The URL can be used to link to this page

Home My WebLink AboutTR-6924 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer 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 CERTIFICATE OF COMPLIANCE # 0654C Date: June 10, 2011 THIS CERTIFIES that the construction of a one-story addition to existing dwelling; new deck; gutters to leaders to drywells At 5160 Indian Neck Lane, Peconic, New York Suffolk County Tax Map # 98-4-23 Conforms to the applications for a Trustees Permit heretofore fried in this office Dated June 25, 2008 pursuant to which Trustees Wetland Permit #6924 Dated July 23, 2008 and Amended on October 21, 2009 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 construction of a one-story addition to existing dwelling; new deck; gutters to leaders to drywells The certificate is issued to ELIZABETH & DAVID BRANCH owner of the aforesaid property. Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ~ / (~- [ ( / X~ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer 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 June 16, 2010 Mr. & Mm. David Bmnch 681Weed St. New Canaan, CT 06840 RE: 5160 INDIAN NECK LANE, PECONIC SCTM#98-4-23 Dear Mr. & Mrs. Branch: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., June 16, 2010: RESOLVED, that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit #6924, as issued on July 23, 2008 and Amended on October 21, 2009. This is not an approval from any other agency. Sincerely, Jl~ '~e s~eD~°t? e~cY: r d~~e s JMD:lms 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 October 21, 2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. & Mrs. David Branch 681 Weed Street New Canaan, CT 06840 RE: ELIZABETH & DAVID BRANCH 5160 INDIAN NECK LANE, PECONIC SCTM# 98-4-23 Dear Mr. & Mrs. Branch: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, October 21,2009: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Wetland Permit #6924 to reduce the size and square footage of the deck and eliminate the screened porch; remove the existing concrete walkway and plant grass to meet with grass that is already present on front lawn area, and as depicted on the revised site plan prepared by Tour de Force Designs, LLC last dated October 9, 2009, and received on October 16, 2009. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, ames F. King President, Board of Trustees JFK:eac Builders 63~3B1B p.1 John Bertani Builder Inc. 1380 Oakwood Ddve Southold, N.Y. 11971 (515) 765-1594 FAX (516) 765-3916 May 5, 2011 Elizabeth and David Branch - Permit no. 6924 MAY - 5 2011 Ms. Jill Ooherty. President Southold Town Trustees P.O. Box 1179 Sou~old, NY 11971 We am requesting a project complete, compliance inspeclJc~ for ~he Elizabelh and David Branch Residence. 5160 Indian Neck Lane Peconic, permit # 6924. Thank y~J. Linda D. Bed,,ani Sent byfaxto 765-6641 - 515/11 ELIZABETH T. BRANCH May 27, 2010 Board of Trustees Town of Southold 5305 Route 25 PO Box 1179 Southold, NY 11971 0959 Re: Elizabeth & David Branch, 5160 Indian N~ck_ [ane~Peconi¢ SCTM# 9~ ~ 23; Permit #6924 Issued July 23, 2008 and Administrative Act~On of October 21, 2009 We are seeking an extension to the permit //6924, issued on July 23, ~2608; to.~:onstruct a one-story addition to our existing dwelling, and a deck. We are also enclosing a check for $50.00 as required by this request. We arc seeking this extension for a few reasons: As noted on our request and as granted by your Administrative Action of October 21, 2009, we reduced the size and square footage of the project. This necessitated additional revised plans to the interior of the main dwelling and delivery of these revised plans to the prospective building contractor. This then caused more time to be expended for construction estimates. While working with the building contractor, it yeas decided to abandon the present septic systmn and well and proceed with a new septic system and hook up to town water system. (This was shown on the survey which *aras submitted to the Town Trustees and is not a change. However, on advice of the building contractor, we have asked the surveyor to show the existing septic and well as "abandoned.") The surveyor also needed to remove a drywell which had been shown when we anticipated reconstruction of the small cottage in the rear of the property which is now not being done. We have been waiting for more than two months for the surveyor to produce this minor notation on our survey in order to fde with the Health Departxnent