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HomeMy WebLinkAboutTR-7391 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fsx (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0674C Date July 27, 2011 THIS CERTIFIES that the 12'X 18' elevated deck and 3.3'X 13' stairs At 2350 Deep Hole Dr., Mattituck Suffolk County Tax Map #123-4-7 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 8/3/10 .pursuant to which Trustees Wetland Permit #7391 dated 9/22/10 was issued and conforms to all of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for A 12'X 18' elevated deck and 3.3'X 13' stairs. The certificate is issued to ERIC KLODNICKI owner of the_aforesaid property. Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pm-construction, hay bale line/silt boom/silt curtain 1st day of construction __ ~ constructed __ Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: ~.~-~ Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I t 79 Southold, NY 11971 Telephone (631 ) 765 - 1892 Fax (63 I) 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 ½ constructed V//' Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7391 DATE: SEPTEMBER 22, 2010 ISSUED TO: ERIC KLODNICKI PROPERTY ADDRESS: 2350 DEEP HOLE DRIVE~ MATTITUCK SCTM# 123-4-7 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 September 22, 2010, and in consideration of application fee in the sum of $250.00 paid by Eric Klodnicki and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a 12'x18' elevated deck and 3.3'x13' stairs; and as depicted on the survey prepared by Nathan Taft Corwin III, last dated April 20, 2010, and stamped approved on September 22, 2010. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. f~ 'FX Lx / TERMS AND CONDITIONS The Permittee Eric Klodnicki, residing at 2350 Deep Hole Drive, Mattituck, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said 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, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. Jil] M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. 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 September 22, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Glenn E. Just J.M.O. Environmental Consulting P.O. Box 447 Quogue, NY 11959-0447 RE: ERIC KLODNICKI 2350 DEEP HOLE DRIVE, MATTITUCK SCTM# 123-4-7 Dear Mr. Just: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 22, 2010 regarding the above matter: WHEREAS, J.M.O. Environmental Consulting on behalf of ERIC KLODNICKI applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 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 Hearing was held by the Town Trustees with respect to said application on September 22, 2010, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 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 ERIC KLODNICKI to construct a 12'x18' elevated deck and 3.3'x13' stairs; and as depicted on the survey prepared by Nathan Taft Corwin III, last dated April 20, 2010, and stamped approved on September 22, 2010. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Jill I~. Doherty v 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 I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated /"~Xq_c~.s'/L3? ~;~)/0 has been reviewed by this Board at the regular meeting o[~o",r~M(c~J:-,~.~?O/O and your application has been approved pending the coml~e~ion of the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ½ Constructed ($50.00) V///Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southotd Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTALFEESDUE:$.