HomeMy WebLinkAboutPizzicara, Richard & Ann
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TOWN OF SOUTHOLD 13 86
BOARD OF TOWN TRUSTEES
MAIN ROAD
SOUTHOLD. NY 11971 50-4461214
PAY
TO THE &.. '/or.. ct_ p .
ORDER OF tI ) IL ,,(Y)~ T CJJ)f) ~'-'1:) (calla
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NORSTAR
BANK
51300 Main R08d,Southhold,NY 11971
FOR filII fftD, ../10 "nd -l'YN" 4 ".
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James F. King, President
Jill M. Doherty, Vice. President
Peggy A. Dickerson
Dave Bergen
Boh 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
March 3, 2008
Ms. Vicki Toth
425 Jacobs Lane
Southold, NY 11971
RE: RICHARD & ANN PIZZICARA
150 LAKESIDE DR. NORTH, SOUTH OLD
SCTM#90-3-1
Dear Ms. Toth:
The Southold Town Board of Trustees reviewed the survey prepared by John T.
Metzger last dated November 13, 2007 and determined the construction of a 45.5'X 32'
one-story addition, a 13.2'X 8' one-story addition, and a 10'X 15' rear deck extension to
the existing dwelling to be out of the Wetland jurisdiction under Chapter 275 of the Town
Wetland Code and Chapter 111 of the Town Code.
Therefore, in accordance with the current Wetlands Code (Chapter 275) and the
Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised,
however, that no construction, sedimentation, or disturbance of any kind may take place
seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of
the coastal erosion hazard area as indicated above, or within 100' landward from the
top of the bluff, without further authorization from the Southold Town Board of Trustees
pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility
to ensure that all necessary precautions are taken to prevent any sedimentation or other
alteration or disturbance to the ground surface or vegetation within Tidal Wetlands
jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such
precautions may include maintaining adequate work area between the tidal wetland
jurisdictional boLlndary and the coastal erosion hazard area and your project or erecting
a temporary fence, barrier, or hay bale berm.
This determinati6n is not a determination from any other agency.
If you have any further questions, please do not hesitate to call.
.
2
.
sincekel ,
07 I
Jame . King, presi6-
Board of Trustees
JFK:lms
~ew York State Depart~e!nt of Environmental conse!tion
Division of Environmental Permits, Region One
SUNY at Stony Brook
50 Circle Road, Stony Brook New York 11790-2356
Phone: (631) 444-0365 . FAX: (631) 444-0360 Website: www.dec.state.ny.us
~
~
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Alexander B. Grannis
Commissioner
January 15 2008
;1.-
Richard & Ann Pizzicara
142 St. Johns PI
Brooklyn NY 11217
r:: n
I J....,j
Dear Permittee:
Re: 150 lakeside Drive Norh, Southold
NYSDEC No. 1-4738-02355/00003
In conformance with the requirements of the State Uniform Procedures Act (Article 70,
ECl) and its implementing regulations (6NYCRR, Part 621), we are enclosing your
permit and approved plans and a Notice Covenant to the deed to the referenced
property. Please read all permit conditions carefully. If you are unable to comply with
any conditions, please contact us at the above address.
Also enclosed is a permit sign, which is to be conspicuously posted at the project site
and protected from the weather, and the dual Notice of CommencemenUCompletion of
Construction. Please follow all instructions on the latter.
Very truly yours,
~.g.w~
Karen S. Westerlind
Environmental Analyst I
Enclosures: 4
cc: V. Toth
.
NEW YORK STATE DEPART.T OF ENVIRONMENTAL CONSERV A.