in Yaphank. It seems no amount of "cajoling" has been successful. We have now been promised what we need by next week. With the needed surveys we will immediately file the necessary papers with the Health Department. We have been advised that is approval can be from six weeks to two months. The Town 'lYustees' Permit expires July, 2010. If we get approval for an extension, we can begin construction as soon as we have the Health Department approval and a building permit from the 'Ibwn Building Dept. We arc anticipating that we will begin the project this summer. - 2 - May 27, 2010 If we can supply further information or clarification, please contact us at our Connecticut address and telephone number. Sincerely yours, 681 Weed Street, New Canaan, CT 06840 Telephone; 203 966-9782 Fax: 203 966-1617 ELIZABETH T BRANCH October 13, 2009 Board of Trustees Town of Southold 5305 Route 25 PO Box 1179 Southold, NY 11971-0959 Re: Elizabeth & David Branch, 5160 Indian Neck Lane, Peconic SCTM# 98-4-2~; Permit #6924, Issued July 23, 2008 Gentlemen: As discussed on the telephone last week, we are seeking an Administrative Amendment to the pertmt #6924, issued on July 23, 2008, to construct a one story addition to our existing dwelling, and a deck and screened porch. Enclosed are two copies of an addendum to the plans ot/ginally submitted to you and on which you based your approval in 2008. We are also enclosing a check for $50.00 as required. The addendum highlights the changes that we would be making, pending your agreement to the amendment. The changes are "bubbled" on the plans, and encompass: 1. Less construction: we are reducing the size and square footage of the deck and eliminaUng screened porch. (See legend on plans as to square footage.) 2. Present Code and Setbacks: changes will comply with code and setbacks and not necessitate variances. 3. By doing numbers 2 and 3, above, the house will be further from the water. 4. Walkway from front steps to beach: present concrete walkway will be removed and no new walkway installed; grass will be planted to meet with grass that is already present on front lawn area. If we can supply further information or clarification, please contact us at our ConnecUcut address and telephone number. Sincerely yours, · rYavid Branch 681 Weed Street, New Canaan, CT 06840 'Telephone: 203 966-9782 Fax: 203 966-1617 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 ~ constructed V// Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6924 DATE: JULY 23~ 2008 ISSUED TO: ELIZABETH & DAVID BRANCH PROPERTY ADDRESS: 5160 INDIAN NECK LANE~ PECONIC SCTM# 98-4-23 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 July 23. 2008, and in consideration of application fee in the sum of $250.00 paid by Elizabeth & D__avid Branch and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct an 881.44 square foot one-story addition to the existing dwelling, a 177.42 square foot deck and screened porch addition onto an existing deck, to be reconstructed, install dryweils, and construct a new 4'x16' pad, with the condition that the new walkway connected to the new pad is to be made of a pervious material and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, and as depicted on the site plan prepared by Tour de Force Designs, LLC, last dated August 19, 2008, and received on August 25, 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. TERMS AND CONDITIONS The Permittee Elizabeth & David Branch, residing at 5160 Indian Neck Lane, Peconic, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 23, 2008 Mr. Ken Poliwoda Polywaters Permits LLC P.O. Box 1147 Southold, NY 11971 RE: ELIZABETH & DAVID BRANCH 5160 INDIAN NECK LANE, PECONIC SCTM# 98-4-23 Dear Mr. Poliwoda: The Board of Town Trustees took the following action dudng its regular meeting held on Wednesday, July 23, 2008 regarding the above matter: WHEREAS, Polywaters Permits LLC, on behalf of ELIZABETH & DAVID BRANCH applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 25, 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 possible through the imposition of the following Best Management Practice requirements: the new walkway connected to the new pad is to be made of a pervious material and in accordance with chapter 236 of the Town Code-Storm Water Runoff, and WHEREAS, a Public Headng was held by the Town Trustees with respect to said application on July 23, 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, 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 