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Home My WebLink AboutTR-7034AJill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hail 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 # 0575C Date: ~2010 THIS CERTIFIES that the extension to the existing garage and new pervious driveway At 1350 Eugene's Road, Cutchogue, New York Suffolk County Tax Map # 97-6-1.2 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 2/17/09 pursuant to which Trustees Administrative Permit # 7034A Dated 2/18/09 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 extension to the existing garage and new pervious driveway The certificate is issued to THOMAS PULS II & DONNA RICCO owner of the aforesaid property. Jill M. Doher/y, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: __ Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~ constructed Project complete, compliance inspection. CERTIFICATE OF COMPLIANCE: 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 F~x (631) 765-6641 September 23, 2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Michael Hughes 1504 Route 112 Port Jefferson Station, NY 11776 RE: THOMAS PULS 1350 EUGENE'S RD., CUTCHOGUE SCTM#97-6-1.2 Dear Mr. Hughes: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., September 23, 2009: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Permit #7034A to install a pervious driveway, as depicted on the survey prepared by Nathan Taft Corwin III last revised February 26, 2009 and stamped approved on September 25, 2009. This is not a determination from any other agency. Sincere~.~.~.. James,:. King, p~eC~siside~ Board of Trustees JFK:lms OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southeld, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 mo~ Jim King, President Town of Southold Board of Trustees LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD From: Mark Terry, Principal Planner LWRP Coordinator Date: September 15, 2009 Re: Proposed Wetland Permit THOMAS PULS SCTM#1000-97-6-1.2 THOMAS PULS requests an Amendment to Permit #7034A to install a pervious driveway. Located: 1350 Eugene's Rd., Cutchogue. SCTM#97-6-1.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the denoted following Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney 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 arc subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thns~ each answer must be explained in detail~ listing both supoortin~ and non- sunoortin~ 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.norttffork.net), the Board of Trustees O~ffis~-Department, all local libraries and the Town Clerk s office. ,':-,i ~ i:.~ -n ~ B. DESCRIPTION OF SITE AND PROPOSED ACTION ~ ~--' , - ~ scm# 9 7 o c, / 2. ' '-'!'! PROJECT NAME '7'¥ 0 ea-t c%~ ?0 I5 The Application has been submitted to (check appropriate response): TownBoard [] Planning Board [~] Building Dept. [~ Board of Trustees ~J 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) Co) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: "Fo Tr,, J'a l l 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 (a) Name of applicant: (b) Mailing address: information shall be provided: Ioo yore (c) Telephone number: Area Code ( ) (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 IH - 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 [] Po ot 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 Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [] No(~]-Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III - PoliCies Pages 16 through 21 for evaluation criteria Yes [] No ~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LVfRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not/Oicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~] Yes [--] N~ 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 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. V-~ Ye? No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLI~ 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 ~Z~ 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 I'~'~'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 PREPAREDBY /~l'C~e~gt .lC[O~[ TITLE Cc~ ~ r~ ~ 4~(-~ EXISTING TOTAL LOT COVERAGE OVER UPLAND AREA DESCRIPTION AREA % LOT COVERAGE HOUSE W/PORCH 1,§4S sq. fi, 5.5% WOOD DECK 687 sq. fl, 2.3% INOROUND POOL & HOT TUB 463 sq. fi, 1.6% STONE