Facility DEC ill 1-4738-02355
o
PERMIT
Under the Environmental Conservation Law (ECL)
Permittee and Facility Information
Permit Issued To:
RICHARD PIZZICARA
142 ST JOHNS PL
BROOKLYN, NY 11217
(516) 765-1008
Facility:
PIZZICARA PROPERTY
150 LAKESIDE DR NORTH
SOUTHOLD, NY 11971
Facility Application Contact:
VICKI TOTH
PO BOX 61
SHOREHAM, NY 11786
(631) 805-2000
Facility Location: in SOUTHOLD in SUFFOLK COUNTY
Facility Principal Reference Point: NYTM-E: 718.77 NYTM-N: 4545.544
Latitude: 41001'54.2" Longitude: 72023'51.4"
Authorized Activity: Expand the existing single family dwelling with two one-story additions, a new
deck and an extension of an existing deck. All work shall be done according to the enclosed plans
stamped "NYSDEC Approved."
Permit Authorizations
Tidal Wetlands - Under Article 25
Permit ID 1-4738-02355100003
New Permit Effective Date: 1/1512008
Expiration Date: 1/1512013
NYSDEC Approval
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict
compliance with the EeL, all applicable regulations, and all conditions included as part of this
permit.
Permit Administrator: GEORGE W HAMMARTH, Deputy Regional Permit Administrator
Address: '*:;$0/ NYSDEC REGION 1 HEADQUARTERS
SUNY @ STONY BROOKI50 CIRCLE RD
STONY BROOK, NY 11790 -3409
Authorized Signature: ~~ Date / /;;1 aP
Page 1 of5
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NEW YORK STATE DEPAR4T OF ENVIRONMENTAL CONSERV A.
Facility DEC ID 1-4738-02355
o
Distribution List
VICKI TOTH
Permit Components
NATURAL RESOURCE PERMIT CONDITIONS
GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS
NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following
Permits: TIDAL WETLANDS
1. Conformance With Plans All activities authorized by this permit must be in strict conformance
with the approved plans submitted by the applicant or applicant's agent as part of the permit application.
Such approved plans were prepared by John T. Metzger, dated April 9 2007 and last revised November
13 2007.
2. Concrete Leachate During construction, no wet or fresh concrete or leachate shall be allowed to
escape into any wetlands or waters of New York State, nor shall washings from ready-mixed concrete
trucks, mixers, or other devices be allowed to enter any wetland or waters. Only watertight or
waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms.
3. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from
construction of this project shall be completely removed from the adjacent area (upland) and removed to
an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas.
4. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal
wetlands or protected buffer areas as a result of the permitted activities.
5. Seeding Disturbed Areas All areas of soil disturbance resulting from the approved project shall be
stabilized as per the specifications of the approved plans immediately following project completion or
prior to permit expiration, whichever comes first. If the project site remains inactive for more than 48
hours or planting is impractical due to the season, then the area shall be stabilized with straw or hay
mulch or jute matting until weather conditions favor germination.
6. Storage of Equipment, Materials The storage of construction equipment and materials shall be
confined within the project work area and/or upland areas greater than 100 linear feet from the tidal
wetland boundary.
7. Contain Exposed, Stockpiled Soils All disturbed areas where soil will be temporarily exposed or
stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales / silt
curtains (or other NYSDEC approved devices) placed on the seaward side between the fill and the
wetland or protected buffer area. Tarps are authorized to supplement these approved methods.
Page 2 of 5
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NEW YORK STATE DEPAR:reT OF ENVIRONMENTAL CONSERV A.
Facility DEC ID 1-4738-02355
o
8. Maintain Erosion Controls All erosion control devices shall be maintained in good and functional
condition until the project has been completed and the area has been stabilized.
9. Establish Vegetated Buffer To protect the values ofthe tidal wetlands, a permanent vegetated
buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography
within an area extending 50 linear feet landward ofthe tidal wetland boundary. .
10. Area of Disturbance for Structures Disturbance to the natural vegetation or topography greater
than 25 feet seaward of the approved structure is prohibited.
11. Install, Maintain Erosion Controls Necessary erosion control measures, i.e., straw bales, silt
fencing, etc., are to be placed on the downslope edge of any disturbed area. This sediment barrier is to
be put in place before any disturbance of the ground occurs and is to be maintained in good and
functional condition until thick vegetative cover is established.
