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HomeMy WebLinkAboutTR-6741 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 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT, INSPECTION SCHEDULE ~-~ Pre-construction, hay bale line 1st day of construction ½ constructed ,-//' Project complete, compliance inspection. ~1.~.,/-b~ (~ ~~.,~ ~ 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 # 0358C Date August 22, 2008 THIS CERTIFIES that the single-family dwelling, sanitary system, driveway, removal of shed, drvwells & gutters, and 50' non-disturbance buffer At 1500 Bay Ave., East Marion Suffolk County Tax Map #31-8-12.9 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 9/13/07 pursuant to which Trustees Wetland Permit #6741 Dated 10/17/07 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 single-family dwelling, sanitary system, driveway, removal of shed, dr/wells & gutters, and 50' non-disturbance buffer. The certificate is issued to ROBERT'S CUSTOM HOMES owner of the Authorized Signature COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC #: C08-16309 I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on0812612008 under Liber D00012562 and Page 880 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 0812612008 SUFFOLK COUNTY CLERK JUDITH A. PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Number of Pages: 4 Receipt N,~mher : 08-0082303 District: 1000 Recorded: At: 08/26/2008 12:18:26 PM Page/Filing COE TP-584 Cert. Copies Received the Following Fees For Above Instrument Exempt Exempt $12.00 NO Handling $5.00 NO $5.00 NO NYS SRCHG $15.00 NO $0.00 NO Notation $0.00 NO $5.00 NO RPT $30.00 NO Fees Paid $72.00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL Judith A. Pascale County Clerk, Suffolk County LIBER: D00012562 PAGE: 880 Section: Block: Lot: 031.00 08.00 012.009 EXAMINED AND CHARGED AS FOLLOWS Number of pages TORRENS Serial # Certificate # Prior Ctf. # Deed. Mortgage Instrument Deed / Mortgage Tax Stamp RECORDED 200'3 Rug 26 i2:!:?,:26 PM CLERK OF SUKFOLK COUNTV L 000012562 P Recording / Filing Stamps 31 FEES Page / Filing Fee Ih Handling 5. 00 TP-584 Notation EA-5217 (County) Sub Total EA-5217 (State) R.P.T.S.A. Comm. of Ed. Affidavit Reg. Copy Other 5. 00 Sub Total Grand Total J 4 Ioistr'ct Isect'on Real Prope~y Tax Service Agency Verification I Block Lot 1000 03100 0800 012009 61 Satisfaction/Discharges/Release List Property Owners Mailing Address RECORD & RETURN TO: }o.I Name Tte# Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec. / Assit. or Spec. / Add. TOT. MTG. TAX Dual Town __ Dual County __ Held for Appointment Transfer Tax Mansion Tax The property covered by this motgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # of this instrument. 5 Community Preservation Fund Consideration Amount $ ;PF Tax Due $. Improved Vacant Land TD TD Title Company Information Suffolk County Recording & Endorsement Page This page forms part of tbe attached C('~ ~0 J(~, Ok .~k'~ c~ ~f~-~//~ ~]r~ ~ made by: (SPECIFY TYPE OF INSTRUMENT) CLf~'~V{N-'¥~ ~9f} The premisis herein is situated in SUFFOLK COUNTY, NEW YORK. TO In the Township of '~O~[h 0 Id ~ ~..~(~ ( J,.---~(~'~ In the VILLAGE ~ ~r( ~ ~0~ or HAMLETof ~t ~ ~ BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) DECLARATION OF COVENANTS AND RESTRICTIONS This Declaration made this 22'~d day of August 2008, by Robert's Custom Homes, Inc. with business office at 25 Kew drive Sound Beach, NY 11789, owner, hereinafter referred to as declarant; WITNESSTH: Whereas, the declarant has title to a certain piece of land, lying and being at Bay Avenue, New York, Town of Southold, County of Suffblk, State of New York, SCTM#1000-31-8- 12.9, said land being more particularly described in Schedule A, attached hereto, and Whereas, the property is situated in or adjacent to lands activities upon which are regulated by the Town of Southold Board of Trustees pursuant to Chapter 275 of the town code of the Town of Southold, as may be amended, and various activities conducted upon the property are subject to the jurisdiction, regulation and approval or disapproval of the trustees prior to being conducted. Whereas, the declarant has applied to the Town of Southold Board of Trustees for a wetlands permit 1bt approval to construct a new single family dwelling on the property described in schedule A and known as SCTM#1000-31-8-12.9 as depicted on the plans prepared by John T. Metzger, Peconic Surveyors, P.C., last dated July 27, 2007; and Whereas, the Town of Southold Board of Trustees, as conditions for the issuance of such Wetlands Pennit, required certain covenants and restrictions be placed on the property as shown on the aforesaid plans. Now, therefbre, the declarant witnesseth: That declarant, for the purpose of carrying out the intentions expressed above does hereby make known, admit, publish, covenant and agree that thc said property herein described shall hereafter be subject to the following covenants which shall run with the land and shall be binding on all purchasers and holders of said premises, their heirs, successors, and assigns, to wit: 1. The grant ora wetland permit for the construction of a single family dwelling with the condition there will be a 50 foot non-disturbance buffer as depicted on the approved survey by John T. Metzger, Peconic Surveyors, P.C. dated August 30, 2007 and identified as SCTM#1000-31-8-12.9, within perpetuity. 