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Home My WebLink AboutTR-7063 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 # 0722C Date: February 3, 2012 THIS CERTIFIES that the construction of a rear deck attached to existing dwelling, and as per survey stamped approved on January 26, 2012 At 1730 Deep Hole Drive, Mattituck, New York Suffolk County Tax Map # 115-12-23.2 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated March 13, 2009 pursuant to which Trustees Wetland Permit #7063 Dated April 22, 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 rear deck attached to existing dwelling, and as per survey stamped approved on January 26, 2012 The certificate is issued to KELLY MYERS owner of the aforesaid property. Authorized Signature James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES ' TOWN OF SOUTHOLD DATE Of INSPECTION: /¢/.~ / Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain I st day of construction ~ constructed Project complete, compliance inspection. INSPECTED BY: ,~,,' COMMENTS: CERTIFICATE OF COMPLIANCE: /-'7~/'/ SURVEY OF PROPERTY SITUATE, HATTITUOK TOhN.' 5OUtHOiD 5,UFFOLK ~T'K, N'f' SURVE'r'ED: MA"f' 2q, 2008 UPOATE~ DEC. I, 2Oli SUFFOLK COUNT'K TAX ~ IOOO - 115 - 12 - 2~,.2 APPROVED BY ~OAIlO OF TRUSTEES NOTES: O PIPE FOUN[2 Ar'so = 8480 S, F. Areo= O.Iq4'/ Acres CONTOURS R. EFE'RENOtE N®V[2 '2q OA~H ~PHIC SCALE I"= 20' c, % N W "+E S JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO..50202 RIYERHEAD, N.Y, 11901 369-8288 Fax 369-8287 REF.-C:\U sers~JohnXDropbox\08\08\08-15 _.pro James F. King, Presidemt Jill M. Dol~erty, Vice-President Peggy A. Dickerson ' Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. 'INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ¼ constructed 'Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7063 DATE: April 22, 2009 ISSUED TO: KELLY MYERS PROPERTY ADDRESS: 1730 DEEP HOLE DR, MATTITUCK SCTM#115-12-23.2 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and iu accordance with the Resolution of the Board of Trustees adopted at the meeting held on April 22. 2009 in coasideration of application fee in the sum of $250.00 paid by Kelly Myers and subject to the Terms and Conditions as stated in the Resolution; the Southold Town Board 6f Trustees authorizes and permits tl following: Wetland Pe~'mit to construct a 633 sq.ft, deck at the rear of the dwelling, with the condition non-treated lumber is used, and as depicted on the plan prepared by Robert Lehnert dated March 9, 2009. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixedl and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee, Kelly Myem, residing at 1730 Deep Hole Dr., Mattituck, NY, 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 fo~ ~;t,3mages, 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 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. 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. 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. 9. 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 Annex 54375 Main Road P.O. Box 1179 Southeld, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 22, 2009 Mr. Robert Lehnert Peconic Permit Expediting 32645 Main Rd. Cutohogue, NY 11935 RE: KELLY MYERS 1730 DEEP HOLE DR., MATTITUCK SCTM#115-12-23.2 Dear Mr. Lehnert: The Board of Town Trustees took the following action dudng its regular meeting held on Wed., April 22, 2009 regarding the above matter: WHEREAS, Peconic Permit Expediting on behalf of KELLY MYERS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, application dated Mamh 13, 2009, 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 6.3 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirement: the use of treated lumber is prohibited for use in decking, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect t° said application on April 22, 2009, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premiSes in question and the surrounding area, and, WHEREAS, the Board has considered all the testimonY and documentation submitted concerning this application, and, WHEREAS, the structUre complies with the standards set forth in Chapter 275 of the Southold Town Code, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of KELLY MYERS to construct a 633 sq.ft, deck at the rear of the dwelling, with the condition non-treated lUmber is used, and as depicted on the plan prepared by Robert Lehnert dated March 9, 2009. 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, Jarr~s F. King, PresidCgnt Board of Trustees JFK:lms - 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: ~'~ Cb,._./ I Please be advised that your application dated z~//,._,g f~) ~ 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) __ ¼ Constructed ($50.00) J 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, Secretao~ Town Hail 53095 Main Rd. D.O. Box I 179 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., April 15, 2009, the following recommendation was made: Moved by Doug Hardy, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of KELLY MYERS to construct a 633 sq.ft, deck at the rear of the dwelling. Located: 1730 Deep Hole Dr., Mattituck. SCTM#115-12-23.2 Inspected by: James Eckert, Jack McGreevy, Doug Hardy The CAC Supports the application with the Condition non-treated lumber is used on the deck. The CAC further recommends a clean-up of the hazardous dock that is grounded on bottom and the impassable ramp. Vote of Council: Ayes: All Motion Carried James F, King. President Jill M. Dohetty. Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio. Jr. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: KELLY MYERS requests a Wetland Permit to construct a 633 sq.ft, deck at the rear of the dwelling. Located: 1730 Deep Hole Dr., Mattituck. SCTM#115- 12-23.2 Type of area to be impacted: b-'S~ltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland .P~c. of Town Code proposed work falls under: hapt.275 Chapt. 111 other Type of Application: ~/"'Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __&King VJ.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- View of House & Existing Deck from Edge of Wetlands View of Wetlands from Existing Deck New York State Departmen'~o f Environmental Conservation Building 40--SUNY, Stony Brook, New York 11794 Bas the infO_rmation you have submit{ed, the New York State Department of'EnVironmental Conservation has determined-that the __ parcel ...... project is: - .......... - ...... -- ~ .~Greater than 300' from inventoried tidal wetlands ': Landward of a substantial man-made structure : , · ........ gr.eater ........ than 100' in length which was constructed prior to 9/20/77. . ' Landward of'-t'he'~0' above'mean sea le~el'~l~vation ~:~" ' Contour..~na' gradual, ~atural slope. · Landward of the topographic crest of a bluff, cliff or dune which is greater than 10' '~n elevation above mean sea level. Therefore, no permit is required unde~ the Tidal Wetlan~s"Act (Article 25 of the Environmental Conservation Law). -Please be advised, however, that no construction, sedimentation or disturbance u£ =ny kind may take place seaward of the 10' contour or topographic crest without a permit.' It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentatto'n or other alteration or disturbance to the ground surface or vegetation in this area as a result of your project.. Such precautions may-include providing adequate work area between the 10' contour or topographic crest and the project-(i.e, a 15' to 20' wide -consTruction area) ~-~-e~e.ct.ion orCa.temporary fence, barrier,'or hay bale berm. Please note that any additional work, Or modification to the project as "-described, may-r~q~i~e aUthOrization by this Department/'" P16a~ c~t~c't .......... this office if such are contemplated. Please be further ad=ised that this letter does not relieve you of the responsibility o'f obtaining any necessary permits or approqals from ~ther agencies. - Vet truly yo Is, Deputy Regional Permit Administrator 115 OFFICE LOCATION: Town Hail 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: 631 765-3136 Jim King, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Scott A. Hilary, LWRP Coordinator Date: April 8, 2009 Chapter 268, WATERFRONT CONSISTENCY REVIEW Wetland Permit for KELLY MYERS SCTM#115-12-23.2 Peconic Permit Expediting on behalf of KELLY MYERS requests a Wetland Permit to construct a 633 sq.ft, deck at the rear of the dwelling. Located: 1730 Deep Hole Dr., Mattituck. SCTM#115-12-23.2 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 us, it is our recommendation that the proposed action is INCONSISTENT with LWRP policy standards and therefore is INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. Comply with statutory and regulatory requirements of the SouthoM 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. § 275-3 Findings; purpose; jurisdiction; setbacks. D. Setbacks. The following minimum setbacks apply to any and all operations proposed on residential property within the jurisdiction of the Board of Trusteqs: (a) Wetland boundary. [l] Residence: l OO feet. The distance from the wetland boundary to the proposed action (633 sq. fl deck) is less than 100 feet; a minimum setback distance of 100 feet from the wetland boundary 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. If the agenc¥~ Board of Trustees makes a contrary determination of consistency~ the agency ~hall elaborate in writing the basis for its disagreement with their recommendations Pursuant to Chapter 268 Waterfront Consistency Review. § 268-5. Review of actions. It In the event the LIg'RP Coordinator's recommendation is that the action is inconsistent with the LWRP, and the agency makes a contrary determination of consistency, the agency shall elaborate in writing the basis for its disagreement with the recommendation and state the manner and extent to which the action is consistent with the LWRP policy standards. 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 weaStal Erosion Permit Application tland Permit Application v~j __AmendmentJTrans(er/E, xtension ~e,Received Application: er Received Fee:$~D-'~ o~ ./'Completed Application __Incomplete __SEQRA Classification: Type I Type II Unlisted__ __Coordination:(date sent) ./LWRP Consistency Assessment Form ~ML'r-AC Referral Sent: ~41 ~__D~at e of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: I./Public Hearing Held: Resolution: Office Use Only Administrative Permit Name ofApplicant ~'e- I ~? Phone Number:( ) Suffolk County Tax Map Number: Property Location: / 7.