12. State Not Liable for Damage The State of New York shall in no case be liable for any damage or
injury to the structure or work herein authorized which may be caused by or result from future operations
undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no
claim or right to compensation shall accrue from any such damage.
13. No Changes to Septic System This permit does not authorize any alteration, expansion or
replacement of existing septic systems.
14. State May Order Removal or Alteration of Work If future operations by the State of New York
require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the
Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation
of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause
loss or destruction of the natural resources of the State, the owner may be ordered by the Department to
remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State,
and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other
modification ofthe watercourse hereby authorized shall not be completed, the owners, shall, without
expense to the State, and to such extent and in such time and manner as the Department of
Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill
and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall
be made against the State of New York on account of any such removal or alteration.
15. Precautions Against Contamination of Waters All necessary precautions shall be taken to
preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents,
lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials
associated with the project.
16. State May Require Site Restoration Ifupon the expiration or revocation of this permit, the
project hereby authorized has not been completed, the applicant shall, without expense to the State, and
to such extent and in such time and manner as the Department of Environmental Conservation may
require, remove all or any portion of the uncompleted structure or fill and restore the site to its former
condition. No claim shall be made against the State of New York on account of any such removal or
alteration.
Page 3 of 5
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NEW YORK STATE DEPART. OF ENVmONMENTAL CONSERV A.
Facility DEC ill 1-4738-02355
CD
GENERAL CONDITIONS - Apply to ALL Authorized Permits:
1. Facility Inspection by The Department The permitted site or facility, including relevant records, is
subject to inspection at reasonable hours and intervals by an authorized representative of the Department
of Environmental Conservation (the Department) to determine whether the permittee is complying with
this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301
and SAPA 401(3).
The permittee shall provide a person to accompany the Department's representative during an inspection
to the permit area when requested by the Department.
A copy of this permit, including all referenced maps, drawings and special conditions, must be available
for inspection by the Department at all times at the project site or facility. Failure to produce a copy of
the permit upon request by a Department representative is a violation of this permit.
2. Relationship ofthis Permit to Other Department Orders and Determinations Unless expressly
provided for by the Department, issuance of this permit does not modifY, supersede or rescind any order
or determination previously issued by the Department or any of the terms, conditions or requirements
contained in such order or determination.
3. Applications For Permit Renewals, Modifications or Transfers The permittee must submit a
separate written application to the Department for permit renewal, modification or transfer of this
permit. Such application must include any forms or supplemental information the Department requires.
Any renewal, modification or transfer granted by the Department must be in writing. Submission of
applications for permit renewal, modification or transfer are to be submitted to:
Regional Permit Administrator
NYSDEC REGION I HEADQUARTERS
SUNY @ STONY BROOKI50 CIRCLE RD
STONY BROOK, NYl1790 -3409
4. Submission of Renewal Application The permittee must submit a renewal application at least 30
days before permit expiration for the following permit authorizations: Tidal Wetlands.
5. Permit Modifications, Suspensions and Revocations by the Department The Department
reserves the right to modifY, suspend or revoke this permit. The grounds for modification, suspension or
revocation include:
a. materially false or inaccurate statements in the permit application or supporting papers;
b. failure by the permittee to comply with any terms or conditions of the permit;
c. exceeding the scope of the project as described in the permit application;
d. newly discovered material information or a material change in environmental conditions, relevant
technology or applicable law or regulations since the issuance of the existing permit;
Page 4 of 5
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NEW YORK STATE DEPART~ENT OF ENVIRONMENTAL CONSERV A.
Facility DEC ill 1-4738-02355
.
e. noncompliance with previously issued permit conditions, orders of the commissioner, any
provisions of the Environmental Conservation Law or regulations of the Department related to
the permitted activity.
6. Permit Transfer Permits are transferrable unless specifically prohibited by statute, regulation or
another permit condition. Applications for permit transfer should be submitted prior to actual transfer of
ownership.