2. These covenants and restrictions can be modified only at the request of the then owner of the premises with the approval of the Town of Southold Board of Trustees after a duly noticed public meeting. Adjoining property owners shall be entitled to notice of such public meeting by publication or as other wise deemed sufficient by the Board of Trustees but their consent to such modification shall not be required. 3. It is the responsibility of any party having any right, title or interest in the property to consult Chapter 275 of the Town Code of the Town of Southold, as may be amended, and to obtain from the Town of Southold Board of Trustees review and such approvals as may be required by Chapter275 for activities regulated therein on the property. Declarant grants the continuing right in perpetuity to the Town of Southold or any of its designated representatives to enforce the conditions and restrictions of the covenants. The foregoing covenants and restrictions shall bind the declarant, its heirs, successors and assigns, and any and all person or persons who shall succeed to the ownership of said premises of any part thereof by transfer or otherwise. In witness whereof, the declarant has duly executed this declaration the day and year first above written. By: Robert,¢ Robert i~o, Owner ustom Homes, Inc. STATE OF NEW YORK) ) SSd COUNTY OF SUFFOLK) On this ~o2- day of T~/./q/,g'75in the year 2007, before ,ne personally appeared Robert Cfiscito, known to me o~ proved to me on tbe basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity and that by his signature on the instrument, the ~ndividual, or the p~upon behalf of which the individual acted, executed the lnst~ent. ~~ Notary Public ~O. ot Toot q ~qG SCHEDULE "A" ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon, situate, lying and being at East Marion, in the Town of Southold, County of Suffolk and State of New York, more particularly bounded and described as follows: BEGINNING at a point on the westerly side of Bay Avenue in the center of the right of way to said premises about to be described, said point being South 34 degrees 12 minutes 40 seconds east 25.00 feet from the intersection of the southerly line of land now or formerly of Krancher with the westerly side of Bay Avenue; thence running South 55 degrees 47 minutes 20 seconds West 200 feet to a point; thence running North 34 degrees 12 minutes 40 seconds West 131.70 feet to a point; thence South 55 degrees 47 minutes 20 seconds West 196.74 feet; and thence along land now or formerly of Hadford North 29 degrees 23 minutes 20 seconds West 150.53 feet to land now or formerly of St. George; thence running along land now or formerly of St. George North 55 degrees 47 minutes 20 seconds East 234.09 feet to land now or formerly of Anderson; and thence running along land now or formerly of Anderson, Thiel, Stan and Krancher South 34 degrees 12 minutes 40 seconds East 256.70 feet to a point; and thence running along the southerly line of Krancher North 55 degrees 47 minutes 20 seconds East 150.00 feet to the point or place of BEGINNING. TOGETHER WITH to a right of way for ingress and egress and for access by public utilities, either overhead or underground, which right of way is described as follows: BEGINNING at the same point of beginning as hereinabove described; thence along the westerly side of Bay Avenue South 34 degrees 12 minutes 40 seconds East 25.00 feet to the northerly line of land now or formerly of Ziegler; thence along said land of Ziegler South 55 degrees 47 minutes 20 seconds West 200.00 feet; thence across the premises heretofore described North 34 degrees 12 minutes 40 seconds West 25.00 feet to a southerly line of land now or formerly of Washburn; thence along said land now or formerly of Washburn North 55 degrees 47 minutes 20 seconds East 200.00 feet to the westerly side of Bay Avenue and the point or place of BEGINNING. SUBJECT TO with a right of way for ingress and egress and for access by public utilities, either overhead or underground, which right of way is described as follows: BEGINNING at the same point of beginning as hereinabove describes; thence along land now or formerly of Washburn South 55 degrees 47 minutes 20 seconds West 200.00 feet to a westerly line of land now or formerly of Washburn; thence along said land now or formally of Washburn North 34 degrees 12 minutes 40 seconds West 131.70 feet to a southerly line of said land now or formerly of Washburn; thence accross said land now or formerly of Washburn North 55 degrees 47 minutes 20 seconds East 50.00 feet to the westerly line of land now or formerly of Stan; thence along said land of Stan and land now or formerly of Krancher South 34 degrees 12 minutes 40 seconds East 106.7 feet to the southerly line of said land of Krancher; thence along said land of Krancher North 55 degrees 47 minutes 20 seconds East 150.00 feet to the westerly side of Bay Avenue; and thence along the westerly side of Bay Avenue South 34 degrees 12 minutes 40 seconds East 25.00 feet to eh point or place of BEGINNING. Said premises is conveyed subject to a utility easement to the Long Island Lighting Company. 