~(~0~° 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., September 15, 2010, the following recommendation was made: Moved by Audrey Horton, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of ERIC KLODNICKI to construct a 12'X 18' elevated deck and 3.3'X 13' stairs. Located: 2350 Deep Hole Dr., Mattituck. SCTM#123-4-7 Inspected by: Audrey Horton, Jack McGreevy Vote of Council: Ayes: All Motion Carried Jill M Dohelxy, President James F King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer P.O Box 1179 Soulhold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ERIC KLODNICKI requests a Wetland Permit to construct a 12'X 18' elevated deck and 3.3'X 13' stairs. Located: 2350 Deep Hole Dr., Mattituck. SCTM#123-4-7 Type.of area to be impacted: _b/S~altwater Wetland __Freshwater Wetland Sound __Bay Distance of proposed work to edge of wetland ~hof Town Code proposed work falls under: apt.275 Chapt. 111 other Type of Application: /~Wetland __Coastal Erosion __Administrative__Emergency Pre-Submission __ Amendment Violation Info needed: ~*~' j~ Modifications: Conditions: Present Were: __&King __J.Doherty __J. Bredemeyer B.Ghosio, D. Dzenkowski other Form filled out in the field by D. Bergen__ Mailed/Faxed to: Date: DEEp HOLE DRIVE .I N/F DICKER$ON Klodnicki 2350 Deep Hole Dr., Mattimck llMAY'10 1230HRS u iJ U 36 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: From: Date: Re: Jill Doherty, President Town of Southold Board of Trustees Mark Terry, Principal Planner LWRP Coordinator September 16, 2010 Proposed Wetland Permit for ERIC KLODNICKI SCTM# 1000-123-4-7 ERIC KLODNICKI requests a Wetland Permit to construct a 12'X 18' elevated deck and 3.3'X 13' stairs. Located: 2350 Deep Hole Dr., Mattituck. SCTM#123-4-7 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the denoted following Policy Standards and therefore is CONSISTENT with the LWRP provided the following: If the action is approved, to further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem it is recommended that a natural veqetated buffer (width to be determined) be required landward from the ed.qe of tidal wetlands. 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. Vegetation shall be maintained to achieve a minimum percent ground cover of ninety-five (95) percent. To achieve the percent ground cover indigenous, drought tolerant vegetation shall be planted. Survival of planted vegetation shall be (ninety) 90 percent for a period of three (3) years. 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 (4') wide access path constructed of pervious material for access to the water-body 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 Office Use Only ~weaStal Erosion Permit Application tland Permit Application Administrative Permit R Amendment/Transfer/Extension ece~vved Application:~_~ } (-~ eceived Fee:$,~%~-~)~ ' _~ompleted Appfication ___Incomplete ~SEQRA Classification: Type I Type II Unlisted__ __Coordination:(date sent)_ __ ____~WRP Consistency Assc,smfn. t. Form ~ !o~1 ~(~ ~/CAC Referral Sent: of pec.on: Receipt of CAC Report:_ ~Lead Agency Determination:__ T~clmical Review: ~l~blic Hearing Held: 7~esolution: AUG - 3 2010 Souti~ho[d 1own Board of Trustees Name of Applicant Eric Klodni ~k5 Address 2350 Deep Hole Drive, Mattikuck.. N_¥_ 11q~? Phone Number:( ) 917-856-3873 Suffolk County Tax Map Number: 1000 - 123- 04- 007 Property Location: 2350 Deep Hole Drive: M~i~,~k (provide L1LCO Pole #, distance to cross streets, and location) AGENT: Glenn E. ,?u~t'-.TMC~ ~nxrlro~menta! Cen~u!tin~ (If applicable) Address:P.O. BOx 447t Quoque, N.Y, ~959-0447 Phone: 63~-653-0607 ~ard of Trustees Application0 Land Area (in square feet): Area Zoning: GENERAL DATA 39,453 sq ft Previous use of property: single family dwellinq Intended use of property: Same Covenants and Restrictions: Yes x No If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Date ~{ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary):. Applicant proposes to construct a 12'x18 elevated deck and 3.3'x13' stair~ Bo~d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeoftheproposedopemtions: Proposed elevated deck Area of wetlands on lot: 1,800 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 62 feet Closest distance between nearest proposed structure and upland edge of wetlands: 59 9 feet Does the project involve excavation or filling? x No Yes If yes, how much material will be excavated? O cubic yards How much material will be filled?. 