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification
The permittee, excepting state or federal agencies, expressly agrees to indemnifY and hold harmless the
Department of Environmental Conservation of the State of New York, its representatives, employees,
and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the
permittee's acts or omissions in connection with the permittee's undertaking of activities in connection
with, or operation and maintenance of, the facility or facilities authorized by the permit whether in
compliance or not in compliance with the terms and conditions of the permit. This indemnification does
not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or
intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under
Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision
under federal or state laws.
Item B: Permittee's Contractors to Comply with Permit
The permittee is responsible for informing its independent contractors, employees, agents and assigns of
their responsibility to comply with this permit, including all special conditions while acting as the
permittee's agent with respect to the permitted activities, and such persons shall be subject to the same
sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee.
Item C: Permittee Responsible for Obtaining Other Required Permits
The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-
way that may be required to carry out the activities that are authorized by this permit.
Item D: No Right to Trespass or Interfere with Riparian Rights
This permit does not convey to the permittee any right to trespass upon the lands or interfere with the
riparian rights of others in order to perform the permitted work nor does it authorize the impairment of
any rights, title, or interest in real or personal property held or vested in a person not a party to the
permit.
Page 5 of 5
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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., February
13, 2008, the following recommendation was made:
Moved by James Eckert, seconded by Don Wilder, it was
RESOLVED to SUPPORT the Wetland Permit application of RICHARD & ANN
PIZZICARA to construct a 45.5'X 32' one-story addition, a 13.2'X 8' one-story addition,
and a 10'X 15' rear deck extension to the existing dwelling.
Located: 150 Lakeside Dr. North, Southold. SCTM#90-3-1
Inspected by: James Eckert
The CAC Supports the application with the Condition the septic tanks are moved further
landward and drywells and gutters are installed to contain the roof run-off.
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/Wark session Report
Date/Time: 2. (' I g to 'IS \ r t-t
RICHARD & ANN PIZZICARA request a Wetland Permit to construct a
45.5'X 32' one-story addition, a 13.2'X 8' one-story addition, and a 10'X 15'
rear deck extension to the existing dwelling. Located: 150 Lakeside Dr. North,
Southold. SCTM#90-3-1
Type of area to be impacted:
-,LSaltwater Wetland Freshwater Wetland
Sound _Bay
Distance of proposed work to edge of above:
Pl!rt of Town Code proposed work falls under:
~Chapt.275 _Chapt. Ill_other
Type of Application: / W etland _Coastal Erosion _Amendment _Administrative
_Emergency _Pre-Submission _Violation _Planning
Info needed:
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Modifications:
Conditions:
Present Were: _J.King _J.Doherty _p.DickersonA-D. Bergen_ B. Ghosio, Jr
_H. Cusack_D. Dzenkowski _Mark Terry_other
Form filled out in the field by
Mailed/Faxed to:
Date:
Environmental Technician
Review
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PROPERTYMIIP
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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: 631765-1938
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR
TOWN OF SOUTHOLD
To: James King, President
Town of South old Board of Trustees
From: Mark Terry, Principal Planner~)
L WRP Coordinator
[--
I L:J
Date: February 12, 2008
Re: Proposed Wetland Permit for RICHARD & ANN PIZZICARA
SCTM#1000-90-3-1
RICHARD & ANN PIZZICARA request a Wetland Permit to construct a 45.5'X 32' one-story
addition, a 13.2'X 8' one-story addition, and a 10'X 15' rear deck extension to the existing
dwelling. Located: 150 Lakeside Dr. North, Southold. SCTM#90-3-1
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the
Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation
that the proposed action is CONSISTENT with the Policy Standards and therefore is
CONSISTENT with the L WRP.
If the action is approved the following best management practice (BMP) is recommended:
I. Require a minimum 50 foot non disturbance buffer landward of the wetland
boundarv.