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 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 J Pre-construction, hay bale line 1st day of construction ½ constructed ,-'//"Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6741 DATE: OCTOBER 17~ 2007 ISSUED TO: ROBERT'S CUSTOM HOMES PROPERTY ADDRESS: 1500 BAY AVE, EAST MARION SCTM#31-8-12.9 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Towxt of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on October 17, 2007~ and in consideration of application fee in the sum of $250.00 paid by Robert's and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a single-family dwelling, sanitary system and driveway, and to remove the existing shed, with the condition drywells and gutters are installed to contain the roof run-off, and in accordance with Chapter 236 of the Town Code-Stormwater Management, the installation of a line of staked hay bales along non-disturbance buffer during construction, and all as depicted on the survey prepared by John T. Metzger last dated August 30, 2007. 1N WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee, Robert's Custom Homes, P.O. Box 372, Wading River, NY as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. I0. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 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 October 17, 2007 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mrs. Vicki Toth 425 Jacobs Lane Southold, NY 11971 RE: ROBERT'S CUSTOM HOMES 1500 BAY AVE., EAST MARION SCTM#31-8-12.9 Dear Mrs. Toth: The Board of Town Trustees took the following action during its regular meeting held on Wed., October 17, 2007 regarding the above matter: WHEREAS, Vicki Toth on behalf of ROBERT'S CUSTOM HOMES applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated September 13, 2007, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program poli'cy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 17, 2007, 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 275 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 have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of ROBERT'S CUSTOM HOMES to construct a single-family dwelling, sanitary system and driveway, and to remove the existing shed, with the condition drywells and gutters are installed to contain the roof run-off, and in accordance with Chapter 236 of the Town Code- Stormwater Management, the installation of a line of staked hay bales along the 50' non-disturbance buffer during construction, and all as depicted on the survey prepared by John T. Metzger last dated August 30, 2007. 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, President, Board of Trustees JFK/Ims Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 10, 2007, the following recommendation was made: Moved by James Eckert, seconded by Don Wilder, it was RESOLVED to SUPPORT the Wetland Permit application of ROBERT'S CUSTOM HOMES to construct a single-family dwelling, sanitary system and driveway, and to remove the existing shed. Located: 1500 Bay Ave., East Marion. SCTM#31-8-12.9 Inspected by: James Eckert Vote of Council: Ayes: All Motion Carried 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 Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: I O- ff-o 7 ROBERT'S CUSTOM HOMES requests a Wetland Permit to construct a single-family dwelling, sanitary system and driveway, and to remove the existing shed. Located: 1500 Bay Ave., East Marion. SCTM#31-8-12.9 Type of area to be impacted_,; Saltwater Wetland~/F Freshwater Wetland Sound Bay JL~ ac~ r~ ,,L~ k~ Distance of proposed work to edge of above: P~haf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: v/Wetland __Coastal Erosion __Amendment __Administrative __Emergency Pre-Submission Violation __Planning Info needed: ModificatiOns: Conditions: Present Were: __J.King ~.Doherty ~P.Dickerson __ H. Cusack D. Dzenkowski Form filled out in the field by Mailed/Faxed to: Environmental Technician Review F'~a '/. ir~ ,~t._ D. Bergen~ B. Ghosio, Jr Date: Mark Terry~other TEST HOLE $150104 el PI~OPOSF_.fl SEPTIC SYST'"""""""""""""""""[~ I - I000 ~aL $£PT1¢ TAtIK I 8' · ~, I~* ~ L~4C. tVtN~ POOL by McDONALD GEOSCIENCE I om fomilior with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES ond will ob/de by the conditions set forth therein ond on the permit to construct. The Iocotion of we/Is and cesspools shown hereon ore from field observotions ond or from doto obtoined from others, ANY ALTERATION OR ADDI170N TO THIS SURVEY IS A VIOLATION OF SECtiON 7209 OF THE NEW YORK STATE EDUCAtiON LAW. EXCEPT AS PER SECT/ON 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE S/GNA TUR£ APPEARS HEREON. · =MONUMENT · =PIPE AREA=46,396 SQ. FT. ELEVATIONS AND CONTOCR LINES ARE REFERENCED TO THE FIVE EAST~ TOWNS TOPOGRAPHICS MAPS SURVEY OF PROPERTY AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-31-08-12.9 SCALE: 1'--50' OCTOBER 6, 200,.7 .