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HomeMy WebLinkAboutTR-7389 James F. King, President O~aOF S~UlyO Town Hall Annex Bob Ghosio, Jr., Vice-President ~ ~ 54375 Main Road P.O. Box 1179 Dave Bergen * ~ Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino '~`0 ~ Telephone (631) 765-1692 Fax (631)765-6641 I~C~U~ ~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 21, 2013 Cheryl Hansen 305 South Windsor Drive Arlington Heights, IL 60004 RE: CHERYL HANSEN 405 WILLIAMSBURG DRIVE, SOUTHOLD SCTM# 78-5-17 Dear Ms. Hansen: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 21, 2013: RESOLVED that the Southold Town Board of Trustees grants the Last One-Year Extension to Wetland Permit #7389, as issued on September 22, 2010. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, James F. King President, Board of Trustees JFK:amn gUFFO(,~ lames F. KinP. President p~ C P.O. Box 1179 Bub Ghosio, Jc~ Vice-President vd Southold, NY 11971 Dave Bergen ~ ~ Telephone (631 765-1892 John Bredemeyer T Fax (631)765-6641 Michael J. Domino O 'r` y~,o1 ~ ,~aa. Southold Town Board of Trustees Field Inspection/Work Session Report Datelfime: ~ f'~ f~ CHERYL HANSEN requests the Last One-Year Extension to Wetland Permit #7389, as issued on September 22, 2010. Located: 405 Williamsburg Drive, Southold. SCTM# 78-5-17 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: haK C Modifications: Conditions: c O Present Were: ~J. King ~ B. Ghosio ~ D. Bergen, Bredemeyer ~ivlichael Domino D. Dzenkowski other Form filled out in the field by ~ . ~--t Mailed/Faxed to: Date: Cheryl Hansen 305 S Windsor Drive D ~ pq Arlington Heights, IL 60004 4+ V 847-421-5581 JU( p 3 ?013 utholtl own July 19, 2013 Board of Town Trustees Town of Southold P. O. Box 1179 Southold, NY 11971 To Whom It May Concern: I am writing that my request for a one year extension on my Permit No. 7389 be added on to the August 21 meeting. This permit if for construction of asingle-family dwelling at 405 Williamsburg Drive, Southold, New York. I have enlcosed a copy of the original permit that was approved September 22, 2012. Sincerely, r ~L~ Chery Hansen Jamea F. King, President ~aOF SOUj~o Town Hall Annex Bob Ghosio, Jr., Vice-Preaident h~ lQ 54375 Main Road P.O. Box 1179 Dave Bergen ~ ~ Southold, New York 11971-0959 John Bredemeyer ~ • Telephone (631) 765-1892 Michael J. Domino ~ Fax (631) 76b-6641 ~y000NTl BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 22, 2012 Ms. Cheryl Hansen 305 S. Windsor Drive Arlington Heights, IL 60004 RE: 405 WILLIAMSBERG RD, SOUTHOLD SCTM# 78-5-17 Dear Ms. Hansen: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 22, 2012: RESOLVED that the Southold Town Board of Trustees grants aOne-Year Extension to Permit #7389, as issued on September 22, 2010. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, o'l ' Jamest'F. King 1~ President, Board of Trustees JFK:amn Cheryl Hansen 305 S Windsor Drive D ~ ~ ~ Q ~ ~ 1 Arlington Heights, II 60004 ~ ~ ' 847-421-5581 ~i ' AUG - 6 2012 Southhold lows Beard of Trustees August 6, 2012 Board of Town Trustees Town of Southold P. O. Box 1179 Southold, NY 11971 To Whom It May Concern: I am writing to request an extension on my Permit No. 7389. The permit is for construction of asingle-family dwelling at 405 Williamsburg Drive, Southold, New York. I have enclosed a copy the original permit that was approved September 22, 2012. Sincerely, /i~~ V Cheryl(~Hansen Jill M. Doherty, President ~ Town Hall, 53095 Main Rd. lames F. King, Vice-President ~ P.O. Box 1179 Dave Bergen ® ~ Southold, NY 11971 Bob Ghosio, Jr. y'~Ql ~ ,~.b'~~ Telephone (631) 765-1892 John Bredemeyer 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 15t day of construction '/2 constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT N0.7389 DATE: SEPTEMBER 22.2010 ISSUED TO: CHERYL HANSEN PROPERTY ADDRESS: 405 WILLIAMSBURG DRIVE. SOUTHOLD SCTM# 78-5-17 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on Member 22.2010, and in consideration of application fee in the sum of $250.00 paid by Cheryl Hansen and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Boazd of Trustees authorizes and permits the following: Wetland Permit to construct asingle-family dwelling, install a gravel driveway and sanitary system; and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated March 3, 2006, and stamped approved on September 22, 2010. 