~t57 (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Ap~ GENERAL DATA Land Area (in square feet): ~c~q~O fi~ ~ Area Zoning: ~9_ 40 Previous use of property: Intended use of property: Covenants and Restrictions: Yes X No If "Yes", please provide copy. Prior permits/approvals for site improvements: 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): of Trustees Ap~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:_~ ~ ~t.~ z~':~-~ --~/~ Area of wetlands on lot: t~ square feet Percent coverage of lot: g7 % Closest distance between nearest existing structure and upland edge of wetlands: ~, ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: fi7 feet Does the project involve excavation or filling? ,~ No Yes If yes, how much material will be excavated? How much material will be filled? O O cubic yards cubic yards Depth of which material will be removed or deposited: 0 Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet 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): of Trustees Applicat COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 1 O0 feet of the proposed activity? No ,~x Yes Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? How much material will be filled? Manner in which material will be removed or deposited: (cubic yards) (cubic yards) Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickcrson Dave Bergen Bob Ghosio, Jr. FI Agent Town Hall, 53095 Main Rd. ?.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631 ) 765-6641 osta~ ; e~)'q2 0~ [dress different flom Item I-~ Yes ILl P g ~ ~ ~mss below: [] No ~ 'R~, ,c,e, Oe? r:; 7---- ,0.0~ '/ .. \%\ v I I '-,'. ~ ~i~ ~ ;.~,/~ ................. ~ ~,~) ~ · ~ ~~~-~:--~--':;'~~,,~"" . ~, - amy sworn, d~ose~d say: That on theJ5 day of~//'t / ,200~, I personally posted the. property known as by placing the Bo~d of Trustees official poster where it can easily be seen, ~d that I have checked to be sure the poster has remained in place for ei~t days prior to the date of the public heating. Date of heating noted thereon to be held Wed.~ April 22~ 2009 on or about 6:00 PM. Dated: ~' /q' O7 Sworn to before me this iL~ day of /~,a,.200 c~ ry Public ~f~atu[e) ~ NOI~III~ PUILIC-ITA'I'I C~ IdlW ¥01tlc IIio, O~'llCd, l$ I S14 · PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK /~,~tV~L ~g~q,~7L , residing at ,~rffb"- ]~4~/~ ~t~La~ ~.e~ , being duly sworn, deposes and says that on the ~ day of ~A/~'I'// ,200~, deponent mailed a true copy of the Notice s~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 (cerhfied) (registered) marl. Sworn to before me this Day of ,20 Notary Public_~ Pill! R. MC;GIIEEVY NOTARY I~UBLIC:-STATE OF HEW YORK HO. 0~K4,151814 Board of Trustees Application County of Suffolk State of New York ~01¢,' ~ ~..~i~ q Cr ~-- BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PF_,R/VIIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK W/LL 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 PERlVl/T(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 1N CONJUNCTION WITH ~~ION. Signature SWORN TO BEFORE ME THIS [/7~ DAYOF //~/~7 ~-o--O' ,200? Notary Publi~ fl '~ NOTARY PUm.tC.STATi O!~ NI'W YOI~K NO. 0~dC4,1$t S14 PROJECT ID NUMBER PART t - PROJECT INFORMATION I.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) SEQR 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or arovide map 5. IS PROPOSED ACTION: [] New ,~Expansion [] Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially w/~' acres Ultimately ./ ~ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [] Yes [] No If no, describe bdefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) NResidential E~] Industrial ~JCommercial E~]Agriculture [~ Park / Forest I Open Space ~'~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, AGENCY (Federal, State or Local) [~Yes ~No If yes, list agency name and permit / approval: L-J NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes ~i~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E~Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If ~e 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~lenc¥1 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. r'~ Yes [~No 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 producfion or disposal, potential for erosion, drainage or flooding problems? Explain briefly: ¢2. Aeathet}c, agricultural, arohaoological, bistofio, or other natural or cultural msoum~s; o; community or neighborhood character? Explain briefly: D3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefly: C4, A community's existing plans or goals as officially adopted, or a change in use or intensity el use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed acfion? Explain briefly: C6. Long term. short term. cumulative, or other effects not identified in C1-C57 Explain briefly: C7. Other impacts Iincluding