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HomeMy WebLinkAboutTR-7154 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765 - 1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: /~, Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction ~ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0640C Date: May 9, 2011 THIS CERTIFIES that the demolition of existing and construction of new dwelling, foundation with gutters to leaders to drywells, deck; replace siding, roof and doors on existing garage; remove existing shed; and 10' wide non-tuff buffer landward of the bulkhead At 1265 Shore Drive, Greenport, New York Suffolk County Tax Map # 47-2-26.1 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated July 22, 2009 pursuant to which Trustees Wetland Permit #7154 Dated August 19, 2009 and Amended on November 18, 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 demolition of existing and construction of new dwelling, foundation with gutters to leaders to drywells, deck; replace siding, roof and doors on existing garage; remove existing shed; and 10' wide non-tuff buffer landward of the bulkhead The certificate is issued to JOHN & MARIE SHACK owner of the aforesaid property. COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC #: C'11-24640 I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 07105/2011 under Liber D00012664 and Page 624 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 07/05/2011 SUFFOLK COUNTY CLERK JUDITH A. PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Number of Pages: 4 Receipt Number : 11-0074620 District: Section: Block: 1000 047.00 02.00 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Page/Filing $20.00 NO Handling COE $5.00 NO NYS SRCHG TP-584 $0.00 NO Notation Cert. Copies $5.00 NO RPT Fees Paid THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL Recorded: At: JUDITH A. PASCALE County Clerk, Suffolk County 07/05/2011 11:28:05 AM LIBER: D00012664 PAGE: 524 Lot: 026.001 Exempt $20.00 NO $15.00 NO $0.00 NO $30.00 NO $95.00 Number of pages This document will be public record. Please remove all Social Security Numbers prior to recording. Deed / Mortgage Instrument Deed / Mortgage Tax Stamp Page / Filing Fee 0~ __ FEES Handling 20. 00 TP-584 Notation EA-52 17 (County) Sub Total EA-5217 (State) R,P,T.S.A. ,~-'--. ~/~ Comm. of Ed. 5. 00 Affidavit Certified Copy ~ NYS Surcharge Other Dist. Real Property Tax Service Agency Verification 15, 00 Sub Total Grand Total 1000 04700 0200 026001 Jul 05 SU[:qTH FI. PA'.:.;CRLE CLERK OF E, UFFOLK L D000i2664 P 5:24 Reco[ding / Filing Stamps Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec./Assit. or Spec./Add, TOT. MTG. TAX Dual Town __ Dual County Held for Appointment Transfer Tax Mansion Tax The property covered by this mortgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # __ of this instrument. 5 Community Preservation Fund Consideration Amount $ CPF Tax Due $ 1 Satisfactions/Discharges/Releases List Property Owners Mailing Address Improved I RECORD & RETURN TO: Vacant Land Mail to: Judith A. Pascale, Suffolk County Clerk 17I Title Company Information I310 Center Drive, Riverhead, NY 11901 ~Co.N~¢ I I Title ~w. su~olkcouBtyny.~ov/clerk .I Suffolk County Recording & Endorsement Page This page fores pa~ of the attached ~2 ~ = ~ ~' ~ ~ ~ ~/~ ~ ~ ~-= / made by: (SPECIFY TYPE ~S~UMENT) ,~ ~~~ ~P~'~ ~~hepre~s'eshereinissituatedin SU~OLK COUNTY, ~W YO~. In the TOWN of In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) IMPORTANT NOTICe. If the document you've Just recorded is your ~ATISFACTION OF MORTGAGE please be aware of the following: · If a portion of your monthly mortgage payment included your property taxes, *you will now need to contact your local Town Tax Receiver so that you may be billed directly ior all future property tax statements. Local property taxes are payable twice a year: on or before January 10~ and on or before May 31'~. Failure to make payments in a timely fashion could result in a penalty. Please contact yoUr looal Town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes 200 East Sunrise Highway North Lindenhurst, N.Y. 11757 (631) 957-3004 Riverhead Town Receiver of Taxes 200 Howell Avenue Riverhead, N.Y. 11901 (631) 727-3200 Brookhaven Town Receiver of Taxes One Independence Hill Farmingville, N.Y. 11738 (631) 451-9009 Shelter Island Town Receiver of Taxes Shelter Island Town Hall Shelter Island, N.Y. 11964 (631) 749-3338 East Hampton Town Receiver of Taxes 300 Pantigo Place East Hampton, N.Y. 11937 (631) 324-2770 Smlthtown Town Receiver of Taxes 99 West Main Street Smithtown, N.Y. 11787 {631) 360-7610 Huntington Town Receiver of Taxes 100 Main Street Huntington, N.Y. 11743 (631) 351-3217 Southampton Town Receiver of Taxes 116 Hampton Road Southampton, N.Y. 11968 (631) 283-6514 Islip Town Receiver of Taxes 40 Nassau Avenue Islip, N.Y. 11751 (631) 224~5580 Southold Town Receiver of Taxes 53095 Main Street Southold, N.Y. 11971 (631) 765-1803 Sincerely, Judith