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 Boazd as of this date. w, oy~01 ~ ~~a ~ TERMS AND CONDITIONS The Permittee Cheryl Hansen, residing at 405 Williamsbure Drive. Southold, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold aze released from any and all damages, or claims for damages, of suits arising duectly 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 Boazd of Tmstees 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 maybe made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Pernuttee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. 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. 7. 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. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Pernuttee will obtain all other pemuts and consents that may be required supplemental to this permit, which maybe subject to revoke upon failure to obtain same. Jill M. Doherty, Preaident ~~DF SD(/~yO Town Hall Annex James F. King, Vice-President ~ 54375 Main Road P.O. Box 1179 Dave Bergen l~[ # Southold, New York 11971-0959 Bob Ghosio, Jr. G John Bredemeyer ~ Telephone (631) 765-1892 ~~.CO~'~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 22, 2010 Ms. Cheryl Hansen 305 S. Windsor Drive Arlington Heights, IL 60004 RE: CHERYL HANSEN 405 WILLIAMSBURG DRIVE, SOUTHOLD SCTM# 78-5-17 Dear Ms. Hansen: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 22, 2010 regarding the above matter: WHEREAS, CHERYL HANSEN 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 August 26, 2010, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 22, 2010, 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, 2 s • WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that 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 CHERYL HANSEN to construct asingle-family dwelling, install a gravel driveway and sanitary system, and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated March 3, 2006, and stamped approved on September 22, 2010. 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, ~ ~6~~ Jill Doherty Pre ident, Board of Trustees JMD/eac ~'~S'~©g~~~4xC0~ . Jill M. Doherty, President ~ ~ Town Hall, 53095 Main Rd. James F. King, Vice-President ~~i` P.O. Box 1179 Dave Bergen ~,yr 'G~ Southold, NY 11971 Bob Ghosio, Jr. Telephone (631) 765-1892 John Bredemeyer ~l ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: ~',hPr>,l ~nsen Please be advised that your application dated /~u uS~a~,, ak~IC7 has been reviewed by this Board at the regular meeting of b do/aand your application has been approved pending the comp etion of the ollowing items checked ofF below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 15t Day of Construction ($50.00) 'h 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: ~ GO ~ TOTAL FEES DUE: $ Sy - BY: Jill M. Doherty, President Board of Trustees • ~o~gpFFD(,~c Peer Young, Chairman Town Hall, 53095 Main Rd. Lauren Standish, Secretary ~ m 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., September 15, 2010, the following recommendation was made: Moved by Greta Schiller, seconded by Doug Hardy, it was RESOLVED to SUPPORT the Wetland Permit application of CHERYL HANSEN to construct asingle-family dwelling, install a gravel driveway and sanitary system. Located: 405 Williamsburg Dr., Southold. SCTM#78-5-17 Inspected by: Greta Schiller, Doug Hardy The CAC Supports the application with the Condition every effort is made to save the large trees. Vote of Council: Ayes: All Motion Carried i ~ QgUfFO~,~C P.o. Box 1 n9 Jill M. Doherty, President ~QV OG James F. King, Vice-President h y Southold, NY 11971 Dave Bergen ~ ~ Telephone (631) 765-1892 Bob Ghosio. Jr. ~ ~ Fax (631) 765-6641 John Bredemeyer yyo! ~ ~aQ! Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: CHERYL HANSEN requests a Wetland Permit to construct asingle-family dwelling, install a gravel driveway and sanitary system. Located: 405 Williamsburg Dr., Southold. SCTM#78-5-17 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: Conditions: Present Were: J.King _J.Doherty _J. Bredemeyer _D. Bergen_ B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: • • ,oV C9,~7" f~ . d~~ ~y. Y t:'. L # 3° ~ • Wit,' r J~. Y-Y. 'rF. NFygNI~~. V.-~ -A~: • , ~ ~s~ ~ ~ ~ ~ °'fir`~ ti a" e" sib ~ i ~y kY? . 'lr r ' 4 . Ata 4' ~ • ~.tr- t . 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J5 T�� ° - �{".yG, '', � Ar �' if I j{ r f• e I t °Rrr. + Jjx ! ���� ( T I'2 f ,1 F Y is-i' t� J 41� "v$.{iS�` u1 ! � �� � '• �� �e fa C t .� ';f�: . \ ,ii '�+ { -BSC 4 •_,� �� N.p;`4`a sr. .40 9 �7M”' _. a~ uJ, o ,wt u: ~ ti XEF 1 / uPY AMIL ce l1" o y ~ ~ _ _ . 4 A~ s y~ A s r¢ non ~ 2 ; m•r.~.,, L~- pp O ' __r - * ~ m -1q• Aar / ~ m . \ ~ia~ ~L k t 4 u ro A 5¢sscn en 9, F n su ' , . s m n.. rX+ wm a'F > n she \~\FR / b / / M1 r ,b F ' m pu ' tW" tWu JY• ~yJ L 'A'• t4 L ~ I 1 ~ yse r ~41tW 5r, • T L t•Ym •~!~_.W 6 .1yS i4r Y'r 3 UA n M WW ? r =ao n n n r n to ~W Yb • AJr a.ur q A ; p ~ y • r. 'r f. U O / r F Wr ~ ~ 'A'L ~ J O 4~ 1Yw lE ~ ,q.Wh Ra 4 r r.w., _ rw,icc COIMTY OF 51FFOLN © E SOUiNOLO ~C1pX x0 e~ - all ~ .,%ma.~w.~R,..a Ped Property iax Service R9encY Y fonlYeM~iMIp~XY 11fI1 M`~~••• wu~..-a- +e um.o P IOW PPCKPLY MM OFFICE LOCATION: ~~OF SOUjyo MAILING ADDRESS: Town Hall Annex ,`O l~ P.O. Sox 1179 54375 State Route 25 * ~ Southold, NY 11971 (cot. Main Rd. & Youngs AveJ Telephone: 631 765-1938 Southold, NY 11971 ~ ~ ~O Fax: 631 765-3136 ~~y00UN1'1,0`~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ~1~ ~Y~~ ~ ~ To: Jill Doherty, President ~ ~~p 2 ~ 2Gi0 Town of Southold Board of Trustees From: Mark Terry, Principal Planner soutnLc~d town LWRP Coordinator ~ ~802'cotlrus'.ees Date: September 21, 2010 Re: Proposed Wetland Permit for CHERYL HANSEN SCTM# 1000-78-5-17 CHERYL HANSEN requests a Wetland Permit to construct asingle-family dwelling, install a gravel driveway and sanitary system. Located: 405 Williamsburg Dr., Southold. SCTM#78-5- 17 The subject parcel is located in Flood Zone AE 8, an area of special flood hazard where the parcel is subject to aone-percent or greater chance of flooding in any given year. Due to the elevation, size and configuration of the parcel, it is not practicable to locate the relocate the structure. 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 the following: If the action is approved to further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem it is recommended that a minimum 25' foot landscaped buffer be located landward from the bulkhead except in front of the existing wood ramp. A pervious buffer area is recommended to be located landward from the edge of the wooden ramp to prevent runoff from entering the water body. An example landscape buffer is enclosed for your use. LANDSCAPED BUFFER --Aland area of a certain length 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 95% ground cover within two years of installation. Survival of planted vegetation shall • • be 90% for a period of three years. Maintenance activities within the buffer are limited to removing vegetation which is hazardous to life and property, trimming tree limbs up to a height of 15 feet to maintain viewsheds, replanting of vegetation and establishing a four-foot-wide access path constructed of pervious material for access to the water body. [Added 12-15-2009 by L.L. No. 15-2009] - ~ ,c 6~20W N1uam2 i 1MrcicY t Lsgvl i MseNU i A+WI av[rde (He$ TcII:n W,4H ryu NrJ Figure 1. Subject parcel (black line) Further the following best management practices are recommended: 1. The installation of gutters, leaders and drywells for storm water collection. 