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Home My WebLink AboutTR-7361 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 # 0629C Date April 6, 2011 THIS CERTIFIES that the 525 sf. addition to the existing dwelling, expansion of the deck, and gutters, leaders and drgwells At 745 Cases Lane Ext., Cutchogue Suffolk County Tax Map #109-5-14.45 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/3/10 pursuant to which Trustees Wetland Permit #7361 dated 7/21/10 was issued and eonforms to aH of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for a 525 sr. addition to the existing dwelling, expansion of deck, and gutters, leaders and drywells. The certificate is issued to JAMES & PHYLLIS RUB1N owners of the aforesaid property. James F. King, President Jill M. DoherW, Vice-President Peggy A. Dickcrson Dave Bergen Bob Ghosio, Jr. 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 1 st day of construction ~ constructed __ Project complete, compliance inspection. INSPECTED BY: ,~-, CO..ENTS: CERTIFICATE OF COMPLIANCE: Jill M. Doheny, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765~o641 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 ½ constructed v/""" Project complete, compliance inspection, BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PE~T NO. 7361 DATE: JULY 21i 2010 ISSUED TO: JAMES & PHYLLIS RUBIN PROPERTY ADDRESS: 745 CASES LANE EXT.~ CUTCHOGUE SCTM# 10925-14.45 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the TOm C0de'of the Town of Southold and in accordance with the Resolution of the Board of Trustees adOl~ied at the meeting held on July 21. 2010, and in consideration of application fee in the sum of $250.00 paid by James & Phyllis Rubin and subject to the Terms and Conditions as stated in the Resolution, the S0Uth01d Town Board of TruStees aUthoriZes and permits the following: Wetland Permit to construct a 535 square foot addition to the existing dwelling and to expand the existing deck; with the condition of the instaHation0f gutters to leaders to 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 John C. Ehlers Land Surveyor, received on September 30, 2010, and stamped aPproved on October 4, 2010. IN WITNESS WHEREOF, the said Board of Trustees herebx 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 James & Phyllis Ruinn, residing at 745 Cases Lane Ext., Cutchogue, New York as part of the consideration for the issuance of the Permit does undemtand 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 ins or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, winch 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 Pennittee wishes to maintain the stmctnre 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 ingh and low water marks. That if future operations of the Town of Southold require the remgval 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 obstmetion 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 o£ ~h..~ work authorized. That the Pennittee 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. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Rob Ghosio, Jr. John Bredemeyer Town HallAnnex 54375MainRoad P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 July 21, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Mark Schwartz, Architect P.O. Box 933 Cutchogue, NY 11935 RE: JAMES & PHYLLIS RUBIN 745 CASES LANE EXT., CUTCHOGUE SCTM# 109-5-14.45 Dear Mr. Schwartz: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, July 21, 2010 regarding the above matter: WHEREAS, Mark Schwartz, Amhitect on behalf of JAMES & PHYLLIS RUBIN 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 June 3, 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 Headng was held by the Town Trustees with respect to said application on July 21, 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, 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 JAMES & PHYLLIS RUBIN to construct a 535 square foot addition to the existing dwelling and to expand the existing deck; with the condition of the installation of gutters to leaders to 