changes in use of either quantity or type of energy? Explain D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AR~A (CEA~ Ill yes, explain briefl}c E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If },es explain: i--I e' i--INa I PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determinewhether it is substantial, large, important or otherwisesigniflcant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irrevers[bility; (e) geographic scope; and (0 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 impact of the proposed action on the environ mental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur, Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documerdafion, that the proposed acfio~ WILL NOT result tn any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Tifie 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) 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 detaii~ listing both supporting and non- sunoortine 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# t2 _ 7. 2_ The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board [--~ Building Dept. ~ Board of Trnstees 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: Pf Pgt~ :~ ~ ~f~ Location of action: Site acreage:_ Present land use: I~ng~h~-t'o ~'(~ Present zoning classification: /~ 4 0 If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name ofapplicant: ]~/¢ /14/7,~r ~4 (b) Mailingaddress: q,~ g~2~.~d~r'l ti]vat [~/~lJr~ P]~ln~/ /blZ/ /t~t(eYff' (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 [] 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 ~)~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable 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 ~ NoN 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. Y cs [] 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 ~ 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 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thc Town of Southold's Code of Ethics nn)hibits conflicts of interest on the hart of town officers and emolovees. The vun)ose of this form is to on)vide 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, fgst name, galddle initial, unless you ave applying in the name of someone else or other enfty, such as a company. If so, indicate the 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 Mooting 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 thc Town of Southold? "Relationship" includes by blood, marriage, or business interesL "Business interest'~ means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or cmpinyment by) a corporation in which thc town officer or employee owns more than 5% of the shares. YES NO X If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of 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 desedbe 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, partner, or employee of the applicant; or __,D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this ~.~yof/}~s~t'a.~ 200 ff S ignature~-~...-~f~ PrintName~'~ A~o~'~-4- ~ ~'~0~ ~ FI:CONIC PERMIT EX?EDITING [Sulldlng / DEC / Variance / Marine 32645 Main Road · Cutchogue, NY 11935 E-Mail peconicpe~nits(a)optonline.nct Ph 631.734.8361 · Fx 631.734.2276 February 3, 2009 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY, 11971 - 0959 Re: Trustees Authorization Letter To Whom It May Concern, This letter is to authorize employees of"Peconic Permit Expediting Inc." to act as my agent in obtaining permits from the Board of Town Trustees of the Town of Southold. If you have any questions, please feel free to call me at any time. Respectfully yours, Respectfully yours, Douglass Myers - Homeowner SURVEY OF PROPERTY 51TUAT~, HATTITUOK tOl~l.- 50UTHOLD ~JJI=POLK ~'r'K, NY 5U~VIET~D: HAY 2Cl, 200~ SUFFOLK C~UNt~ TAX # IOOO - II5 - I2 - 2~ DOUGLAS , ,~PROVED BY ~ JARD OF TRUSTEE :, ~','VN OF SOUTHC' N JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.-\\Compaqserver~pros~08~08-152.pro EXI5TING DECK TO DE REMOVED AND REPLACED WITH PROPOSED +/- G33 5.P . DECK -% SITE PLAN ~ SCALE l" 20' ~1~ SITE AND ZONING DATA ZONING REQUIREMENT5 R40 PO415TING OONDITION5 PROPODED CONSTRUCTION A5 rEP- 260 - 124 LOT AREA ¢, 4¢0 ~.F, ¢, 4~0 S.F, F~ONTYA~D 5~BACK 35.0 ~ 52. ¢' ~ 52. ¢' ~. REAR YARD S~DACK 85.0 ~ ~2. g ~. 57, ~ ~. 51DE YARD S~5ACR I 0.0 ~ 8. 0 ~. 8. 0 ~. TOTAL~ DOTHSIDE5 25,0 ~ [8 0 ~ I¢. 0 ~ M~, GE055 FLOOR A~A 20% I 172 5.F. 13.¢% 1805 5.F. 2 I, 4% M~[MUM HEIGHT 35.0' ~ 20. O' ~ 20. O' ~ C'4 :1 · PP. OPOSED DECR REAR ELEVATION SCALE: I/8" = I '-0" DECK PLAN 5CAKE: I/4" = I'-0" 5TRUCTU RAL TO NEW WOOD RAILrNG APPROVED BY BOARD OF TRUSTEES TOWN OF,SOUTHOLD DATE zf_r~;_ O~ PROPOSED DECK AT THE MYERS RESIDENCE 1730 DEEP HOLE DRIVE MATTITUCK, NY S.C.T.M. # 1000 - 115-12-23.2 REVISIONS: DATE: DEJ'IG P.O. Box 1106 OSSINING, NY 10562 Phone: 914.762.6072 Fax: 914.801.4167 PECONIC PERMIT EXPEDITING PHONE: G3 I .734.83G I THESE PLANS AND SPECIFCATIONS ARE INSTRUMENTS OF SERVICE AND ARE TIlE PROPERTY DIP PECONIC PERMIT EXPEDITING INFRiNGEMENTS WILL BE PROSECUTED DATE: %%09 DR. BY: RWL SCALE: AS NOTED CI-IKD: J.S. PROJECT NIJIVIBER SHEET IqlJIVlBER 0813 A-1