0 cubic yards Depth of which material will be removed or deposited: 0 Proposed slope throughout the area of operations:. 1: 1 Manner in which material will be removed or deposited: n / -_ feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): As proposed~ th~~Drn4~mF. ~hm,~l~ ....... h=,7~ ...... ~ --~*-~-~'"~ impacts on the wetlands or waters of the Town of Southold B~d of Trustees Application COASTAL EROSION APPLICATION DATA Purposes ofproposedactivity: pr~p~e,~ ~ ev~_te~_ ~_eck Are wetlands present within 100 feet of the proposed activity? No × Yes Does the project involve excavation or filling? x No Yes If Yes, how much material will be excavated? .(cubic yards) How much material will be filled? 0 (cubic yards) Manner in which material will be removed or deposited: n / a Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) There are no negative environmental impacts anticipated 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION lTD De complezea Dy A =p,canz or r-rojecz opu.~urI 1. APPLICANT/SPONSOR i 2. PROJECT NAME Eric Klodnicki Proposed deck and stairs 3. PROJECT LOCATION: Municipality Mattituck County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 2350 Deep Hole Drive Location map and survey enclosed 5. PROPOSED ACTION IS: [] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to const~'uct a 12' x 18' deck and 3.3' x 13' stairs 7. AMOUNT OF LAND AFFECTED: Initialty 0.0] ac~es Ultimately 0.01 acres 8. ~NILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] NO If NO, describe bdefly 9. WHAT IS PRESENT LAND USE iN VICINITY OF PROJECT? [] Residential [] Industrial [] Commercial [] Agdculture [] Park/Forest/Open Space [] Other Describe: Single family dwellings 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes [] No If Yes, list agency(s) name and permit/approvals: Southold Town Trustees, Southold Town Building Department & N.¥.S.D.E.C. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No If Yes, list agency(s) name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION.) ~/ILL .F;~ING PERMIT/APPROVAL REQUIRE MODIFICATION? DYe, r No /// / / I CERTIFY THAT TlaI~ IN ~RMAT~ON PROVII~J~ ABO~E IS TRLI~,~'O THE BEST OF MY KNOVv1.EDGE / Applicant/sponsor name: Glenn E~/~usta age.~ ~ ~/~ Date: Signature: ,/ .,~.~) L ' //,~// ~ in the Coastal Area i state agency Coastal Assessment Form before Proceeding with this assessment OVER Reset PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coonY~nafa the re,~ew presess and use the FUU. EAF. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative dedamffe~ may be superseded by anntber involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (.Nlswere may be handwKffon, If tuglble) Cl. Exis~ air qnaRy, su~ace or grmmdwaier quality or quand{y, riotse le~ds, existing traffic paffem, ~ waste prnduchon or disposal, potential for or. ion, drainage or flooding problorna? Explain I~. C2. Aesthe~c, egdcultuml, archaeological, historic, or nthor natural or coltund reeo~es; or community or naighborhond charec~or? F_~olain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or thmatoned or endangered sgec~es? Explain briefly:. 04. A community's exlsiing plans ~r ~cels as officially adopled, ~r a cha~ge in use or Inlens#y of use of ~ or ~ on~ ~? ~in ~: C~. Grey, h. sul~qonnt de~sio~mont, o~ related ac~t~a Iike~/te t~ i~tuc~l by tho ~ a~on? ~. Long t~m, shod lerm, retaliative, or nthor ~11~:~ not Idenflf~d in C1-~? E~ain b~: C7. Otherlmpacfa, linctuding chan~es In ese of e~er c~uantit~ or t-/~e ofane~ Ex~alnbdefl)c D. ~U. THI-- PROJfiCl H^VE ~ IMPACT ON THF FN¥1RO~8/F:i~AL CH~R~TERI$11~ THai CUSED ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: E. IS THERE, OR IS THERE UKELY TO BE; CONTROVERSy RELATED TO'pOTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If )~es explain: PART III - D~- i .