A. Pascale Suffolk County Clerk DECL~LRATION OF COVENANTS THIS DECLARATION made this ~7~day of Shack and Marie A. Shack, residing at 2Y Valley Road, hereinafter referred to as "DECLARANTS": , 20/ /, by John Woburn, MA 01801, WI TNES S E TH : WHEREAS, DECLARANTS are the owners of certain real property located on 1265 Shore Drive, Greenport, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 47, Block 2, Lot26.1 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANTS therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a 15 FOOT WIDE, "non-turf buffer" be established adjacent to and landward of the BULKHEAD, OF THE PROPERTY; NOW, THEREFORE, the DECLARANTS do hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and subsequently maintained ADJACENT TO, and running the length of, THE BULKHEAD, A 15-FOOT WIDE "non-turf buffer" ,as defined by Chapter 275 of the Town Code; and 2) These covenants shall run with the land and shall be binding on the DECLARANTS, their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner) has/have duly executed this instrument this 27 day of J--~z~_ , 20 H OWNER'S SIGNATURE OWNER' S SIGNATURE STATE OF ~ ~o¢~ : ss: COUNTY OF On the ~?+~ day of ~-~._ , in the year 20t( , before me the undersigned, a Notary Public in and for said State, personally appeared John Shack and Marie A. Shack, personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their capacity, and that by their signatures on the instrument, the individuals or the persons on behalf of which the individuals acted, executed the instrument. Notary Public TAMM! S. GRAI't*AN Notary Public, State of New YO~ NO. OIGR6142lll Oualified in Suffolk County.,. Commission Expires March 13, 20/'7' ~.~. that certain plot, piece or parcel of and improvements thereon erected situate, lying land and with being the in buildings the Town of Southhold, County of Suffolk, State of New York,known and designated ~l~\as lots 16 and 17 and part.of lot 15,on a certain map entitled JMap of Greenport Shores,Section 1 a~d filed in the office of the Clerk of the County of Suffolk on June 29,1950, as Map No. 1759, said lot and part of lots being more particularly described and bounded as follows: ~ BEGINNING at a point on the Southeasterly side of Shore Drive, where the same is intersected by the division line between lots 17 and 18 on he above mentioned map; running thence Northeasterly along the South- easterly side of Shore Drive , the following (2) courses and distances: 1) North 50~ 38' 30" East 100 feet 2) North 6 ~ 19' 20" East 19.57 feet thence thru lot 15, South 39~ 21' 30" East 145 feet to the North- westerly side of Pipes Cove; thence along the Northwesterly si~e of Pipes C~ve, on a bearing South 51° 18' 20" West 114.02 feet to the division line between lots 17 and 18; thence along said division line, North 39~ 21' 30" West 130 feet to the Southeasterly side of Shore Drive, at the point or place of B~GZ~NZ~G. Together with an easement over Shore Drive as shown on said map for ingress and egress only. It being intended to convey the same premises known as and by the street number 516 Shore Drive, Greenport, N.Y. conveyed to Mary M Sayegh by deed dated August 1st 1979 recorded in the Suffolk County Clerk's Office on August 16th,1979 in Liber 8678 Page 34 and now designated as lot 26Jon the Tax Map with a street address number of 1265 Shore Drive TO~ETIIER with all right, title ~d interest of the part les o! the first part of, in and to the land lying in the stre~s ,nd road~ in front of and adjoining ~aid premise~. TO(;ETIIR. R wi& ~e appurten.~n~ and all the estate and rights of the part ies of the firs~ part in and to said plz~xi~s. :'.,.~' TO~IAYEANl)TOHO]LDfl~epremi~h~ffranteduntothepanies ofthe~econdpar~ ~the~'~".he~rs and ~i~ms forever. MARTIN D. FINNEGAN TOWN ATTORNEY martin,finnegan @town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer.andaloro@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town,southald.ny,us OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 Mr. John G. Shack, Jr. 17A Valley Road Waburn, MA 01801 April 28 2011 RE: 1265 Shore Drive, Greenport Dear Mr. Shack, I have reviewed the Declaration of Covenants draft you submitted to this office with respect to the above referenced matter concerning the 15 foot wide non-turf buffer to be established adjacent to and landward &the bulkhead. The covenants and restrictions document must be executed and filed with the County pursuant to §275-10K of the Southold Town Code (attached). Please note that a copy of this document, or, in the alternative, a sworn statement attesting to the filing is to be presented to the Office of the Board of Trustees within 90 days of the issuance of the permit. Regards, Assistant Town Attorney Ecl. Cc: Board of Trustees Facsimile Cover Sheet To: Board of Trustees Company: Town of Southold Phone: 631-765-1892 Fax: 631-765-6641 From: John G. Shack, Company: Attorney at Law Phone: 781-938~0700 Fax: 781-938-6767 Date: 