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Home My WebLink About1000-90.-2-1 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: Leslie Weisman, Chair Town of Southold Zoning Board of Appeals From: Mark Terry, Principal Planner LWRP Coordinator N - Date: June 21, 2010 Re: SIM MOY #6383 SCTM#1000-90-2-1. SIM MOY #6383. Request for Variances from Code Sections 280-124 & 280-116 based on an application for building permit and the Building Inspector's January 12, 2010, Updated March 15, 2010, Notice of Disapproval concerning construction of a new single family dwelling, at (1) less than the code required minimum rear yard setback of 35 feet, (2) less than the code required setback from a bulkhead of 75 feet at; 750 West Lake Dr., Southold, NY. SCTM#1000-90-2-1. (adj. to Little Peconic Bay and dug Inlet) 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 below listed Policy Standards and therefore is CONSISTENT with the LWRP. In September of 2009, the Board of Trustees issued a permit for the proposed action requiring a 14' non-disturbance buffer, no grading or fill on the property (except for that necessary to site the sanitary systems) and other best management practices that further the policies of the LWRP. Pursuant to Chapter 268, the Southold Town Zoning Board of Appeals shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Jennifer Andaloro, Assistant Town Attorney r'~ameofAppl~¢a.t: Sim Moy c'rrvt# 1000-90-2-1 ZBAFUe# ~3~ P~ASO~S FOR ~PE~ (additional sheet~ ma~ be ~ed with ?re~arer'~ siguamre}: A~A V~CE~SONS: Please see attached. (1) ~ und~irable change wffi not be pr~uced in the C~CTER of the neighborhood or a det~ment to nearby properti~ if granted, becausev (2) The benefit sdught by the ap. plieant CAN'NOT b~ achieved by some method feasible for the applicant to pursue, other than au are~ variance, because: (~) The amount of Celiefrequested is not substantial because: (4) The varl:~nce Will NOT. have an adverSe'effect or impact on the physical or environmental condition~ in the neighb6rhoed oi' district because: ~ (5) Has the alleged difficulty been self-created? ( )Yes, ArethereCovena~itsandRestrlcOonsconcerningthisland:~No. [~Ye~(nleascfttrnishcqpg). This is the. MINIMUM ~hat is necgssary and adequate, and at the same time preserve and protect the character of the neighborhood and the health, safety, and welfare of the community. Cheek this box f . ) IFA USE. V~4PJANCE I$ .BEING REQUESTED, AND PLEASB COMPLETE THE A ~A CriED U~E VA~CE 8~T: (Plebe be sure O ednsuff~our ~orney0 Sl~u~pp~r ~or~ ~t . (Agent must ~bmlt ~rl~en Autho~flon from day of~. Nota~ Public Matthew D. Ivans NoteL Public ol New York No 011V6053859 Qualified in Sulioik County Commission Ex2~res January 22, 20 ff Application of Sim Moy West Lake Drive, Southold SCTM#: 100-90-2-1 Area Variance Reasons 1. An undesirable change will not be produced in the CHARACTER of the neighborhood or a detriment to nearby properties if granted, because: The proposed construction of a single family dwelling and deck will not create an undesirable change in the neighborhood as the proposed construction is in keeping with the character of the neighborhood, which is generally characterized by undersized lots containing structures that do not comply with dimensional setbacks. Likewise, the proposed improvements will not create a detriment to nearby properties for the same reasons. 2. The benefit sought by the applicant CANNOT be achieved by some method feasible for the applicant to pursue, other than an area variance, because: Because of the undersized nature of the lot (8,861 ft2), the property cannot be reasonably developed without variance relief. 3. The amount of relief is not substantial because: The amount of relief is not substantial because it is the minimum relief necessary to reasonably improve the property with a single family dwelling. 4. The variance will NOT have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because: The variance will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district because the surrounding properties which are similarly improved have not been demonstrated to have an adverse physical or environmental impact to the neighborhood or district. Additionally, the Southold Town Trustees and the NYSDEC have issued a Wetlands Permit for the proposed improvements, which they would not have done if the improvements were expected to have an adverse environmental impact. 5. Has the alleged difficulty been self-creatd? No. This document was prepared by: ~-~ ~.~z/~- Page 3 Applica';ion by: Assigned Applicaiion No. Office Notes: Part B: REASONS FOR IJ,SE VARIANCE fit r, equestedJ: Not applicable. F, or Each and Every ,Permitted Use under the Zoning Regulations for the Parli~ar Distdcl'Where the Project Is Located [Please consult your attorney before corttpleflng)i / 1. Applicant Cannot realize a reasonable i:eturn for eac. h and eve~'permlfled use under the ' zonln,g ~'egulal!ons for the Particular district where' the [6rOpetly I~//ocaled~ d~monSfr'ated by compefel~t financial evidence. The applicant CANNOT realize ct ~[~A$ONABLE RETURN:because: {describe b'ri a separate sheet}. * ' -- ' ' 2, The alleged ~ardship.relating to the ,properly is unique '. 3. The. alleged hatdshlp does flat apply because: of the district or neighborhood 4. The request will not alter the essential charac . neighborhood because: ' 5. The atleged hardship has not been self- because: 6. Thls. Is the minimum relief character of the [~elghborhood While at the same time' preserving and protecting the ; safely and welfare of the community. (please 7. The spirit Of fha ordlnanc~ s~bsfa~tfl'al j'~ observed, public. Safety arid weffare will be secured, and (Please explcdn oil a separate sheet if n, ecessary.