requirement 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 ELIZABETH & DAVID BRANCH to construct an 881.44 square foot one-story addition to the existing dwelling, a 177.42 square foot deck and screened pomh addition onto an existing deck, to be reconstructed, install dryweils, and construct a new 4'x16' pad, with the condition that the new walkway connected to the new pad is to be made of a pervious material and in accordance with chapter 236 of the Town Code-Storm Water Runoff, and as depicted on the site plan prepared by, last dated February 18, 2008, and received on February 25, 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 truly yours, King President, Board of Trustees JFK/eac 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 Please be advised that your application dated ,..Tc~,. ~Ls'-~ ~::~'g" has been reviewed by this Board at the regular meeting of and your application has been approved pending the compl~etion'of the following items checked off below. \/Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of C6nstruction ($50.00) .//J/2 Constructed ($50.00) v Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees am 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 ~et forth in Chapter 275 of the Southold lown Code. lhe following fee must be paid within 90 days or re-application fees will be necessary. You will receiYe your permit upon completion of the aboYe. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $. _~---(~) O.~ BY: James F. King, President Board of Trustees James F. King, President Jill M. Dohe~ty, Vice-President Peggy A. Dickemon 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: ELIZABETH & DAVID BRANCH request a Wetland Permit to construct an 881.44 sq.ft, one-story addition to the existing dwelling, a 177.42 sq.ft, deck and screened porch addition onto an existing deck, to be reconstructed, install drywells, and construct a new 4'X 16' concrete pad. Located: 5160 Indian Neck Lane, Peconic. SCTM#98-4-23 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _~hapt.275 Chapt. 111 other Sound /~Bay Type of Application: ?f-,,Wetland __Coastal Erosion __Amendment ~Administrative__Emergency __Pre-Submission Violation Info needed: . Modifications: C (~-,, -, ~ L Present Were: __&King __J.Doherty __P.Dickerson ,~. D. Bergen__ B.Ghosio, D. Dzenkowski Mark Terry__other Form filled out in the field by 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-I 892 Fax (631 ) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 16, 2008, the following recommendation was made: Moved by Jack McGreevy, seconded by Don Wilder, it was RESOVLED to SUPPORT the Wetland Permit application of ELIZABETH & DAVID BRANCH to construct an 881.44 sq.ft, one-story addition to the existing dwelling, a 177.42 sq.ft, deck and screened porch addition onto an existing deck, to be reconstructed, install drywells, and construct a new 4'X 16' concrete pad. Located: 5160 Indian Neck Lane, Peconic. SCTM#98-4-23 Inspected by: Jack McGreevy Vote of Council: Ayes: All Motion Carried I/ COUNTY OF SUFFOLK OD i[ * - ~ &OUTHOLD Tour de Force Designs 40 Laurel Hill Road Brookfield, CT 06804 Telephone: (203) 775-2538 Fax: (203) 775-2539 TO: Board of Trustees Town Hall Annex PO Box 1179 Southotd, NY 11971 Transmittal DATE: 06/19/08 JOB: Branch Residence 5160 Indian Neck Lane/Peconic Town of Southold Suffolk County, NY 1 t971 RE: Revised ST-I Drawings Trustees Submission WE ARE SENDING YOU: A~ched [] Shop drawings ~l~ts [3 Under separate cover via [] Plans [] Samples the following items: [] Specifications [] Copy of letter [] Change order [] Olher: COPIES DATE NO. DESCRIPTION I 08/19/08 ST-1 Revised Site Plan /Trustees Submission THESE ARE TRANSMITTED as checked below: [] For approval [] Approved as submitted [] Resubmit copies for approval [] For your use [] Approved as noted ~ Submit ~requested Returned for corrections Return [] [] [] For review and comment [] Other: copies for distribution corrected prints [] FOR BIDS DUE [] PRINTS RETURNED AFTER LOAN TO US Enclosed please find the revised ST- 1 plan per your request. The walkway and pad have been changed to reflect pervious material. Any questions let me know. Thank you for your time. Jacqueline A. Salame, AIA COPY TO: D&B Branch & K. Pollywada If enclosares are not as noted, kindly notify us at once OFFICE LOCATION: Town Hall Annex 54375 State Route 25 Main Rd. & Youngs Ave. Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD From: Date: Re: Jim King, President Town of Southold Board of Trustees Scott Hilary, LWRP Coordinator July 16, 2008 Proposed Permit to Wetland Permit for ELIZABETH & DAVID BRANCH requests SCTM#98-4-23 Polywaters Permits on behalf of ELIZABETH & DAVID BRANCH requests a Wetland Permit to construct an 881.44 sq.t~, one-story addition to the existing dwelling, a 177.42 sq.ft, deck and screened porch addition onto an existing deck, to be reconstructed, install drywells, and construct a new 4'X 16' concrete pad. Located: 5160 Indian Neck Lane, Peconic. SCTM#98-4-23 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the $outhold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The distance from the edge of wetlands (Beach) to the proposed action(s) is less than 100 feetI a minimum setback distance of 100 feet from the wetland line is required pursuant to Chapter 275-3. Findings~ purpose~ iurisdiction~ setbacks. Please require that the applicant amend the application to meet the above policy to the greatest extent practicable. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application l~-Wetland Permit Application __ Administrative Permit Amendment/Transfer/Extension ce~vved Application: ~(o1~ ~ ceived Fee:$~'~O~- --.~omPleted Application ~6~ ! ~I~ Incomplete SEQRA Classification: Type l__Type II Unlisted Coordination:(date sent) ,~L~VRP Consistency Assessment Form ~[~'~!fi~ ,~ACReferral Sent: /~lg_"l~[7 ~of Inspection:~ Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~.Ag~51ic Hearing Held: '? ! ~.~!~1~ __Resolution: Name of Applicant ~'~/,'2^~£+1, Phone Number:( ) Suffolk County Tax Map Number: 1000 Property Location: (provide LILCO Pole #, distance to cross streets, and location) (If applicable) Address: Phone: b~]- .~"~ -~¢~ er//] of Trustees Applica~ GENERAL DATA Land Area (in square feet): J/Y' Area Zoning:. ~fS,'ded4,~l Previous use of property: f~fSiclE,~4,~ / Intended use of property: ,~£~/d~'/J-/.~ ~/ Covenants and Restrictions: Yes No If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? / No Yes If yes, provide explanation: Project Description (use attachments if necessary): o,v,'o E~s~,~] bet~ 'to ae ~oard of Trustees Applica~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /qbe, ~ ~9,~,~ ~, ,' Area of wetlands on lot: ~?mo z ,_~CCL) square feet a f- f3'k',q¢ t4 Percent coverage of lot: ,,.7._5~ % Closest distance between nearest existing structure and upland edge of wetlands: gq. 7 feet Closest distance between nearest proposed structure and upland edge of wetlands: ~q, ? feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? 100 cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: ,4ff~o~: ~ feet Proposed slope throughout the area of operations: 7/~'5' '(~)" Manner in which material will be removed or deposited: ~7/qdl4:,.)~ 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): NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GWEN NOTICE: 1. That it is the intention of thc undersigned to request a Permit from the Board of Trustees to: 2. That the 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: _2~.},/ 23 . 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: MAIL1NG ADDRESS: PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: STATE OF NEW YORK COUNTY OF SUFFOLK ., residing at · being duly swom, deposes and says that on the day of ,20 , deponent mailed a tree 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 , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ,20 Notary Public PROJECT ID NUMBER DART 1 - PROJECT INFORMATION 1, APPLICANT / SPONSOR 3.PROJECT LOCATION: 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME oou ty SEQR 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc - or provide mae 5/40 y.d, u 5. IS PROPOSED ACTION: ~ New ~;~ Expansion ~ Modification / alteration L_J DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Inifially acres Ultimately acres · WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r~Yes [] NO If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ['~----]Residential [~lndustrial r~commercial r~Agriculture [] Park / Forest / Open Space [~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) [~Yes [~No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes ~]No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E es r No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Signature ~ ~.r~ if the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. [-'-]Yes [~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C, COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1.Existing air quality, sun'ace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I C4. A commumly s existing plans or goals as officially adopted or a change m use o y P [ C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdefly: / C6. L!