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 John C. Ehlers Land Surveyor, received on September 30, 2010, and stamped approved on October 4, 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, Ji M~. Doherty~ President, Board of Trustees JMD/eac Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ¢, Iix ! Please be advised that your application dated ~--r~t~6 ~_~¢ ¢,~:2~/~ has been reviewed by this Board at the regular meeting of -..qT~[~ al; ,~'~:::)10 and your application has been approved pending the completion of the following items checked off below. V//Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) V/' 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: Jill M. Doherty, President Board of Trustees Peter Young, 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 Wed., July 14, 2010, the following recommendation was made: Moved by Jack McGreevy, seconded by Audrey Horton, it was RESOLVED to SUPPORT the Wetland Permit application of JAMES & PHYLLIS RUBIN to construct a 535 sr. addition to the existing dwelling and to expand the existing deck. Located: 745 Cases Lane Ext., Cutchogue. SCTM#109-5-14.45 Inspected by: Audrey Horton, Jack McGreevy The CAC Supports the application with the Condition of a drainage plan to include drywells, leaders and gutters, and the turf is removed from underneath the deck. Vote of Council: Ayes: All Motion Carded Jill M Dohe~xy. President James F. King, Vice-President Bob Ghosio, Jr. John Bredemeyer PO Box 1179 Southold, NY 11971 Telephone(631) 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: JAMES & PHYLLIS RUBIN request a Wetland Permit to construct a 535 sf. addition to the existing dwelling and to expand the existing deck. Located: 745 Cases Lane Ext., Cutchogue. SCTM#109-5-14.45 ~twf area to be impacted: ater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland !~ha Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: Wetland __Coastal Erosion __Amendment __Administrative__Emergency __Pre-Submission Violation Info needed: Modification · Conditions: B.Ghosio, __ D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: ~vironmental Conservation 20]0 IL-Y-/ PERMISSION TO INSPECT PROPERTY 1 ~oulhhold ?owlk . . 9aM of Tr~ste~ty signing ~is permission form for submission with an application for a permit(s) to the Department of En{,ironmental Conservation ("DEC"), the signer consents to inspection by DEC staff of the project site or facility for which a permit is sought and, to the extent necessary, areas adjacent to the project site or facility. This consent allows DEC staff to enter upon and pass through such property in order to inspect the project site or facility, without prior notice, between the hours of 7:00 a.m. and 7:00 p.m., Monday through Friday. If DEC staff should wish to conduct an inspection at any other times, DEC staff will so notify the applicant and will obtain a separate consent for such an inspection. Inspections may take place as part of the application review prior to a decision to grant or deny the permit(s) sought. By signing this consent form, the signer agrees that this consent remains in effect as long as the application is pending, and is effective regardless of whether the signer, applicant or an agent is present at the time of the inspection. In the event that the project site or facility is posted with any form of"posted" or "keep out" notices, or fenced in with an unlocked gate, this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further agrees that during an inspection, DEC staff may, among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soils and vegetation (taking samples for analysis), and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s) sought by the application. Permission is granted for inspection of property located at the following address(es): By signing this form, 1 affirm under penalty of perjury that I am authorized to give consent to entry by DEC staff as described above. 1 understand that false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210. 45 of the Penal Law.