} ( ) Check this box complete PART A, QuestiOns on previous page to apply AREA col~sulf your attorney.) O~herw'ise, please proceed to ,the / Sworn to he. re me this day ~~ .............. (u ary Public) 200_. Signature of Appellant or Authorized Agent (Agent must submit Authorization from Owner) AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD I~-tEI¥ TO USE THIS FORM: The fornt mnst be completed by the applicant for arty special use permit, site plan approval, use variance, or subdivision approval on property within an agricultural district OR within 500 feet of a farnt operation located ht agricnltural district..dH applications requiring att agrictdtnral data statement must be refe.rred to the SuJfolk County Depakttnent of Planning itt accordance with Sections 239- m and 239-tt of the General Mttnicipal I. aw. 1) Name of Applicant: Shawn M. Barren, Suffolk Fnvironmental Consulting, Inc. 2) Address of Applicant: P.O. Box 2003; Bridgehampt0n, NY 11932 3) Name of. Lan_d Owner (if other than applicant): Sim Moy 4) Addl~sS of ][~9.d OwIler: 106 Mulberry Street Apt. 7 New York. NY 5,) Description of Proposed Project: Construction of single family dwelling, deck and sanitary system. 6) Location of Pr0perty (road and tax map number): West Lake Drive. 100-90:2-1 7) Is the parcel within an agriCUltural district? [] No [] Yes' If yes, Agricultural District Number 8) Is this parcel actively farmed? ]~No [~¥es 9j Name and address of any owner(s) of land within the agricultural district containing active farm operation(s) located 500 fe~t of the boundary of the proposed project. (Information may be available through the Town Assessors Office, Town Hall location [765-1937) or from any public computer at the Town Hall locations by viewing the parcel numbers on the Town of Southold Real Property Tax System. Name and Address 2.. (Please use back side of page if more than six property owners are identified.) The lot numbers may be obtained, in advance, when requested fi.om either the Office of the Planning Board al 765-1938 or t~ Zo,,.~_n~g Board of Appeals at 765-1809. Note: 1. Thc local board will solicit comments from the owners of lend identified above in order to conside~ tho effect of the proposed action 9n their farm operation. Solicita0on will be made by ~upplylng a copy oF this statement. 2. Comments returned to tho local board will be take~ into oonstdamtion as part of tho oveCall review of this application. 3. Copies of the completed Agricultural Data Statement shall be sent by applicant and/or th~ clerk of the board to the property owners ' identified above. The cost for/nailing shall be paid by the applicant at the time the application is submitted for review. Failure to pay at such time means the'application is not complete and cannot be acted upon by the board. 1-14-09 App]Licnnt: Sim Moy APPLICANT'S PRO,IIi;CT DESCRIPTION (For ZBA Date Prepared: 1/21/10 I. Ii'or Demolition of ExisQag Building Areas Pl~aso d~oribe areas being r~noveA: Not applicable , IL .New Construction Arqas (New Dwelling or New Additions/ExtenSions); Dimensions of fi~st floor oktcnsi0n: 42.4' x 25' DimermionS ofnewg~oondfloor:4'2.4' X 25' Di, .,m~. ?ns 0f:fli)or above se, e, on.d. levcl: Not applicable . Fle~ght (fi'om finished greed ~0 top 0tkidig~):,' 29' 2" ' Is.'bascmcat or lowest ftoor~a being cOnsm.~cted? If~es, pleas~ provid~ height (above taea~ored.'ii'oTM ~tu~al ~;xJstit~ grade to first floor: No. . Proposed Construi;tion Descripfio. n,(Alteraflons or Structural Changes)' (att~h exUasheet ifa .e~-~a. ~y)- Ple~6 desoribe building ~r~as: ' Numb~;,i'bfFlo6i'sahdGencr~tcharadteri~ficsBl~PORE~,Itetafions: New Construction.. Number bi~Floors ~ihd Changes Wn'R:Alter~.fions'." IV. Calculations of bdilding areas.and lot coverage (from surveyor): Existii{g square fo0~agc 9f buildifigs 'on your property: 0 Prop0sed inorea, se of building c ov~ri~ge...-~r;0C~.T-s~7.. R--. ~ ~ ,C~.o~_~ Square foe/age o~yourlot: 8,861 ~Cl. ft.' [ P~rcentage ofc0verage ofyo~ lotby building area;....~-~'~o ' V. Purpose afNew. Constrnction: Residen$ia[ dwe linq on .vacant VI.I Please de~cribe the ~and co~ltou, rs {flag slppei%~ heavRy wooded, marsh area, etc.) on your land and how it relates to the difficulty in meeting the code requirement(~): ~lata . , Please Sfibml~ s ,~i, en (7) ph0tosi Labeled to Show different angles' 0{r yard are~ after s~aking c~rners for new eonstrucjl0n), and photos of building, area robe altei'ed with yard view. 7~2002; 2/2005; 1/2007 QUES~ONNAllZE FOR 1?~ .lNG ~ YOUR Z.B.A. APPLICATION A. Is the ~bjeel promises listexl .On the real estate market for sale? O Yes ~No B. Are there, any proposals ~ chmage or alter land con~6urs? [3Ho ll~l Ye.s, please, explgm: on attached sheet. 180 c.y. fill for s~ptic only. C. 1)'Are. there ~eas.that.~ontain sand or wetlafid g~sses? Yes. 2) Are these areas shown on tha,mal~ shbmi~d with this~applicationTYes. 3)Ia..th~ p~opcRy build, earled l~twe~n the Wetlands area'at/d the upland building moa? Yes a thofi,qh un-revetted wet aqds are present Off subiect property , 4)If yo~ property. ~antai~s'WetlandS'qr pond.areas, have you c?~taotod the .~ffi009f the Town Tmste~ for i~s d~ermthaQan of'jutisdieti0n? yes ' . Pleas~ c~Wa'm status of your inqgir~ or ~pplioafion with the Tm~a~es:'Permit ~7133 .Issu0d 'J~ulv 22, 20,09 mad if issue, pl~se at, eh edpies of pemait with conditions a~d approved map. D. Is there a depreS~zon or'sloping elevaUori near the area of proposed construction at or below five feet above mcm~ sea level? NO. Are there any patios, concrete barriers;.b'ulkheads or feaeea that exist and are not shown on. the.'survey-map that 'you are subdai~tting? 'No. (Please show area of these structures opa diagram if ~ny exist. Or state"none" on the above line, if applicableS) Fo D6 you have any oonstru~tion taking place at this: time concerning you? premises? No. If yes, please submit a copy 0f your building permit and map as approved by the Building DepartmerR and describe: G. Do you or any cfi-owner also own other land clo~e to this parcel?N0. .If yes, please label thc proximity of your. lands on yo~r map 'with this application. ' - H. Plees. e list pre~nt use or opexationS.