The BMP will further Policies 5. Protect and improve water qualitv in the Town of Southold and
6.3 Protect and restore tidal and freshwater wetlands. item 0 (below).
D. Provide adequate buffers between wetlands and adjacent or nearby uses and activities in
order to ensure protection of the wetland's character, quality, values, andfunctions.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing
its written determination regarding the consistency of the proposed action.
. "
.,
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James F, King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
.
Town Hall
53095 Route 25
P,O, Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
_Coastal Erosion Permit Application
~etland Permit Application _ Administrative Permit
~ _Amendment/Tran s~ rlExt nsion
eceived Application:' () tr'
ReceivedFee:$~
~ompleted Application~
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_Coordination:(date sent)
/tWRP Consistency Assessment Form ~
~AC Referral sent:~
~ate ofInspection:
~eceipt of CAC Report:
_Lead Agency Determination:_
Technical Review:
Aublic Hearing Held:~
_Resolution:
Office Use Only
~~ J~"~: H ~
Southhold Town
Board 01 Trustees
Name of Applicant Richard q-- Ann PI?< l'carC{
Address 14:J.. 51- 00h():"5 PbtJi BrOfJklyx V/j (/d-11
Phone Number:( ) 1/)1 -7!?3 - '-1100
Suffolk County Tax Map Number: 1000 - 9a ~ .5 - /
Property Location: /S{) I...dkes,'rU D/?;.j" 3ou-~Jd
8/5 Lakes/de.DI2 Je,. ('prne.tl-c/s Cedar PoIA;r lJll
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:_1J,uu --r;;f-V\
(If applicable)
Address:-=f-~ 'S ..:Tc;ccobs {../l
2rh.ctL/cl IVy Irq--rJ
Phone:U'3/ 0J3 s--- ,,)-,;L/ 9'
. \'Ctf~
S9-FNJ~'
~d of Trustees APplicatio4lt
GENERAL DATA
Area Zoning:
Sf, / ~1
.
k - ~C
Land Area (in square feet):
Previous use of property:
y.es,'A,e i\.C~
Y e.X I O..R.- ~'-~ Q..-)
Intended use of property:
Covenants and Restrictions:
If "Yes", please provide copy,
Yes
;(. No
Prior permits/approvals for site improvements:
Agency
Date
~ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
---4-No~ Yes
If yes, provide explanation:
Project Description (use attachments if necessary): -is,,') x,~c2 I rreq
one 6lury add{'+'OlL) /-..3.0< xP' OJuc.Sfvri addf:';'~
lOX I:) tedf rh &f' .film f'/dll
~d of Trustees APPlicatio~
Purpose of the proposed operations:
WETLANDITRUSTEE LANDS APPLICATION DATA
~jron,<: -10 ..ero ;S-/;htf
rlUJP,)(tYlq
Area of wetlands on lot:
/.1 ~O square feet
.'1, 4 % ..ekA'S-h if
S~ 9% O~IC-- C~I1tp/dto?-V
Percent coverage oflot:
Closest distance between nearest existing structure and upland
edge of wetlands: 9'1 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: / tJr feet
.
Does the project involve excavation or filling?
Z1
No
Yes
If yes, how much material will be excavated?
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:
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):
'Y1tr.e..IAJltl ~ ()O P-t+ec.J- on LuiC+/a~<:;.
1-/(211 h1 b_~ un / ( ill lI..ct d -Ir) /]reA/'~
(U. If ru Y! (Jf.;:
.
Board of
.
Trustees Application
County of Suffolk
State of New York
/L.Lfz I! rvv)~ BEING DULY SWORN
I5EPOSES 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 HlS/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 PLICATION.
~
SWORN TO BEFORE ME THlS~DAY OF
,204
~
.
F NICKOLAS FELELLA
I NOTARY ""8UC-STATE OF N.Y.
I QUALIFI .1 NASSAU COUNTY
COMMISSI\ PIRES MAY 31, 2008
#62-64685
..
