ apply)t .. A) ~he owner of grea~er ~han 5% of ~he shares oE ~he corporate e~oek of ~he appliefin~ (~hen ~he appiluan~' · la a corporablon)l ~) ~he legal or bbn~flelal o~ner of any in~er~s~ in a noneorporate'en~l~y (~hen ~he appileane la no~ a corporation); C) an offleer~ direeeor~ Pa~Uer~ or e~ploree, ot applleaub I or ~D) She ~kual applleanb. :l'own of Southold ,LWRP CONSISTENCY ASSESSMENT FORM Ao INSTRUCTIONS 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. Before answering the ques~tions 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 Water~ont Revitalization Program. A m osed action will be evaluated as to its si ificant beneficial and adverse effects u on the coastal area which includes all of Southold Town. 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 !.aw..~ detail iistin both sunnortin and non- ~. llan action cannot be certffied 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 librahes and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION PROJECT NANIE ~ ~c_d~O~,/~q The Application has been submitted to (check appropriate response): Town Board [] Planning Board ~-~ Building Dept. 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: __ , Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nameofapplicant: ~:~'~r'~..~ ~--~or~lr'~ ~2::~F~ClC~J~'C~_ (c) Telephone number: Area Code ( (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [~ No[--~ Ifyes, wkich state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~-~ Yes [] No ~ 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 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 ~'~ NoB 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 ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southoid from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [] Yes ~ No [] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~-~ Yes ['~ No,~2~, Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southo water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~ Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~ Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section II/- Policies; Pages 62 through 65 for evaluation criteria. [] Yes ~ No~ Not Applicable Attach additiom~l sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section/II - Policies; Pages 65 through 68 for evaluation criteria. ~ Yes ~ No ~ Not Applicable Amended on 8/1/05 \ \ \ \ SURVEY OF PROPERTY AT INDIAN NECK TOf~ZN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000--9~ 05 14.3 SCALE: 1'-50' OCTOBER 20, 2004 I om [~mW~r ~'Hb Ihs STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SING£E FAMIL %' RESIDENCES and will abide by lbs condIIJons set forlh lhere]n and on permil lo conslruct. CERTIFIED TO' ENTRUST TITLE AGENCY LLC Tills # S - 2410633 SANDRA ENGELKE EXISTING SEPTIC SYSTEM TO FILLED IN OR REMOVED 0 I=MONUMENT · =PIPE A=STAKE AREA= 2.9939 Acres TO 71E LINE ELEVA770NS REFERENCED TO N.O. VD. /PECONIC (65~) 765-5020 P.O. BOX 909 12J0 77~A ~LER SOUTHOLD, N. K 11971 INDIAN NECK LANE NIOIF NETFE & ~LLM~M VAN TREUREN ~ESIDENC~E AN~ E~EAC, H E~HED, 15OO ~AL E:~PTI~- SITE DATA SCTM # 1000-98-05-14.3 PROPERTY: 5704 Indian Neck Lane ADRESS Peconic, NY. OWNER: SANDRA AND GEORGE ENGELKE 83 CHELSEA ROAD GARDEN CITY, NY. 11530 SITE: 130,414.28 SQ. FT. = 2.9939 ACRES ZONING: R-80 TANK. (ST) I~ITH (I),,4.' pla DISTI~It~UTION BOX (D~), ~ITH (2)~' Pla x D' HIgH LEACHIN~ POOL5 ~P) ~ /// ~ EXISTIN~ ~ITH FU~ LOGATION FOR (I)~' DIA~ x HIgH LEACHIN~ POOL~ ~) j ~ / ~ 2~ GAUGE PA~IN~ FF+J~ ~ EXISTIN~ cou~ j ~a~ , ~ +rq~5~ POLE Iq.5+ ~ 20' SURVEYOR: PECONIC SURVEYORS P.C. P.O. BOX 909 1230 TRAVELER STREET SOUTHOLD, NY. 11971 LICENSE# 49618 DATED March 11, 2005 LOCATION MAP Ii E[XI~TIN¢ HOUSE TO BE .m '~ " ~ PROPOSED i ~= ~ ~N~= ~ ~ RESIDENCE ~ ', 00~ EXISTIN~ ~5 ~ TO ~ ~HO~D ~ ~ I ~ BEAC~ I'-~" ~ ~ ~2~ ~SE TO ~  ~ L25 ~PO~ ~ ---~~ _~ ~ I APPROVEDBY ~ ~ ~ BOARD OF TRUSTEES ~ ~¢ TOWN OF SOUTHOLD ~ DATE TOTAL SITE PLAN ENLARGED PARTIAL SITE PLAN s--C-~[~: -~-~20'-0" TRUSTEES REVISED DATE: May 30, 2006 SCALE: 1" = 20'-0" SHEET TITLE: SITE PLAN Alternate HEET NO.: 1