* Print Name Title 'S~ignature Date *The signer of this form must be an individual or authorized representative of a legal entity that: owns fee title and is in possession of the property identified above; maintains possessory interest in the property through a lease, rental agreement or other legally binding agreement; or is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in the property for the purpose of consenting to inspection of such property. ~ITUATE: CAJTCl4OfoUE TOINN, e-oOUTHOLI2 5tJFFOLI¢. C_xDtJNTY, NY 5Ut~VI=¥1=[~ JAN. 2(2, 2010 5~FFOLK COUNTT' TAX # I000 - IC~ - 5 - 14.4~ NL ENc N NOTE~: O PIPE FOUND A $TAKI= FOUND ELEVATION F~EFEt:P-.I=NC.E N~VD '2q DATUM FLOOD ZONE A5 ANNOTATED FI:~.OM FEI'4A FLOOD ZONE HAP NO. 3'610~00163H Aroo = ~5,120 5. F. Ar~o = I.-/245 A~ros ®~.APHIO SCALE I"= 40' I, qi=TLANE) FLA65 TII=D TO DAGOHARI5 ~ BY SURVEYOR (, LAS ] M\IN g i I,'.} I i "; '~ :,. LI(' NO. 50202 JAN. 26, 2010 A5 LIMIT OF HIgH MAF~.5H t,U\'ERIII{,\D. N '~ !l'>i ! O~.~ g2~x t"nx :~69--M287 REF--C'L\l)t,,~umcms ;did 5tqlill~,',( )~<rwr,N15 l)oculucnls~M) l):opbox~10~10-106lpro REVISIONS: '"B" lOT "C" CAMERA SHOT "E" CAMERA SHOT "F" CAMERA SHOT "G" CAMERA SHOT "H" CAMERA SHOT "1" CAMERA SHOT "J" CAMERA SHOT K CAMERA SHOT "L" CAMERA SHOT "M" CAMERA SHOT "N" Z OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 21,2010 Re: Proposed Wetland Permit for JAMES & PHYLLIS RUBIN SCTM#109-5-14.45 Mark Schwartz, Architect on behalf of JAMES & PHYLLIS RUBIN requests a Wetland Permit to construct a 535 sf. addition to the existing dwelling and to expand the existing deck. Located: 745 Cases Lane Ext., Cutchogue. SCTM#109-5-14.45 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 LWRP provided that the following best management practices are considered. 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 significant, undisturbed, natural vegetated buffer be required landward from the wetland boundary. UNDISTURBED NATURAL VEGETATED BUFFER -- a land area of a certain length and width where existing vegetation occurs prior to the commencement of any grading or clearing activity. Maintenance activities within the buffer are limited to removing vegetation which are hazardous to life and property, trimming tree limbs up to a height of fifteen feet (15') to maintain viewsheds, replanting of vegetation and establishing a four foot wide access path constructed of pervious material for access to the water-body. Further the following best management practices are recommended: 1. Require the installation of gutters, leaders and drywells for storm-water control. 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 Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _~,~astal Erosion Permit Application ~L~Wetland Permit Application Administrative Permit A Amendment/Transfer/Extension ece~-ved Application: ~ ~_Completed Application ~ _._Incomplete SEQRA Classification: Type I Type II Unlisted Coordinafion:(date sent) Form q -~' LWRP Consistency Assessment~., ~'Date of Inspection: r} B~,~ Receipt of CAC Report: Lead Agency Determination: Technical Review: ~Public Hearing Held: r~ Resolution: Soothl]old lo~n _ Board of Trustees Name of Applicant Address - Phone Number:( ) 5//~ - 4~'7 ' [/ag,, Suffolk County Tax Map Number: 1000- [0 ~ -- O .5 "' f.4~. 4,~ Property Location: "'/4 · C~]-.F~'-P 6 ~t~'~ ~To, c-~J'/a.,~) (prom'~e LILCO'Pole ~, distance to cross ~,lt'eets, and location)- (If applicable) Address: /tPd d6))~ 7.ff~ Phone: ?3q - 4/ 5 ~rd of Trustees Applicati, Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA / Covenants and Restrictions: Yes J~ No If "Yes", please provide copy. Prior permits/approvals for site improvements: Date __ No prior permits/approvals for site improvements. Has any permit/approval ever be~n revoked or suspended by a governmental agency? ~No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: .'~0 £~ .~r-, ~. ,~_~ ~-~ Area of wetlands on lot: Percent coverage of lot: [~. o~ /8. % square feet Closest distance between nearest existing s ~tructure and upland edge of wetlands: /~ .