} V ~ c._,. · ~J. ~, 2oo4- frev/~/bn ~ ? \ 12J~ NO. 49618 l) 765-1797 03-260 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD To: James King, President Town of Southold Board of Trustees From: Mark Terry, ~ LWRP Coordinator, Principal Date: October 12, 2007 Planner OCT t2 2,?07 Southhold Iowa Re~ Request for Wetland Permit for Robert's Custom Homes SCTM#1000-31-8-12.9 ROBERT'S CUSTOM HOMES requests a Wetland Permit to construct a single-family dwelling, sanitary system and driveway, and to remove the existing shed. Located: 1500 Bay Ave., East Marion. SCTM#31-8-12.9 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it ~s my recommendation that the proposed action is generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the following standard best management practices are implemented. 1. Require erosion and sediment controls (haybales, silt fencing) to protect the freshwater wetland system. 2. Require water quality protection measures for areas generating runoff (gutters, downspouts, dry wells and pervious driveways) post construction. 3. Maintain the existing wooded buffer as a non disturbance area, to protect the water quality of Marion Lake. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. James F. King, President Jill M. Doherty, 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 Office Use Only Coastal Erosion Permit Application ){-Wetland Permit Application Administxative Permit R AmendmenffTrans fcr/El~tension eceived Applicatiom~0~ eceived Fee:$ oj~5~2r'x'' ~_~ompleted Application q! [31~3. Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) ~_flaWRP Consistency Assessm, ent Form ql IR I~) ~ Referral Sent: ql ~%i ~/bate of Inspection: ~lCJ{k~) __Receipt of CAC Report: __Lead Agency Determination: Technical Review: --~ublic Hearing Held: ~L)113 It~'3 Resolution: ' ' ~' ! Southhold Towll Board ef Trustee~ Name of Applicant '~O&f~ ' Address PO /~O.k" -3 VA Phone Number:( ) Suffolk County Tax Map Number: lO00- Property ocation: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: /~..~ Phone:~" OQ~/~ rd of Trustees Applicatic Land Area (in square feet): Area Zoning: ~- Previous use of property: Intended use of property: GENERAL DATA Covena2ts and Restricti2nl - Yes ' No [~'~t~O¥1'Q ~' ~k~'¢~J'l If"Yes", please pro'id} col:pT ~ ~ Prior permits/approvals for site improvements: Agency __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? __No ,~x Yes If yes, provide explanation: /~ ¢~-~ F¢¢0 ~ ,~.s'~X~r Project Description (use attachments if necessary): O,a~ P~. ~ / I z of Trustees Applicati¢ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose oftheproposed operations: 0X3th%~q(ll_ 0~1/I ~ ~lDq~ ~ Area of wetlands on lot: O square feet Percent coverage of lot: C~ % Closest distance between nearest existing structure and upland edge of wetlands: X ) I 4¥ feet I Closest distance between nearest proposed structure and upland edge of wetlands: l,XS- feet Does the project involve excavation or filling? No Y,. Yes If yes, how much material will be excavated? O cubic yards How much material will be filled? ~ cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: {~Y2(6~O5~ Manner in which mater/al 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): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION .PROJECT LOCAT,ON: Municipality 4. PRECISE LOCATION: Street Addess and Road Intersection,, 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME Prominent landmarks etc - or provide map SEQR .IS PROPOSED ACTION: ~] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 8. WILL PROPOSED ACT[ON COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? []Yes [] No If no, describe bdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) rl~ Residential [] Industrial ~] Commercial [~]Agriculture [] Park / Forest / Open Space F-~ Other (describe) ULTIMATELY FROM ANY OTHER GOVERNMENTA 10. DOES AOT,ON ,NMOLVE A PERM,T APPROVAL. OR FUND,NG. Newer AGENCY (Federal, Stateor Local) ~Yes ~No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACT ON HAVE A CURRENTLY VALID PERMIT OR APPROV,~? [~Yes []No If yes, list agency name and permit / approvak ~.~...~¥~'~ ~[~)-~"[~__..~ ~ 12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor S ,gna t u re '~ ,~ ~.~,L~"'"~--~ Date: If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? ff yes, coordinate the review process and use the FULL FAF. [~] Yes [~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C3. C4. C5. C6. C7. 