4125/2011 Pages including this cover page: If you do not receive all pages, please call 781-938-0700 immediately. THE INFORMATION CONTAINED IN THIS TRANSMISSION IS CONFIDENTIAL AND/OR ATTORNEY- CLIENT PRIVILEGED. IT IS INTENDED FOR THE USE OF THE ADDRESSEE ONLY. ANY USE, DISTRIBUTION OR DISSEMINATION BY ANY MEANS OF THIS MESSAGE BY AN UNAUTHORIZED RECIPIENT IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY ATI'ORNEY JOHN SHACK IMMEDIATELY BY COLLECT TELEPHONE. Commen~: Enclosed please find a draft covenant for the property at 1265 Shore Ddve, Greenpe~ ZBA file 6363~ Please call if ther am any questions or if you woud like me to make any changes, I would like to record fl~is document this week as we are anxious to move in ~o our new home. Also, do you have any proble~n with me getting the document notarized in Massachusetts? 07/18/2030 03:54 #0275 P.002/004 DECLARATION OF COVENANTS THIS DECLARATION made this .... day of , 2O Marie A. Shack, residing at 17 Valley Road, Woburn, MA 01801, to as "DECLARANTS": , by John Shack and hereinafter referred WITNESSETH : wHEREAS, DECLARANTS are the owners of certain real property located on 1265 Shore Drive, Greenport, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 47, Block 2, Lot26.1 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction Of the ~oard of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be s~bject to the regulation and approval of the Trustees prior to being conducted; wHEREAS, the DECLARANTS therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a 15 FOOT DEEP, "non-turf buffer" be established adjacent to and landward of the BULKHEAD, OF THE PROPERTY; NOW, THEREFORE, 1) Upon the substantial completion of activities there shall be established ADJACENT TO, and running the length of, the DECI2%RANT$ do hereby covenant and agree as follows: the aforementioned permitted and subsequently maintained THE BULKHEAD, A 15-FOOT DEEF "non-turf buffer" ,as defined by Chapter 275 of the Town Code; and 07/19/2030 03:54 #0275 P.003/004 2) These covenants shall run with the land and shall be binding on the DECLARANTS, their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution Of the Trustees. IN WITNESS WHEREOF, the owner) has/have duly executed this instrument this __ of 20 .day OWNER'S SIGNATURE OWNER' S SIGNATURE STATE OF : COUNTY OF On the -- day of , in the year 20 , before me the undersigned, a Notary Public in and for said State, personally appeared John Shack and Marie A. Shack, personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their capacity, and that by their signatures on the instruatent, the individuals or the persons on behalf of which the individuals acted, executed the instrument. Notary Public 2 07/19/2030 03:55 #02?5 P.004/004 % AIL that certain plot, piec~ or parce! of lalld with the buildings ancl improved?nfs thereon ereotedi situate, lying and being in the Town ~1~:~;~ 16 ,~: 17 ~d pa~ of. lo2 15,on a oe~~ ~1~ ~ of ~ ~tng ~a ~r~icul,arly ~crl~d ud / ~ follows= ~~ ~I~ at a ~lnt on the Sou~eas~erly si~ of Sho~ Drive, whe~ ','~ i~ ~ ~ ~ntioned ~p~ r~ thence .Northeasterly aloag ~ South- ~ e~terly side of Shore Driv~ ; th~ following (2) ~ 1) Nor~ 50~ 38~ 30s East 100 feet ~' 2) ~orth 6~ 19~ 20" ~st 19.57 feet ill N~ - th~ce ~ lot 15, South 39~ 21~ 30" East 145 feet to the North- ~.. : westerly side of Pl~s Cove'} thefloe aloag the Norttw~es~erly s~e~e ~.~-.~,'~ a ~.~~ ~aring South 510 18' 20" West 114.02 feet to the division tiae " helen lots 17 ~d 18; thence along said division line, North 390 21' 30" Wes~ 130 f~t to th~ Southeasterly side of Shore Drive, at the point or place of BEGI~ING. Together with an easement over Shore Drive as shown.on said map for ingress and egress only. It being intended to convey the same premises known as and by the street n~mher 516 Shore Drive, Greener,, N.Y. ¢oaweyed to Mary M Sayegh by deed dated August 1st 1979 recorded in the Suffolk County Clerk's Office on August 16th,1979 in Liber 8678 Page 34 and now designated aS lot 26Jori the Tax ~ap with a street address nt,~b~r of 1265 shore Drive VACANT PUBLIC WA TER IN STREET SHORE TEST BORING b~ McDoneld Geo$clence 7/~1/0~ CH ~ ~ I Wa/er in ~own ~ I water ~ Pale ~r. ~ ~1' [ Fine *~d SP ~ N. 50'38'30' E. I00.00' EXIS TING' IE 11.7 LOT 0.5 LOT ZONE' AE ( el. ~ 54V370' ~ FLOOD ZONES FROM FIRM 36103C0159 5/4/.98 ELEVA T/O/V: ,a,¢E RF_FERENCEtP TO NGV'D PIPES AREA = 15,746 sq. ft. to tieline LOT 1~ 114.22' COVE ANY AL TERA T/ON OR AODITION TO ~ SURVEY I~ A VIOLA TION OF SECTION 7ff09 OF THE NEW YORK STATE EDUCATION LAW, EXCEPT AS PER SECTION 7209-SI.~DIVlSION 2. ALL CERTIFICATIONS HEREON ARE VAUD FOR T~ MAP AND COPIES THF~EOI: ONLY F SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SI6NA TURE APPEARS HEREON.. ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTERED BY' MUST BE USED BY ANY AND ALL SURVEYORS UTILIZ~V~ A COPY OF ANOTI~-.R ~URVEYOR'S MAP. TERMS SUCH AS 'INSPECTED' AND 'BROU~HT'TO'OA TE' ARE NOT IN COMPLIANCE WITH THE LAW. PlO LOT FIN FLR- EL. 15.8 CROSS SECTION SURVEY OF LOTS 16, 17 & P/LOT I~P OF GI~J~PORT SHORES ~ ,o.