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 i ~ ~o~pgUFFa(,~cOGy Jill M. Doherty, President w Town Hall, 53095 Main Rd. James F. King, Vice-President r, T P.O. Box 1179 Dave Bergen ~ ~ ~ Southold, NY 11971 Bob Ghosio, Jr. '~/0 Telephone (631) 765-1892 John Bredemeyer 1 ~ Fax (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oas[al Erosion Permit Application Wetland Permit Application Administrative Permit _Amendment/Transfer/Extension eceived Application: /a eceived Fee:$ Completed Application -Incomplete ~ ~ fZ ~ n/J _SEQRA Classification: (1 LS U ~ Type IType IIUnlisted a ~ ~ I~ Coordination: date sent Lr ~ q , , I f' ?LWRP Consistency Ass ssment Form ~.~~1~ r 2 6 ~,'Q ,GCAC Referrai Sent ~ I ate of Inspection: [a t Socthhc4iiawn -Receipt of CAC Report: - Poar_r, ,1 7,„S.,~S f _ J Lead Agency Determination: -Technical Review: ~ublic Hearing Held: Resolution: Name of Applicant C,[jE~~/`?/USG/1/~j/~ Address,365 c~i cylNdS'AR A~ ~~-ING-~~i/ /!zi-~ T~ ~oOQ~~~ 817 Phone Number:( ) 5? ~7 - 3 S`a ~ ~ 7-y~i - S~! ~c t Suffolk County Tax Map Number: 1000 - _ ~ $ - AS- / 7 Property Location: /~)tLLIfJ-!nS/3U~G- ~cflVL (provide LILCO Pole distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~1\b ~ ' >~d of Trustees Application GENERAL DATA Land Area (in square feet): /S SN`~ $Cwl¢!2L /=EcT Area Zoning: ~ES C--iU Y' //¢l- Previous use of property: `/ACi3iV7`- ~l4N9 Intended use of property: c~/NGLC T~4/yilLc,/ /1 G/ELU/UG Covenants and Restrictions: Yes No If "Yes", please provide copy. Does this project require a variance from the Zoning Boazd of Appeals ~ Yes No If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agen Date ~rySc2Ui4~9 D/l~ No prior permits/approvals for site improvements. Has any permiUapproval ever been revoked or suspended by a governmental agency? ?No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~'~/U (,.L N Fi4/~/Lv/ dLL~CLL//1109- w' lTN-iN -Tlfi< ~Nl/~=G/J~b' W ON SU~.U B~d of Trustees Application WETLAND/TRUSTEEnnLANDS APPLICATION DATA Purpose of the proposed operations: CANS 7-, °y(/Qi/~ f} ~S'~nr~~b ~-s~-/~~uf f~W~~~iNG- Area ofwetlands on lot:/ d i1/ F_ squaze feet Percent coverage of lot: Closest distance between neazest existing structure and upland edge of wetlands: f~ feet Closest distance between neazest proposed structure and upland edge ofwetlands:~ feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? / 2 ~ cubic yards How much material will be filled? cubic yazds Depth of which material will be removed or deposited:~_ feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: ,GULL ~C7 Z~s 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): B~d of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes 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) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) - _ _ • sn.zo SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) t. APPLICANTISPONSOR 2. PROJECT NAME ~ ~NSEN 3.PROJECT LOCA~T2IO . Municipality J (J 7~/~(~ County C~ U F UL. 4. PRECISE LOCATION: Street Adtless and Road 1rr~yersections, P~m~ent landmarks etc - or provide map y05 CLl?i/~-13G'7'"f~ ~iYNL/ J'UcJ7'/}~l OTC o% rr/q-)N j/9-yt/ieW 'fl-Fr,p.t~ 21~-11-1" RFiFR ST, Pig-r~bc C'~m~=rlQ. 5. IS PROPOSED ACTION : ~ New ~ Expansion ~ Modifcation /alteration 6. DESCRIBE PROJECT BRIEFLY: ~o~usa-IZVe7'i~n/ o% s~NG-~~ ~14/~l~y l~cv~`~iN~ W 1 rH 6-/2,~ v~ ~ 1J ~ I v~ Gv,~ 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately ~ acres 8. WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ? No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~1iesidential ~ Industrial ~ Commercial ?Agriculture ~ Park /Forest /Open Space ~ Olher (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Feder State or Local) J es No If yes, list agency name and permit /approval: 17. D0 ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~s ~No If yes, list agency name and permit /approval: d ~ ~ ,g-ill/ D E~'/9 re.Tia~ ~rv~r- o~ lfL=~ ~ 7'y 5 ~~L v i eC--S 1f2~. 1A"S A RES T OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? n' es No I CERTIFY THAT/THE INFORMATION,(~lf.~O~VIDED A_B/OVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor Name l.i / ` NS ~dt' Date: Signature L+ I the action is a Costal Area, and you are a state agency, complete he Coastal Assessment Form before proceeding with this assessment PART N - IMPACT ASSESSMENT o be tom rated Lead A enc A t)OES ACTION l7(CEED ANY TYPE 1 TFtlt£SFIOLD IN S NYCRR, PART 617.47 H yes, axHdhlate d,e review p and use the FULL FJ1F. ?Y~ B. VNLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 8 NYCRR PART 617.87' H Na, a negative dedaratlon may be supereeded by another MvoMed agency. . Yes © No C. OOUID ACTON RESULT IN ANY ADVERSE EFFECTS ASIKKIATED V'ATH THE FOLLOVANIi: (ArIBWefa may be hantlwriUen, H legible) Ct. Fxistlrq ek QtreNH, surface «gmsdwater Quality quaMtiy, rides levels, existlng aaflk Pin, solid waste productlon «dlsposei, poterdid for erosbn, drekrage «fleodkg prWlems7 E>Plain btiaay: No C2. AeslhetlG agAwHUre4 archaeobgkal, ldstoric, «otller' natural «alliaal resources: «cemmuNty «neighborhocd dlaradel? Explain briefly. No C3. Vegetatlon or fauna flab, aheflflsh «wpdtite spades. sigNficent habitats, «tllreatened «endargered apedes7 Explain brieflK No C4. A mmnaarhy's exbdrg plans «goais ee ofadesy adoptoa «s drenge H use «Mensiy of use or land «otlr« naaeal resources? Exp1aM bdMy: No C5. Growth, devebpmera, «related adw>dea Wkaly to be induced by the proposed adorn? Explain briefly: . No Ce. tong term, shQA term. emulative, «other elfeds not Wentifled h C1-C57 Explain briefly: No C7. oflr« NI use of eHh« or a No O. WILL THE PROJECT HAVE AFt IMPACT ON THE EfNiRONMENTAI CHARACTERISTCS THAT CAUSED THE ESTABLISHMENT OF A CRITIGLL ENVIRONMENTAL ARFJ1 CFA 7 H e sin Fufefl . Yes Q No E IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTEN7W. ADVERSE ENVIRONMENTAL IMPACTS? H IaN: Yes ~ IVo PART IN -OET'ERlfllllA'IION OF SICaNIFRCAIICE (To be canpleted by Agerwy) INSTRUCTIONS: Fareachadvereeeffedkentifiedabove,detefminewhelherNfsarPostarrdal,large, YnportantorogletwiseeignificanL Each atlas attoald ba assessed m oonnaction witll lta (a) sedirlg qe. urban or nHai): (b) probaMNty of ocatrrkl8; duration: (cn IrreversNdfily; (e) yaographic scope: and (ry magnitude. If naoessary, add attachments or reference aupportlng materials. Ensure that explanatbna contain suNicierltdatati to showlhat atl pakvant adverse tmpada have been identlliedand adapuatety addressed. Ifquastlon d of part Nvresdledced yea. thadeterminefionofsignif~alrosmustevalua(albs potantlal Nrpadoftheproposed adbn on lheenNronnreMalrfiararsaristlrsoflhe CEA ChadctldaboxHyauhavaMerdfledone«morepoteMiaaylaryeoraigniMxntaav«seimpadswhidiMAYocar. Then proceeddMedlyloNre FAF anNar prepare a positlve dedaretbn. Check tlAs 6mr tlyou Have det«rrrkred, bated on the lyd«mation and arlaryrah above and say xppoAkq doanrl«rtatlon, tlrat the proposed VnLL NOT rewtl In arty eprtlflcent adverse emNonmantal hnpacts AND provide, an atladxneMS as necessxy, the reasons auppoitkrN dekrrnaratl«r. - Board of Trustees ~ ~ Date - Name of Lead Agency _ Jilt M. DoheAV President nt or Type am o sponsib cer M a Agency Title of Responsible Officer lure o one a Hoer m Lead.Agenq Signature c aver ( respon - oBicer do~~~~ Town of Southold Erosion, Sedimentation 8 Storm-Water Run-off ASSESSMENT FORM PROPERTY LocartoN: s.c.T.M. a: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~01 T~ ~-a (/J 5 STORM-WATER, GRADING, ORAINAOE AND EROSION CONTROL PLAN 'i• -y ~(o T- CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK -PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? 