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TR-6912
Jill M. Doherty, President Jaraes F. King, Vice~President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town HallAnnex 54375MainRoad P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0538C Date: May 12~ 2010 THIS CERTIFIES that the addition to existing dwelling, new septic system, raise grade level~ public water connection, gutters, leaders to drywells~ a 10' wide non-turf buffer along the bulkhead At 7433 Soundview Avenue, Southold~ New York Suffolk County Tax Map # 59-6-5.1 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 5/19/08 pursuant to which Trustees Wetland Permit # 6912 Dated 6/18/08 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 addition to existing dwelling, new septic system, raise grade level, public water connection~ gutters~ leaders to drywells, a 10' wide non-turf buffer along the bulkhead. The certificate is issued to FRANK & DIANE PALILLO owner of the aforesaid property. Authorized Signature Jill M. Dohcrty, President James F. King, Vice-Presid~nt Dave Bergen Bob Ghosio, Jr. John Bredemcyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 1t971 Telephone (63 I) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: __ Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~ constructed Project complete, compliance inspection. CERTIFICATE OF COMPLIANCE: COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC#: C10-13301 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 myoffice on04/12/2010 under Liber D00012621 and Page 650 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 04/1212010 SUFFOLK COUNTY CLERK JUDITH A. PASCALE SEAE SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Number of Pages: 5 Receipt Number : 10-0042783 District: 1000 Recorded: At: 04/12/2010 11:14:53 AM Page/Filing COE TP-584 Cert. Copies Received the Following Fees For Above Instrument Exempt Exempt $25.00 NO Handling $20.00 NO $5.00 NO NYS SRCHG $15.00 NO $0.00 NO Notation $0.00 NO $6.25 NO RPT $30.00 NO Fees Paid $101.25 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL J~DITH A. PASCALE County Clerk, Suffolk County LIBER: D00012621 PAGE: 650 Section: Block: Lot: 059.00 06.00 005.001 EXAMINED AND CHARGED AS FOLLOWS Number of pages This document will be public record. Please remove all Social Security Numbers prior to recording. Deed / Mortgage Instrument Deed / Mortgage Tax Stamp FEES Page / Filing Fee Handling TP-584 Notation EA-52 17 (County) EA-5217 (State) R.P.T.S.A. Comm. of Ed. Affid ~avi~-~. MS Salt:charge Other 20. 00 4 Dist. Real Prop~ Tax Serv Agency. Verificati Sub Total 5. 00 e 15. 00 Sub Total Grand Total 1000 05900 0600 005001 6 ;atisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: Mail to: Judith A. Pascale, Suffolk County Clerk 17 ] 310 Center Drive, Riverhead, NY 11901 ¢o. Name www. suffolkcountyny, gov/clerk Title # Reco[ding / Filing Stamps , 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 mortgage is or will be improved by a one or two family dwelling only. YES or NO If NO, s~ee appropriate tax clause on page # Preservation Fund Consideration Amount $ CPF Tax Due $ Improved Vacant Land __ TD TD TD Title Company Information Suffolk County Recording & Endorsement Page This page forms part of the attached ~ ~.~C L-Or~L tx~--Vl Ob,) O '~ C~ 0 &-IQ t-Mx)-("-[* made by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK. TO In the TOWN of ~ L~ W ~-© ~ ~.~ : In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. x2.o~o4. ,o~o~* (over) 01/24/1997 09:54 6317342738 R O BARRATT PAGE 02 'DECI~R~T~ON OF THTS DBCI~RAT~ON made this _~ day o£~'/'/ 20/~.~ by WITNESSETH : ~, D&~I~WJ~T(S)' in/are the owner (n) of Ce~_a~. re~l property located ~ To~ of s~thold, Co~ty' o~ Suffolk, State of N~ Y~=k, ~scri~d ~n the SuffOlk ~ty T~ ~p as District 1000, Section, "'~' , Bl~k Lot ~'] which is more particularly bo~ed and described forth in lc~dule 'A" ~exed hereto, herei~fter referred to ae the Property; ~HEREAS, the Property is situated on lands within the Jurisdiction of the Board of Trustees of the Tow~ of Southold (hereinafter the ~Tr~stees#) pursuant to Chapter 275 of the Town code of the Town of Southold or its successor, an~ various activities conducted upon the ~roperty may th~s be subject to th~ regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECI~d~I~NT(S) therefore made application to the Trustees undertake certain regulated activities; and WHERBA~, as a condition o~ the granting of a Wetlands unae~z~ake s~=h Fec~ulated ac~ivities, ~he Tru~t~e~ _rec~ired that a. ~-tur~ buffer' adjacent to and l~d~ard o£ ~bt~lBd~sde~k~dml 01/24/1997 09:54 6317342730 R O BARRATT PAGE 03 NOW, follows= l) THEREFORE, the DECLARANT(S} do/does hereby covenant and agree as UPon the substantial completion of the aforementioned permitted activities there shall he established a~d subsequently maintained ~jm~tto~h© s'10f0ot 'non-turf buffer" az defined by chapter 2?5 of the Town Code; and ~) These covenants shall run with the land and shall be binding on the DECLARANT(S), his/her/their heirs, assigns, purchasers, or successors in interest and ~ay on1¥ be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this OWNER' $ $I(~NATURS ~ - - ~/ ; , in the year 20~ ~, ~fore ~ the ~Y o~ , ~ ,f~ ~../ :_ __~ tot said State, Derso~lly me t~e ~ rsigned a N~ta~. ~c mn ~A*~ ~ ~-- --e ~ appeared~r~ :~,~'.r~,,.--, r = =--~- ~-~ivid~l(s) whose n~e(s) t~ bamihof satisfacto~ evidence co m~ ~,,= ~---- is/are s~scrib~d to the within instr~ent ~d ac~owledged to me t~t he/she/=hey executed the s~e ~n his/he~/their caDaci=y, ~d that by on behal~ of which uhe indiv%dual(s) act~, executed ~e lnst~ent. Oualili~ in Kin~s Cuunty ~nl/) Underwriter No. L543954 Title Number AA'1776-S Schedule A Description Revised: 1112012008 Page '1 ALL that certain plot, piece or parcel of land, situate, lying and being at Southold, Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a point on the southwesterly side of a Pdvate Road, distant 160.74 feet northwesterly from the corner formed by the intersection of the northwesterly side of Soundview Avenue with the southwesterly side of a Private Road, said point of beginning being where the division line between the premises described herein and land now or formerly of Smith intersects the southwesterly side of a 'Private Road; RUNNING THENCE from said point of beginning, South 67 degrees 32 minutes 50 seconds West along land now or formerly of Catherine Smith, 122.58 feet to the bulkheaded high water mark of Great Pond; THENCE along the bulkheaded high water mark of Great Pond, the following three (3) courses and distances: 1. North 24 degrees 45 minutes 51 seconds West, 57.36 feet; 2. North 67 degrees 59 minutes 52 seconds East, 3.20 feet; 3. North 23 degrees 22 minutes 03 seconds West, 88.20 feet to a point; THENCE along the highwater mark of Great Pond the following two (2~ courses and distances: 1. South 81 degrees 48 minutes 43 seconds West, 12.36 feet; 2. North 48 degrees 08 minutes 14 seconds West, 2.52 feet to land now or formerly of Rudolph Bemstein and Edith Inge Bernstein; THENCE North 85 degrees 58 minutes 30 seconds East along land now or formerly of Rudolph Bernstein and Edith Inge Bernstein, 132.82 feet to the southwesterly side of a Pdvate Road; THENCE along the southwesterly side of a Private Road, the following 4~w (2) courses and distances: 1. on a curve to the left having a radius of 170.00 feet, a distance of 90.82 feet; 2. South 40 degrees 11 minutes 30 seconds East, 20.85 feet to land now or formerly of Catherine Smith and the point or place of BEGINNING. TOGETHER with a right of way over the following described parcel, which is comprised of certain 30 foot private roads and a private beach: BEGINNING at an iron pipe set on the northwesterly side of Sound View Road, Continued On Next Page Underwriter No. L543954 Title Number AAI776-S Schedule A Description- continued Revised: '11/20/2008 Page 2 126.10 feet southwesterly along said northwesterly side of Sound View Road from the southeasterly corner of land now or formerly of John A. Muir