~ feet Closest dist~ce be~een newest propose~ st~ct~e ~d upl~d cdgeofwetl~ds: /~4 f~ Does the project involve excavation or filling? No ~ Yes ol If yes, how much material will be excavated? [ff"~) cubic yards How much material will be filled? ~) cubic yards Depth of which material will be removed or deposited: ~_~ feet Proposed slope throughout the area of operations: ; Manner in which material will be removed or deposited: ,'7/'~'lz Statement o~.fl!e ~.ff_ec_% !f_any, °9 the wetl_a~__cls an~_fid~l_.w.a._te_r.s_ _o.f ~e. town tha_t.~ax r_¢_s~l[ by . reason of such proposed operations (use attachments if appropriate): 14-1~-~ (~/95~--Text 12 IPROJBCT I.D. NUMBBR 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only .PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPUCANT/SPONSOR I 2. PROJECT NAME Mark K. Schwartz, Architect I Rubin Property 3. PROJECT LOCATION: u~+~,~ Southolf Town co,,~ Suffo'lk 745 Cases Lane Extension (adjacent to corner of Wood Way and Cases Lane Extension SEQR 5. IS PROPOSED ACTION: r~ New [~ E.~..~e~ [] Mo~lflcmtlon/&lleratlon 6. O~C~BE ~E~ BRIEFLY: ~O~C~ slightly expand the existin~ deck size. A new poured concrete fo~dation is proposed and the excavated material (approx 150 c~ic yards) will be removed fo~ the site. Haybales will be installed and maintained durin~ the construction phase. 7. AMOUNT OF ~NO AFFE~E~: . 0 5 ~ U~lmlt~y Same 8. WI~ ~S~ ~ION COMPLY ~H ~I~ING ZONING OR ~ Y~ ~ No i~ NO. d~ WHAT IS ~ENT LAND USE IN V~N~rY ~ ~O~E~'r~ 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY STATE OR LOCAL)? 11. OOE~ ANY A(q~OT OFTHE ACTION HAVE A CURRENTLY vAUD PBRMIT O~ A~F'~C~VAL? 12. AS A RESULT OF PROPOSED ACTION WIT~ EXISTING PERMrrlA~m"VAL REQUIRE MODir-~G, kT~OH; I CERTIFY THAT THE INFORMATION PROVIDED ABOVE I~ TRUE TO THE BE~r OF MY KNOWLEDGE ~t~: ~1~/2 ~./1 App~lc~nt/~x~n~r nlm4c Mark Schwartz, A~cl~itect I If the actt~ is in the ~a~al Ama, and am a sta~ i~ncy, o~plete the ~astal ~e~m~t Fo~ ~fom p~ing with this as~ssment I PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I TI-IRESHOLD IN 6 NYCRR, PART 617.47 ff yes, coor~nnte tbe renew procees and use the ~JLL EAF. I-Iv,, IZ].o El. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative I-'1 C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Anawe~ may be handwoven, if laglbto) C1~ Exlsltng air qua~/, surface or grou~lwnter qua,ty or quant~y, ~lae levels, e~sting lraffi¢ pnttsm, soM wa~ ~ or ~, potefdfal for em~k~, drainage or flood~ problems? Expfaln bdelty: C2. Aenthe~to. sgdctdbxal, archaeofaglc, al, historic, or ob~or nabxat or cultural resoumes; or ~mmlunlty or ceighbedm~d character? F.~ bdelly: I"° I C3. Vegetntto~ or fauna, fish, shellfish or wildlife sped, es, significant habfts~s, or Ihmafaced or endengemd species? Explain briefly:. I"° , I C4. A community's existing plans or goals as officially adopted, or a change In use or int~ensif¥ of use of land or othe~ natural resuemes? Explain briel~./: I C5. Geowth, subsequent de~etopment, or related actlV~r likely to be Induced by lt~e pe0posud action? Explain briefly:. ~. Lono tom~, *ho~ torm, ~mulati~, or oth~ ef~t~ not Identi~:l in C1-057 F~in C7. Other Impacts,['mdudin~l changes in use of ei~ler qual~t~ or 1~ of ene~l),? F..~lain bdell)t: D. V,~LL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS TI4AT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRON MENTAL AREA (CEA)? (If yes, explain bdefly: Nol ........ E. 18 THERE, OR~IS THERE LIKELY TO BEt CONTROVERSY RELATED TO'POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If )res ex,)lain: PART III - DI: I I=RMINATIGN OF SIGNIFICANCE (To be completed by Agency) INSTRUC'nONS; For each adverse effect identified above, detemllne whether tils substential, large, im~or o~ s~n~nL Each effect should be assessed in connection wib~ its (a) saifing (i.e. urban or rural); (b) probability of occurring; (¢) duration; (d) irmversibiitiy; ($) geographic sex,e; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure Ihat e,~plenatiens contain sufficient detail to show that ali relevant adverse Impacts have been identified and adequately addmused. If qu',~on d of part ii was checked yes, the,determination of significance must evaluate the potential impact of the proposed action on the envfrenmentel characteristics of Ule CEA. EAF and/or prepare a positive dedam~on. WILL NOT result in any significant adverse envimnmentsl Impacts AND provide, ce attachments as necessary, the masons SUppo~ tl~ determination. Board of Trustees Name of Lead Agency .Jill M. Doherty I Pdnt or Type Name of Responsible Officer in Lead Agency Signature oTR~spo~rsible (~cer in Lead Agency J Date President Title of Responsible Officer Signature of Preparer (If different from responsible officer) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.I~ #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~b~ l~.t~o~ D~ ~.~.~ STORM-WATER~GRADING, DRAINAGE AND EROSION CONTROL PLAN B~ LO~ CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CON~Iv~[~'J[I[ON l'JfA~I~ / WOI~T~A~SF~ a. What is the Total Area of the Pro'pct Parcels? 1 Will this Project Retain All Stom~Wate~ Run-Off (Include Tofal Ama of all Parceis Iocsted ~lhin ~. :~s~ __V~ the Scepo of Work for Proposed Construction) 7 Generated by a Two (2") Inch Rainfall o~ Site? · F. (This item will include all ran-off created by site b. What is the Total Area of Land Claaitng claadng and/or construction activities as well as all and/or Greund Disturbance for the proposed1'4 (~ 0 0 Site Improvements and the permanent creaiton of construction activity? impervious surfaces.) {S.F. ;,~,) 2 Does the Site Plan and/or Survey Show AIl Proposed PROVIDE BRIEF PROjeCT DF~CRII=TION (~0~.,~,~ P~- ~ N~) Drainage Structure~ Indicaitng Size & Location? This t,/I I Item shall include all Proposed Grade Changes and &O/~.~7-~VCT"- /~ ~-..~" ~*~:: Slopes Controlling Surface Wator Flow. ' ' 3 Does the Site Plan and/or Suwey describe the erosion i~p/~)l~Ta,,~ ~ ~ ~l~'r~/,~ and sediment centrol practices that witi be used to · · control site erosion and storm water discharges. This ~.~_ ~ l t"~ ~.,~.~'4 ,~ ~' o'~ C I C ~l'L ~ itemmusthamaintainedthwughouttheEnitre / Construction Peded. / Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Mstedal within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.} Square Feet of Ground Surface?~ -- 6,s there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction~ Ge~erct DEC 5WPPP R®qulr~ents: or within One Hundred (100') feet of a Wetland or -- Submleslo~ of a SWPPP is required for ali Cons~ctio~ act h~ities involving soil Beach? disturbances of o~e (1) or more ac~es; incleding disturbances ot less ~han one acm that 7 Will there be Site preparation on Existing Grade Slopos ~ are part of a larger common plan that will uEimataly disturb one or mom acres of land; whfch Exceed Fifteen (15) feet of VedJcal Rise to~ thctudir~j Conalmcflon activities involving soil disturbances of less than one (1) acm where One Hundred (100') of Horizontal Distance? -- the DEC has determined that a SPDES permit is required for storm water discharges. SWPPP'a Shall meet the Idtulmum Requirements of the SPDE$ General Penctt 8 Will Ddveways, Parking Areas or other Imgen~ous ~m- Storm Wate~ Discharge~ from Construction activity. Permit No. OP.0.~ 0-00t.) Surfaces be Sloped to Direct Storm-Water Run~Dlf~ t. The SWPPP shall be pmpan~l prk~ tu the submittal of the NOI. The NOI shall be into and/or in the direction of a Town dght-of-way? -- submitted to the Department p~or to the commencement of corrct~cben aclleKy. 