~onduptedat~is;parcel None. Vacant laod. ~ , , . .' . and propo~cd use Si,ngle.famity dwellings' . (~xampl~., ex~ slngl~-fam['l~ propb~]:. ~-'l~m~'~vith garage or pool, or off,er desefipti0n.) Au"ffi~fized Sign~t~r¢.ar/d Date l { 2,0~; i/co James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. July 22, 2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fsx (631) 765-6641 Mr. Sim Moy 106 Mulberry St., Apt. 7 NewYork, NY 10013 RE: 750 WEST LAKE RD., SOUTHOLD SCTM#90-2-1 Dear Mr. Moy: The Board of Town Trustees took the following action during its regular meeting held on Wed., July 22, 2009 regarding the above matter: WHEREAS, Suffolk Environmental Consulting, Inc,. on behalf of SIM MOY applied to the Southold Town Trustees for a permit under the previsions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 31, 2005, 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, Public Hearings were held by the Town Trustees with respect to said application 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 APPROVES the application of SIM MOY to construct a single-family dwelling and sanitary system with the following conditions: the area between the timber curb and the bulkhead is left as a non-disturbance buffer, with the exception of a 4' wide path to the water; no grading of the property; no fill or other material is placed on the property with the exception of the amount necessary for the sanitary system, as approved by the Heath Dept.; the remainder of the property is maintained as a non-turf area; a line of staked hay bales is installed prior to any construction activities, and all as depicted on the survey prepared by David H. Fox last revised September 10, 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: $100.00 Very truly yours, Jam ing ~'~ President, Board of Trustees JFK/Ims BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7133 DATE: JULY 22~ 2009 ISSUED TO: SIM MOY PROPERTY ADDRESS: 750 WEST LAKE DR.~ SOUTHOLD SCTM#90-2-1 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 July 22, 2009 in consideration of application fee in the sum of $250.00 paid by Sim Mo¥ and subject tc and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a single-family dwelling and sanitary system with the following conditions: the area between the timber curb and the bulkhead is left as a non-disturbance buffer, with the exception of a 4' wide path to the water; no grading of the property; no fill or other material is placed on the property with the exception of the amount necessary for the sanitary system, as approved by the Heath Dept.; the of the property is maintained as a non-turf area; a line of staked hay bales is installed prior to any construction activities, and ali as depicted on the survey prepared by David H. Fox last revised September 10, 2009. IN WITNESS WttEREOF, 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. Bob Ghosio, Jr. - NAY James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghos±o, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ¼ constructed Project complete, compliance inspection. WEST LAKE 0 0 / / j O~WA,r S t¢ I t~ ) Lot 1,9 89. LITTLE /::)ECONIc BAy GRADE ao, CJ. COVER TO GRADE 1[ J EL-2.4 -- SEASONAL HIG~ GROUND WATER SEP'nC TANK CESSPOOL St. TEST HOLE DATA McDONALD GEOSCIENCE DEC. 20, 2004 AND LOAM GW 4,7 EL=I.5 WATER IN MIXED SAND AND LOAM 7,0 WATER IN BROWN BOG 13.0 WATER IN ~ROWN SILTY 15.0 WATER IN Lot 118 now Johns o~r. formerly cP~SCOpol Church APPROVED BY BOARD OF TRUSTEES NOTES: 1. TOT~ 2.0= 3. SUB IN T 4. £LE~ 5. 'rills DILIF 361( 6. APP 180 7. ADd~ HOU$ DECK TOTAl 8. THE V1A .... ~..F SOUl;: Survey for: SIM MOY Lot 1 19, "Cedar Beach Park" At Bayview Town of $o~thold Suffolk County, New York S,C.T.M.: 1000-090.00-02o00-001,000 20 0 20 SCALE: 1 FORM NO. ? NOTICE OF DISAPPROVAL DATE: January 12, 2010 Update: March 15, 20'10 TO: Shawn Barron for Sim Moy P O Box 2003 Bridgehampton, NY 11932-2003 Please take notice that your application dated January 6, 2010 For construction of a new single family dwelling at Location of property- West Lake Dr., Southold, NY County Tax Map No. 1000 - Section 90 Block 2 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed new dwelling on this non-conforming 8,861 sq. ft. lot, is not permitted pursuant to Article XXIII Section 280-124 which states; "This section is intended to provide minimum standards for granting of a building permit for the principal building~ of lots which are recognized by the town under 280-9, are nonconforming & have not merged pursuant to 280-10." For lots less than 20,000 sq. fl., the required rear yard setback is 35'. The proposed new dwelling indicates a rear yard setback of 31'. In addition, the proposed dwelling is not permitted pursuant to Article XXII Section 280- 116 which states: "All building~ or structures located on lots upon which a bulkhead, ... and which are adiacent to tidal water bodies other than sounds shall be set back not less than 75 feet from the bulkhead." The survey indicates the proposed dwelling setback 24' from the westerly bulkhead & 26' fi-om the southerly bulkhead. This Notice of Disapproval was written based on the survey by D Fox, last dated 2/25/10. FORM NO. 3 NOTICE OF DISAPPROVAL DATE: January 12, 2010 TO: Shawn Barton for Sim Moy P O Box 2003 Bridgehampton, NY 11932-2003 Please take notice that your application dated January 6, 2010 For construction of a new single family dwelling at Location of property- West Lake Dr., Southold, NY County Tax Map No. 1000 - Section 90 Block 2 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed new dwelling on this non-conforming 8,861 sq. ti. lot, is not permitted pursuant to Article XXIII Section 280-124 which states; "This ~ection is intended to provide minimum standards for granting of a building permit for the principal buildings of lots which are recognized by the town under 280-9, are nonconforming & have not merged pursuant to 2p_~l 0." For lots