and George G. Muir and the southwesterly corner of land now or formerly of Carl Reiter; RUNNING THENCE the following courses: 1. North 40 degrees 11 minutes 30 seconds West, 345.00 feet; thence 2. North 49 degrees 48 minutes 30 seconds East, 125.00 feet to said land now or formedy of Cad Reiter; THENCE along said land now or formerly of Carl Reiter, North 40 degrees 11 minutes 30 seconds West, 100.00 feet, more or less, to the shore of Great Pond; THENCE southwesterly along said shore of Great Pond, 150.00 feet, more or less; THENCE the following courses: 1. South 40 degrees 11 minutes 30 seconds East, 133.00 feet, more or less, to an iron pipe; 2. on a curve to the left having a radius of 170.00 feet, a distance of 267.04 feet along said curve to an iron pipe; thence 3. South 40 degrees 11 minutes 30 seconds East, 181.59 feet to an iron pipe set on the northwesterly side of Sound View Avenue (Road); THENCE along said northwesterly side of Sound View Avenue, North 42 degrees 14 minutes 10 seconds East, 30.26 feet to an iron pipe; THENCE the following courses: 1. North 40 degrees 11 minutes 30 seconds West, 177.60 feet; thence 2. on a curve to the right having a radius of 140.00 feet, a distance of 219.91 feet along said curve to an iron pipe; thence 3. South 40 degrees 14 minutes 10 seconds East, 298.99 feet to an iron pipe set on said northwesterly side of Sound View Avenue; THENCE North 42 degrees 14 minutes 10 seconds East, 30.26 feet to the point or place of BEGINNING. SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Number of Pages: 5 Receipt Number : 10-0042783 District: 1000 Recorded: At: 04/12/2010 11:14:53 AM Page/Filing COE TP-584 Cert. Copies LIBER: D00012621 PAGE: 650 Section: Block: Lot: 059.00 06.00 005.001 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt $25.00 NO Handling $20.00 NO $5.00 NO NYS SRCHG $15.00 NO $0.00 NO Notation $0.00 NO $6.25 NO RPT $30.00 NO Fees Paid $101.25 IS A PART OF THE INSTRUMENT THIS IS NOT A BILL THIS PAGE JUDITH A. PASCALE County Clerk, Suffolk County Number of pages This document will be public record. Please remove all Social Security Numbers prior to recording. 20i0 ~pr i2 ii:14:~i5 ~H JU£:,Ii-H R: F'qSCRLE CLERk( OF SUFFOLK L b00012621 P 650 Deed / Mortgage Instrument Deed / Mortgage Tax Stamp [ Recording / Filing Stamps 3 ] FEES Page / Filing Fee Handling 20. 00 TP-584 Notation EA-52 17 (County) EA-5217 (State) R.P.T.S.A. 25(~; ~ Comm. of Ed. 5. O0 '~fS $i:rcharge 15. 00 Other Sub Total Sub Total Grand Total 4 Dist. Real Prop~ Tax Serv: Agenc] Verificati 6 I 1000 05900 0600 005001 Satishctions/Discharges/ReleasesListPropeayOwnersMailingAddress RECORD & RETURN TO: Mail to: Judith A. Pascale, Suffolk County Clerk 310 Center Drive, Riverhead, NY 11901 www.suffolkcountyny, gov/clerk 5 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 mortgage 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 Community Preservation Fund Consideration Amount $ CPF Tax Due $ Improved Vacant Land TD TD TD 5o.IName Title Company Information Title # Suffolk County Recording & Endorsement Page This page forms part of the attached ~ ~C UOvfLtMWi Oh,) O '~= C~ O ~-)x,) (SPECIFY TYPE OF INSTRUMENT) l~-r0 ,Z qrL ~i ~ ~3 ~ Q C4 t_ i ~-,-~D The premises herein is situated in SUFFOLK COUNTY, NEW YORK. made by: TO In theTOWN of ~--~UT~rot-~ ~ , In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) DECLARATION OF COVENANTS THIS DECLAP. ATION made this day of ~/ , 20/0, by WI TN~S SETH : WHEREAS, I~(S) il/are the owner(i) of Ce__r.t_m_!~. re.a_l property located on 7433 ~)UNDVIEWAVE , SOUTHOLD Town of ~outhold, ~'"*" ~ , *, ~ ~,%u.~ of .uf_o_k, State of Ne~ U~-~, ~escribed ,in the SuZ£Olk C~nty Tax Map as District 1000, Section '}~' , Block 06 Lot ~'] which is more particularly bounded and described ~w-set forth in ~_b~dule "A" m~nexed hereto, hereinafter referred to as the Property; W~IER~AS, the Property i~ situated on lands within the Jurisdiction of the Board of Trustees of ~he Town of Southold (hereinafter the ~Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; W~ERF_~, the DECLARANT{S) therefore made application to the Trustees %tlldertake certain regulated act~vities; and WHEREAS, as a condition of the granting of a wetlands Permit to undertake IBch rg~ulated activities, the Trustees recN~ire~ that a IO~M '~:~-ture bu£~er' adjacent to and l~Jward o£ ~heboikheadandssdeDic~edon survey pre ed by NlflUm Cot'win lest dated .2008 NOW, THEREFORE, the DECLARANT(S) do/does hereby covenant and agree as followst 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and subsequently maintained adjex~emtotbe alOfoot "non-turf buffer" as defined by Chapter 2T5 of the Town Co~e; amd These covenants shall run with the iartd a-~d shall be binding on the DECbARANT(S), his/her/their heirs, assigns, purchasers, or succesaors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this On the .~-. iv day of , in ~he year 20{ ~, before me the un~lersigned, ,a Notary. Public in and for said State, personally appeared ~/'=-; ~ the ~si~of satisfacto~ evidence to be the individual(s) whose n~e(s) is/are ~scribed to the within instr~ent ~d ac~owledged to me t~t he/she/chey, executed the s~e in his/her/their caDacicy, ~d t~t by on behalf of which the individual(s) act~, executed~e inst~ent. ~,c~:~,~ /L/%~'~ /~'~~ ' NOTARYNo.PUBUC'01RA5068565~ta~ Quatifi~ in Kin~s Count~/~ ~mmivsio~ ~ires Nov. 4, Underwriter No. L543954 Title Number AA1776-S Schedule A Description Revised: 11/20/2008 Page I ALL that certain plot, piece or parcel of land, situate, lying and being at Southold, Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a point on the southwesterly side of a Private Road, distant 160.74 feet northwesterly from the corner formed by the intersection of the northwesterly side of Soundview Avenue with the southwesterly side of a Private Road, said point of beginning being where the division line between the premises described herein and land now or formerly of Smith intersects the southwesterly side of a Private Road; RUNNING THENCE from said point of beginning, South 67 degrees 32 minutes 50 seconds West along land now or formerly of Catherine Smith, 122.58 feet to the bulkheaded high water mark of Great Pond; THENCE along the bulkheaded high water mark of Great Pond, the following three (3) courses and distances: 1. North 24 degrees 45 minutes 51 seconds West, 57.36 feet; 2. North 67 degrees 59 minutes 52 seconds East, 3.20 feet; 3. North 23 degrees 22 minutes 03 seconds West, 88.20 feet to a point; THENCE along the highwater mark of Great Pond the following two (2i courses and distances: 1. South 81 degrees 48 minutes 43 seconds West, 12.36 feet; 2. North 48 degrees 08 minutes 14 seconds West, 2.52 feet to land now or formerly of Rudolph Bemstein and Edith Inge Bemstein; THENCE North 85 degrees 58 minutes 30 seconds East along land now or formerly of Rudolph Bemstein and Edith Inge Bemstein, 132.82 feet to the southwesterly side of a Private Road; THENCE along the southwesterly side of a Private Road, the following4e~v (2) courses and distances: 1. on a curve to the left having a radius of 170.00 feet, a distance of 90.82 feet; 2. South 40 degrees 11 minutes 30 seconds East, 20.85 feet to land now or formerly of Catherine Smith and the point or place of BEGINNING. TOGETHER with a right of way over the following described parcel, which is comprised of certain 30 foot private roads and a private beach: BEGINNING at an iron pipe set on the northwesterly side of Sound View Road, Underwriter No. L543954 Title Number AA1776-S Schedule A Description- continued Revised: 11/20/2008 Page 2 126.10 feet southwesterly along said northwesterly side of Sound View Road from the southeasterly corner of land now or formerly of John A. Muir and George G. Muir and the southwesterly corner of land now or formerly of Carl Reiter; RUNNING THENCE the following courses: 1. North 40 degrees 11 minutes 30 seconds West, 345.00 feet; thence 2. North 49 degrees 48 minutes 30 seconds East, 125.00 feet to said land now or formerly of Carl Reiter; THENCE along said land now or formerly of Carl Reiter, North 40 degrees 11 minutes 30 seconds West, 100.00 feet, more or less, to the shore of Great Pond; THENCE southwesterly along said shore of Great Pond, 150.00 feet, more or less; THENCE the following courses: 1. South 40 degrees 11 minutes 30 seconds East, 133.00 feet, more or less, to an iron pipe; 2. on a curve to the left having a radius of 170.00 feet, a distance of 267.04 feet along said curve to an iron pipe; thence 3. South 40 degrees 11 minutes 30 seconds East, 181.59 feet to an iron pipe set on the northwesterly side of Sound View Avenue (Road); THENCE along said northwesterly side of Sound View Avenue, North 42 degrees 14 minutes 10 seconds East, 30.26 feet to an iron pipe; THENCE the following courses: 1. North 40 degrees 11 minutes 30 seconds West, 177.60 feet; thence 2. on a curve to the right having a radius of 140.00 feet, a distance of 219.91 feet along said curve to an iron pipe; thence 3. South 40 degrees 14 minutes 10 seconds East, 298.99 feet to an iron pipe set on said northwesterly side of Sound View Avenue; THENCE North 42 degrees 14 minutes 10 seconds East, 30.26 feet to the point or place of BEGINNING. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 10, 2008 Mr. Robert Barratt 4295 Vanston Rd. Cutchogue, NY 11935 RE: FRANK & DIANE PALILLO 7433 SOUNDVIEW AVE., SOUTHOLD SCTM#59-6-5.1 Dear Mr. Barratt: The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed., December 10, 2008: RESOLVED, that the Southold Town Board of Trustees APPROVES the request for a Transfer of Wetland Permit #6912 from Shiu Ching Chen to Frank & Diane Palillo, as issued on June 18, 2008. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Jame .~King President, Board of Trustees JFK:lms Mr. Robert Barratt PE 4295 Vanston Road Cutchogue, NY 11935 Tel 631 875 0275 Fax 631 734 2730 E-Mail: robertbarratt(~optonline.net Board of Southold Town Trustees //J ~,~. /rOll Town Hail / 530. oute 25 ! POBox 1179 Subject: 7433 Soundview Avenue, Southold, NY, SCTM# 1000-59-6-5.1 Members of the Board of Trustees, The sale of the subject property was closed on Friday November 21st, 2008 and the new owners are.' Frank and Diane Palillo 16 Glendy Lane Brookville NY 11545 The following trustee documents should be transferred to the new owners: Wetlands Permit # 6912 Dated 6/18/08 Wetlands Permit # 5051 Amended 7/23/08 and associated Certificate of Compliance # 0379C dated 11/05/08 Yours faith_fully, Robert Barratt Transfer fee of $100 paid by Visa 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 ¼ constructed __ Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6912 DATE: JUNE 18~ 2008 ISSUED TO: SHIU CHING CHEN PROPERTY ADDRESS: 7433 SOUNDVIEW AVE.~ SOUTHOLD SCTM#59-6-5.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 18, 2008 in consideration of application fee in the sum of $250.00 paid by Shiu Ching Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and following: Wetland Permit to construct an addition to the existing dwelling, abandon the existing well and cesspool, install a new septic system and raise grade level to elevations 9.4' and 10.2' when excavation spoil and top soil is replaced after installation, and to public water service, with the condition gutters and drywells are installed in accordance with Chapter 236, Stormwater Management, of the Town Code, and a 10' non-turf buffer is maintained along the landward side of the bulkhead, and as depicted the survey prepared by Nathan Taft Corwin last dated June 26, 2008. IN 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. 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 June 18,2008 Mr. Robert Barratt PE 4295 Vanston Rd. Cutchogue, NY 11935 RE: SHIU CHING CHEN 7433 SOUNDVIEW AVE., SOUTHOLD SCTM#59-6-5.1 Dear Mr. Barratt: The Board of Town Trustees took the following action during its regular meeting held on Wed., June 18, 2008 regarding the above matter: WHEREAS, Robert Barratt, PE on behalf of SHIU CHING CHEN applied to the Southold Town Trustees for a permit under the previsions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated May 19, 2008, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: the installation of gutters and drywells in accordance with Chapter 236, Stormwater Management, of the Town Code, and a 10' non-turf buffer along the landward side of the bulkhead, and, 2 WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 18, 2008, 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, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of SHIU CHING CHEN to construct an addition to the existing dwelling, abandon the existing well and cesspool, install a new septic system and raise grade level to elevations 9.4' and 10.2' when excavation spoil and top soil is replaced after installation, and connect to public water service, with the condition gutters and drywells are installed in accordance with Chapter 236, Stormwater Management, of the Town Code, and a 10' non-turf buffer is maintained along the landward side of the bulkhead, and as depicted on the survey prepared by Nathan Taft Corwin last dated June 26, 2008. 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: $50.00 Very trulyyours, Jame F.~K[ng, Presid'~t Board of Trustees 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 Sou~hold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD J Please be advised that your application dated been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of the following items checked off below. has __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ½ Constructed ($50.00) /'~inal Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES:. TOTAL FEES DUE: $. ~0. O'~ BY: James F. King, President Board of Trustees James F. King, President .ill M. Doherty. Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: /_~ '""' I (--1~)<:~ SHUI CHING CHEN requests a Wetland Permit to construct an addition to the existing dwelling, abandon existing well and cesspool, install a new septic system and raise grade level to elevations 9.4' and 10.2' when excavation spoil and top soil is replaced after installation, and connect to public water service. Located: 7433 Soundview Ave., Southold. SCTM#59-6-5.1 ~rea to be impacted: er Wetland Freshwater Wetland __Sound Bay Distance of proposed work to edge of wetland Partp~Town Code proposed work falls under: L_,,~"hapt.275 Chapt. 111 other Type of Application: ~Wetland __Coastal Erosion ___Amendment __Administrative__Emergency Pre-Submission __Violation Info n~eeded: _ '£ ! Modifications: Conditions: Pr.ese~'t Were: ~J.King __~.Doherty _P.Dickerson i.-,' D. Dzen~'~wski Mark Terry ~oother ,'~_~ , ' Form filled out in the field by . Bergen /B.Ghosio, Mailed/Faxed to: Date: Environmental Technician Review- 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., June 11, 2008, the following recommendation was made: SHUI CHING CHEN to construct an addition to the existing dwelling, abandon existing well and cesspool, install a new septic system and raise grade level to elevations 9.4' and 10.2' when excavation spoil and top soil is replaced after installation, and connect to public water service. Located: 7433 Soundview Ave., Southold. SCTM#59-6-5.1 The CAC did not make an inspection, therefore no recommendation was made. ECEg~E dUN - 9 2OO8 Seuthho/d Tow~ 9oard ef Tmstee~, Looking East from Great Pond, Photo arrow# 10A, taken 1/15/08 Looking West from House, Arrow gl0B, taken 5/5/08 Looking Southwest from Driveway, Arrow # 10C, taken 5/5/08 Site 7433 Soundview Avenue, Southold, NY 11971 Applicant: S C Chen Applicant s agent Mr. R O Barratt PE Stake test hole, Arrow # 11(1), Taken 4/17/08 Arrow # 11(2), Taken 4/7/08 Stake marking leaching pool water' Arrow # 11(3), Taken 4/7/08 Site: 7433 Soundview Ave, Southold, NY 1171, Applicant: S C Chen, Applicant's Agent R O Barratt Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ISSUED TO DATE.' RICHARD SANSEVERE 10/29/97 Pursuant to the provisions of. Chepfer 615 of. the Laws the State of. New York, 1893; and Chapter 404 of. the Laws of. the State of New York 1952; and the Soufhold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on 10/a9/97. 