2. The SWPPP shall de~:ribe the emslen and sediment coctml pmctlees and where 9 Will this project Require the Placement of Material. reqvired, ~t-constmction storm water management prac~ces that will be used end/or Removal of Vegetation and/or the Constmcti~ of any constructed th reduce the pollutants in stem~ water discharges and to assure Item Within the Town Right-of-Way or Road ShoulderI--I component shall be prepared by a qualified Design Pmfe~slenal Ucensed in New York a storm-Water, Gradteth D~atusge & Erocten Contrst pten I~ Required b~ f~e To~m of CONNIE D BUNCH STATE OF NEW ¥ORK, -- N0ta Pu' ' .............................. .......................................................... Owner and/or repmscnt~v¢ o£ the Ov~er or Owners, and is du]¥ anthofizcd [o perform or have pc~ormed the s~d work and to make and ftc this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. FORM - 06/t0 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 Waterfiont 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 Waterfxont 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", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 Deparlment, all local libraries and the Town Clerk's office. B. DESCR1FrlON OF SITE AND PROPOSED ACTION SCTM# 1000 - 109 -05 .14.45 The Application has been submitted to (check appropriate response): TownBoard ~ Planning Dept. ~ BulldingDept. ~ BoardofTrustees 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: Construct a 535 sf addition to the existing residence and slightly expand the deck size. A new poured concrete foundation is proposed and the excavated material (approx. 150 CY) will be removed from site. Haybales will be installed and maintained during the construction phase. Location of action: 745 Cases Lane Extension (adjacent to comer of Wood Way and Cases La Ex1 Site acreage: 1.7 acres (75,120 sf) Present land use: 5 % Present zoning classification: R 40 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: Mark Schwartz, AIA- Architect (b) Mailing address: P O Box 933 Cutchogue, NY 11935 (c) Telephone number: Area Code (). 631-734-4185 (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? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ~Yes ~ No [~ (Not Applicable - please explain) This project entails additions and alterations to a single family dwelling on a previously developed site in a heavily developed neighborhood. Policy 1 is not applicable to the project. 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 - please explain) This project does not contain nor does the project affect historic or archeological resources; nor is the project located in a historic maritime area. Policy 2 is not applicable to the project. Attach additional sheets if necessary Policy 3. Enhance visual qnnlity and protect scenic resources throughout the Town of Southold. See LWRP Section IH - Policies Pages 6 through 7 for evaluation criteria ~ Yes ~ No ~'~ (Not Applicable - please explain) To the extent that this project is applicable to the proposed project, visual quality and scenic resources will be protected at the site through the protection and maintenance of the wetlands and wooded areas buffedng the developed portion of the site Eom West Creek. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of fife, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria ~ Yes ~ No ~ (Not Applicable - please explain) This project does not address nor affect erosion control structures or other erosion/flooding control initiatives. Policy 4 is not applicable to the project. 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 - please explain) The proposed project is consistent with Policy 5 with the installation of drywells to control and recharge stormwater runoff, retention of the existing wetlands and wooded areas and will be protected from site disturbance dudng construction by project limiting staked haybales. 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 - please explain) The project will be consistent with Policy 6 for the same reasons as Policy 5. 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. See Section III - Policies Pages; 34 through 38 for evaluation criteria. [~ Yes [--] No [~ (Not Applicable - please explain) lhe project will neither affect nor have an impact on air quality in the Town of Southold. Policy 7 is not applicable to this project. Attach additional sheets if necessary Policy 8. MinimiT~ environmental degradation in Town of Southold from solid waste and baT~rdous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes ~ No [~] (Not Applicable - please explain) The project will neither create nor require the handling of solid waste or hazardous substances. Policy 8 is not applicable to this project. 