~g term: sh01~ t~rm, cumulative, or ofhei~ects n~i i~e~[ified ,n~,:C5? C7. Other im_ ........ pjacts (includin ~ chan ~ es in use of either (~ uanti [~ ort ype of ener D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? Ill yes, explain briefly: E. iS TH ERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? )f yes expiain: ~ART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (bi probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (fi magnitude. If necessanJ, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of signiticance 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. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi.~ determination. Name of Lead Agency Date Title of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS NalYle: Address: STATE OF NEW YORK COUNTY OF SUFFOLK }/£,c/ IOo/,'~x.~ ~/.,,v~',~'tffR$ ?f_~n,~?)esidingat /~Yf- /~,¢,'Geo-/,'~/' ,~,~. ~,~,,-~fio/cl -,Att/. II~/ ,beingdulyswom, deposesandsaysthatonthe lq day of~,.7~ I,-'] ,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 Officeat ~o~-/-~.~-~ }QL/ , that said Notices were mailed to each ofsaid persons by Sworn to before me this Day oft'-.., ~ f.~ ,20d;~ Notary Public N. CONNIED BUNCH omfy PuM¢, S~te of New York No. 01BU6185050 ,...Quaifi~in.S~ffolkt~&flty t,mnm ssmfl Expires Aoril 14. 20/.,9-. IIL'g" 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) AFFIDAVIT OF POSTING I, /(eM ~],'~aob, q (~6£,0';.), residing at being duly sworn, depose and say: That on the,I ~] day of J'u Iq ,2000°, 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 fpr.eight days prior to the date, of the public hearing. Date of hearing noted thereon to be held (,/.Jt'~- ~ &4 o~.:~,: c~P0~' . Dated: (signature) S~Lom to before me this It/ day of~ 200? ary Public ~m~ssion Expires April NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEE& TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Pemfit from the Board of Trustees That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 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: XloJ,I :~:5 . You may contact the Trustees Office at 765-1892 or in wnhng. 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. Enc: Copy of sketch or plan showing proposal for your convenience. APPLICAN~PRESENTATIVE TRANSAC~ DISCLOSURE FORM The Town of Southold's Code of Ethics omhibits conflicts of interest on the hart of town officers and cmnlovees. The our~ose of this form is to orovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is ne - 't void same_. (Last name, first name, ~niddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other pomon's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ~ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activity.) Do you perscoally (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 ~1~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the spoce prox/ided. 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 applic0nt (when the applicant is a corporation); __B) the legal or beneficial ownqr of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, partner, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this Signature ]~.~.~'~') Print Name 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 Waterfxont Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- supoortin~ 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# lO00 ~:~ ~] - ~23 PROJECTNAME ~E¢~. /~oRCf-] / .~ 5'frothy flc/tJi4iod The Application has been submitted to (check appropriate response): Town Bo.rd Planning Bo.rOV Bu O g Oept. Bo.r of Trustees 71 Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ~-] construction, planning activity, agency regulation, land transaction) ~ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name (b) Mailing address: (c) Telephone number: Area Code ( ) ~0 3 ° ~' - ~20°.2 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [-'] No ~-] If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [] Yes [] No [--] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout thc Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~i~ 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 ~2] Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in thc Town of Southold. Sec 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. 