19 97 , and in consideration of. the sum of' $ i50.00 paid by Land Use for RICHARD SANSEVERE Southold . N. Y. and gubiect to the Terms and Conditions listed on the reverse s~de hereof, of Soufhold Town Trustees authorizes and permits the following: Wetland Permit to reconstruct 150~ of timber retaining wall ln- kindJinplace and backfill as necessary and place a 10' non-turf buffer landward of retaining wail as per revised plans dated and ,F~ceived~0/29 / ~ all In eccoraance w,fh the detaiJed specifications as presented in the orlglnaflncj appJicaf;on. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ;ts Corporate SeeJ fo be att.;xed, and these presents to be subscribed by a maiorify of fha sard Board as of this da+e. Alber~ J. Kmpski, President John Holzapfel, Vice President Jim King Martin H. Gan-el1 Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 ~csober 30, 1997 Land Use Corp. 2576 Sound Ave. Baiting Hollow, NY 11933 Re: RICHARD SANSEVERE SCTM ~59-6-5.1 Dear Ms. Lachenmeyer, The following action was taken by the Board of Town Trustees during its Regular Meeting held on October 29, 1997, regarding the above matter: WHEREAS, RICHARD SANSEVERE, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated September 29, 1997, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on October 29, 1997, 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 standard set forth in Chapter 97-18 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 approves the application of RICHARD SANSEVERE to reconstruct 150' of timber retaining wall inkind/inplace and backfill as necessary and place a 10' non-turf buffer landward of retaining wall as per revised plans dated and received 10/29/97. BE IT FURTHER RESOLVED that this determination should not he considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: Very truly yours, Albert J. Jr. President, Board of Trustees AJK/djh cc. DEC ACE Dept. of State Bldg. Dept. JOINT APPLICATION New York State FOR PERMIT United States Army Corps of Engineers 1. Check permits applied for: 2, Name of Applicant (Use full name) Telephone Number (daytime) NYS Dept. of EnvironmentalCooservation ~'tl-J t ~ (~ ~ ~l%J (~ I~ H [~ J~J~ [] Navlgable Waters (Excavation and Fill 4''~'- 3..~ 141 .~'~/ A 6LVJ:) [] CoastaI Erosion Control [] Owner [] Operator E] Lessee E] Municipatity/GovemmentalAgency [] 401 Water Quality Cedification Owner Or AgentJContact Person [] Owner [] Agent/Contact Person Telephone Number (daytime) [] Aquatic Vegetation Control Z~ ~ ~ ~ V ~1~ j~ S '1"'~ J~ ~ 0 ~ D [] Aquatic Insec~ Control ~_ I~ ~ ~. (,-~ ~) C1 U ~;~ ,~' (State Owned Lands Under Water) .-~k.) F~{~) J..~.~ ~{3 U ~' ['~ ~ U b Utility Easement (pipelines, conduits, ~ ~J' ~ ~ ~(3 U ~,~ b ~J ~ ~-~ ~ ~.~ ~.~J [] Docks, Moodngs or PlatformS(construct or Place) ~'~lJ'J' J'~ ~) L'b N~'~ ( [J~"~[ ~-~.~ ~ ~-*~.T Po I~J b ~ Se~ion404(WatersoftheUnit~St~es) ~ ~ --~0 ~ ~ ~ T~ ~ Nation.de Permit (s) ~JT~I~ ~ I STIN~ ~-- Identi~Num~r(s) ~ ~ b~ ~1~1~ t6, Wilt ~ls Pmj~ R~uim Add~onal ~ ~ ff Yes, ~ ~ ~ ~ ~ ~ F~er~l, S~e, or Local Pe~? Yes No Please List: ~' ~ * ~T ~ 3 6~V or u~s a fal~ fi~ifious or fraudulent ~ement ~ ~ __ Date ~[~ Signature of Applicanl~ ~ Title O~teAl=l ~ Signature of Owner~~ ~ Title General Instructions Incomplete or inaccurate information may delay processing and a final decision on your application 1~ Type or pdnt clea~y in ink. Aitach FIVE copies of additional information required in A. through C. below+ A, A USGS map, or equivalent showing the project location, lr~lude on the map wetlands, seasonally wat streams and ditches. B. A sketch plan drawn to scale or with dimensions given or engineehe9 drawings showing location and extent of work as well as view directions of the photographs required in C C. At least three (3) representative color photographs of the project area and surroundings with time and date when they were taken indicated. 2. Appricabens by counties, cities, towns, and villages must be signed ~3y the chief executive of that municipat~ or the head of the depar~meof or agency undertaking the project. 3. If someone other than the owner ~s applic,3n{, wMtfan consent of the owner to use the property / facility must accompany the application+ 4. The app~icard is resFonsible for obtaining any other federal, state or local permits, Separate autho~izatior~ or letter of NO Jurisdiction should be received from the Department of Env6~onmentat Conse~atlon (DEC), Office of General Services (OGS), Adirondack Park Agency (APA) or Lake Georg~ Park Commission (LGPC) and the An,ny Corps of Engineers (ACOE) prior to initiation of work in wetlands or waterways, 5. Location Coordinates (section 8) am expressed in New York Transverse Mercator units or NYTMs (UTM Zone 18 expanded to ermompass the entire state). These are based on the North Amedcan Datum 1983. If you are able to supply accurate coordinates, please do so+ Otberwise the Department will determine them Other Requirements 6, If project iS an untisted action pursuant to the State Environmentat OuaIi[y Review Act regulations - 6 NYCRR Part 617, a completed Part 1 of a Short Enwronmenta} Assessment Form must be submitted with the application. 7. If Proiect is a Type 1 action pursuant to the State Environmental Quality Review Act regulations - 6 NYCRR Part 617, a completed Pad t of a Full Environmental Assessment Form must be submitted with the application 8. if project is classified as major pursuant to the Uniform Procedures Act rogu~ations - 6 NYCRR Part 621, a completed Par[ 1 of a Structural Archeological Assessment Form Special Requirements for Specific Permit Applications New York State A,qencies Department of Environmental Conservation REGION 1 REGION ? SUNY, 50 Circle ROad 616 Erie Blvd West RE~ION $ Office of General (518) 62:~128~ Adirondack Park Agency (315)785~2245 Lake George Park Commission Distribution 1STCOPYPerrnitAdministrator 2NDCOPYCorpsofEngineers 3RD COPY Program 4TH COPY NYS Agency 5TH COPY Applicant Legend DEC Regional Office DEC Regional Sub-Office Adirondack Park United States Army CorDs of Enoin~r~ Department of the Army A~FN: Regulatory Branch New York District, Corps of Engineers, 26 Federal Plaza, New York NY 10278~090 Telephone (917) 7BC~8511 for DEC Regions 1,2 and Westchesfar and Rockland Counties (917) 790~411 for DEC Region 3 except Westchester and Rockland Counties Upstate Regulatory Fie~d Office Telephone (518) 266-6350 - DEC regions 4,5 1 Buffiogton Street, Wate~iat, NY 12189-4000 1776 Niogara Street, Buffalo NY 14207-3199 "GREAT POND " N ./ Mr. Robert Barratt PE 4295 Vanston Road Cutchogue, NY 11935 Tel 631 875 0275 Fax 631 734 2730 E-Ma robertbarratt~optonline.net Southold Town Board of Trustees Town Hail 53095 US Route 25 PO Box 1179 Southold, NY 11971-0959 June 27th, 2008 Subject: 7433 Soundview Avenue, Southold, NY, SCTM# 1000-59-6-5.1 Members of the Board of Trustees, Thank you for your guidance in the matter. Please fmd enclosed three (3) copies of the survey revised to incorporate the following changes requested at the trustee meeting of 06/18/08. 1. Move the active leaching pools to a distance equal to or greater than 100fi from the bulkhead. 2. Show the 10ft wide non-turf buffer 3. Add gutters and drywells in accordance with the Southold Town Code .Following your final approval we look forward to making application to the SC Heaith Services Dept. Yours faithfully, Robert Barratt Encl/Revised survey dated June26, 2008 OFFICE LOCATION: Town Hail 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: Jim King, President Town of Southold Board of Trustees From: Scott Hilary/Mark Terry, LWRP Coordinators Date: June 16, 2008 Re: Chapter 268: Waterfront Consistency Review Wetland Permit for SHUI CHING CHEN SCTM#59-6-5.1 Sot:thold Be3rd of Trustees SHUI CHING CHEN requests a Wetland Permit to construct an addition to the existing dwelling, abandon existing well and cesspool, install a new septic system and raise grade level to elevations 9.4' and 10.2' when excavation spoil and top soil is replaced after installation, and connect to public water service. Located: 7433 Soundview Ave., Southold. SCTM#59-6-5.1 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 is INCONSISTENT with the LWRP policy standards and therefore is inconsistent with the LWRP. The proposed action is less than 100' from the wetland boundary which is within the minimum setback of the Board of Trustees pursuant to ~ 275-3~ and therefore is inconsistent with LWRP sub-policy 6.3. Further the proposed addition constitutes more than 25% of the original structure and is not reviewable as Minor/Exempt, Pursuant to § 268-3 Definitions. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the $outhold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recotnmendations as set forth in Trustee permit conditions. § 275-3 Findings; purpose; jurisdiction; setbacks D. Setbackx. (1) The following minimum setbacks apply to any and all operations proposed on residential property within the jurisdiction of the Board of Trustees: (a) Wetland boundary. [1] Residence: l OO feet. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __.~OeaStal Erosion Permit Application tland Permit Application Administrative Pernfit __Amendment/Transfer/Extension __Received Application: ~Received Fee:$ ~-----'~ompleted App~ichtion_5-~ [ ~}! (~ __Incomplete SEQRA Classification: Type I Type II Unlisted __.Coordination:(date sent) ~(,A~RP Consistency Assessment rorln ~'~ __CAC Referral Sent: ~Date of Inspection: ~1 Itt(~ __Receipt ofCAC Repor~:l ' Lead Agency Determination: __Technical Review: ~_.1~g61ic Hearing HeldL/o([ J~(.3[~ ___Resolution: 2008 Name ~'~-o~t ~ q Phone Number:( ) Suffolk County Tax Map Number: 1000- ~:~ Property Location: ~-~'~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: .1~. ~D, ~ ~ lC.. ~--~T' 1' I> ~" (If applicable) Address: My Board of Trustees Applic~ 3n Z Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency T~.u s"nsa :he Yes x~ No Date ., , ..... __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attaclunents if necessary): · Connect SCWA water service · Install new septic system · Re-model part of existing house within footprint · Abandon existing well and cesspool Board of Trustees Applici WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: O % ,, Connect SCWA water service · Install new septic system · Re-model part of existing house within footprint · Abandon existing well and cesspool square feet Closest distance between nearest existing structure and upland edge of wetlands: ~7 feet -- Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet To Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated? ~o O cubic yards How much material will be filled? ~ cubic yards Depth of which material will be removed or deposited: -- (o ~ ~ I Proposed slope throughout the area of operations: O ~ I: IS Manner in which material will be removed or deposited: feet ixl~. oxJ $~ PTtr-. 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): The freshwater non-tidal pond is separated from the residential lot by a bulkhead that is in good condition having been renovated under trustee permit # 4817 dated 10/29/97 which also required that a 10ft non-turf barrier be established between the bulkhead and the remainder of the lot. It is not planned to disturb this barrier or the bulkhead. Accordingly no effect on the wetland is planned Board of Trustees ApplicOn COASTAL EROSION APPLICATION DATA Purposes of proposed activity: · Connect SCWA water servi-c~ .... · Install new septic system · Re-model part of existing house within footprint · Abandon existing well and cesspool Are wetlands present within 100 feet of the proposed activity'! No ~ Yes Does the project involve excavation or filling? No X/ Yes If Yes, how much material will be excavated? ~O .(cubic yards) How much material will be filled? ~O (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) The replacement of the well by SCWA service will have no long term adverse environmental impact since the capping of the well will follow well established practice as recommended by the SC Health Services Dept. The abandonment of the cesspool near the bulkhead will be conducted again using washing and filling procedures approved by the SC Health Services Dept. Its replacement with a modem septic system installed in the fi.om yard of the property with the leaching pools placed almost 100fl from the freshwater lake will introduce a positive environmental impact. The home improvement of adding a bedroom will increase the liquid waste potential flow, but this is mitigated by the fact that the waste is being treated in a system that is no longer within 35ft of the bulkhead. The introduction of the leaching pools will raise the level of the front yard grade by about lfi on average in 30fi. Any excess run-off can be captured in drywells located at the front comers to the house before it can flow to the freshwater lake. 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL. ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by A])pIIcant or Project sponsor) 1 APPLICANT/SPONSOR [2. PROJECT NAME 3. PROJECT LOCATION: Municipality --~o~J I~H ~ I..l~ County -~'O ~' F:IDI...~ 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5 PROPOSEDACTION IS: [] New [] Expansion [] Modification/alteration DESCRIBE PROJECT BRIEFLY · E Connect SCWA water service Install new septic system Re-model part of existing house within footprint Abandon existing well and cesspool 7 AMOUNT OF LAND AFFECTED: Initially O,"~ ~ ac*es Ultimately O ,~S acres 8 W1LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If No, desc~be bdefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [] Industrial [] Commercial [] Agriculture [] Park/Forest/Open Space [] Other Describe: 10. DOES ACT ON NVOLVE A PERM T APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? r~] Yes I I No If Yes, list agency(s) name and permit/approvals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMit OR APPROVAL? ~ Yes ~ No If Yes, list agency(s) name and pe~iFapprovals: I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: p~, ~ ~ /~1'~ ~ 1~, "l-'l" Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 Reset PART II - IMPACT ASSESSMENT {To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD ~N 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. B WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACT ONS N 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency E~] Yes r--~ No c COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1 Existing air quality, sudace or groundwater quality or quan ty, no se evels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain beefly: C2. Aesthetic, agdcuflural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3 Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or hreatened or endangered species? Explain bdefly 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: C5. Growth, subsequent development, or related activities likely to be indu~.~:l by the proposed action? Explain briefly: C6. Long term, shod term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7. Other impacts (including changes in use of ether quantity or type of energy)? Explain bdefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? [] Yes [] No If Yes, explain briefly: E. IS THERE, OR S THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENV RONMENTAL IMPACTS'~. [] Yes [] NO If Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidentl~edab~ve'determinewhetheritissubstantia~'~arge~imp~rtant~r~therwisesigni~cant 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 exptanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequatety 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 identified 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, ] Checkthisboxifyou have determined, based on theinforma ion andanays s aboveand any supporting documen~tion, that the proposed action WtLt NOT resu n any s gn ficant adverse environmeotal impacts AND provide, on attachments as necessary, the reasons supporting this determination Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Oate Title of Responsible Officer Signature of Preparer (if different from responsible officer) Reset PROOF OF MAILING oF NOTICE ATTACH CERTIFIED MAIL Name Address Zbigniew & Anna Kozlowski 7345 Soundview Ave ,000. 9.6., Rudolf & Daisy Bemstein 15314 Sobey Rd, 1000- 59-6-10/11/6 Saratoga, Ca 95070 USE I USE STATE OF NEW YORK COUNTY OF SUFFOLK , being duly sworn, deposes and says that on the day of rq ~,-/ ,200~, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at .5~ ,o-v,.~ o ~r> , that said Notices were mailed to each of said (certified) (registered) mail. l~womtob,e~remethisc~' day of ~0~ ,20 D~ No~ ~ublic ~ NOT~Y PUBUC.State of N~ ~ No. 01DO4634870 Qualified in Suffolk Coun~ ~ NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: SCTM# Ic~c~ ~ct~ r~ ~ ~. I YOU ARE HEREBY GiVEN NOTICE: That it is the intention of the undersigned to request a Permit from the Board of Trustees to: · Connect SCWA water service · Install new septic system · Re-model part of existing house within footprint · Abandon existing well and cesspool That tile property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: . You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Satlle Zbigniew & Anna Kozlowski 1000-59-6-5.2 Rudolf & Daisy Bemstein 1000- 59-6-10/11/6 Address 7345 Soundview Ave Southold, NY 11971-2736 15314 Sobey Rd, Saratoga, Ca 95070 STATE OF NEW YORK COUNTY OF SUFFOLK ., being duly sworn, deposes and says that on the day of n~ ~,-/ ., 20 6~, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~ ~,-r,, o ~.~ , that said Notices were mailed to each of said persons by (certified) (r~g~atarzd) mail. Sworn to before me this day of ,20¸ Notary Public 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 of the Application of ....................... COUNTY OF SUFFOLK) STATE OF NEW YORK) I, ]~E,/~/y ~fllCeg'-iT' , residing at being duly sworn, depose and say: AFFIDAVIT OF POSTiNG g-'Zq That on the7~ day of tldq.~ , 200~, I personally posted the property known as 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 ~/Jt~.. -~lxt. cm~l (~ o~O0 (' -- ^,~A Dated: (signature) Sworn to before me this ~day o~d~ 200q ~o}~y Ptiblic MELANIE OOROSKI NOTARY PUBLIC. State of New Yo~ No. 01D04634870 ~ualified in Suffolk Count~ ,-.,~/-, ~ D Commission Ex~ires Septembw 30. ~---.~-~ O Board of Trustees ApplicOon ~5~ (where AUTHORIZATION the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) 8 7433 $oundview Ave $outhold NY 11971 NYSDEC-Region 1 Division of Environmental Permits SUNY-Bldg 40 Stony brook, NY117-2356 Southold Town Board of Trustees Town Hall Annex Southold, NY 1 t971 Suffolk County Health Services Wastewater Management 360 Yaphank Ave Suite 2C Yaphank, NY 11980 January 16, 2008 Subject: 7433 Soundview Avenue, Southold, NY 11971 To whom it may concern, Please be advised that I have appointed Mr. Robert Barratt to act as my agent regarding the subject property. His details are as follows: Mr, Robert Barratt PE 4295 Vanston Road Cutchogue NY 11935 Fax (631) 734 2730 Cell (631) 875 0275 Please address all telephone calls and correspondence to his attention Thank you for your cooperation, · S/C~ Chen, Owner Sworn before me this ,',~' ~, ~ate ~/~,V ~' ?..00g Day of '~.~ ,26. 0 ~ Notary Public '~ BETTY J HO ;,!~ ~ No 01H05022561 I~-.~, ~e~ae ~I Board of Trustees Appl ion County of Suffolk State of New York ~ H- t ~3 C ~ t ~ q C t-4 tE k3 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. SWORN TO BEFORE ME THIS DAY OF }/~A Y ,200 ~> Notary Public BETTY J HO Co,- ....... ., 3"4'~ (~~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The eumose of this form is to nmvide information which can alert the town of vossthle conflicts oflnterest and allow it to take whatever action is necessary to avoid same. YOURNAME: C~F-2.~ SF!-I~3 ~ (Last name, first name, middle initial, unless you are apptying in the name of someone e]s¢ or other entity, sucb a~ a company. If so, indicate the other per~an'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"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title Or position of that person Describe the relationship between yourself (the applicant/agentJrepresentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): ___A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); ___C) an officer, director, preener, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this ~-- day of NI ~, Signature ~ .~'-k~ ' ' Print Name ,,~."x)~.. C ~:~.~' 200 ~ 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 si?4fificant 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- suDtoortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# t ~ ~':i' (o - ~' I The Application has been submitted to (check appropriate response): TownBoard R Planning Board [-~ Building Dept. [] BoardofTrustees [] 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: Connect SCWA water service · Install new septic system · Re-model part of existing house within footprint · Abandon existing well and cesspool Locationofaction: ~"I~'EB ~:>o~ot~u~o O,-U~ Site acreage: Present land use: ~t ~ qc.~_ F~ ~ c.~ tq-c~ ~t ~. Present zoning classification: :~E%t~-mo'z-~ qt.._ If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nameofapplicant: t5.c2. C*-t~td (Ot,osl~-re.) gG~'~JT. ~.~. gog, ce~-i~ (b) Mailing address: I1~. 12..o. 4~-'=t%- ~','~,,d~:'rD~,3 R--o~q-D,t C~TC._~O~.C,,~.i /k,j~ II (c) Telephone number: Area Code ( ) (z>'~l~ ~'7~'~ (d) Application number, if any: Will the action be directly undertaken, require fimding, or approval by a state or federal agency? Yes [] No[~ Ifyes, which state or federalagency? 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 Praetiees 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 '7 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 No No~plicable 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 III - Policies; Pages 34 through 38 for evaluation criteria. [] Yes [-~ No X 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. [] YeD NOPSI Not Applicable Attach additional sheets if necessary WORKING COAST PI Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. Sec LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [] Yes ~ No ~ Not Applicable Policy I1. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. Sec LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~-~ Yes [] No [] Not Applicable ~o~ ~ 'T~ '1~ ,q ~...... Attach additional sheets if necessary Policy 12. Protect agricultural land~ in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. At~ach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~ No ~ Not Applicable PREPARED BY TO THE ORDER OF - ~ Commerce FRANK W PALILLO ESQ ATTORNEY AT LAW 299 BROADWAY, SUITE 1820 NEW YORK, NY 10007-1913 FOR ,'OOO ~ Pchl' 229 DATE ?~ 258 5 & ?~ ?,' FRANK W PAMLLO ESQ 12-07 ATTORNEY AT LAW 299 BROADWAY, SUITE 1820 NEW YORK, NY 10007-1913 TOTHE ORDER OF FOR 225 II'DD08;S,' ':OB~,O~-~,&?~,;: ?q 25.°.5 Mr. Robert Barratt PE 4295 Vanston Road Cutchogue, NY 11935 Tel 631 875 0275 Fax 631 734 2730 E-Ma robertbarratt~optonline.net Southold Town Board of Trustees Town Hall 53095 US Route 25 PO Box 1179 Southold, NY 11971-0959 Mayl 7th, 2008 Subject: 7433 Soundview Avenue, Southold, NY,. SCTM# t 000-59-6-5.1 Members of the Board of Trustees, It is my pleasure to inform you that I have been retained by Ms. S. C Chen, the owner of the subject property, to act on her behalf regarding the subject wetland permit application. Her notarized letter of assignment is attached as part of the application. I have also been retained by Frank and Diane Palillo who plan to buy the property from S. C. Chen and their checks in the amount of $250.00 are attached to cover the full application fee. Three (3) copies of the application are attached for your review. We have also submitted a freshwater permit application to the NYSDEC. It is my plan to keep you up-dated as I receive feed-back from them. On the basis ora successful outcome of these actions we will apply for a permit to the SC Health Services Dept. I look forward to hearing from you in the near future regarding the date of the hearing, so I may mail certified notlees to the adjacent land-owners. Yours faithfully, Robert Ban'att End/Checks for $250.00 and 3 copies of applicati°~n New York State Department of Environmental Conservation Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0364 FAX: (631) 444-0360 Website: www.dec.state.ny.us Alexander B. Grannis Commissioner June 11, 2008 Mr. Shiu Shing Chen 42-20 Kissena Blvd. Apt A-4 Flushing, N.Y. 11355-3288 Re: Permit #1-4738-03830/00001 Dear Permittee: . JUN 16 2005 Southoig Town Board of Trustees 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. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. 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. Sincerely, Carol A. Farkas Environmental Analyst CAF/dj Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. The limits of clearing, grading and ground disturbance line is equal to 20 feet east of the bulkhead as shown on the approved plans. 2. Any work, disturbance, and or storage of construction materials shall be confined to within the limit of clearing and ground disturbance shown on the approved plan. 3. Any demolition debris, including excess construction materials and or excess excavated materials, shall be disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland by the close of business on the day such material was generated. 4. Prior to commencement of any construction activities, a continuous row of straw bales shall be staked end to end along the clearing limit line as described above. The bales shall be maintained, repaired and replaced as often as necessary to ensure proper function, until all disturbed areas are permanently vegetated. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are removed. 5. Straw bales shall be recessed two to four inches into the ground at all times. 6. All fill shall consist of clean soil, sand and gravel that is free of the following substances: asphalt, slag, flyash, broken concrete, demolition debris, garbage, household refuse, tires, woody materials including tree or landscape debris, and metal objects. 7. All equipment and machinery shall be stored and safely contained greater than 100' landward of the regulated wetland or waterbody at the end of each day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. Fuel or other chemical storage tanks shall be contained and located in an area greater than 100 feet landward of the regulated wetland or waterbody at all times. If equipment cannot be stored and safely contained 100 feet landward of the wetland or waterbody at the end of each day, then an absorbent tarp/mat system must be used. The absorbent tarp/mat system must ensure that inadvertent leakage of deleterious substances never reaches the ground or into the regulated wetland or waterbody. The tarp/mat must be large enough so that no part of the equipment over hangs the edge of the tarp/mat at any point. 8. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass and mulched with straw immediately upon completion of the project, within two (2) days of final grading, or by the expiration date of this permit, whichever is first. Mulch shall be maintained until a suitable vegetative cover is established. If seeding is impractical due to the season, a temporary mulch shall be applied and final seeding shall be performed as soon as weather conditions favor germination and growth. 9. Suitable vegetative cover is defined as a minimum of 85% area vegetatively covered and no unvegetated areas larger than one (1) square foot in size. 10. The permittee shall incorporate the attached Covenant (or similar language) to the deed for the property where the project will be conducted and file it with the Clerk of Suffolk County within 30 days of the effective date of this permit. This deed covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to: NYSDEC, Bureau of Habitat Regional Manager, SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 DEC PERMIT NUMBER 1-4738-03803/00001 PAGE 2 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( FRESHWATER WETLANDS) 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 of the 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. 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. All necessary precautions shall be taken to preclude contamination of anywetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 4. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across or along the bed of a waterway or floodplain, deposits within any regulatory floodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 5. There shall be no unreasonable interference with navigation by the work herein authorized. If upon 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. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302,303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Robert O. Barratt on 5/12/08. DEC PERMIT NUMBER 1-4738-03830/00001 PAGE 3 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMIT'I'EE 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, 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 permifiee. 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 dghts 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. GENERAL CONDITIONS General Condition 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 Depadment) 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 dudng 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. General Condition 2: Relationship of this 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. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permiL 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. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the dght to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. 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 matedal information or a matedal change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any previsions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. I DEC PERMIT NUMBER I i 1-4738-03830/00001 PAGE 4 of 4 NOTICE COVENANT TO THE DEED DECLARATION THIS DECLARATION, dated day of ,200 ~ is made by (hereinafter the "Declarant"), whose address is WITNESSETH WHEREAS, the Declarant is the owner of certain real property located in the Town of Southold, County of Suffolk, State of New York, Tax Map # District 1000, Section 59, Block 6, Lot(s) 5.1 which real property is more particularly described in Exhibit A annexed hereto (hereinafter referred to as the "Property"); and WHEREAS, the Property is situated in or adjacent to regulated fi'eshwater wetland SO-5 of the Southold Quadrangle which has been inventoried and mapped by the New York State Department of Environmental Conservation (hereinafter "Department"), pursuant to Environmental Conservation Law (hereinafter "ECL") Article 24 (also known as the "Freshwater Wetlands Act") and Part 664 of Title 6 of the New York Code of Rules and Regulations (hereinafter "6 NYCRR"); and WHEREAS, various activities conducted both in and adjacent to freshwater wetlands are regulated by the Department pursuant to ECL Article 24 and Part 663 of 6 NYCRR and require written authorization fi*om the Department prior to being conducted; NOW, THEREFORE', in recognition of the Deparlment's jurisdiction as set forth above, it is the responsibility of a party having any right, title, or interest in the Property, to obtain from the Department or any successor organization, a current description of all activities which are regulated pursuant to ECL Article 24 and Part 663 of 6 NYCRR, and to obtain written authorization from the Department prior to such regulated activities being conducted on the Property. Regulated activities include, but are not limited to clearing of vegetation; application of chemicals; excavation; grading and filling; and erection of any structures. By: STATE OF NEW YORK ) )SS. COUNTY OF ) On the day of in the year 200 , before me, the undersigned, a Notary Public in and for said state, personally appeared , personally known to me or proved to me on the basis of satisfactory evidence to be the person 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 person or entity upon behalf of which the person acted, executed the instrument. NOTARY PUBLIC ~umbcr of pages :erial # ,'ertificate # >rior Cfi. # TORRENS Deed / Mortgage Instrument Deed / Mortgage Recording / Filing Stamps Page / Filing Fee Handling 5, O0 TP-584 Notation EA-52 17 (County) EA-5217 (State) R,P.T.S,A. Comm. of Ed. 5. 