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 ~] (Not Applicable - please explain) As the project is limited to the upland portion of the property, public access and recreational use of the adjacent coastal waters and public lands and resources will not be affected by the project. Policy 9 is not applicable to this project. Atlach 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 IIl- Policies; Pages 47 through 56 for evaluation criteria. ~Yes ~-~ No [~ (Not Applicable - please explain) The project neither proposes nor affects the water-dependent uses. Policy 10 is not applicable to this project, 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 HI - Policies; Pages 57 through 62 for evaluation criteria. ~'~ Yes ~-~ No ~ Not Applicable - please explain The project neither proposes nor affects marine resources in Long Island Sound, the Peconic Estuary or Town waters. Policy 11 is not applicable to this project. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. [-~Yes ~] No~ Not Applicable - please explain The project is neither situated on nor adjacent to agricultural lands. Policy 12 is not applicable to this project. 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-please explain The project affects neither the use nor the development of energy and mineral resources. Policy 13 is not applicable to thi of Trustees Applica~n County of Suffolk State of New York DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF I-BS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN Tills APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES 1N CONJUNCTION WITH REVIEW OF THIS ~P,~I,,5,A/~I,~ON. Signature (x~// SWORN TO BEFORE ME THIS ~O~3 DAYOF q~{A,'x~ ,20 ]O Notary Public CONNIE 11 BUNCh Notmy Public, State of New Yor~ No. 01BU6185050 xmres Aori114 JO Mr. and Mrs..James Rubin 129 Soundview Drive Great Neck, New York 11020 516-487-8090 May 26, 2010 To Whom this May Concern: I, James Rubin, authorize Mark Schwartz, AIA - Architect, to act as agent for permit applications to the Southold Town Board of Trustees, New York State Department of Environmental Conservation and the Southold Building Department. The proposed residential construction project is located at 746 Cases Lane Extension, Cutchogue, NY (SCTM# 1000-109-05-14.46). Sincerely, James Rubin date: I'l,J,,'~N,~/~,iJ'rl'i~ J,,~/~i, IJl~(~i,{ LMI!I,Jl,', APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the Dart of town officers and employees. The Dumose of this form i~ ~o nrovide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Schwartz, Mark, K (Last name, first name, middle initial, unless you am 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: (Cheek all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooting Exemption from plat or official map Planning Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO X If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that per'mn Describe the relationship between yourself (the applicant/agcot/repre sentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): ___A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporatiun); ___C) an officer, direc~r, partner, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 FILE NOTES (For Office Use Only) bATE & INITZAL5 SUW. VEY' OF PROPF:RT'r' 51TUATE-. TOINN.. 5~;~rl'HOLI2 SUFFOLK ¢.,0~, ff:~RVEYED JAN. ge, 2010 ]'%~OOo 51TE DATA AU~. 12, 2oio 5k,rF:FOLK C, OUNT'T' TAX # ID00 - IOq - 5 - 14.45 TO: PHYLLIg RUBEN NOTSS: o PIPE FOUND A STAKE FOUND ELEVATION REFEP-,,ENCE N®VD '2q DATUH FLOOD ZONE A5 ANNOTA'I~D FROH FEMA FLOOD ZONE MAP NO. ~6IO~COI6~H Ar'e, cl = "/5,120 S. F. A~'ec~ = 1.'/245 Acr'e~ ®P..APHIC, SCALE I"= 40' 05¸ DATA: METLAND FLA~5 TIED TO ~.ACC, HAI~IS E~U~H t~¥ .EI,IRVI~'OR JAN. 26, 2010 AO LIMIT OF HIgH -.~:/-~,KD OF TRUSTEES l :~?'N OF SOUTHOL_D____ .... , / i LAND NO ~ILLiA~ ~. ~O~NE~L~ N 6 EAST MAIN STREET N.¥.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.-C:kDocuments and Settings\Owner\My DocumentskMy Dropbox\l 0\10-106 with improvements.pro