PATIO & WALKS 1,156 CONC. PAVERS 727 sR. fh 2.4% SHED 101 sq. fl. 0.3% TOTAL EXISTING 4,757 sq. fi. 15.9% PROPOSED TOTAL LOT :OVERAGE OVER UPLAND AREA DESCRIPTION AREA % LOT COVERAGE HOUSE W/PORCH 1,645 sq. ff. 5.5% INGROUND POOL & HOT TUB 465 sq. ff. 1.6% STONE PATIO 357 sq. ft. 1.2% SHED 101 sR, fl. CONC. PAVERS 169 sq. ft. 0.6% PROP. GARAGE EXTENSION 582 sq. ff. 1.5% EXISTING BUILDING COVERAGE OVER UPLAND AREA DESCRIPTION AREA % LOT COVERAGE HOUSE W/PORCH 1,64S sq. ff. 5.5% ROOF OVER WOOD DECK 96 sq. fi. 0.3% INGROUND POOL & HOT TUB 465 sq. fl. 1.6% SHED 101 sq. ff. 0.3% TOTAL EXISTING 2,505 sq. ft. 7.7% PROPOSED BUILDING COVERAGE OVER UPLAND AREA DESCRIPTION AREA % LOT COVERAGE HOUSE W/PORCH 1,64S sq. ff. 5.5% ROOF OVER WOOD DECK 96 sq. Et. 0.3% INGROUND POOL & HOT TUB 465 sq. ft. 1.6% SHED 101 sq. ff. O.S% PROP. GARAOE EXTENSION 382 sq. ft. 1 TOTAL EX]STING 2.685 sq. ff. 9.(3% 2 STORY FRAME & BRICK HOUSE & GARAGE 120' 183" APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD DATE ~',E? NOTE; 1. 2. SURVEY OF PROPERTY SITUATE CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-97-06-1.2 SCALE 1"=20' APRIL 6, 2007 JANUARY 9, 2009 ADDED PROPOSED ADDITIONS FEBRUARY 8, 2009 ADDED LOT COVERAGE FEBRUARY 26, 2009 SET LATH FOR SITE INSPECTION TOTAL AREA = $2,846 sq. ff. 0.754 dc. UPLAND AREA = 29,861 sq. ff. THIS PROPERTY IS IN FLOOD ZONE AE (EL B). ELEVATIONS ARE REFERENCED TO N.G.V,D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN TNUS:~o 19~'08 H ~S 59? 15.78 THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. Nathan Taft Corw n III Land Surveyor PHONE (651)727-2090 Fox (651)727-1727 ~7-osa~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickersen 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 1 st day of construction '~ constructed Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7034A Date of Receipt of Application: February 17, 2009 Applicant: Thomas Puls SCTM#: 97-6-1.2 Project Location: 135 Eugene's Rd., Cutchogue Date of Resolution/Issuance: February 18, 2009 Date of Expiration: February 18, 2011 Reviewed by: Trustee Dave Bergen Project Description: To construct a 17.2'X 22.2' extension to the existing garage. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the proposed extension to the garage as indicated on the survey prepared by Nathan Taft Corwin III last dated February 8, 2009. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jame F.~King, Presell' id~ 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~._~ 0 rw'~ Please be advised that your application dated oq_llO/0~ has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ~ Constructed ($50.00) 1/// Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. fi,) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$ BY: James F. King, President Board of Trustees James F. King~ President Jill M. Doherty, 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: THOMAS PULS - SCTM#97-6-1.2 Type of area to be impacted: 7~.~Saltwater Wetland Freshwater Wetland Distance of proposed work to edge of wetland P~of Town Code proposed work falls under: hapt.275 Chapt. 111 other Sound Bay Type of Application: __ Wetland __Coastal Erosion ~Amendment '~Ad ministrative__Emergency Pre-Submission __Violation Info needled: r . Modifications: Conditions: ~ .,-o ,-.~ ~j ,~. Present Were: __&King __J.Doherty __P.Dickerson D. Dzenkowski Mark Terry__other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: Environmental Technician Review- James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, 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/ __Wet/and Permit Application t.~Adrainistrative Permit --Amendment]Transfer/Extension ~eceived Application:~.] ,~') ]OF? _ 4 eceived ree:S &! ql°q ~--------~ompleted Appl~cc-~tion~g~]~ ~lncomplete · __SEQRA Classification: Type I Type II Unlisted____ Coor-~-ma tion: (data,sent) --7"L"WRP Consistency Assessment Form ~CAC Referral Sent:_~¢ . - ~.d)ate of Inspection:~tlg) Receipt of CAC Report: __Lead Agency Determina~ __./~echnical Review: __ ublic Hearing Held:~-~~ Resolution: Suffolk County Tax Map Number: Property Location:_ ] ~ (provide LILCO Pole #, distance to cross streets, and location) AGENT:_ ~ (If applicable) Address: /q-O'.{ 1~: '~lJ_~___.