,
.d of Trustees APPlicatioe
AUTHORIZATION
(where the applicant is not the owner)
.....
I, 11r.ba rei -I- f)/J~Z7J rllt2ft
(print owner of property)
residing
at I~ S/-JO)VI5 (JlaC/L
(mailing address)
'--;g(Y)() kJ <(>1 Ah{ /1 d-17
~rk,--/ofh
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
,{;ak4 ;::'3.' ~"-
(owner's~'gnature)
/' '.
~~~
8
Ie
.
I PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
617.20
APPENDIX C
STATE ENVIRONMENTAL QUAliTY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
(To be completed by Applicant or Project Sponsor)
SEQR
,. APPliCANT I SPONSOR
UI
2. PROJECT NAME
deL. -+t 0
(";-
3 PROJECT LOCATION: /SO 1.-o..J<J J/ib. /)~_
J
Municipality
County
-r-fo/K
45;~CI~;;;I~ ;/-;;;~s;;;: RO&~~~onsi!:/Imin{> e:;~",;rks~ci -~ ;o'De;aD Sou--f~ (CI
5. IS PROPOSED ACTION
~ New
D Expansion 0 Modification I alteration
6.DESCRIBE PROJECT BRIEFLY~rx3,7 1//'f?'1 ()flP Sfor-y Clddcftc.r:h./ /3,o?;(8'"
one Sfory addi:luf}'L; ;0:( t5~ rear aec~ --f~--!-et1/IO~
7. AMOUNT D AFFECTED:
Initially 891'e'r Ultimately ~
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
cBJves D No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY
I:tJ Residential D Industrial D Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture D Park I Forest / Open Space
DOther (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal. State or Local) /J'/SD&5
GtIYes DNO If yes, list agency name and permit I approval: .sOun!oW TDu)(}TR11S!P{5
tltelld {
11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAliD PERMIT OR APPROVAL?
mYes DND If yes, list agency name and permit I approval: N 1./ 5 Dc:c... 1-t..{13~-O;?'35J10tJC()3
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
[Jy es No
Applicant
I CERTIFY THAT
PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
a 1 ed 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 II - IMPACT ASSESSMENT (To 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.
DYes DNo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
DYes DNo
C. COULD ACTION RESULT IN ANV ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
I I
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
I I
C3. Vegetation Of fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
I
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly:
I
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
I
C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I I
C7. Other imnacts (including chanqes in use of either Quantilv or tvpe of enerav? Explain brieflv:
I I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I
o Ves 0 No I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
OVes ONO I I
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 (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, thedetermination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL
EAF and/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
Pnnt or Type Name of ResponSible Officer In Lead Agency
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency
Signature of Preparer (If different from responsible officer)
.
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
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter ofthe Application
of
___il({_6g/JCLctl!JLQJ?Ll2!C~~1~__________
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
I, V dJ0 T o-fh
AFFIDAVIT OF POSTING
, residing at 11 ""f5 J Clcub""~ Ln
3(,)\l.~h0ld N'I IICnl
being duly sworn, depose and say:
That on the Iq da~ of Co\~{\l..\l\~, 200~, I personally posted the property known as
Iv 0 L...a...K6S1 nr;.I5Jz !\fa. Soui-hmn 1\1\/ (1'1 Y I
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 { I )(l'-t'. '-;4-1) (, ,~ ~~-
JQ)n. ~'\ OtlQJf t;:OD 1'11,
Dated:
Sworn to before me this
20 day of;:e..\? 200<6
\( ,C -=J1
~ ~U' ! 15-/1,-
(signature)
v{2r:h~;: K~~O
Notary Public
ljJO
LID". flMIIClUIM