00 Affidavit Certified Copy NYS Surcharge 15. 00 Other FEES Sub Total Sub Total Grand Total 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 Trmnsfer Tax Mansion Tax The property covered by this mortgage 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, RETURN THIS FORM TO: PERMIT NUMBER: PROJECT LOCATION/ADDRESS: CONTRACTOR NAME: NOTICE OF COMMENCEMENT OF CONSTRUCTION COMPLIANCE Bureau of Habitat NYSDEC 50 Circle Road - SUNY Stony Brook, NY 11790-2356 OR FAX TO: 631-444-0272 ISSUED TO: ADDRESS: TELEPHONE: Dear Sir: Pursuant to the General Condition of the referenced permit, you are hereby notified that the authorized activity shall commence on · We certi~ that we have read the referenced permit and approved plans and fully understand the authorized project and all permit conditions. We have inspected the project site and can complete the project as described in the permit and as depicted on the approved plans. We can do so in full compliance with all plan notes and permit conditions. The permit sign, permit and approved plans will be available at the site for inspection in accordance with general Condition No. 1. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS A T LEAST TWO DA YS PRIOR TO COMMENCEMENT OF THE PROJECT AND /OR ANY ASSOCIA TED REGULA TED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HA VE THE PERMIT AND APPROVED PLANS AVAILABLE A T THE WORK SITE FOR THE DURA TION OF THE PROJECT MA Y SUBJECT THE PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENAL TIES FOR NON-COMPLIANCE WITH PERMIT CONDITIONS. Cut alon~] this line ~ ~ ~ ~ ~_ RETURN THIS FORM TO: COMPLIANCE OR FAX TO: 631-444-0272 Bureau of Habitat NYSDEC 50 Circle Road - SUNY Stony Brook, NY 11790-2356 PERMIT NUMBER: PROJECT LOCATION/ADDRESS: ISSUED TO: CONTRACTOR NAME: ADDRESS: TELEPHONE: Dear Sir: Pursuant to the General Condition of the referenced permit, you are hereby notified that the authorized activity was completed on · We have fully complied with the terms and conditions of the permit and approved plans. (Both signatures required) PERMITEE DATE CONTRACTOR DATE THIS NO TICE, WITH PHOTOGRAPH$ OF ~ mE CO~P~.c ~ :u ~O,'~K Aivu/OR A COMPLETED SURVEY, AS APPROPRIATE, MUST BE SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. 95-20-1 (11/03) -9d New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of the approved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Permit Number Expiration Date Regional Permit Administrator ROGER EVANS NOTE: This notice is NOT a permit mmber of pages TORttENS ~ # rior Cfi. # _ D~ed / Mor~ggge Instrnment Deed / Mortgage Tax S~ / Filing Stamps FEES ~age / Filing Fee tandling 5. 00 7P-584 qotation :~A-52 17 (County) Sub Total -- ~A-5217 (State) . :I.P.T,S.A. __ · ~ d 5, O0 ~om.m. of E . Affidavit Certified Copy NY$ Surcharge 15. 00 Sub Total Other Orand Total Real Proper~y Tax Service Agency Verification Saris}actions/Discharges/Releases List Property Owners M~iling Address RECORD & RETURN TO: 1. Bask Tax 2. Additional Tax _ Sub Total Spec./Assit. Spec./Add, __ 51eld for Appointment Transfer Mansion Tax fanfily dweI1/ng only, or NO ommunity Preservation Fund Consideration Amount $ _ CPF Tax Due $ Improved Vacant Land TD TD TD I I Title Company Information Co. Name Suffolk County Recording & Endorsement Page This page forms part of the attached ff'~ ~ ~ made by: ' (SfECIFT T'C.~E OF INSTRUMENT) ~ I The prerrfises herein is situated in sUFFOLK COUNTY. NEW YORK. TO In the Township of ~ ~'~ In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR pRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING (over) ROB Robert 0 Barratt Notes $ Proposed SCWA water servine 6 Area encompassing the septic tank and leaching pools, the grade level will be raised to elevations 9.4it thru 10.2fi when the excavation spoil mad the top soil is replaced after installation of new septic system 7 Existing well to be abandoned 8 Existing structures are per sur~ey 9 10th~ line from the bulldaead has been theluded for reviewe~'s convenience 11 Legend: Photos of st~kes (1) Test-hole lool~ag east (2) Septic Talflc waterside looking east (3) Leaching pool waterside looldng soutbe~t Property owner: Shiu Ching Chen Subject property SCTM# 1000-59-6-$.1 Property address: 7433 Soundview Ave. Southold, NY 11971 Location Utility Pole #, LIL 6 DRAWN BY ~.. O ~ 121.22' APPROVED BY BOARD OF TRUSTEES TOWN OF SO"tJTHOLD -off PROPOSED SEPTIC SYSTEM DETAIL SEP~ TANK SURVEY OF PROPERTY S £ TUA TE SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000--69-06-6.1 SCALE 1"=30' APRIL 8, 2008 AREA = 14,576 sq. ff. NOTES: r. ELF~/ATIONS ARE REFERENCED TO N.G.V.D. 192.9 DATUM EXISTING [L[VAllONS ABE SHOWN THUS: ~0 2t MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1,200 GALLONS. I TANK; 8' DIA. $'.UQUID DEPTH QPEOPOSED LEACHING POOL PROPOSED SEPTIC TANK 4. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. B. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE ABANDONED IN ACCORDANCE WITH S.C.D.H.S. STANDARDS. TEST HOLE DATA Nathan Taft Corwin III Land Surveyor PHONE (6511727-2a90 Fox (6511727-1727 1 Proposed addition within existing building footprint ,2 2~, ', · I~Av, 1 9 2005 ~ ,~,, ~, .. 2 Proposed lay-down area on existing driveway ~ ~' :'~~-?~X~/ 3 Existing cesspool to be abandoned ~ -'--~ \\ \~ '~ ~ ~ .' ..~'¢ f~=m\.'rT& \ % ';re, x/ 4 Bulkhead with non-fidal Great Pond ~~~ ~'~,-x"~r', 6 Area encompassing the septic tank and leaching pools, the grade level will be raised to ~~~.~.~ ~~.~ ' ~'~¢~,.~.~.~"x installationelevati°ns 9.4ft thru 10.2ft when the excavation spoil and the top soil is replaced afterofnew septic system ~~ .~ ~~.x v 7 Existing well to be abandoned ~ .~.~ ~,~._~.~__'ve~ -rtq~ 8 Existing structures are per survey ~~~, \ ~ ~.-~'~ ~ 9 100ft line fi`om the bulkhead has been included for reviewer's convenience ~, 10 Legend: Photos of general views ---- / ,¢~%~ ~,_ ~i ~~~x7%~x~ (A) Looking east from "Great Pond" (B) Looking west from house ~ (C) Looking southwest from driveway ~,~,,~ q ,o ~, oo°~'~u'~ I:m.~ so,~,~o~.~. ~,o,~a_~ o~- ~.~...~-">'- ¼%v 11 Legend: Photos of stakes 'I,,o~,~ ~,e~.,~ ct er 4,a~'~ ~x~ (1) Test-hole looking east t,~,t~t~ ~olan[ q-/ ~\.~-~ ~- (2) Septic Tank waterside looking east ~r<~,~ t~.~J-r o ~' T'~-~ ~-/'~ ['zo*~ ~~L)- (3) Leaching pool waterside looking southeast ROB Pr°perty °wner: Shiu Ching Chen DWg~ Subject property SCTM# 1000-59-6-5.1 .t-v no Robert O Barratt Property address: 7433 Soundview Ave. Southold, NY 11971 . ~ -' . P~o~io.~ ~.z.~ Location Utility Pole #, LIL 6 asnwn aY 429~ Yanston Rd Phone 631 875 0275 SCALE Fax 631 734 2730 IHv,~= rain, PITCH 1/4'/1' rnln PFTOH ' I PROPOSED SEPTIC SYSTEM DETAIL SEPTIC TANK (1] LEACHING POOLS (6) N 8558~ E ~/o/r RUDOLF BERNSTEIN DWELUNG 0 121.22' x SURVEY OF PROPERTY SITUATE SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-.59-06-5.1 SCALE 1':20' APRIL 8, 2008 AREA = 14,576 sq. ff. (TO BULKHEAD) 0.~,~5 NOTES: 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS: 5O 2. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1.200 GALLONS. I TANK; 8' DIA. 5' LIQUID DEPTH $. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ff SIDEWALL AREA. 6 POOLS; 2' DEEP, 8' dio. PROPOSED EXPANSION POOL PROPOSED LEACHING POOl PROPOSEDSEPTIC TANK 4. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE OBSERVATIONS AND/OR DATA OBTAINED/FROM OTHERS. 5. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE AGANDONED IN ACCORDANCE WITH S.C.D.H.S. STANDARDS. FROM FIELD TEST HOLE DATA (TEST HOLE DUG BY McDONALD GEOSCIENCE ON MARCH 4, 5,7' THE EXISTENCE OF RIGHTS OF WAY NYS. Lic No, 50467 Nathan Taft Corw n III Land Surveyor PHONE (631)727-2090 Fox (631)727-1727 28-07~