~' RLEO~UI~2~ ~ RLENO. 1759 ~ AT GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N K 1000 - 47- 02-P1026 ~CALE.. Y' = 20' SEPT. 1, 1998 JAN. ;~?~ ~OOF (PROP. ADDIT.; ~JNE 5~, ~.007 /LOT COVERAGE) AU~. IZ, ZOO9 (PROt=, ADDITION) De= 4, ~_.oo~ (631] 765 - 5020 P. o. ~ox ~o~ -- 1230 TRAVELER ~TREET SOUTHOLD~ N. Y. 11971 RAIN RUNOFF CALCULA HOUSE AFTER CONSTRUCTION -2147. sq. ft. 2147 x 0]7 ~ I = 365 cu./L 365/~.3 = 16.4 VF GARAGE = 545 sq.-fl ASPHALT DRIVE = 592 sq. ft. GARAGE & DRIVEWAY = 11~7 1137 ~ 0.17 ~ I = 193.3 cu.//. 193.3/2~.3 = 8,7 VF Z5.1 v? PROVIDE 4 DW$ 6'¢ *: 7 LOT COVERAGE EX/STING Z~34 sq. ff. 223411574~ = 14%' AT COMPLETION OF CONSTRUCTION 2692 sq. fl. 2692/15746 17% 98- 283 (2) 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 November 18, 2009 Mr. & Mrs..John Shack 17A Valley Rd. Wobum, MA 01801 RE: 1265 SHORE DR., GREENPORT SCTM#47-2-26.1 Dear Mr. & Mrs. Shack: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., November 18, 2009: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Permit #7154 to remove and replace in the same footprint, the existing foundation of the dwelling, and as depicted on the site plan prepared by Robert Bassolino, Architect last dated September 15, 2009. This is not a determination from any other agency. Sincerely, Ja s~F. King,C:'~re ' nt Board of Trustee~es'~n JFK:lms James Eckert, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631 ) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Thurs., November 12, 2009, the following recommendation was made: Moved by Peter Young, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Amendment application of JOHN & MARIE SHACK request an Amendment to Permit #7154 to remove and replace in the same footprint, the existing foundation of the dwelling. Located: 1265 Shore Dr., Greenport. SCTM#47-2-26.1 Inspected by: Peter Young The CAC Supports the application with the Condition a line of staked hay bales is installed prior to the construction activities. Vote of Council: Ayes: All Motion Carried 69/22/2809 14:~8 7656641 BOARD OF TRUSTEES P~GE ~2 James F. King, Pr~t~ident Tow~ Hall Jill M DohQ~y, Vice-Preoident ~3095 Route 25 P.O. Box 1179 P~g~ A. Dickerson Southold, New York 11971-0959 Daw Bergan lo~ Hol~pfcl Telephone (631) 765-1892 ~o~ o~ rO~ ~US~ES 1~ fl/ O~T - ~ ., //1~ TOW~ OF SOUT~OLV /~~ APPLICATION FOR AN AMENDMENT TO A ~TLA~ DATE (~3 AGENT ,MDDRESS PHONE I/We ~ ¢ ' request an Amendment to Permit # 7 ] ~)''' to ' ~ ) ~ ~ Signed By: ATTACH STATE OF NEW YORK COUNTY OF SUFFOLK 7008 2810 7008 ~ 7563 9641 2810 00~1 7563 9634 7008 2810 0001 7563 9627 ~-//fi~/?f £/d. /Q?/~ -- , being duly sworn, oepos~s and says that on the ex/ 'day of 49c~7~ ,20~)fl, dep°nent mailed a tree c°py °f the N°tice s~t foffh, in the Bo~d of Trustees Application, directed to each of the above rimed persons at the ad&esses set opposite there respective n~es; that ~e ad~esses set opphsite ~e nines of said persons ~e the ad.ess of said persons ~ shorn on the c~ent assessment~oll~f the Tom of Southold; that said Notices were m~led at the Un~ted States Post Office at N¢~-~,,~;~ ~ ., that s~d Notices were mailed to each of sa~d persons by (ce~ified5 (registerS) mail' ~~~f Swom to before me this '~ ~ Dayof ~pVe~f., 20fl ~ _ 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 I 179 Southold, NY 11971 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 JOHN & MARIE SHACK COUNTY OF SUFFOLK) STATE OF NEW YORK) I, \~)~/u q~/~a' (-4~- , residing at/dba AFFIDAVIT OF POSTING being duly sworn, depose and say: That on the / day of ,/~U , ,200 ], I personally posted the~pro£~rty, known as by placing the Board of Trustees official poster wher~'it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed.~ November 18~ 2009 on or about 6:00 PM. Dated: ~ig~ature) Sworn to before me this cf f3 day ° fd~e~e~O0 7 / NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under. Chap. ters 32, 37, and/or 97 of the Town Code is open to public comment on: ~30t.), (~'D3 / ~00(~ . You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. Enc: Copy of sketch or plan sho~ving proposal for your convenience. A GOI--J~TI~.U C, TIO kJ NOtEs VACANT PUBLIC WATER IN STREET SHORE TEST BORING 7/~1/06 e'l ~.~ OL Cle)-ey Sand Wafer in Pale wt ~z.7 N. 50'35'$0' E. I /o' ntb~ I00.00' 5m,4 __ tg LOT LOT I~ ZONE X LOT ZONE wooo ~ AE ( el. S. 54'/$'10' FLOOD ZONES FROM FIRM $6105C0159 5/4/98 PIPES COVE ELEVATIONS ARE REFERENCED TO NGVD AREA = 15,746 sq. ft. to tieline AUG 14 Southhold Town Board of Trustees ANY AL TERA TION OR AO0~ TO TI-I~ ,~URVEY IS A VIOLATION OF SECTION ?~09 OF THE NE1F YORK STATE EDUC~ TION LAW, EXCEPT AS PER SECTION X~O~-SUSDIVI~ON E. ALL CERTIFTCATION~ HEREON ARE VALID FOR TF4S MAP AND COPIES THEREOF' ONLY F ~ MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WI'lOSE ~ TURE APPEARS HEREON~ ADDITIONALLY' TO CO~OL Y ~TH SAID LAW THE TERM 'ALTERED BY" MUST BE USED 8Y ANY AND ALL SURVEYORS UTg-IZIN6 A COPY OF ANOTHER ~URVEYOR'S MAP. TERMS SUCH AS 'IlCS~ECTED' AND 'BROUgHT-TO-DATE~ ARE NOT IN COMPLIANCE ~flTH THE LAW, APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE ,~u~ /'f o'/ SURVEY OF (~ =o: LOTS 16, 17 & P/LOT 15 ,c~ MAP OF GREENPORT SHORES P/O LOT ~ ~o.e' FILED JUNE 29, 1950 FILE NC). 1759 v~ ',~ A T GREENPORT. ~ TOWN OF SOUTHOLD · .~ SUFFOLK COUNTY, N Y. · .~ 1000 - 47 - 02 ~ PlO 26 RAIN RUNOFF CALCULA HOUSE AFTER CONSTRUCTION -2147. sq. ff. 2147 ~ 0.17 ~ I = 365 cu. ft. 365/22.3 = 16.4 VF GARAGE = 545 sq.-Il ASPHALT DRIVE = 592 Gq. fL GARAGE & DRIVEWAY = 1t37 _~q. ft. 1137 ~ 0.1~' x I = 193.3 cu. fl. 193.,~/~2.3= 8.7 VF / ~5.1 VF PROVIDE 4 DF$ 6'¢ ~ 7r DEC_C 'OR EQUAL LOT COVERAGE EXISTING 2234 sq.l.L 2234/15746 = 14%' A T COMPLETION OF CONSTRUCT/ON 2692 Gq. fl. ' .2692115746 = 17% SCALE: 1" = 20' SEPT. 1, 1998 JAN. ~7, ~.007 (PROP. ADDITJ JUNE 5, ~007 (LOT COVERAGE) AUG. 12, ~009 (PROP. ADD/T/ON) (651) 765 _~:,~,~c~5 ' "~ ., ;~, j ,~',/ 1230 TRA VELER "'~f/;~E~c~t:~ . SOUTHOLD~ N.Y. 11~'77~'~-~' A I:::II:;~$T F LO0~?_ P L k. LJ New York State Departm'O of Environmental Conser Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www. dec.state.ny~us , LETTER OF NON JURISDICTION TIDAL WETLANDS ACT Denise M. Sheehan Commissioner John Shack 146 Pleasant Street Wobum, MA 01801 December 8, 2006 Application # 1-4738-02383/00007 Shack property, 1265 Shore Drive, Greenport SCTM # 1000-47-02-p/o 26 Dear Mr. Shack: Based on the information you have submitted the Department of Environmental Conservation has determined that the property landward of the pre-existing (prior to 8/20/77) bulkhead is beyond Tidal Wetlands Act (Article 25) jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required. Be advibed,, no construction, sedimentation, or disturbance of any kind may take place seawar~ ~fi~he tidal wetlands jurisdictiona! boundary, as indicated above, without a permit. It is your responsibility to ensure that all precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictionai boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hale bay berm. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. Sincerely, Mark Carrara Deputy Permit Administrator Robert Bassolino BMHP. file James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS. PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ¼ constructed V~Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7154 DATE: AUGUST 19~ 2009 ISSUE_D TQ: JOHN & MARIE~SHACK PROPERTY ADDRESS: 1265 SHORE DRIVE~ GREENPORT SC~TM# 47-2-26.1 AUTHORIZATION Pursuant to thc provisions of Chapter 275 and/or Chapter I 11 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 August 19, 2009, and in consideration of application fee in the sum of $250.00 paid by John & Marie Shack and subject to the Terms and Conditions as staied in the Resolution, the Southoid Town Board of Trustees authorizes and permits the following: Wetland Permit to demolish an existing dwelling and construct a new one-story dwelling with attic space, remove/replace the existing deck, replace siding, new roof and doors on existing garage, and remove the existing shed, with the condition of a line of staked hay bales with silt fencing is installed prior to construction 10' landward of, the bulkhead, the installation of gutters, leaders and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, and as depicted on the survey prepared by Peconic Surveyors, P.C,, last dated August 12, 2009~.and received on August 14, 2009. IN WITNESS WHEREOF, the said BOard of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee John & Marie Shack residing at 1265 Shore Drive. Greenoort, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permitree assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Ji]] 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 August19,2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. &Mrs. John Shack 17A Valley Road Wobum, MA 01801 RE: 1265 SHORE DRIVE, GREENPORT SCTM# 47-2-26.1 Dear Mr. & Mrs. Shack: The Board of Town Trustees took the following action dudng its regular meeting held on Wednesday, August 19, 2009 regarding the above matter: WHEREAS, JOHN & MARIE SHACK 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 22, 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 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 August 19, 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, 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that 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 JOHN & MARIE SHACK to demolish an existing dwelling and construct a new one-story dwelling with attic space, remove/replace the existing deck, replace siding, new roof and doors on existing garage, and remove the existing shed, with the condition of a line of staked hay bales with silt fencing is installed prior to construction 10' landward of the bulkhead, the installation of gutters, leaders and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated August 12, 2009, and received on August 14, 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:S100.00 Very truly yours, James F. King President, Board of Trustees JFK/eac James F. King, President Jill M. Doherty, Vice-president Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ~ has been reviewed by this Board at the regular meeting ~'~ ~ pending and your application has been approved the completi6n of the' following items checked off below. Revised Plans for proposed project i,~Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ~ 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 James Eckcrt, 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 12, 2009, the following recommendation was made: Moved by Greta Schiller, seconded by Doug Hardy, it was RESOVLED to SUPPORT the Wetland Permit application of JOHN & MARIE SHACK to demolish an existing dwelling and construct a new one-story dwelling with attic space, remove/replace the existing deck, replace siding, new roof and doore on existing garage, and remove the existing shed. Located: 1265 Shore Dr., Greenport. SCTMf147-2-26.1 Inspected by: Greta Schiller, Doug Hardy The CAC Supports the application with the Condition gutters and drywells are installed to contain roof run-off. Vote of Council: Ayes: All Motion Carried James F. King, President Jill M. Dohedy, Vice-President Peggy A. Dickerson Dave Be~en 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 JOHN & MARIE SHACK request a Wetland Permit to demolish an existing dwelling and construct a new one-story dwelling with attic space, remove/replace the existing deck, replace siding, new roof and doors on existing garage, and remove the existing shed. Located: 1265 Shore Dr., Greenport. SCTM#47-2-26.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound ~"'Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: '//'Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Present Were: /~.King ~J.Doherty ~/-~-'~.Dickerson __ D. Dzenkowski other Form filled out in the field by ~'D'D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 South(Ad, NY 11971 Telephone: 631 765-193S Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: From: Jim King, President Town of Southold Board of Trustees//. Mark Terry, Principal Planner LWRP Coordinator Date: August 13, 2009 Southhold Town Board of TIustees Re: Proposed Wetland Permit for JOHN & MARIE SHACK SCTM#47-2-26.1 JOHN & MARIE SHACK request a Wetland Permit to demolish an existing dwelling and construct a new one-story dwelling with attic space, remove/replace the existing deck, replace siding, new roof and doors on existing garage, and remove the existing shed. Located: 1265 Shore Dr., Greenport. SCTM#47-2-26.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the denoted following Policy Standards and therefore is CONSISTENT with the LWRP provided that the following recommendations to further the below listed policies are implemented. Policy 6. Protect and restore the quafity and function of the Town of Southold ecosystem 6.3 Protect and restore tidal and freshwater wetlands. E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided: Maintain buffers to achieve a high filtration efficiency of surface runoff. Avoid permanent or unnecessary disturbance within buffer areas. Maintain existing indigenous vegetation within buffer areas. If the action is approved it is recommended that the existing trees on-site be preserved through the establishment of a perpetual landscaped buffer be required landward from the bulkhead. A sample definition follows: LANDSCAPED BUFFER -- a land area of a certain lenqth and width which is planted with indigenous, drought tolerant, vegetation similar to that found within the immediate proximity of the parcel. Vegetation shall be installed in sufficient densities to achieve ninety-five (95) percent ground cover within two years of installation. Survival of planted vegetation shall be (ninety) 90 percent for a period of three years. Maintenance activities within the buffer are limited to removing vegetation which are hazardous to life and property, trimminq tree limbs up to a height of fifteen feet (15') to maintain viewsheds, replanting of vegetation and establishing a four foot (4') wide access path constructed of pervious material for access to the water-body. Further, to further Policy 5, "Protect and improve water quality and supply in the Town of $outhold' and protect and improve the water quality and supply in the area; the following best management practices are recommended: 1. Require that all landscaped areas use indigenous, drought tolerant vegetation in landscaping to minimize irrigation and the use of synthetic fertilizers and herbicides. 2. Require the installation of gutters, leader and drywells to minimize storm water impacts. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ,~ Wetland Permit Application __ Administrative Permit .R __AmendmenffTrans~r/E~:tension eceived Application:~J~OJ~ eceived Fee:$r~'-~~ r - ~'Completed Application r~ ~.~O~ Incomplete SEQRA Classification: Type I Type 1I Unlisted __Coordinat/on:(date sent).__ ~/LWRP Consistency Assessment Form ~ [ ~ I 0 q ~AC Referral Sent: ~ 7Date of Inspection: ~ ~Receipt of CAC Report: __Lead Agency Determination: Technical Review: .M~blic Hearing Held: Resolution: Address Phone Nmber:( Suffolk County T~ Map Number: 1000- Prope~y Location: ~rovide LILCO Pole ~, dist~ce to cross streets, AGENT: (If applicable) Address: Phone: of Trustees Applicati¢ GENERAL DATA Land Area (in square feet): i~' } r}t~0 %%, Area Zoning:. "¢,- qO Previous use of property: Intended use of Property: Covenants and Restrictions: If "Yes", please provide copy. Yes No 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 govermnental agency? ){ No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): of Trustees Applicati¢ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t~t~ 0~61%~Dr0~ YE%'lc~B0-~ Area of wetlands on lot: I~ , 3 ~(O square feet Percent coverage oflot: I~'~ ~ % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ q feet Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated? ~ ') -} cubic yards How much material will be filled? © cubic yards Depth of which material will be removed or deposited: t~ feet \ Proposed slope throughout the area of operations: to 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): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 3.E)ROJE.C..T LO ATION: Municipality 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) cou. °o C F?obt(. 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide mad 5. IS PROPOSED ACTION: ~ New ~ ~pansion ~M~on/altemfion 7. AMOUNT OF LAND AFFECTED: Initially ~ ~ acres Ultimately L .~) acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? 9. WHAT IS PRESENT LAND USE IN VICINI~ OF PROJECT? (Ch~se as many as apply.) ~ Residential ~ [ndustdal ~Co~mercial ~Agriculture ~ Park/Forest/Dp n Space ~Other (descdbe) 10. ~ES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTI~TELY FROM ANY OTHER GOVERNME~AL Yes NO If yes, list agency permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~]Yes F~No If yes, list agency name and permit / approval: I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE"ro THE BEAST OF MY KNOWLEDGE Applicant/SponsorSignature Name ~./~~,~ . . ~~ Date: ~ 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 EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process and use the FULL EAF. [--]Yes E]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. E~Yes E~]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 production or disposal. potential for erosion, drainage or flooding problems? Explain br~efly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural msoumes; or community or neighborhood character? Explain bfieffij: I C3. Vegetation or fauna, fish, shelffish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? ExpJain briefly: C5. Growth subsequent developmect or related achwhes hkely to be reduced by the proposed action'~ Explain bnefly C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: I C7. Other impacts (including_~:~an~es in use of either quantity or tyPe of energy? Explai~ briefly: i D. VVILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEAI? Ill yes, explain briefl}~: r'~ Yes E~N° I E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? if }'es explain: 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 connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (~ 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 d etermination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actJo[ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessaPj, the reasons supporting thi~ determination. Name of Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible O~icer in Lead Agency Signature of Responsible Officer in Lead Agency 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 I 179 Southold, NY 11971 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 JOHN & MARIE SHACK COUNTY OF SUFFOLK) STATE OF NEW YORK) AUg - 3 X'i;~ $outhh01d Town Board et Trustees AFFIDAVIT OF POSTING ' I, /'~?7~ C?~'C4~ , residing at /dba /'~c~'~- C.~/~z5/'e-' being duly swomidepos~d sa~ That on the ~ day o~ ,20~, I personally posted the progeny ~own as by placing the Bo~d ~Tmstees bfficial ~ost~r wher~ can ~sily ~ seen, ~d that I have checked to be sure the poster has rmain~ in place for ei~t days prior to ~e date of the public hearing. Date of heating noted thereon to be held Wed., August 19~ 2009 on or about 6:00 PM. Dated: Sworn to b~fore me this day of~l'h~ 200cJ Notary Public COi~l'llr. D. tlUI~ICH Nota~ Public. State of New No. oleu618505o ^ qualifi~ in Suffolk Coun~ . ~,ommmsion i:x~ifea April 14, 2'0 1::3 [:3 Re Rest~cted Delive~ Fee ~1=~3 ~r'l~ (Er3, C3 (EndorsementRequlred) i~: Fa ~ ~ g~ ~ ~¢F~:~.