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, noise levels, axis§rig traffic pa[tern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural ~i ~'l'i~'r~l resources; or communiiv Or neighbo;ho0~i character? Explain briefly: [ Vegetation or fauna, fish, shellfish or wildlife species, significant habitat*, or threatened or endangered species? Explain briefly: A community's existing plans or goals as officially adopted, or a change in use or intensgy of use of land or other natural resources? Explain briefly: Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: Other impacts (including changes in use of either quantit7 ort~pe of ener~l¥? Ex~lain tirieflT: D, WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA I~A~? E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [--'~ Yes r--~ No PART III - 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 (al setting (i.e. urban or rural); (bi probability of occurring; (c) duration; (d) irreversibility; (el geographic scope; and (fl 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 must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have id entifled one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supposing 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 Title of Responsible Officer Signature of Preparer (If different from responsibie officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency 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 York11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of .................. COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at being duly sworn, depose and say: That on the ~ bay. of0c]v&~t, 200~, I personally posted the property known as by placing the Board of Trustees officml poster where it c~ 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 being. Date ofhe~ng noted thereon to be held (l ]~. (%c ~. ~ .~_~3 '_ Dated: /O/7/6-)7 (signature) J Sworn to before me this /7 dayof 00 7 ary Public M_) John M. Judge NOTARY PUBLIC, State of New York No. 01 JU6059400 C~mlni~sion Expiles M~y 29, 20 ~ [ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK (}~f~ -"/-0-~ , residing at · being duly sworn, deposes and says that on the O~~q day of ,5~,3Z~1 ~L , 200'~, deponent mailed a tree copy of the Notice set forth, in the Board o~Tmstees Applic&tion, 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 ._~'t~ ~ -//~ o ? d , that said Notices were mailed to each of said persons by ~ (registered) mail. Sworn to before me this Dayof ~_~3c ,20 ~Notary P/X~ubh~ John M, Jude NOTARY pUbLIC, State of New York No. 01JU6059400 Qualified n Suffolk County Commission Exp res May29, 20 ~ ,L rd of Trustees A~plicati~ AUTHORIZATiON (where the applicant is not the owner) ~~ ~1~.~ residing at ~ ~ ~7~ (print owner of property) (mailing address) Sou do hereby authorize (Agent) to apply for permit(s) from the on my behalf. 8 of Trustees ApplicatiOn County of Suffolk State of New York ~/ ICI/',4 TO~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS I~ DAYOF ~3~-J'kk~)t~ktr, 20 07 '~-~Notary Public t~Nt~ BEDELL No. 011BE6099317 ~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics omhibits conflicts of interes~ on the hart of town officers and emolovees. The oumose of this form is to orovide information which can alert the town of vossiblc conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name,~iddle initial, unless you am applying in the name of someone else or other entity, such as a company. If so, indicate the other persun'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 (lf "Othar', 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 Soothold? "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 pa~inl ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the To~vn of Southold Title or position of that person Describe the relationship between yourself (the applicant/agcot/mpresent ative) 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 greatar than 5% of the shares of the corporate stock of the applicgnt (when the applicant is a corpomtlon); __B) the legal or beneficial owner of any interest in a non-corporate entity (when thc applicant is not a corporation); __C) an officer, director, paslmer, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this .~.~Lday of Signature '~ C..7_.~ Print Name V Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. 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 questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 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- snooortiw, facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office. local libraries and the Town Clerk's office. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board ~ Building Dept. [] Board ofTrustees 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: Location of action: Site acreage: Present land use: Present zoning classification: '1 If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nameofapplicant: ~th~p~r'45 (~M~b~h !-[D0~q~ (b) Mailingaddress: ~) ~(v'¥ ~'~- ~O~C~Dt2 ~\~{O~t; ~)U ]17~c7~ (c) Telephone number: AreaCode( )~05[ ~ ~9~--- ~)]3 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No ~ If yes, which state or federal agency? 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 Southoid 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 l 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 Appl'cahle 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 F 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 ble No% \oca 4 on a,oag+a( 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 Southold from solid waste and hazardous substances and wastes. See LWRP Section Ill - 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 ~] Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. ~ Yes [] No .~ Not Applicable