less than 20,000 sq. Ii., the required rear yard setback is 3~. The proposed new dwelling indicates a rear yard setback of 31 '. In addition, the proposed dwelling is not permitted pursuant to Article XXII Section 280- 116 which states: "All buildings or structures located on lots upon which a bulkhead, ... and which are adjacent to tidal water bodies other than sounds shall be set back not less than 75 feet from the bulkhead." The survey indicates the proposed dwelling setback 24' fi'om the westerly bulkhead & 26' from the southerly bulkhead. This Notice of Disapproval was written based on the survey by D Fox~ last dated 9/10/09. tFge: $ Office Notes: -- lqlcd By:. For Office Oss Only Date A~igned/As$igumcnt No. Pared HouseNo. ~7~Cgtreet West Lake Drive Hamlet Bayview {Southold} 8CTM 1000Section90 Block~. .2 Lot(S), 1 i.LotSiZe 8,861 sq.fl. Zone R-40 Applicant/Owner(s): Sim Moy l~hiil&g 1 OB Mulberry street - Apt. 7; New York.' NY ' Address: Telepl~ione: 212.431.8531 Authorlged R~p~'esentativi~;Suff°lk Environmental Consulting, Inc. for (~/) Ov{,ner, ~r ( ) Other: Address: P, O. BOx. 2003; Bridgehampton, NY 11932 Telephone: 631.537.5160 Please check box to spegify who you wish correspondence to be.mailed to, from the above names: '~ Applicant/Owner(s) ~ Authe rized Representative El Other NamdAddress: , ... , , . ,~g .WHEREBY THE BtJIII)ING INSPECTOR DENIED AN A~PLICATION DATE~, e e e. '.c t ElCer~tifie~ifeofOeeupaney EIPre*Certifi at ofO c pa y El changevof Use [] Permit for As-Built Constr~tction ElOther: Provision of the Zolting,Ordtnahee Appealed~ Indicate Article, Sedion,.Subsection of Zomn~ Ordinance b3' immbers .Do not quote the code. Articl~ 23. , Section280-~24 & 280-116 8ubsection Type 0£ Appeal An Appeal is made ~or: ~ A Vm~anee t? the Z~ning Code or Zorfing Map. El A Variance due ~o labk of a~¢ess required by New York Town Law-Section E] Interpretation of the Town Code, Article_ Section U Reversal or Other A prior appeal E] hos~t(has not been made with respect to thi~ property UNDER Appeal No. Year . (Please be sure to research before completing this qnestion or call our office assis¢ you.). Office Location: Town Annex/First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 Mailing Address: 53095 Main Road P.O. Box 1179 Southold, NY 11971-0959 http://southoldtown.northfork.net BOARD OF APPEALS TOWN OF SOUTItOLD Tel. (631) 765-1809 Fax (631) 765-9064 March 19, 2010~ Mark Terry, Principal Planner %, j,~d~ LWRP Coordinator ~ Planning Board Office ~x' ,~,, x~-~x-, Town of Southold x x~v Town Hall Annex ,~x~ Southold, NYl1971 "~ / Re: ZBA File Reft No.//6383 (Moy) ~ / 1 Dear Mr. Terry: \/ We have received an application for construction of a new s~ngle family dwelling in Southold. A copy of the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and survey map, project description form, are attached for your reference. Your written evaluation with recommendations for this proposal, as required under the Code procedures of LWRP Section 268-5D is requested within 30 days of receipt of this letter. Thank you. Very truly yours, Leslie K. Weisman Chairperson Encls. TRANSACTIONAL DISCLOSURE FORM APPLICABLE TO OWNER, CONTRACT VENDEE AND AGENT: The Town of 8outhold's Code of Ethics prohibits conflicts of interest on the part ofTox~n offioers and employees. The purpose of this form is to provide information, wh/eh can alert the Town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. Shawn M. Barton (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the Other person or *property name.) NA'II. IRE OF APPLICATION: (Check all that apply.) Variance Special' Exception *Othor .Appi'oyal or Excmpti6n from plat Or official map Cti~ngc of,Zone T/~ O~a..vanc~ '~If"Othor'~ hame the activity: DO you peri~onally (or through your company, spouse, sibling, parent, or chit.d) hay, a r~latioxlship with any- officer or employee of the Tom of Southold? "gelationship" includes by blood, .m~'riage, or bUSiness :/nterest. '~Btminesa intexe~t" means a.busip, es~..irieludin[-a .pat~ershipd in whk:h th, Tom offiCer or employee ha~ even a partial owflership of (or omplovrnent by) a corD0ration in whi~.h the Town officer or emoloveo owns mor~ than. 5%~the. YES · NO Vr If you answered "YE~'; complete the balance of tMs form and'date and sign wherb htdicate& l~Iame of person employed by the Town of 8outhold: Title or position of that person: Describe that relationship between yourself (thc applicant, agent or conlract vendee} ahd the Town of'fleer or employ'ce. Either check the appropriate tlne A through D' (below) and/or describe the relationship .in the space provided. The Town officer or employee or his .or her~ spouse, sibling, pa~ent, or child is (gheck all that apPly): . A) the oWner of greatefthan 5% of the shares of the eorp6rate stock of tlie applicant (when the applicant is a corporatidn); B).the legal or beneficial owner of ~ny inter~t in a non-co~orate entity (when the applicant is not a corporation)} ' ' C) an Officer, diregt0r, partner, or employee of the applicant; or · ' D) the'actUal aPl~lieent - , '~. ,.. .·. .,. / ....a, ~ ,-..~,-.=~0 I~ 8ubm,tted this ~ of ~/t/~l~. . Notary ~ubhc o) Ne~ York ' · ¢0mmissi0r Exp res January 22, 20t/ PrintNsme- ~h~,~ LWl~2 C@NSiSTENCY ASSESSMENT A. INSTRUCTIONS All applicmtts for pe~rrdts* including .Town of Southold agencies, shall complete [his CCAF for proposed actions that are subject to the Town of Southold Wateffiont Comistency Review Law. This assessment is hatended to supplement other information used'by a Town of Softhold agency in malting a deto~i~lnation of eonai~tenoy. *~x. eopt minor exempt action.