1 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels bceted vrithin /y, Syry Generated by a Two (2") Inch Rainfall on Site? the Scope of Work for Proposed Construction) / (This Item will Include all run-off created by site (S.F. I Aces) b. What is iha Total Area of Land Clearing clearing andlor consWclion activities as well as all andlor Ground Disturbance forthe proposed ~s- LIO Site Improvements and the permanent creation of construction activity? / impervious surtaces.) (S.F. / Aaes) 2 Does the Site Plan andlor Survey Show All Proposed PROVIDE BRIEF PROJECT' DESCRIPTION (Pmvua Addxbe.i P.a••n N••d•G) Drainage Structures Indicating Size & Location? This r1 Item shall include all Proposed Grade Changes and C0~57RUGT /7 5/NG'L~ ~i~/~//L ~ Slopes Controlling Surface Water Flow. 3 Does the Site Plan andlor Survey describe the erosion p w~G G lNc~ and sediment control practices that will be used to control site erosion and stone water discharges. This Item must be maintained throughout the Entire Construction Period. Q Will this Project Require any Land Filling, Grading or ? Excavation where there is a change to the Natural ~ / Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? rj Will this Application Require Land Disturbing Activities ? I Encompassing an Area in Excess of Five Thousand y (5,000 S.F.) Square Feet of Ground Surface? s Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction ? General DEC SWPPP Reguiremema: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP b required for all Constmclbn activlaes invdving soil Beach? disturbances of one (t) or more acres; lntluding dislurbancea of leas then one acre that 7 WIII there be Site preparation on Existing Grade Sopes ? - ere pen or a larger cemmon plan that wR u0lmetety disturb one or more acres of land; which Exceed Fifteen (15) feet Of Vertical Rise to Indudirg Constredbn activities Involving sal disturbances of less than tine (t J acre where One Hundred (100') of Horizontal Distance? the DEC has determined Thal a SPDES pemtlt 5 required for storm water discharges. (SWPPP's Shall meet the Minimum Raqulremenb of the SPDES General Permit $ WIII Drive Ways, Parking Areas Or other Impervious ? - for Storm Water Discharges from Conalmttlon actlvily -Permit No. GP-0-10-007.) Surfa085 be Sloped t0 Direct Storm•Waler Run-OtF 1. The SWPPP shell be prepared prior to the submilbl of the NOT. The NOI shall 6e into andlor in the direCfiOn of a Town right-Of-way? subMtled to the DepaMrant prior b the commencement of censwction ecOVky. 2. The SWPPP shall deudbe the erosion end sediment tonal practices end where 9 Will this Project Require the Placement of Material, ? - requlreq poslconawdion stone water management prectices that will be used end/or Removal of Vegetation andlor the Conswction of any lam' conswcled to reduce iha polubnts b storm wabr discharges and to assure Item Within the Town Rightof--Way Or Road SFroulder compliance with the temp end condPoOns of this permit. In addklon, the SWPPP ahaA Areal (rhb rpm wrn uoT rncwde un r,rmrMlon a om...y APr•m.l Identity pobn0el sources of polulion which may reasoneby ba expected b affect the quality of alone water discharges. NOTE: If My Mswar to W gtlona One tltrough Nina Is Mswarad wah • Cheek Mack 3. All SWPPPS Mel require the poslconswabn storm water management practice in a Box and the eonatructlon sib dbturbarru b batvwen 5,000 S.F. B 7 Ate In area, canponent shell tre papered by a qualifred Design Professbnal Licensed In New Vork a Sbnn-Wabr, Grading, Dninege 8 Erosion Carrtrol Plan is RaqulrM M the Town at that h knovAedgeable in the pdndples ant Drectlces of Slone Water Management Soumold and Muet ba Submaled ter ReWew Pdor to lesuand of Arry eulldln0 Permit (NOTE: A Cherh Merk I aM/a Maier far eaM Question b Required for a Cwnpble Apdiatlon) STATE OF NEW YORK, ( ~ COUNTY OF Y~.......... SS I^ That I, .~Y`..'w.. ~ ~~1.......~~~:~`.~....~ being duly sworn, deposes and says that he/she is the applicant for Permit, (Nam of individual signingJ]pcument) And that he/she is the (Owner, Coniredor, Agent, Coryorela Officer, etcJ Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his lutowledge aztd belief; and that the work will be performed in the manner set forth in dfe application filed herewith. Sworn to before pte thj;; day of .....Vab~............. , 20.~ b Notary Pub .....................................#M?RiNA•KOKKINOS ._C~~1..1./~...L..~...