rII1fllNlIUaIC. _......v.IIII
..."MIt_
- - -........ CllIIIllr
01....,')' ..........,IO.LO
'-i 7- ZJ c.a_r~ SC'~\bOo-q()- 3 ~ I
.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Address:
Ib"id t<. to()l'Ol\(} 315 Wcz-fey Te.nnRCL SoLL-\..h,Vld
c..()\rD\~A .So..hl \1 4m LLlcKes)ck.b(l.~o ~6~\d
'Ph;\\p ReJlIl1 /Q85'WantC('..J(..Ave. Norik6.u\mon'itJy
o 1t7ID
I()C()..\?~ ~0- 15,S5~
(000. c{o-3 -.el-
I DO c J,D-'-{ - rJ-
STATE OF NEW YORK
COUNTY OF SUFFOLK
t ')1~~It, , residing at 4<:2") -:To-<- ~",ln &vi l.....u Id..-
, beinf duly sworn, deposes and says that on the
{ day of _yp 4~11 J Wi L, 206 , deponent mailed a true copy of the Notice
set forth in the Board of Trusteb Apphcalton, 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 Sou...--\'" Co i ci , that said Notices were mailed to each of said persons by
(certified)(Nlliitmll) mail. \ / .. ~.... '/
\{ cili ) 01 L^'--
Sworn to before me this ;; b't't-
Day of hZ..vrlJ..O r16 ,20...QjL
~/~
Notary Public
IJNDA P. '"' III4JlPH
NarNfY PU8lJC. .... Ill'" VlIlI
ND.011lA11_
.... ......" 8uIIaIk ""'-
Co...... .... .....~ilL 0
',,'
.
.
"
APPLICANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The ouroose of
this form is to orovide information which can alert the town of Dossible conflicts of interest and allow it to take whatever action is
necessarv to avoid same.
\~ \llck.l
(Last name, first name,1piddle initial, unless you are applying in the name of
someone else or other entity, such as a company. Ifso, indicate the other
person's or company's name.)
YOUR NAME:
NAME OF APPLICATION: (Check all that apply,)
Tax grievance
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(If''Other'', name the activity.)
Building
Trustee
Coastal Erosion
Mooring
Planning
,(
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business,
including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
YES
NO
x
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of South old
Title or position of that person
Describe the relationship between yourself (the applicanUagenUrepresentative) 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 own~rofany 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
S~bmitted thi~ of0llf1Ii{) Y1 ZOOt'
SIgnature ~'-'
Print Name lIlt K..\ ,0,\+
Form TS I
Town of South old
.
.
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
I. All applicants for permits' including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of South old Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. · Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the L WRP policy standards and conditions contained in the consistency
review law. Thus. each answer must be explained in detail. listinl!: both supportinl!: and non-
supportinl!: facts. If an action cannot be certified as consistent with the L WRP policy standards and
conditions, it shall not be undertaken.
A copy of the L WRP 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# 90
s-
/
;lId /'()~J'
PROJECTNAME Pr7ZfCr/tf'.1!
The Application has been submitted to (check appropriate response):
Town Board 0 Planning Board 0 Building Dept. 0 Board of Trustees .ltI
I. Category of Town of South old agency action (check appropriate response):
(a)
Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
o
o
(b) Financial assistance (e.g. grant, loan, subsidy)
(c)
Permit, approval, license, certification:
[tJ
Nature and extent of action: 12> / 'cJ, ,
.j x39 /./ ec; 0171/ 0" /-r;rtf odd. t1/Iv J
/9.:J. X f OI1f! shy adrf( fr()~/ JOY /<;" Y-Pt// C/Prfjlf/kJ{//{~
','
.
Location of action: ISO /a/(ISI dR
Site acreage: ,L)/ /dr k
f ~
Present land use: r.fS, d ~d7a I
.
UIl-AIa, .f00-f~/d
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: R\c..roxd-..\ ~1J,.j ~z..:-UC.ARfI
(b) Mailing address:_l 4-;:A s-+ :::r C) h n s P 10.. u:.......