1 Yes No ~rNot Applicab e 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. V~ 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 [] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for publie 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. ~-~ yej~ No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [] Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes [~ No [] Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~ No ~ Not Applicable PREPARED BY ~,E,'~ /~¢L'~ob~ TITLE DATE ~'UN-24-~8 '16: 8~ ~CEI~ I_A~' OFFICE L:~13°~79~ P. 0~' Bo.~rd of Trus2eesAp~licat£on DEPOSES AND AFFIRMS ~'HAT HFJSHE IS THE APPLICANT FOR TH~ ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN AR'8 TRUE TO THE 8EST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALt, WOR.K WILL BE DONJ~ IN 'FILE MANNER SET FORTH ]N THIS A~PLICATION AND AS MAY BE APPROVED BY THE $OUTHOLD TOWN BOARD OF TRUSTEES. TI-Fd APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAOES AND CLAIMS ARISING; UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE TIlE TRUSTEES, THEIR AGENT(S) OR REPRESENTATiVES(S), TO ENTER ONTO MY PROPERTY TO INSPECt TFIE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS___~, ~ 7.~... DAY OF ~ ot',g2 ._,20p..~ Notary Publi~ DAVIDA M. OI.INYK 06/24/08 03:56 PM DECEW SPERRY A Page 2 JUN-~,4-~008 16:07 20:~"~ P.03 D~CEWLAWOFFICE ~ma~ o~ ~z~ste'es AUTH~HI Z&TIC~ (where the applicant is not the owner) 1, ZlA=abech B~a.,~ch:-David B~anch'. ~dsl~l)-ng at:_ (~&}~?Teed S. creec · - ~print G~rner of property) (mal~ng aadre, ss) do hereby authorize ( Agent to apply for pe~it(s) £rom Trustees on ~ ~lf. 06/24/08 03:56 PU 8 DECEW SPERRY A TOTAL P.03 Page S / / ..< / PROPOSED DRYWELL~ NEW WOOD STEI UP REOONFIOURED NEW MUDROOM LEACHING ,POOLS -~. .INE OF ~ SEPTIC SHOWER EXISTING 1-1/2 STORY FRAME HOUSE F. FL 14.45 NEW 1 STORY PROPOSED~ ]RYWELL NEW WOOD OF ZONING DATA ZONE - R~ U~E - 5INGLE FAMILY LOT R3:QUIP-.EMENT5 REQUIR`ED / ALLOWED EXISTING / PR`OPODED LOT 51ZE 40,000± 5P Min J g,g,35G.04 -+ 5P = 4,278_+ ACR. E5 LOT COVERAGE - 20% 20% (8.000 5? Mm ) 1.51% (3,s7o 4 st) / 2.42 %(4,5 ~,555~J 5~TBACK FRONT (STP~ET) N/A N/A 5tDE(LEFT) 20.0h~ J0.9 hq'_+ / G.J ST_+ PERVIOUS / PERVIOUS MATERIAL GR05¢ FLOOR. AP-CA EXISTING PRO?ODED CHANGE MAIN HOUSE: PR~--P-~NE I~ DRYWELL TANK ~ ~, ~.T~C~ ~7' ~ ~ / ~ .... '---. ~/co~c ST~ /~ / AlE CONDITIONER ~ WA" J UNITS -~ ~: ~ k ~ ~ ' ~ ~ ~ ' t,/_) ~ ~ ~ - ~ ~ / ,, ~ x ~ x ,~ ~ x APPROVED BY ~. X , ~., _ , '~s . ~- ' - ~ BOARD OFTRUSTEES ~ ' ~ ~ ~ k ~ DATE N/~/~ ~,.~-~/~ .ous~S~e"~ ~ ~ ~ ~ ~ ~ ~ AUG 2 5 2008 ~ / / . 2162.00' 1 ~ ~ ~ ~ ~' /// N 4~ 2~; W SEE DETAIL ......... POP`` ADDITIONAL 5]TE NFOR`MATION DEE 5UR`VEY OF pR`OpdET'rl '" '~ '~ '" SCALE:1" = 20'-- O" ??J~FAR.ED DY NATHAN TA~T COR`WiN III LAND 5UR`VEYOP-., "'-- - 5.C. TAX No. J 000 ~¢- 4-23, ?EBR. UAP-.Y I 5, 2OOG LA.%T R`EVISION APP-JL ] 5, 20OD. =~ I P-.ESIDENCE I ST-I / / '~... ~--~.~ PROPOSED~. /' ~'~.~,~. ~'/ ~ DRYWELL ~ ~NECT TO ~ DRAINAGE ZONING DATA ZONE - P.2 USE - SINGLE FAMILY LOT P..EQUIR/=MENTS REQUIRED / ALLOWED EXISTING / FP-.O?OSED LOT 51ZE 40,000-+ DF Mtn. 18G,35G.04± DF: 4.278+- ACRE5 " ' ~' '~' "' '~ SEPTIC OF + '~' ~' ~ OVERHANG ~ / PROPOSED NEW NEW WOOD '~. 1 STORY STOOP · -.~ SHOWER GROSS FLOOR AREA ~3(ISTING PROPOSED CHANGE %- ~p NEW WOOD RECONFIGURED BRICK EXISTING MOVE EXISTING CONCREYE PAD AND/ 1 - 1/2 STORY CONCRETE WALKWAY/ 4V~~ FRAME HOUSE / F. FL 14.45 ~ ~ ~ -- ~ 77''''~ ~1 /~ / ~RYWELL/ AIR CONDITIONER ~ WA~ / UNITS . / ~ ~ DETAIL " '' ~- ' " ~VISED SUB~SSION I '~ I I ~ 262.00' / / ~ AE5ID~NCE SEE DETAIL .~ NOTE: 1" I0' 0" __ -- 1"20'0" 5.C. T~ No. , 000 98- 4-23, PEDRUARY I 5, 2~6 ST I I ....... SCALE: = - ZONING DATA OVERHANG PROPOSED ~ -. DRYWELL7 ~- ~opW~O NL~ %.... NEW 1 STORY SHOWER ~- 0-'"- POST ¢:_ _9.9_' _ _ + WOOD RECONFIOURED ~ Bf~lCK GRODS fiLOOR AD. EA EXISTING PROPOSED CHANGE MAIN HOUSE; FIRST FLO0~. 1,206. I G 5F 2,0~9 %0 DF 661.44 DF EXISTING STORY FRAME HOUSE F. FL 14,45 PERVIOUS / "IDE 'CARD sE'fBAC~K ~ __ ~ -- -- ~'~L'~ OPOSED/ 2_0 ~ SID~ .-- __ PROPANE '~Xv~X~ ~SCREENE ~ DR~LL ' ~ TANK ~ ~ PORCH/ I ~ / -.. ~ / ~ / DETAIL II - - / ¢ ¢ 1-10 -0 II ~ ? ', ',, ~ +/ / 262.0'0' / su uiss o ; I ~x~~ N 43'28'50" W SEE DETAIL _j/ ~EDIDENcE~NCH ~ 1"=10'-0" FO~ ADDITIONAL 51TE INFOKMATION DEE 5URV~ OF P~OPE~ o~NO: % ~ SCALE: = - 1" 20' O" P~PARED BY NATHAN TA~ COEWlN III ~NO 5UEV~OE, 5.C. T~ No. 1000 9¢- 4-23, P~BAUABY I 5, 2006 ST-I