`~~..:.......... (Signature of AppNcent) FORM - 06/10 No. i' _ ~ t^+r'.t~t94t Guallfleo .rt ~Wifolk County My Commtwlon BIIji11'IAI Aul)Wt 46, 2012 • Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that aze 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 detemvnation of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the prepazer 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 sigmficant beneficial and adverse effects upon the coastal area (which includes all of Southold Townl. 3. 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 standazds and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listiue both supportive and non- supportine facts. If an action cannot be certified as consistent with the LWRP policy standazds 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 Boazd of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF STTE AND PROPOSED ACTION SCTM# PROJECT NAME ~ / G6 dI~-f77S/~ !/~2 G Q~I IOE; ~C~ US E The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: z/0~ W /LUaI-1nS 130/2-C~- /~~-ll~L Site acreage: ~3 /-1-~' ~ Present land use: V ~-C-19-/V T Present zoning classification: /~~S /n ENT !/4L-- 2. 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: ~~~{unn/L f?"f~,i/SE/y (b) Mailing address: 30,5 c~, UJ /N/I.S d/2 p/2 ~ f~,~L/NG--TUN ~<rY~ yL IQ oOO 5~ (c) Telephone number: Area Code ( ) ~y'/ -S?~I - 3Sa8 B y 7-yo7-~ -s s~/ (d) Application number, if any: Will the action be directly~,~~untd~~rtaalkce ~ qui~ fi~~,t~g, of approval by a state or federal agency? Yes IJ No ? If yes, which state or federal agency? I~lg-5 ~h n22~11RL QED /9-Nd) ~ BPS}-27-r1'J b`/V7" ~ ~ /-1 E~-!~"/~~~~iES' 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. QYes No Not App ' able ~ _ 7~-~ 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 LWRI' Section III -Policies Pages 8 through 16 for evaluation criteria ? Yes ? No u 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 LW1tP Section III -Policies Pages 32 through 34 for evaluation criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? No ~NOt Applicable PUBLIC COAST POLICIES Policy 9. Provide for 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. ? Ye~ No u 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(eva~luation criteria. ? Yes ? No I"I Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III -Policies; Pages 65 through 68 for evaluation criteria. ? Yes ? No Not Applicable PREPARED BY~f~~~NSe/I/ TITLE _ ~ Ly N~/Z DATE Board of Trustees Application County of Suffolk State of New York C~1fE~1L ,~fa-/?S~/? BEING DULY SWORN DEPOSES AND AFF S 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/I~R 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 VIIZTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THI:IR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. LP.! Sign lure SWORN TO BEFORE ME THIS~_DAY OF 20 MApiNA KOKKINOS Notery Public -Stele of New York No.O1KOg191941 C1YmiHNd In 9ulfolk County otary Public My CtiinPoli?91on Hxpirea August 25, 2012 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees. The purposeg{ this form is tQprovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: ~ AJS~/lI ~ffr~I~ (Last name, fuss e, rpiddle initial, less you are applying in the name of someone else or other entity, such as a company. [f so, indicate the other person's or company's name J NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ~ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or otticial map Planning Other (If"Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, [[carriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which [he town officer or employee owns more than S%/of~the shares. YES NO t~ If you ansvered "YES", complete the balance of this forth and date and sign where indicated. Name of person employed by the Town of Southold Title or position of [hat person - Describe the relationship between yourself (the applicanUagenUrepresentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spoux, sibling, parent' or child is (check all that apply): _A) the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legs! or beneficial owner of any interest in a non~otporate 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 Submitted this da of 200 _ Signature Print Name C~ A/ Form TS i Cheryl Hansen 305 S Windsor Drive Arlington Heights, IL 60004 (847)577-3528 (847)42-15581 Au ust 22 2010 L~~ ~ ~ ~ ~ U Board of Trustees t P. O. Box 1179 I P,UG 2 6 2010 U Southold, New York 11971 Southhold Tawn Dear TrUSteeS: Bozrd of Trustees A building permit was granted to me in 2004 to build a house on my property located at 405 Williamsburg Drive. I have since been given 2 extensions on this property but unfortunately, I was unable to build for the following reasons: 1. The bulkhead was in such disrepair that it became a priority for it to be replaced. 