~ '~ .................................................. STATE OF NEW YORK COUNTY OF SUFFOLK ('~/~-~t7 ~/) r~ , being duly sworn, deposes and says that on the / ' c~ay of/?4fl= ,20 ~, deponent mailed a true copy of the Notice set forth, in the Board of'Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the T9wn of $outhold; that said Notices were mailed at the United States Post Office at .(~o ./~//,~..t~,~ /D ~/ ,that said Notices were mailed to each of said persons by (certified) (registe~ted) mail. / Sworn to before me this Day of?~ ,20C~q Notary Public CONNIE D. BUNCH Notary Public.State of New York No. 0lBU6185050 Qualified in Suffolk County ~ ,, [;ommission Expires April 14, 20.L~:~'- of Trustees County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), 1F GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS ~7cIr~ DAY OF ~{~ 0q ,20 co, '-"Notary Public LAUREN M, STANDISH Notary Public, b'~ bf New York No. 01ST6164008 Qualified in Suffolk County Commission Expires April 9, APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the vail of town officers mad emnlovces. The our0ose of this form is to nmvide information which can alert the town of oossible conffic~ of interest and allow it to take whatever action is nec~sarv to avoid same. (Last name, f~rst'hame,.iniddle initial, unless you are applying in the name of someone else or other entity, 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 Change of Zone Coast~ Erosion Approval of plat Mooting Exemption from plat or official map Planning Other (lf"Othcr", name the activity.) Do you personally (or through your company, sl?oase, sibling, parent, or child) have a relationship with any officer or employee of thc Town of Southold? "Rclationshlp' includes by blood, marriage, or bUSiness interest- "Business interest' means a business, including a partnership, in which thc town officer or employee has cvcn a parlial ownership of (or employment by) a corporation in which thc 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 appmprlate 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): __fi) the owner of greater than 5% of the shams of the corporate stock of the applicont (when the applicant is a corporation); __.B) the legal or beneficial owner of any interest in a non-~:orporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted ~i~ e3q¢ d~of~.¢~.. Print Name 20o ] 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 PROJECT NAME The Application has been submitted to (check appropriate response): TownBoard Planning Board r-] .ildingDep,. [] oa o,T s,ecs Catego~ of Town of Southold agency action (check appropriate response): (a) Co) 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 zoning classification: ~ - Ot 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 of applicant: (b) Mailing address: Iqh (c) Telephone number: Area Code (). q~' l ~ q 3 ~"'~ ~ l~> g (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 bc returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, p~reserves 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 Atlach 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. Sec LWRP Section III - Policies Pages 6 through 7 for evaluation criteria Yes E 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 71 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 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 r~ No .~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~Yes ~-~ No~~] Not Ct~)plic~le~ ~ L0~t/ I_ 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 T Attach additional sheets if necessary WORKING COAST POLICIEI 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. 62 through 65 for evaluation criteria. Yes [-q No [-~ Not Applicable Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages ' 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 _ ~'~e. ~ ~/#,~ ~,'//~ b~,,'/~'//~i~ ~_ 'F TITLE DATI~g~ ff'~/~)k //~' VACANT PUBLIC IFA TER IN STREET SHORE TEST BORING OL Brown C/o)'e~ Sond SC Woler Fine S~d ~v,z.~' N. 50'35'30' E. /o' mi4 I00.00' 5~,4 E'X~ TIN6 ? #*? LOT 0.5 Om'. LOT 1~ ZONE X ZONE AE ( el. ~ S. 54'/370' W. ~ETTY FL OOO ZONES FROM FIRM 36103C0159 5/4/98 ELEVAT/ONS ARE REFERENCED TO NGVD AREA = 15,746 sq. ft. to ti~line PIPES ~or (~ COVE AUG 1 4 2009 Southhold Town Board of Trustees APPROVED BY CROSS SECTION BOARD OF TRUSTEES TOWN OFSouTHOLD DATE ~IN ~R- F).. SEPTIC SY~T~ SURVEY OF LOTS P/O LOT I(~ MAP OF GREENPORT SHORES - SECTION ONE- , ~ ,o.e' FILED JUNE 29, 1950 FILE NO. 1~59 '" AT GREENPORT. 16, 17 & P/LOT 15 RAIN RUNOFF CALCULA HOUSE AFTER CONSTRUCTION -~1~7. sq. ff. ~147 ~ 0.17 ~ I = 365 cu. fl. 365/~.3 = 16.4 VF GARAGE = 545 sq.-fl' ASPHALT DRIVE ~ 592' sq. lf. GARAGE & DRIVEWAY = 11~7 ~q. fl. 1137 ~ 0.1~ I = 193.3 cu. lf. 193.3/~2.$~ $.7 VF / 25.1 VF PROVIDE 4 DWs 6'¢ ~ 7r DEEF 'OR EQUAL LOT COVERAGE EXISTING Z~34 sq.(t. 2~34115746 = 14% AT COMPLETION OF CONSTRUCTION ~69~ sq. ff. ' 269~/15746 ' 17% ' TOWN OF SOUTHOLD SUFF?oO~LK- COUNTY, NY. 47 - 02 - P/O 26 SCALE.. 1" = 20' SEPT. [ JAR. ~7, gOO? (PROP. ADDIT.) 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