~r()()lcLcp. 10~ ' 1<211
(c) Telephone number: Area Code ( tJ IX - 111:S - t.f lOw
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes [K] No 0
If yes, which state or federal agency? ^J/~ beG
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 L WRP Section III - Policies; Page 2 for evaluation
criteria.
lKJYes 0 No 0 Not Applicable.. .' .. . j
p~~~~ Q~e11~}J Et~n ~~d~ U~YI~'
~rrnr.tAf.Pd . ( I'.,j....." d /0. / m ..
1A.) o~ 0. 'vi :-i.~
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of South old. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
DYes 0 No [XI Not Applicable
'. .
.
.
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
L WRP Section III - Policies Pages 6 through 7 for evaluation criteria
DYes D 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 0 No D Not Applicable r
---fLCO-rn~qd ad('/. '<.(..(0(2\ ()rp I()f I -/rom w(l;f(ondf.
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
[Xl Yes D No DNotAPPlicable . I . j , ,/'1 ~
~D~,(':1yN~{)roposi~ cuJ.dC*1cfYlJ rpglArR- Uf9raott1ff ~
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.
00
D
D
Yes
No
Not APplble
.
" .
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of South old. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
DYes 0 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 L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
IXJ Yes 0 No 8 Not Applicable .
All dR...bVIC, <l-- ~'L~05S Cr)uc./.eVla./ ~1l1 PDi1Stru C;;/lOll -0 U1Ll,jJff VnJllwKl-fomst'k k
0-1'\ ~)OY7J\'"i'd iA.p/an(( (lY.N~ Frr.. rj)'<;.pnJoJ. .
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 L WRP Section 111- Policies; Pages 38 through 46 for evaluation
criteria.
o YeO No [Xl Not Applicable
Attach additional sheets if necessary
W~~NG COAST POLICIE_
.
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section 111- Policies; Pages 47 through 56 for evaluation criteria.
DYes 0 No ill 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 L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
DYes 0 No !Xl Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages
62 through 65 for evaluation criteria.
DYes 0 No [!J Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See L WRP
Section III - Policies; Pages 65 through 68 for evaluation criteria.
DYes 0 No ~ Not Applicable
PREPARED BY
c~
V~l:-t' ~
TITLE a~1-
DATE
N
DB/VE CDGE 01' GRAIEl. ROAD
128.60'
SURVEY OF PROPERTY
AT BA YVIEW
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. 1':
1000-90-03-01
SCALE: 1"-40'
APRIL 9, 2007
NOfI. /.3,_ 2oo7{h:VI.)',,;,y
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LOT COVERAGE
............~
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37.26 ~". ~ ~
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7 '1-i'-t'",- ----__
J'.> ~
'<",. ~ nt: UNt:
F.F. EL.' 12.3'
GAR. FLoqR EL.,9.7'
51,124 sq./I
AREA WETLANDS 1080 s,/.fl. .- I
50,0004 sq.ft uplands
EXISTING 174/1 50,004 sq./I ~ 3.4"
A T COMPLETION OF IMPROVEMENTS
,
2'3'/50,004 "5.9"
"
. .
,
\ \.'
..'
.'
~ ~ J~II ~: u ~
~ S88'S6'10.W
7E.E./f'42'E/J? 38:70'
~e-
South hold Town
ELEVA nONS REFERENCED TO N. G. V. D. Board of Trust.es
LOT NUMBERS REFER TO .. MAP OF CEDAR PARK"
FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE
ON DEC. 20, 1927 AS FILE NO. 90.
ANY AL TERA nON OR ADDtnON TO THIS SURVEY IS A WOLA nON
OF SECnON 72090F THE NEW YORK STA TE EDUCA nON LA w.
EXCEPT AS PER SEcnON 7209-SU8DIWSlON 2. ALL CERnACA nONS
HEREON ARE VAUD FOR THIS MAP AND ,COPIES THEREOF ONL Y IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WHOSE SIGNATURE APPEARS HEREON.
49618
. =PIPE
& = WETLAND FLAG
AREA-51,124 sa. FT.
TO TIE LINES
65-1797
,