__po £ t _Phone: of Trustees Applicat Land Area (in square feet): Area Zoning:. GENERAL DATA Previous use of property: Intended use of property: 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 Board of Trustees Applica WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: ff ? ~:9~ square feet Percent coverage of lot: /~,, / % Closest distance between nearest existing structure and upland edge of wetlands: { 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 2 '~ feet Does the project involve excavation or filling? If yes, how much material will be excavated? (.a (~ cubic yards How much material will be filled?--~' C~ ~- cubic yards Depth of which material will be removed or deposited: -- (~D ~ Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet Statement of the eff~c_t, if any~ ~ the wet_!a~_ds and tidal. wa_ters _of ~ town _tha_t ~ay res_u![by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION APPLICANT / SPONSOR 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 oo.. 3'0 /ro/A SEQR 3.PROJECT LOCATION: Municipality ~(~ ~J~'~ ~ l ~ 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map s.,s PROPOSED ACT,ON: [] .ew t pa.s,o. I--]Mo.,.cation,a,te.aflo. 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 describe no, briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~] Residential [] Industrial r-] CommerciaI [-~Agriculture r--i Park / Forest / Open Space [] Olher (describe) i10.' 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. uu~;;5 ANY A;SF[:L;I UI" THE A(.;IION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r'~Yes [~No If yes, list agency name and permit / approval: 12.E~YesAS A BoLT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE / S Na e pate: If th~ action I~ a Co*tal Aroa, and you ar~ a Btat~ ag*n¢¥, ¢ompl~t~ th* Coastal A~$$mont Form before pro¢o~ding with this a~*~mont PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL FAF. 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, surface or groundwater quality or quantity, noise levels, exis fing traffic pattern, solid waste production or disposal, potenfial for erosion, drainage or flooding problems? Explain bdefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: g y p g ly o~ use of land or other natural resources? Explam briefly C6. kon~ term, shorl term, cumulative, or other effects not identified in C~-C67 Explain briefly: C7. Other imp'a~t; (i~cluding ~h;r~g~s !n us; Of ~!t~iquan!ib/ or ~pe Of energy? ~plain b[~iefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTASI_I~HME~; 0~F ENVIRONMENTAL AREA (CEAI? Jif ~,es, explain bdefi}~! ....... E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If },es ex~lain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency} INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritissubstantia~~Iarge~imp~rtant~r~therwIsesigni~cant~ Each effect should be assessed in connection with its (a) setting (Lc. urban or rural); (bi probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (fi 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 · . ignific.?.~ rice muc~e.;31uctc ffic peteRtial4m, p.cct cf theprcpcc, cdc. ct[c.n on thc ~ nv=,~o~,mcnt~l ch~r~ct~r,,~t~ ~ ~he C~. Check this box if you have identffied one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl FAF and/or prepare a positive declaration. Che(~l~ ~his box ~ ~,~' I~v~ ~mYr~edl ~ oll {h~ ~nf~)~;mation anci ~aly~is ~b0ve and a~y ~upporting doc~me~[io~i t-;~'a~ the-i~r0p~s~ ac~o~ 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) Board of Trustees Appli~ion County of Suffolk State of New York ~/]/]~"C~tr~ / //~ / ~ 5 BEING DULY SWORN DEPOSES AND ~F~ THAT ~/S~ IS T~ ~PLIC~T FOR T~ ~O~ DESC~ED PE~T(S) ~ T~T ~L STATE~NTS CONT~D ~ ~ ~ TO T~ BEST OF ~S~R ~OWLEDGE ~ BEL~F, ~ T~T ~L WO~ W~L BE DO~ ~ T~ ~R SET FOR~ ~ ~S ~PLICATION ~ AS MAY BE ~PRO~D BY T~ SOUTHOLD TO~ BO~ OF TRUSTEES. T~ ~PLIC~T AG~ES TO HOLD T~ TO~ OF SOUTHOLD ~ T~ TO~ TRUSTEES ~ESS ~ F~E FROM ~Y ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY ~T~ OF S~ PE~T(S), ~ G~TED. ~ CO~LET~G T~S ~PLICATION, I ~BY AUTHO~E T~ ~US~ES, T~ AGENT(S) OR ~P~SENTATI~S(S), TO EN~R ONTO ~ PROPERTY TO ~SPECT T~ P~SES ~ CON~CTION ~TH ~W OF T~S ~PLICATION. SWORN TO BEFORE ME THIS_ /?o~ DAY6 /qotary Public LAUREN M. SIAND S?~ Notapj Public, State of New Yor~: No. 01ST6164008 Qualified n Suffo k County. Commission Expires April 9, 20!