* including Building Permits and other mini*terial pe.ra~..tt~ not located within the Coastal Erqsion ttazard Area; ' Before answering the quoations in Sect.ion C, 'tho preparer of this 'form should review tho exempt miaor action Iisf,'polioies and o.xplanations of each policy contained'in [he Town Of 8outhokl Local Waterfiront Revitalizatio. n Program. Apf. oposed action wi}l be evaluated as t~ its sigfifleant beneficial and advemo.offects up6n the coastal arm (wlii~h'includ~s all of S0uthold If any qq ~e~ti°n in..Seetion'C on this 'form is answered ,,yes,,, then.the pmp0sed action may affect the achievement of the LWRP policy standard~ :and ~ndih.'on~ 'eontaineA in the consisten0y review law. Tlmh, the action shohld be analy4e4 in more detfil 'anjt, it' neeesSaty,.modified prior to making a determln~tion that. it is eomist~nt 'to the maximum .extent practicable With the LVv~g..~ policy standards and conditiom.- If an a'ctlola 'camnot b~ certified as consistent with the LWRP policy standards and eondifion~ .it shall lint be miitea'taken. X copy of the LWRP ig available ia the following places: online at the Town of Southold's website (southoldto~n.northfo~k.net), the Board of Tmstees Office, the Planning Departmenl~ all local libraries and 'the Town Clerk's office. DESCRII°TION OF SITE AND PROPOSED ACTION SCTM# 90 2 1 The Application'has been ~qubmdtted to (check appropriate response): l. Category of Town of 8outhokl agency action (check ~ippmptiate.reSPonse) (a) Action undertaker~direotly by Town agency (e.g. capital [-~ construction,.planifing aoflvify, agencyrogulafi0n, land trans~ction) ,~) Financial assistance (e.g. grant, loan, subsidy) ' (c) permit, approval, llc6~aSe, ce~tiliiSation: Nature and extent of action: Applicant proposes to construct a two story single family dwelling with 3 bedrooms with an attached deck, pervious driveway, and an elevated sanitary system requiring 180 cubic yards of fill. ' r~--~'~ Location of action: S/s West Lake Drive, Bayview; Town of Southold Site acreage: 0.2 acres Present land usc:. Vacant Present zoning classification: R740 If ar~ ~plibation for the proposed action has bema'fited with the Town of 8outhold agency, the following infomai~tion shall be provided: (a),Nameo£a~plicant: $!m H. May ~). Mailing address: 106 Milberry Street- Apt. 7; New York, NY 10013 (0) Telephone mtmber: Area Code ( ) 2 t 2 431 8531 (d) Application number, if any: . Wil[the action bedire~tly undertake~, requi~6 funding, or approval' by, a state oF feAeral agency? Yes ~ No ~ If yes, which state or federal agency?. C. DI]Iy~.LOP]iD COAST POLICY PolicYt. Foster a'pattern of development in the Town ti Southold that enhances communit3, character, prgserves ,~pen space, makes, efficient use of infrastructure, makes beneficial rise 6f a coastal location, and minimizes adverse effects of deyelopment, See LWRP Section III a Policies; Page 2 for e/,aluation 'criteria, · '~-]"xreS [~ No [~'No~3,pplieable rhis project will improve on vacant residentiall'~ zoned Iand, upon a,lot.located in ,a nieghbobhood of similarly sized properties and "~tructures. %he l~rqpbsal as d,esigfled, will not msul~.in adverse effects to the surrounding environment ih that the i~rdJect has b~en dosignea so as tc rdaintain or exceed ali regulatory conditions associated with improwng an a 1o[, situated in-promm~ty to the surface waters in the Towf of Southold Additionally, the surroundin!~ neighborhood is~omprised ofsimilarl~ sized dwellings on similarly siz~[i orooerties which have existed harmoniously in this area and have not resulted in adverse effects to the surrounding envlronmem, As sucY we submit th.at the projec[ IS consistent WlIn InlS ~o~icy ' - · Attach additional sheet~ i[i~eceasary -l%l~rotee't anff-pT~i,~ hi~torie and areha~610g~W~l resoui~ces ti' tl~e 't'owh o~8ollthold. See LWRP Section IH-.Pollcies'Pages' 3 through 6 for evaluation criteria Attach additional sl~¢ets if necessary ?0~icy .3, Enhance visuat quality and prolecl scenic resources throughout the Town of Southold, ~e LWP, P Seetlon !II - ?o, iides Pages 6 through 7 for evaluation criteria [~ Yes ~ No ~ Not Applicable The proposed project will not ~dversely xmpact the visual quality of the surrounding ~rea in'that the surrounding area is comprised of properues improved with sii~gle-family dwellings of similar and larger sizes. Scenic resources are not at risk dut to tile property beiog s~tuated al the terminus of West Lake Drive which resfllts in only one ,adjacent parcel to the west which could potentially be imp,a..cted, and flhich is owned by the app!icants husband Furthermore. this policy cannot, preclude,the d~vd?pment o f '~his lot a,s it is a pre:e, xisung building l~t , .. · r ;Alfaeh additional ~h?t~ 'if ne,~ssar/- NATURAL COAST POLiCiES Pnlicy 4, Minimize loss of lif~, structure, ai~d natural resources from floodigg and erosion.See LWRP' Section i'II ?~ Policies Pages'8' through, 1.6-for evaluation eriteri:a ~] ¥&s No F~ Not ~pplieable ' ~nbj~ct pr0p'~rty, i~ cUrrent!y imprgved with a bulkfiead. Therefore the property is substanttally proteet~d'l'rom ~loodihg an'~l/or erosion. Additignally the pro,led wfllrbe constructed U accordance with the applicable F£MA regulations Therefore ~he loss of lile structures and . natural iesources Will be minimized. I Attack additional sh~ts if necks 'ary .. P~licy.5. .Protect aad improve water quality and supply in the Town of 8outhold. See LWRP Section m - P61ieies Pgges 16 througli 21 for evaluation criteria ~ Yes [---] No' F'-~Not Applicable ~ubject propdsal will utilize,public wat~er and ,a mddern sanitary system that will comply ~th all applic,able SCDHS standards. ~s sfich ~he,re should he no, !mpact to water qu~tlity/or the water supply of the ?,wn of Southo[d: At,ch additt6nal S~.~t~ if nec~ary Policy 6- Protect and restore the quality and functibn of the Town of 8oathold ecosystems including :Significant Coastal Fish and Wildlife Habitat§ and wetlands. S~e LWRP Seetio. ,IH ~ P, olic~es~- Pages. 22 thrO.