2. The economy took a turn for the worse. With my second extension expiring this coming November I am hereby submitting another application requesting permission to build a house on this property. The dimensions of the home are the same as those listed on my previous application/ building permit. It is my hope that since my new application includes the same dimensions and building envelope as the previous one, that 1 won't have to incur the costs of having the land surveyed and staked again. I've enclosed photos that were taken by surveyor John Metzger prior to the filing of my last application. Thank you in advance for your consideration. Sincerely yours~~~~~~ ~J~ Cheryl Hansen mil' Q NOVSE of N/~~F ~~<</ ~f'v flr e/ I Z ~ S9. ~ Q, G /per Bl 7.4 PRQ°OSFl1 GRAOE .a l / hQ 2/ B G ~ 9~/C 4 A VEO PIPE 4' APPR. PIPE ~ ~'QCi' qTF' ~E G' /Y00 GAL. BI --11 rO,oFNI 'A/(~qr F'N 'pi /eL~' sEPncrANx lE,~;y ~rFS.i CESSPOOL __~g'-; r~ O~L 2 . ~E ( ''/w ~ pLS ~c~,!ti1AR ~~Ap HIYY _ _ B' OIA3'~ Lo11AR OF. LEAN 3 iND J ~(,A O Gam. 2S~sY/~~ '9TC p~~ ANa.E NON. fir." wcJre r eJ / 7 cEVreR c.P. DFFlVE P %p„ /N O/ PoaL ctvsTER 6R 6~ 0 , ~ D° F ~ sT A @ 3' PROPOSED SEWAGE DISPOSAL SYSTFN 6 PDOCS • .~S et Y~ _ '9' WITH OCEAN SAND 3' COLLAR, 1200 GAL PRE ! ~ p V/^y r~ CAST CONCRETE SEPPC TANrC BOTTOiI OF G5 SSY' ,tl~y f1 ~y ~,g, 1 ~ ' ' V O LEACFW~IG POOLS TO BE 2' AFOVE GAIXA`~M'ATER. Jpc!` ~ ~G ~y ~ ~S~ ~ B30° ~ Op 4~ wE~ov~NTE~ialA~L BELOW L.P.. ro sAnp sP s FN.L 0' ~~`k',f, ~~O~F ~~t ~ ~ ~ 'F ;~5 c~ , g32 titi CROSSECTION -SEPTIC SYSTEM \ w''F,ye1F~ ~ s / tiq -o 0 5 A PrE . p p, ~ NOTE ~~i i~~,~~~ < ? o ~ 3 . ~ A7 A . i~,c Do.2E 5 ~ Jr S ~rY ~ SEYI n ! t O SPOSAL r ~r ~ / ~ ~ ~ \ \.`F \ B/ \O,o~ ~ ES e - s ~ To 9T~ ~ ..s, tio' StiP~Q P~ SURVEY OF P ~°F 9~ ~o ~ 0 PROPERTY - o~P G A T BA YVIEW ~ 9 ~ tiFT` ~o ~ o~F o~~~,~~P TOWN OF OUNT YON m~0 9 Q5251 P4~~ SUFFOLK C p N h ~ ~ F o ~~'1i ~ w 5 ~ ,e~~~ 1000-78-05-17 asst \ ~ oo SITE ADDRESS i~ ~ 9 `9~ q'~A ,~;P~ 405 WfLL(AMSBURG ROAD SCALE: f = 30 . BA'1VfE'r.; N. Y• - DEC. 29, 2005 c ig, Se- ropa~'~'c /''ak 1-~V ~6T.3 ~cY~(11lcrsi s2s% P LOTACOVERAGE HOUSE 89~GRIVE _ (5.°~ c - /,~~s iQ.~ E;GARD OF TRUsTcES ~ ~ C~ ~9f~ tl-'U~ ~ ~ ~i AREA = 14 547 SQ.FT. ~ x ° Lar.Ii TOVr'N OF SOUTHOLD ;j >ESr~ ?per; • AUG 2 6 ~~'0 e vr2ioe BY McDONALD C,EOSGENCE DATE _ ~ _ ~ ~ L~ DARK BROWN LOAM OL - r ~ Southhoid Town BROWN CLA rEr SAND sc qNY Al TERATION OR ADDITION TO THfS SURVEY IS A L'IOLATtON Board of iiustees P/ 1.7~ OF SECTION 7209 OF THE NEW YORK STATE EDUCA TIOiv LAW. FLOOD ZONEAE (ei. Bi WA rER xr eROwN cLArer S<rro sc EXCEPT AS PER SECTION 720J - SUBDIVISION 2. A!1 LES,t/f7 ~A TIONS FIRM 36/ 0300/66 v S/04/ - _ H,EREON ARE VALID FOR TH.S MAP AND CO: /t5 THEREOF ONL. IF SAID MAP O,4 COPIES SEAR THE IMPRESSED SEAL OF THE SURVEYO° - _ a• WATER FV BROWN CLAY CN ~4'HOSE S/GNA T TIRE APPEARS HEREON. Io wArER rc~ eeawN cLArEr sanu sc / nm familiar with the STANGAROS FOR APPROVAL ~ N.Y.S. LIC. NO. 496/8 AND CONSTRUCTION OF SUBSURFACE SEWAGE The locations o/ wells and cesspools ,L- DlSI'nSAL SYSTEMS FOR SGVGLE FAM1L Y RESIDENCES shown hereon are from field observatio.as PECONI~C RI~EYORS, P.C. WATER N PALE BROWN ~wc 54Np sv and ^'iii vbide by the condi!ions set lorlh (herein and on the and or from data ob(oined /rom others. (63IJ 765 - 5020 FAX (63/J 765 - /797 pnrcmil /o roes/rucl. P. 0. BOX 909 1230 TRAVELER STREET EL.EVA TIONS ARE REFERENCED To N, c. v.D. SOUTHOLD, N. Y. 1/97/ Ir