( the appl£cant is no~ the Owner) owner o~ ( ~.t l.tn~ add. ess do he=e~ authorize (A~ent) to apply ~or Southold ~oard o~ Town Trustees on m~ behal£ · 8 £00/£00~ ............................. XY& ~!:~ ~tf]~ 600~/[0/~0' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics t>rohibits conflicts of interest on the hart of'toWn 0fficem and emt~lovees. The ouroose of thil~ form is to orovide information which can alert the town of t>ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, ~niddle initial, unless you are applying ia the name of someone else or other entity, such as a company. I f so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check ali 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, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/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 applicant (when the applicant is a corporation); __B) the legal or'beneficial owngr of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, parmei', or employee oftbe applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 200 _ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its 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- 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 The Application has been submitted to (check appropriate response): TownBoard ~] Planning Board ~ Building Dept. ~ Board of Trustees Category of Town of Southold agency action (check appropriate response): (a) (b) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) 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: ~4"s, &v ~t ,[ x Present zoning classification: 1~ ~->; If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: 'j~ eo ¢-, ,~ (b) Mailing address: I O0 0 ~t ~ (c) Telephone number: Area Code (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 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 ~LNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not A~cable At~ach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [-~ Yes [~ No ~] Not Applicable Afrach 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. ~ Ve~--~ No [~Not Applicable Attach additional sheets if necessary WORKING COAST POLIC~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent oses 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 Peconie 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 co+ch EXISTING TOTAL LOt COVERAGE OVER UPLAND AREA DESCRIPTION AREA ~ LOT COVERAGE HOUSE W/PORCH 1,643 sq. ff. 5.5% WOOD DECK 887 sq. ff. 2.5% INGROUND POOL & NOT TUB 463 sq. ff. 1.6% STONE PATIO & WALKS 1,136 sq. fl, 3.8% CONC. PAVERS 727 sq, ff. 2.4% SHED 101 sq. fl, 0.5% TOTAL EXISTING ¢,757 sq. ft. 15.9~ PROPOSED TOTAL LOT COVERAGE OVER UPLAND AREA DESCRIPTION AREA ~ LOT COVERAGE HOUSE W/PORCH 1,645 sq. ff. 5.5% INGROUND POOL & HOT TUB 465 sq. fl, 1.6~ STONE PATIO 357 sq. fl, 1,2% SHED 101 sq. ff. O.S~ CONC. PAVERS 169 aR, ff. 0.6~ PROP, GARAGE EXTENSION 582 sq, rE, 1,5~ PROP. DECKS 605 sq. ff. 2.0% PROP. FLOATING DECK 542 sq. ff. 1.1~ PROP. POOL COPING & PATIE 557 sq. ff. 1.8% PROP. PAVER 491 sq. ff. E.7~ TOTAL PROPOSED 5,090 sq, fi, 17.1% EXISTING BUILDING COVERAGE OVER UPLAND AREA DESCRIPTION AREA ~ LOT COVERAGE HOUSE W/PORCH 1,64S sq. ff. 5.5~ RGOF OVER WOOD DECK R6 sq. ft. 0.5% INGROUND POOL & HOT TUB 463 sq. ft. 1.6% SHED 101 sq. fl, 0,5~ TOTAL EXISTING 2,SOS sq. ff. 7,7% PROPOSED BUILDING COVERAGE OVER UPLAND AREA DESCRIPTION AREA % LOT COVERAGE HOUSE W/PORCH 1,643 sq. fl, 5,5% ROOF OVER WOOD DECK 96 sq. ft. 0.3~ INGROUND POOL & HOT TUB 463 sq. ff. 1,6~ SHED 101 sq. ff. 0.5% PROP. GARAGE EXTENSION 562 sR, fi, 1,5% TOTAL EXISTING 2,685 sR. Et, 9,0% G STORY FRAME & BRICK HOUSE & GARAGE 163' FENCE SURVEY OF PROPERTY SITUATE CUTCHOGUE IOWN OF Sou-rHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-97-06-1.2 SCALE 1"=20' APRIL 6, 2007 JANUARY 9, 2009 ADDED PROPOSED ADDITIONS FEBRUARY 8, 2009 ADDED LOT COVERAGE TOTAL AREA = UPLAND AREA = NOTE: 1. THIS PROPERTY iS IN FLOOD 2. ELEVATIONS ARE REFERENCED EXISTING ELEVATIONS ARE /92.08 ¢ ?/ / ,x / ,x~' / / 52,846 sq. ff. 0.754 ac. 29,861 sq. ff. ZONE AE (EL 8). TO N.G.V.D. 1929 DATUM SHOWN THUS: 50 '~/S 59' 15.78,51 THE EXISTENCE OF RIGNT$ OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. PREPARED IN ACCORDANCE WITH ~lE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE LI,A.L~ AND APPROVED AND ADOPTED N.Y.G. Lm. No, 50467 Nathan Taft Corwln III Land Surveyor Fox (651)727-1727 27 083~