~gh 32 for 'ev~iluatlon e~'If, erla. .... Permits for the proposed project ha, ye been issued b) the Southold Town Trustees and the NYSDEC. Therefore. no impacts additional sheets i£neccssary Policy 7, Protect and improve,air quality in the Town of Southoid. See LWP& Section IIi -POlicies P,ages 32 ~hrough 34 for evaluation criteri,a. Yes [~bIo[~] Not Applicable No inhoacts to the air quality, of the Tow~3 of Sguthold are anticipated Attach addifi6nalsk¢~t/'if ~*c~ary Policy 8. Minii~ti~e environ, ment~! degradatio~i in Iow~l of Southoid from Jsolld was}e and hazardous ..~nbstan'ees ~nd w,astes. See'LwRP Section 1II ~ P01icibs; P~iges 34 through 38 for evaluation erit~rla, ' The proposed project does not involve.the disposal and.or trans~srtatinn of solid waste and hazar,dous substances and wastes POBLIC COAST POLICIES l~olicy'9. Provide fur 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 eyaluatiOn criteria. ~ Yes[-~ No[~ Not Applicable Subject property IS pnvaie prope, rB and does not p[ovtde for public access to adjacent coastal waters or public resources of the Town of Southold Attach additional glio~ts ifnecess~ry ' ' WORI~GI I~O~T'POLIClE$- 'Potiey 10. P~otect 8oathold's water-dependent us~ and promote siting of new water-dependent us~ in s~ltable locations, See LW~ Section HI ~ Polict~; Pag~ 47 through 56 ~or evaluation criteria, The proposed project does not involve a water dependent use. Attach additional sheets if necessary Policy 11. Promote sustainable use o~[ living marine resources ia Long Island Sound, the Pectate ]gsCaary and Town waters. See LWRP Section III- Policies; Pages 57 through 62 for evaluation criteria. [--] Yes ~ No [~] Not Applicable The proposed project does not involve any form ti marine resom'ce managemem XttaOh i~ddifional sheets if necessary - Poligy 12. Protect agricultural lands in the Towd of Southold. S~e LWR.P Section HI - Policies;. Pages 62 through' 65 for ev~iuation crReria~ ' The'proposed project does not ir/volve agricultural lands, nor is it located within an Agricultural District. Attach additional sheets ifnec~sar/ Policy 13. Promote appropriate use and development of energy and mineral resources. See LVVrl[LP · Section III - Policies; Pages 65 through 68 for evaluation criteria, ~¥es ['~ No [~ NotAppikable The proposed project does not involve the development'of energy' and or mineral resources Created on 5/25/05 J 1:20 AM Appendix C ~HORT E~RO~ ~SESSME~.FO~ Fqr ~ISTED ~Ng Only P~T I - Pr6je~ ~o~a6oa (To b~'complete by Applier or Pwjagt 1. Appll~t I ~p~sor . 2. P~I~t Name ~-~ffoil~ Environmental Consulting, Inc. 3. Project Iocaflbn: Munl~lpallly Count,/ .:l~;wn..of SoutholO (Bayvie~), County o; Suffolk . 4..P~e~& I~0allon (S~6t ~r~ and mad 3nleme~ons, pr~ml~tl~hdma~, e~ or provue ~ap) Trminus Lake 487' west of Road Of West Drive, Midway Construction of a single family dwelling and related appurtenances. 7. Amouoi~)f I~nd aff'e~ted: '~tr~l~all~ 'acres; UIIImaleiy: a~ {8,861 square feet; 8,861 square feet ~. ~li p.pos~'aC"~ ~ply ~ e~s~ng ~ o~er e~s~ land use. r~c,onsl ea.variances required. 9.'~ha[ Is pmseht ~nd use in ~ldhi~ of.pmlecb (~s~be): 10. DOes a~on l~l~e a p~t approvat or ~n~ng, now or ultlmalely ko~ any ot~er ~mmen~l agen~,(F6d~mL Stale or ~o~l)'? , HQ If Yes. list ag~s} and p~l~approvals: ' . 11. ~es an~ aspec{ of ~e ac~o~ h~e a ~ently ~d peril or appro~l? eqO ' If ~, ~st ~gen~(~) and pe~lVa~p~l~: ' e; and NYSDEC Wetlands Permits. 12. ~'a r~It of proposed act~n. ~11 e~s~ng pe~l~approval require mediUm,on? NO 1[ Yes, ~st agents) and p~tFapprovals: I ce~/~ that the info~atlon provided a~ve i~ f~e to the beat of~y knowledge [Appli~nt ~ Sponsor Name; ~. ~D~le: ~t/ APPLICANT TP-~xNSACTIONAL DISCLOSURE FORM Tile Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees. The purpose of this lbrm is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAMe: MOY, SIM H. Last name, first name, middle initial, unless you are applying in the name of someone else of other entity, such as a company. If so, indicate the other person's or company's name.) NATURE OF APPLICATION: (Check all that apply.) Tax grievance Variance X Change of zone Approval of plat Exemption from plat or official map 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 person Describe the relationship between yourself (the applicant) and the town officer or employee. Either check to 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 then 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 noncorporate 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 Signature Print name 2009_ OWNER'S ENDORSEMENT (TO BE SIGNED IF APPLICANT IS NOT OWNER) STATE OF NEW YORK) COUNTY OF SUFFOLK) SS: SIM II. MOY, being duly sworn, deposes and says; I reside at 106 Mulberry Street- Apt. 7, New York City In the County of New York and the state of New York , and I am the (_owner in fee) (officer of the Corporation which is owner in fee) of the premises described in the foregoing application and that I have authorized Suffolk Environmental Consultingr Inc. to make the foregoing application as described herein. Signature Signature If Corporation, name of corporation and Officer Officer's Title Before me, this ~0 day of ,2009 Notary Public TOW"N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined ,20__ Approved ,20.__ Disapproved a/c Expiration PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Cheek Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT DateMarch 5 ., 20 10 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub!ic streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, ifa cmporation) P.O. Box 2003, Brid§ehampton, NY 11932 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Agent Sim Moy Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: West Lake Drive Bayview House Number Street County Tax Map No. 1000 Section Subdivision Cedar Beach Park 90 Hamlet Block 2 [] Filed Map No. @0 Lot1 Lot 119 2.' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Vacant Land b. Intended use and occupancy Single Family Dwelling 3. Nature of work (check which applicable): New Building. Repair Removal Demolition 4. Estimated Cost 250,000 5. If dwelling, number of dwelling units 1 If garage, number of cars not applicable Addition Alteration Other Work Fee $50.00 (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Not applicable 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height Number of Stodes Rear 8. Dimensions of entire new construction: Front 29' 2" Height Number of Stories 9. Size of lot: Front 89.93' Rear 77.04' Rear 48.4' Depth 104.5 .Depth 32.3' 10. Date of Purchase 11/30/2004 Name of Former Owner 106 Mulberry Corp. 11. Zone or use district in which premises are situated R-40 12. Does proposed construction violate any zoning law, ordinance or regulation? YES~-] NO [--'] 13. Will lot be re-graded? YES[~ NO~-'] Will excess fill be removed from premises? YES[--] NO[~-] 14. Names of Owner of premises Sim Moy readdress lO6 Mulberry St; Apt. 7, NYC Phone No. 212.431.8531 Name of Architect Joseph Fischetti AddressP.o. Box616; Southold, NY Phone No 631.765.2954 Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a fi'eshwater wetland? *YES ~] .NO ~-] * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERM~-~i MAYrI~ REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES I~1 NO.I~I__ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. any covenants and restrictions with respect to this property? * YES [~ NO ~ 18. Are there · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Agent (Contractor, Agent, Corporate Officer, etc.) of said 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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of 20 Notary Public Signature of Applicant PLANNING BOARD MEMBERS JERILYN B WOODHOUSE Chair WILLIAM J CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D SOLOMON MA/LING ADDRESS: P.O. Box 1179 Southold, N-Y 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 icor. Main Rd & Youngs Ave.) $outhold, NY Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE ....-~,.~ -" TO: Town of Southold Board of Trustees ~ From: Mark Terry, Senior Environmental Planner Date: August 23, 2005 Re: Request for Wetland Permit for Sim Moy R~ S CTM# 1000-90.-2-1 SIM MOY requests a Wetland Permit to construct a single-family dwelling, attached rear deck, pervious driveway, retaining wall and sanitary system. Located: 750 West Lake Rd., Southotd. SCTM# 90-2-1. The parcel is located on Little Peconic Bay. The proposed action has been reviewed to Chapter 95, 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 generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the following standard best management practices are implemented. }. Require water quality protection measures for areas generating runoff (gutters, downspouts, dry wells and pervious driveways) post construction. Depth to groundwater is extremely shallow. To further Policy 5 and protect surface and ground water quality and conserve water supply to the greatest extent possible it is requested that the Board require the following best management practices for landscaping and lawn establishment post construction: 1. Require native landscaping to minimize irrigation and avoid fertilizer applications. 2. Require disease-resistant and drought-tolerant plants (where possible). 3. Retain existing vgg~tation w th n non-disturbed buffers to minimize lawn areas. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Please contact me at (63l) 765-1938 if you have any questions regarding the above. TOWN ~ SOUTHOLD PROPERTY RECORD CARD OWNER FORMER OWN EP~ N VILLAGE W DISTRICT ACREAGE SUB. LOT TYPE OF BUILDING RES, SEAS. FARM COMM. IND. CB. j MISC. LAN D I M P. TOTAL DATE REMARKS AGE NEW Farm BUILDING CONDITION Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Tara I NORMAL Acre BELOW Value Per Acre ABOVE Value /v York State Department.of Environmental Conservation ision of Environmental Permits, Region One NY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 one: (631) 444-0403 · FAX: (631) 444-0360 ebsite: www.dec.state.ny.us Denise M Sheehan Commissioner December 19, 2006 Sim H. Moy 106 Mulberry St. Apt. # 7 New York, N.Y. 10013 Re: Permit #1-4738-01002/00008 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please carefully read all pennit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Sherri L. Aicher Environmental Analyst SLA/dj Enclosure NEW YORK STATE DEPAR'[MENT OF ENVIRONMENTALCONSERVATION./~'f" DEC PERMIT NUMBER EFFECTIVE dI~TE 1-4738-01002/00008 December 19, 2906 FACILITY/PROGRAM NUMBER(S) P E RM IT EXPIRATION DATE(S) Under the Environmental Conservation Law December 31,2011 TYPE OF PERMIT · New [] Renewal [] Modification [] Permit to Construct [] Permit to Operate []Adicle 15, Title 5: Protection of Waters [] Article 15, Title 15: Water Supply [] Article 15, Title 15: Water Transport [] Adicle 15, Title 15: Long Island Wells [3 Adicle 15, Title 27: Wild, Scenic and Recreational Rivers [] 6NYCRR 608: Water Quality Certification [] Adicle 17, Titles ?, 8: SPDES [3 Adicle 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation [] Adicle 24: Freshwater Wetlands · Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management [] Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management [] Article 34: Coastal Erosion Management [] Article 36: Floodplain Management [] Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control PERMIT ISSUED TO Sim H, Mo¥ ADDRESS OF PERMITTEE TELEPHONE NUMBER (212) 431-8531 106 Mulberry St. Apt # 7, New York, N.Y. 10013 CONTACT PERSON FOR PERMITTED WORK Suffolk Environmental Consultin9, P.O. Box 2003, Brid~]ehampton, N.Y. 11932 NAME AND ADDRESS OF PROJECT/FACILITY tTELEPHONE NUMBER (631) 537-5160 Mo), Property, Southwest end of West Lake Drive, Ba)Niew, N.Y. SCTM # 1000-090-02-001 COUNTY ITOWN WATERCOURSE I NYTM COORDINATES Suffolk Southold Peconic Ba¥/VVest Lake E: N: DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a single family dwelling with deck, septic system with retaining wall and approximately 180 cubic yards of fill, water service and pervious driveway as shown on the 12/6/04 survey by David Fox, L.S., last revised 6/26/06 and stamped NYSDEC approved on 12/19/06. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this )ermit. DEPUTY PERMIT ADMINISTRATOR: George W, Hammarth (SLA) AUTHORIZED SIGNATURE ADDRESS Region 1 Headquarters SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 DATE December 19, 2006 Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable, to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Uniess expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1 ,SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. DEC PERMIT NUMBER PAGE 4 of 4 1-4738-01002/00008 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Necessary erosion control measures e.g., staked haybales, silt fencing, etc. are to be placed on the downslope edge of any disturbed areas. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good and functional condition until thick vegetative cover is established. 2. All erosion control devices shall be maintained in good and functional condition until the project has been completed and the area has been stabilized. 3. Driveways and parking areas shall be constructed of NYSDEC approved pervious materials. 4. Sanitary systems (bottom of the tank and leaching pools) shall be located a minimum of 2' above seasonal high groundwater. 5. Roof runoff shall be directed into dry wells a minimum of 20 linear feet landward of the tidal wetland boundary for immediate on-site recharge. 6. All fill shall consist of "clean" sand, gravel or soil (not asphalt, slag, flyash, broken concrete or demolition debris). 7. All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate vegetation (grasses, etc.)immediately following project completion or prior to permit expiration, whichever comes first. Ifthe project site remains inactive for more than 48 hours or planting is impractical due to the season, then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. 8. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and/or protected buffer areas. 9. Any debris or excess material from construction of this project shall be completely removed from the adjacent area and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands or protected buffer areas. 10. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. DEC PERMIT NUMBER PAGE 2 of 4 1-4738-01002/00008 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 6O8 ( TIDAL WETLANDS) If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. All necessary precautions shall be taken to preclude contamination of anywetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across or along the bed of a waterway or floodplain, deposits within any regulatory floodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 5. There shall be no unreasonable interference with navigation by the work herein authorized. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by_ DEC PERMIT NUMBER PAGE 3 of 4 1-4738-01002/00008 95-20-1 (11/03) -9d New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of the approved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Permit Number Expiration Date----~ ~ c :~/'/ p,,o// Regional Permit Administrator NOTE: This notice is NOT a permit nOw Or, fOrmer, Johns ~P~SCOpoI t~hUrch NOTS: 1. TOTAL ARIA = &86~ S.F. (AJ3JAC*CN? AREA) , Survey for: SIM MO¥ Lot 1 19, "Cedar Beach Park" At Bct~ie'w Town of South. otd Suffolk County, New York SC'I'M~: I000- (t90- (}2 - 001 Date: Jat~t~ary 20~ 20H) Photograph of staked indicating/he location ol the proposed improvements, The view is to the south. Photog,'apb {l ,t d~e, ii~clkal:ing,/he hx: ~tiei~ eJ ti~e ixoposed i Nwoven-:er~ts 1-he view S{ t'M~¢': H)O ) - 090 - 02 - OOt Date Januaiy 20, 2010 Photograph of stakes indicating the location of the proposed improvements. The view is to the west. TEST HOLE DATA 0 CP LITTLE PECONIc BAY' SANITARY SEC110N: NOTES: RETAINING WALL SECTION FINISHED GRAD[,' 8" ,' TOP DF WALL St. 1. TOTAL AREA = 8,661 ADJACENT AREA = 8,454 S.F. 3. SUBDIVISION MAP "CEDAR BEACH PARK" FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON DEC. 20. 1927 AS FiLE NO. 90 4. ELEVATIONS SHOWN HEREON ARE REFERENCED TO B. THIS PARCEL IS WITHIN FIRN ZONE VE(EL 10) AS DILINEATED ON FIRM BOUNDARY MAP NO. 36103C0169 H LAST DATED SEPT. 25. 2009 6. APPROXIMATE: FILL REQUIRED 180 CUBIC YARDS REQUIRED (FOR SANITARY). 7. ADJACENT LOT COVERAGE: HOUSE = 1,061 S.F. Lot 118 dohn8 ?. forrnerly cP;$c°Pal Church TO 8ACKF1LLrNG Survey for: SIM MOY Lot 119, "Cedar Beach Park" o/c At CERTIFIED TO: SIM MOY 64 SUNSET AVENUE V~STHAMPTON BEACH, N.Y. 11978 (631) 288-0022 Bayvie~u Town of Southold Suffolk County, New York SCALE: 1 =20 / SEASONAL HIGH T -- 1 5 5 S F OR 1 JOSEPH FISCHETH, PE GROUND WATER TO AL - . 9 . . 8.9~ PROFESSIONAL ENGINEER SEP~IC TANK CESSPOOL 8. THE NON-~JRF BUFFER MAY BE MAINTAINED 1725 HOBART ROAD ~..? lceo ~L VIA MOWING. SOUTHOLD, N.Y. 11971 DWG: 2004-744 il ' NORTH ELEVATIO,~,f SCALE: 1/4" = 1'-0" WEST ELEVATION SCALE: 1/4" = 1'-0' DRAWN BY: JF/MH November 13, 200ti SCALE: 3[/4" = 1'-0" SHEET NO: EL SOUTH ELEVATION SCALE: 1/4" = ". -0" EAST ELEVATION SCALE: 1/4" = 1'-0" · ~w DRAWN BY: JF!HH SHEET NO: DECK DINING [~ ~ 6'-10" 6'-0" 10'-7" ,,. DECK MASTER BATH~ ~ ~ ~ ~ ...... ~ ~NTRY. ~ ' .......... o B~T~ ~0 1 ~ D 0 II II Il '11 ~L I~1 ' II II NATURAL ~RADE: EL. 7.0' ] NEW 6RADE: EL. ZO.O' ~ TOP OF F~N. FLOOR: EL ~.0' ~) PROJECT NORTH IST. FLOOR PLAN SCALE: 1/4" = 1'-0' LU DRAWN BY: .1F/MH November 1.3, 200H SCALE: 1/4" = Y-O" SHEET NO: a Il l} u {{ ,, u {{ I u {{, {{ ,{1 ,._~ I ~ -- ~ , . I II { II II I ,, - ~ PROJECT NORTH 2ND. FLOOR PLAN SCALE: 1/4" = 1'-0' DRAWN BY: 3F/MH SCALE: 1/4"~1'-0" SHEET NO: ~ ........ ,, ..................... O- ....................... 0 ..................... O ........................... ~, ~ p 12)2XI2PTGIRD£R 12) 2X[2 PT 6~RDgR ' , {2) ~12 PT ~D~ (2) ~12 PT ~D~ / k O ............. O- ............... O- ............... 0 ......... 0 ~ .... 0 .................. ~ (2) 3XX2 PT GZRDER , (2) 3X12 PT 6/RDER 0 (2) 3X12 PT G]~ ~ / ' 4" 4" 4" ~ Feb~a~ 26, 2010 SHEET NO: