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Home My WebLink AboutTR-6967 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town HallAnnex 54375Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD CERTIFICATE OF COMPLIANCE # 0444C Date: July 8, 2009 THIS CERTIFIES that the installation of an in-ground swimming pool~ patio and shed and maintaining the 50' Non-Disturbance Buffer At 5223 Indian Neck Lane~ Peconic, New York Suffolk County Tax Map # 98-1-1.4 Conforms to the applications for a Trustees Permit heretofore f'ded in this office Dated 7/1/08 pursuant to which Trustees Wetland Permit # 6967 Dated 9/17/08 was Issued and was Amended on 11/19/08 and on 5/20/09 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 installation of an in-ground swimmin~ pool, patio and shed and maintainin~ the 50' Non-Disturbance Buffer The certificate is issued to ROBERT & LISA DEFRESE owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ~'~Ch. 275 Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction ¼ conStructed ~'""~'Project complete, compliance inspection. CERTIFICATE OF COMPLIANCE: 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 May 20, 2009 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Mr. & Mrs. Robert' Defrese 5223 Indian Neck Lane Peconic, NY 11958 RE: 5223 INDIAN NECK LANE, PECONIC SCTM#98-1-1.4 Dear Mr. & Mrs. Defrese: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., May 20, 2009: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Permit #6967 to relocate the 10'× 16 'shed, as shown on the plan last revised April 13, 2009. This is not a determination from any other agency. Sincerely, Jame .~King, Preside~ Board'of Trustees JFK:lms AREA = 1602'2 Acres u:i:'il JUL - T 2oo8 L 0 T' NUMBERS ARE REFERENCED TO ' MINOR .~UBDIWSION FOR THE O'~ULA !:.4 MIL Y ' Hov- 5 2008 N /O/F JOHN PON Sol~Jlhold Tow~ I NIOIF M. & E. MCKIERNAN , ~, _~../. ,~ 90'~15,00. 3Z5/' E.. ~" g,30 N. 79'06 40 48.19' s. ~s./~.9o. ~. dO. ,~/ ~l. lines aloha ( ol gui/er of Richmond's Creek APPROVED .......... ~t wetInny* .... ... EOARD OF TRUST~ _.~.~-h ~ .' SOUTHC~[ i O'V¥ N OF ~ ROBERT' L. & LISA M DeFRESE s. 7~'~'°°' ~, A T INDIA N'NECK ~ TO WN OF SOUTHOLD £o~ ~ SUFFOLK COUNTY, N Y. .~ ~ooo - ~ - o~- PlO z ~ ~.' APR 1 3 m Scale.. 1" = 50' July 3~, 1996 AUg, 19~ 19~ (Cerllllc~llonJ . , Oc/. 7, 1996 Nov. 15, 1996 (conlou~s added) Apr// 7/997 fi/nM) CERT,'lED ROBERr L. D,FRESE LISA &4 O~FRESE REPUBLIC ABSTRACT CORP. FIOELITY NATIONAL rifLE NSURANCE OF NEki YORK 8RIDGEHAk4?TON NATIONAL BANK 1 om I~n~ ~tlh //~ STANDARDS FOR APPROVAL kVD CONSTRUCTION OF SUBSURFACE SE~CAGE DISPOSAL SYSTEMS FOR'S~GLE FA~L Y R¢S¢ENCES ~d ~ ~l~ ~1 lh~ con~?ibn~ scl /oflh Ih~tob ~d on 1275,58' INDIAN NECK ROAD The /ocoh'one o/ we/Is and cesspools showo hereon ore /rom field observolions and or /rom data ob/abed /rom others. CONTOUR LINES ~ND ELEVAT/ONS ~RE REFERENCED Fo N.G.V.D. 78"44'00' 20,05' i0. 49618 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzap fel 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 APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT DATE .;::;'zt, fl~-, [ OWNER i-~:x < PHONE ADDRESS AGENT PHONE ADDRESS PROPERTY LOCATION ~-~0,/.~ ::T; ,.-~g- >.,_ ,A~c/. TAX MAP NO. / o o o - ¢~,C- / ~ /- y request an Amendment to Permit Signed By: f~' ~ 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD February 17, 2009 Mr. & Mrs. Robert Defrese 5223 Indian Neck Lane Peconic, NY 11958 Re: 5223 INDIAN NECK LANE, PECONIC SCTM#: 98-1-1.4 Dear Mr. & Mrs. Defrese: Wiih regards to the necessary clearing to install your approved shed, clearing landward of the 12' contour line and from the large oak tree angled back to the western property line is permitted. Replacing cleared area with lawn landward of the shed is also permitted. There is to be no clearing seaward of the most northerly corner of the shed. The hay bale line is to continue along the property to the westerly property line pdor to any construction beginning. Sin ly, Peggy Dickerson, Trustee 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 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 November 19, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. & Mrs. Robert DeFrese 5223 Indian Neck Lane Peconic, NY 11958 RE: ROBERT & LISA DEFRESE 5223 INDIAN NECK LANE, PECONIC SCTM# 98-'1-'1.4 Dear Mr. & Mrs. DeFrese: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, November 19, 2008: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Wetland Permit #6967 to relocate the 16'x10' shed to the westerly side of the property, and as depicted on the revised site plan prepared by Robert DeFrese, and received on November 5, 2008. 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, James F. King President, Board of Trustees JFK:eac James F. King, Presid( nt Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Jolm Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES ~ TOWNOFSOUTHOLD I ] --v" /~~/~j ~/ NOV - ~ 2~[1~ APPLICATION FOR AN AMENDMENT TO A WE~J~k~ DATE OWNER~k~.w ? C;$~ ~e PHONE 7~'o~70 ~ ADDRESS 5'~a3 --~/~,~;*,~ /~e~: ~.,~_ ~,~,...¢, ,4/7__ AGENT PHONE ADDRESS PROPERTY LOCATION ~'DD..i' .~/..~. ~.~./¢ TAXMAPNO. /COO - ~}Y- / -- ]. I/We ~-~t.oo~r ~t (..;$.~1 ~J¢ request an Amendment to Pcrmit #~ Signed 135': A,RFA : ~ 607.9 A cr~ L~'T NUMBERS ARE REFERENCED TO ' MINOR b'U~OIVIb'ION FOR THE O'KULA o. ~/, R/0-96-0069 N/O/F M. & E. MGKIERNAN 37. jI, ' ¢,60' ¢' N. 79'06'40' 48,19' ~ht','o Ir'noS olon, q ~ al qullOf o'! Richmond s Crook ,6' APP~,~,~ED BYc~ TOWN OF '~UTHOLO DATE J,e'"P /7 ~ SUR VE Y FO/? ROBER'E L. & L/SA/id DeFRESE A T/ND/AN NECK TO WN OF SOUTHOLD SUFFOLK COUNTY, N 7000 - ~s - o~ -P/O z ~ Sca]e: 1"= 50' Ju/y 31, 1996 '% Aug. /9, 199~ (Cerlff/ool/on~ Ocl. 7, 19.96 (foUndation) Nov. 15~ 199~ (contours April 7,1997 (final) ~ O~RESE REPUBL lC ABS TRA C f CORP, F~EL/FY ~ flONAL T/FLE ~SURANC~ OF NEW YORK uno i Kuc [IoN OF SUBSUREACE SEWAGE DI~OSAL SYS[E~S FOR S~GLE FA~L y RES~ENCES iNDIAN NECK RoAD The /ocohons Q/ we/Is qnd cesspools showD h~reon ore /rom I/e/d observoh'on$ /~/~z~ t ond or /rom doto oblomed /rom o/hers. (516) 785 CONTOUR L/NEE AND ELEV~ T/ONE P. O. ~OX 90 ARE REFERENCED FO N.G.V.D. 1230 TRA VEL6'-~ SOU THOL D, hi: ?, ' S, 7~'4~ '~-' 20.05' 49618 11971 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Gbosio, 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 ~,4 constructed ~" Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK qO. 6967 DATE: SEPTEMBER 17~ 2008 ) TO: ROBERT & LISA DEFRESE PROPERTY ADDRESS: 5223 INDIAN NECK LANE~ PECONIC SCTM# 98-1-1.4 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 1 t 1 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 September 17, 2008, and in consideration of application fee in the sum of $250.00 paid by Robert & Lisa DeFrcse 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 install a 20'x42' in-ground swimming pool, patio and 16'x10' shed, with the condition of a line of staked hay bales with silt fencing is installed prior to construction, maintain the 50' Non-Disturbance Buffer on the property, and as depicted on the site plan prepared by Randy T. Rodecker, and received on July 1, 2008. IN W1TNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Robert & Lisa DeFrese, residing at 5223 Indian Neck Lane, Peconic, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. 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. 2. That this Permit is valid for a per/od 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. 3. 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. 4. 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 obstraction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work author/zed. 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 September 17, 2008 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Randy T. Rodecker Swim King Pools 471 Route 25A Rocky Point, NY 11778 RE: ROBERT & LISA DEFRESE 5223 INDIAN NECK LANE, PECONIC SCTM# 98-1-1.4 Dear Mr. Rodecker: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 17, 2008 regarding the above matter: WHEREAS, Swim King Pools on behalf of ROBERT & LISA DEFRESE 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 July 1,2008, 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 issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 17, 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 Southoid Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of ROE~ERT & LISA DEFRESE to install a 20'x42' in-ground swimming pool, patio and 16'x10' shed, with the condition of a line of staked hay bales with silt fencing is installed prior to construction, maintain the 50' Non-Disturbance Buffer on the property, and as depicted on the site plan prepared by Randy T. Rodecker, and received on July 1,2008. 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: $100.00 Very truly yours, President, Board of Trustees JFK/eac James F. King, President Jill M. Doherty~ Vice-President Pegg~ A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated x~.~ I, ~.00~~' has been reviewed by this Board at the regular meeting ~'~~ I and your application has been approved pending the ¢oml~letion of the following items checked off below. __ Revised Plans for proposed project ~////Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) 1/~ Constructed ($50.00) //'/Final 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: $. BY: James F, King, President Board of Trustees 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., August 13, 2008, the following recommendation was made: Moved by James Eckert, seconded by Don Wilder, it was RESOLVED to SUPPORT the Wetland Permit application of ROBERT & LISA DEFRESE to install a 20'X 42' in-ground swimming pool, patio and 16'X 10' shed. Located: 5223 Indian Neck Lane, Peconic. SCTM#98-1-1.4 Inspected by: James Eckert The CAC Supports the application with the Condition the pool is relocated away from the large oak tree in order to avoid removal of the tree. Vote of Council: Ayes: All Motion Carried New ork State Department of Environmental Conservation Division of Environmental Permits, Region One SUNY at Stony Brook 50 Circle Road, Stony Brook, New York 11790-3409 Phone: (631) 444-0365 · FAX: (631)444-0360Website: www.dec.state.ny, us July 11 2008 Randy T. Rodecker Swim King Pools 471 Rte 25A Rocky Point NY 11778 JUL 2 3 2008 Sc ~,d ?c,',ri Alexander B. Grannis Commissioner Re: Application of Lisa Defrese for 5223 Indian Neck Lane, Peconic DEC No. 1-4738-01481/00001 Attached is a Letter of Non-Jurisdiction which was sent to the applicant in 1996. It states that the property lying landward of the 10 foot elevation contour is outside the jurisdiction of the Tidal Wetlands Act. Since the newly proposed swimming pool and patio are to be situated landward of that contour, these structures would also lie outside the jurisdiction of the Tidal Wetlands Act. if any alteration to the plan were to be made so that any part of the pool and patio were to be situated seaward of the 10 foot contour, a permit would be required. It is also the responsibility of the applicant to ensure that no disturbance or sedimentation of the land within the Tidal Wetlands jurisdiction occurs. To this end it is recommended that erosion control methods be employed, such as establishing an adequate work are and placing hay bales or a silt screen between the work area and the area seaward of the 10 foot contour. If you have any questions, I may be reached at 631-444-0362. Very truly yours, Karen S. Westerlind Environmental Analyst I cc: L. Defrese York S ate Department of Environmental Conservation ling 40 - SUNY, Stony Brook, New York 11790-2356 phone (516) ~.~.-0365 ;imile (516) ~.~.~4)373 Michael D. Zagata Commissioner November 29, 1996 Mr. & Mrs. PO Box 503 Aquebogue, Robert DeFrese NY 11931 Dear Mr. & Mrs. DeFrese: 1-4738-01481/00001 DeFrese Property Indian Neck Rd, Southold BCTM #1000-98-1-1.4 Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: the property landward of the 10' contour elevation on a natural, gradual slope as shown on the survey prepared by Peconic Surveyors, dated July 31, 1996 and last revised October 7, 1996 is beyond the jurisdiction of Article 15 Tidal Wetlands. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. BM~P File Very truly James F. King, P~xtsident Jill M, Doherty, Vice-Pres/dent 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: ~;~/] ~/d~;' ROBERT & LISA DEFRESE request a Wetland Permit to install a 20'X 42' in- ground swimming pool, patio and 16'X 10' shed. Located: 5223 Indian Neck Lane, Peconic. SCTM#98-1-1.4 T~Sa of area to be impacted: Itwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland ~.hOhaf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: V/Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Modifications: Present Were: __&King __J.Doherty ~ckerson __ __ D. Dzenkowski Mark Terry__other Form filled out in the field by Mailed/Faxed to: Date: D. Bergen__ B.Ghosio, Environmental Technician Review- 9 EAST CUTCHOGU Yc CD COUNTY OF SUFFOLK (~) I ~~ .... 'mi're" SOUTHOLD 098 J OFFICE LOCATION: Town Hall Annex 54375 State Route 25 Main Rd. & Youngs Ave. Southold, NY 11971 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 63l 765-3136 To: From: Date: Re: Jim King, President Town of Southold Board of Trustees Scott Hilary and Mark Terry, LWRP Coordinators August 20, 2008 Chapter 268, WATERFRONT CONSISTENCY REVIEW Wetland Permit for ROBERT & LISA DEFRESE SCTM#98-1-1.4 Sctttho[d Town Bo3rd of Trustees Swim King Pools on behalf of ROBERT & LISA DEFRESE requests a Wetland Permit to install a 20'X 42' in-ground swimming pool, patio and 16'X 10' shed. Located: 5223 Indian Neck Lane, Peconic. SCTM#98-1-1.4 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 our recommendation that the proposed action (POOL) is CONSISTENT with LWRP policy standards and therefore is CONSISTENT with the LWRP; provided that the proposed pool and related structures are placed at a minimum setback orS0 feet from the wetland boundary pursuant to § 275-3. Policy 6. Protect and restore the quality and function ofthe Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requiremenls of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. § 275-3 Findings; purpose; jurisdiction; setbacks. D. Setbacks. [Amended 10-11-2005 by L.L. No. 17-2005] 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. [5] Swimming pool and related structures: 50feet. lf_~th~,~ proposed action (pool)is app~ed the lbllowing best management Pra~(BMP)is recommended: ) ~ · 1. Require the applicant to maximize a perpetual non-d sturbance buffer na ntaining the existing indigenous vegetation seaward of the proposed pool and i:elated structures. The BMP will further advance LWRP Policy 5 Protect oa~d improve water quality in the Town of S0uthold and 6.3 Protect and restores tidal and freshwater wetlands. If the Agency, Board of Trustees makes a contrary determination °f ~onsistency, the ~geacv Shall elaborate i~ writing the hasis for it~ disagreement With their 268 268-5. Review °factions. IZ In lhe event the L~VRP Coordinator's recommendation is that the action is inconsistent with the L~VRP, and the agencu makes a contrary determination of consistency, the agency shall elaborate in writing the basis./bt its disagreemen! with the recommendation and state the manner and extent to which the action is consistent uqth the L I, VRP polioT standard~. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Wetland permit for Rob and Lisa Deft'ese SCTM#90-1-1.4 Swim K~ng Pools on behal/'ofROBERT & LISA DEFRESE requests a Wetland Permit to install a 20'X 42' in-grounc] swimming pool, patio and 16'X 10' shed. Located: 522:3 Indian Neck Lane_ Peconic. SCTM#98-1-1.4 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P,O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD ~CwOaStal Erosion Permit Application etland Perm/t Application Amendment/Trans fe//Bxtension ece~ved Application:~ eceived Fee:$ ~-)~ ompleted Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) ~ Consistency Asses. spent Form 1~ ! I '.'C~C Referral Sent: ~ [I ~Q~ - .~'Date of Inspection: ~ Receipt of CAC Report: Lead Agency Determination: Technical Review: ,..~lrublic Hearing Held: Resolution: Office Use Only Adrrdnlstrative Permit Name of Applicant Eob 4 Address5~ ..~.t arl ~f_,~ I.d,. ~'~e ~.D 0 i'C_~ Phone Number:( Suffolk County Tax Map Number: 1000 - ~ ~ Property Location: ~&~ ~D (provide LILCO Pole #, distance to cross streets, and location) (If applicable)~ I ...... / Address: ~{ ~.~f~.~ ~}F~ ~qc ~1 I I"-/q ~9 Phone: ~d of Trustees Applicatio0 Land Area (in square feet): Area Zoning:. GENERAL DATA Previous use of property: Intended use of property: Prior permits/approvals for site improvements: Agency Date / No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspe, nde/d by a governmental agency? v No Yes If yes, provide explanation: Project Description (use attachments if necessary):. mo rff h kd of Trustees Applicatio0 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: i~.~o-~l .'l~tou_ot~._ ,,cq Area of wetlands on lot: _square feet Percent coverage of lot: ~ % Closest distance between nearest existing structure and upland edge of wetlands: lb ~ -t4' feet Closest distance between nearest proposed structure and upland edge of wetlands: ~/0' feet Does the project involve excavation or filling? No ~Yes If yes, how much material will be excavated? IR 0 cubic yards How much material will be filled? ~ cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ~o ~d of Trustees Applicatio0 COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No v'"' Yes Does the project involve excavation or filling? No / Yes .,} b00J'~/'JK~u~i If Yes, how much material will be excavated? (~ c yards) How much material will be filled? ~) ¢31D(~6[co (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting fi.om implementation of the project as proposed. (Use attachments if necessary) PROJECT ID NUMBER SEQR PART 1 - PROJECT INFORMATION 1. PLICANT/SPO SOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) Municipality County PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide maD 5. IS PROPOSED AGTION: [~New [--]Expansion ~]Modification/aiteration 6. DESCRIBE PROJECT BRIEFLY: 7, AMOUNT OF LAND AFFECTED: ~ ~'~ Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ential r-'-llndustrial F'-]Commercial ~lAgriculture [] Park / Forest / Open Space [~]Other (describe) NOW OR ULTIMAT LY FROM ANY OTHER GOVERNMENTAL 10 DOES ACT ON NVOLVE A PERMT APPROVAL. OR FUND NG. ELY FI~ AGE. Federal. State or Local) L~Yes [~No ,, yes. ,st agency name and permit/approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~o If yes. list agency name and permit / approval: 12. AS A RESL[J~' OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [ es I CERTIFY THat .~E./{NFORMATIO~OVIDED ABOVE lb TRUE tO THe BEST Of MY KNOWLEDGE Applicant/Sponsor Name t~¢,3t~.~"7-/~ /-- '/(~~ Date: ¢~10~ ~ignatu~~ ¢~ } If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXJ.C.~D ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. E~] Yes [~o B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be s~,q~'eded 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, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potengal for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeolo0ical, historic, or other netuml or cultural msot~rcasi o~ community ~r neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitat, or threatened or endangered species? Explain briefly: C4. A commungy's existing plans or goals as officially adopted, or a change in uso er intensity of use et land or other natural resoumes? ~xplain briefly: C5. Growth, subsequent devetopment, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL E. IS THERE, OR IS T..JC~ERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If },es ex !ain: f--iVes j I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connect[on with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed, if question d of part ii was checked yes, the determination of significance must evaluate the potential impactofthe proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially la rge or significant adverse im pacts which MAY occur. Then proceed directly to the F UL' EAF and/or prepare a positive declaration, Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: STATE OF NEW YORK COUNTY OF SUFFOLK , ,o , , being duly sworn, deposes and says that on the ~ I day of ~ ~[ ~ ,20 0~, 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;oil ofth~ Town of Oouthold; that said Noticesfiv~.~ mailed at the United States Post Office at ~0CY. x4 [JO,~ ~{ , that said Notices were mai~ed to each of said persons by (certified) (register'- ~d) mail. ~/ Sworn to before me this ~ I Dayof 4t, L~V ,20 00 ' I Notary Phl~lic 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 residing at ~oQ- qO}Tt~r ~ being duly sworn, depose and say: That on the ~ day ofPC~.~b~. ~ 200'3, I personally po,,~sted the ~perty&kp~ ~own as by placing the Bo~d of Trustees official poster where it can easily be seen, ~d that I have checked to be s~e the poster has remained in place for eight days prior to ~e date of the public hemng. Date of hearing noted thereon to be held (~. ~. ~O, ~ ~ ~ ~ Dated: (' ) , . '~~~~;. (si~ature) ~D 0 Swom to before me this ¢ dayofh~ 200* BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: SCTM# YOU ARE HEREBY GIVEN NOTICE: That it is the intention of the undersigned to request a Permit from the Board ,of Trustees to: 0 0o1, pwl-,o 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 Enviro~ental Review ~der Chapters 32, 37, ~or 97 of the Town Code is open to public comment on: ~1~ ~O, ~ . You may contact the Trustees Office at 765-1892 or in wfi~ih~ ' ~:00 ~ 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: PHONE ~: Enc: Copy of sketch or plan showing proposal for your convenience. BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: That it is the intention of the undersigned to request a Permit from the Board of Trustees 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: ~/~l/ill/~ 90, ~00~ . You may contact the Trustees Office at 765-1892 or in wri[i~. ' {e:O0 f9~'l 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. NOTICE TO ADJACENT PROPERTY OVCNER jOOO .- BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU ~ HB~BY G~N NOTiCe: I. That it is the intention of the undersized to request a Pe~it ~om the Bo~d of Trustees 2. That the property which is the subject of Enviromnental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Enviromnental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: q/~.lgl/k.~ ~.O, ;200~ . You may contact the Trustees Office at 765-1892 or in writi~). ' ¢:00 ~>m 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: PHONE fl: Enc: Copy of sketch or plan showing proposal for your convenience. NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. SCTM# 1000- Q ~'01- ~ q That it is the intention of the 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 Enviromental Review under Chapters 32, 37, anWor 97 of the Town Code is open to public comment on: ~1~ ~O, ~ . You may contact the Trustees Office at 765-1892 or in wdiih~ ' 0:oo em 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:D--.~.l)[)O.~q_ MAILING ADDRESS: PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience. NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: SCTM# YOU ARE HEREBY GIVEN NOTICE: That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property ~vhich 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 Enviromental Review under Chapters 32, 37, ancot 97 of the Town Code is open to public comment on: ~i~ ~O, ~6 . You may contact the Trustees Office at 765-1892 or in wfi~in~ ' ¢:00 ~m 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: MA~G ~D~SS: PHONE ~: Enc: Copy of sketch or plan showing proposal for your convenience. .q-a o%v- iooo- B-i-15 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU ~ HE,BY G~EN NOTICE: 1. That it is the intention of the undersized to request a Pe~it from the Board of Trustees 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 Rev. ie~v under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: JJL/gl//,.q'[- 20, ~00~ . You may contact the Trustees Office at 765-1892 or in wri{i~ 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: MA~G ~D~S~: PHONE S: Enc: Copy of sketch or plan showing proposal for your convenience. NOTICE TO AD~CENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: SCTM# lO00- 6? ~0 } - } q YOU ARE HEREBY GiVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ?~4ail ct ~.o'~q0-' In~yo,~ So~ ~,~ ~0o~, pa-bo 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 prQect which is subject to Enviromental Review under Chapters 32, 37, an&or 97 of the Town Code is open to public comment on: .~1~ ~O, 2~¢ . You may contact the Trustees Office at 765-1892 or in wdiih~ ' ¢:oo ~m The above-referenced proposal is under review of the Board of Trastees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NmE: MAILING ADDRESS: PHONE ~: Enc: Copy of sketch or plan showing proposal for your convenience. Service bUUIHULU ~ ~ 1000' PROPERTY MAP o,~ ,. :~., c~ SOUTHOLD SECTION NO O98 swim. King Pools 471 Route 25A · Rocky Point · New York 11778 Phone: 631-744-8100 · Fax 631 744-8292 www.swimking.com King Pools 471 Route 25A · Rocky Point · New York 11778 Phone: 631-744-8100 · Fax 631-744 8292 www.swimking.com 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 suooortin~ and non- suooortin~ 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 scm# ' o li. PROJECT The Application has been submitted to (check appropriate response): Town Board JUL l Southold Town Board of Trustees ~ Planning Board [-~ Building Dept. ~ Board ofTrustees ~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital constmction, 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 Site acreage: I.. (o 0-/oq Present land use: ~,r/~l< Present zoning classification: (a) Name of applicant: (b) Mailing address: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (c) Telephone number: Area Code ( ) ¢ 9~ I ~- ~'~ q - ,~ '7 6 q (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 [--~ot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III ' Policies Pages 3 through 6 for evaluation criteria [] Yes [] No [--~Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~ Yes [~ No ~Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [-~ Yes ~ No [~Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria Yes No I otApp,icable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. 'Yes No ~Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in thc Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [--~ Yes ~-~ No ~NNot 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 public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No Nr~otApplicable 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 Applicablc 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,ff~4( I TITLE APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohthits conflicts of interast on the oart of town officers and emvlovees. The oumose of this form is to orovidc information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name,~aiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate thc other person'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 personally (or through your company, spouse, sibling, paint, 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 J If you answered "YES", complete the balance of this form and date and sign where indicated. Name of pcrson 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 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 applic0nt (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, parmer, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Board of Trustees Application County of Suffolk State of New York /ldU"F ~J(~ BEING DULY SWORN DEPOSE'S 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 WlTH/~ OF THIVLICATION. SWORN TO BEFORE ME THIS ,~O DAY OFk/~,trl e ,20/) ? NOTARY . ' ', ard of Trustees Applicat AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at 5~% ~&~9 (mailing address do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. Q~aliltea tn ~ulk~k County comrnisslo~ Expires ~ 2§, 20Z~_~ 8 June 18, 2008 Town of Southold Town Hall P.O. Box 1179 Southold, New York 11971 To Whom it May Concern: I, Lisa Defrese, residing at 5223 Indian Neck Rd., Peconic, do hereby give my permission to Swim King Pools, 471 Rt. 25A, Rocky Point, N.Y. to file an application with the Board of Trustees on my behalf. I wish to install an inground swimming pool at the above address. The contact person will be Kathy Quigley at Swim King Pools, 744-8100 x.125. Thank you for your attention to this. Lisa Defrese ,, , ,~REA = Z 6072 A cre~ APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE ~-~? ~? o~ LOT NU~tBERS ARE RE?ERENCED 7-0 ' M/NOR !TUBDIV/SiO/V FOR THE O'KULA SCOH,c, ReL ~ ~10-96-0069 N/O/S M. ~. ~ MCKIERNAN VlO/F JOHN PONTINO S. 80W5'00. 3Z51, ' ' s. '95'12'00, ~.. '1~'~0 30. ~/, ~~ L, & LiSA ~ DeFRESE A T INDIA N NECK TO WN OF SOUTHOLD SUFFOLK COUNTX N ~ 1000 - 98 - 01- P/O ZI Scale: 7' = 50' July 8~ 1996 Au~. /9, 1996 (Ce~tlflc~tlon} . Ocl. 7, 1996 (foundolion) Nov. /5, 1996 (contours odded) Apr// 7,/997 (final} CER TTIED TO. ROBERT L. D~FRESE LISA ~. D~-RESE REPUBLIC A£S [RA C ? CORP, FiDELITY NAtiONAL T/l'L£ ~/SURANCE OF NEW YORK BRIDGEHA~IP TON NA T/ONAL BANK / ~ I~f ~111~ 1,~ $?ANDARD$ FOR APPROVAL ~O CONStRUCTiON OF SUBSURFACE SEWAGE DI~OSAL S~S[EMS FOR S~GLE FA~L ~ RES~ENCES ~d ~ ~;~ bJ lh~ cond/lion~ ~1 {orlh lh~r~ and on Ih~ N. 79'06'40" 48,19' ~ll~e lines olon, g ~ al gulter o'1 Rlchmond s Creek .6' 5~ 5' S. 78'44 ~':~" 20.0~ 1276.68' INDIAN NECK ROAD shown h~r~on or~ /rom fie/c/ obza~vohons ~ ! ~,.,~j:p,~.~ ~ (5/6) 765 ' RE REFERENCED ; O N.G.V.O. 1230 rna ,'0. 49618