-RMINA1X)N OF SIGNIFICANCE (To be completed by Agency) iNSTRUCTIONS; F~reachadvareee~ectiden~edab~va~determinev/netheritis$ubst~nha~a~e~im~~s~n~nL Each effe~ shouk:l be assessed in connection wilh hats (a) seffing (i.e. urban or rural); {b) probability of occurring; (C) dumhan; (d) in'evemibillty; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting matelfals. Ensure that explanations contain ~mffictsnt detail to show that all relevant advame impacts have been identified and adequately addressed. If questkm d of part Ilwas chech, ed yes, the,determination of significance must evaiuato the po~nflai impac~ of the proposed action mi the envlro~rnentsl characts~has of the CEA. Check this box If you have klantifled one or mom pofantially ts~ge or sigelflsant adverse Impanfa which MAY occur. ~ proceed directly to the FUM FAF and/or prepare a ponlfise.dedaration. ~ thts box ff you have dntmmined, based on the information and analysis above and any supp~fl~g docomentailon, that the p~k~naed actlo~ WILL NOT result in any significant adverse environmental impacts AND provide, on attechmonts as necessary, the reasons suppontng thl~ determination. Board of Trustees Name of Lead Agency Jill M. Doherty · Pt nt.or Type Name of Responsible Officer in Lead Agency ~.J~ Slgon[ure of Responsible Offip~r in Lead Agency President Signature of Preparer (if different from responsible officer) Title of Responsible Officer ) Town of Southold Erosion, Sedimentation & Storm.Water Run-off ASSESSMENT FORM P~Opsm,'Y Localiofl: S~?,IL t~ THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 1000-123-04-00? 6TORM-WATEPq elf, AD]N~ DJ~AEJA~E AND Ei~6~ON CONTROL PLAN SCO~O~,VO~ - P~O~OSED CO~S'I~UCTI*~ON /'I*'E~# / a~or ~nd D~ ~ ~p~ ~ ~ ~ous su~.) ~*P' Applicant proposes to construct a 12' x ~8' 3 D~P~r~~ elevated deck and 3.3' x 13' ~mmu~mmi~i~~ stairs 4 CO~ O~ ...,~.~.~.~ .................. ~ x, ...~k~n~_..~.,._.a.~.t. ............................... m~ md ~ ~s ~on; ~ ~ s~ c~ed ~ ~e ~ ~ ~ ~ff~ed ~ ~e ~ner ~t fo~ in ~e ~p~on ~ h~ ~ // f // s~o~o~; /]// ~ ~ // ~% ~ / ............................................. ~ a.~ or.......~ ............... ............................. ............. ........ FORM-O~IO GINA A. LOCKE No. 01 LO6057960 Notary Publi~, State of New yo~ Qua ified in Suffolk County ~v Commission Expires 04130120~-L- Town of Southold Erosion, Sedimentation & Storm.Water Run-off ASSESSMENT FORM .1,~n ,n 0~,,~ '~ -~,~ - 0 ~7 ~TOmLWA?ER, eRAom., ORAm~GE ~.O EROmOfl CONTROL PLAN $COPE OF WORK - PROPOSED CONSTRUCTION 1TEM# /WORKASSESSMENT [ Yes No 1 (IndudeTotslAreeofMP~rcelslocatedwi~in 39 ~,453 ~f Gene~ted by a Two (2') Inch Rainfall ~ concretion aclivib? ir.per, us surfaces.) ~.F. ~ .~,~) 2 Doe~ the Site Plan and/or Sur~y S;~v AJ ~ ~..... / Item ~111ncJude all Proposed (~ade ~,langes Applicant proposes to construct a 1 2' x 1 8 ' deck 30~meS~ePm.~dmrSunmyG~cdbemee~k~ 5 W'dl this Appricaf~n Requlm Land Disturbing Ac~vlUes D / ~ite? Is thb Project within ~qe Trus~ee~ ju~dic~ion 'or 8hxm WM~' I)lKh&-'g~. hm Ceflebuclkxt activity - Peml~ NO. GP.0.10-gOI.) Surface~ be $1opod to Direct ~(~m-V~ale~ COTUNTY OF .....-~...~...~.~.i~E... .......... SS ~ ............ ;'i'"'"*; ............ ~;*~ ~,'~; .............................................................. Ow~c~ aed/or rcp~cscntafiv~ of the O'umer o~ Ow~s, and is du¥ au~hor;.zcd to perform ~ h~LVC perf4:~med ~ sa~d work. a. ed LO make and £dc this application; that all statements conlaincd in th/s appllcalion arc wac to thc best of his knowledge mid beliel~ ;md that thc work will be performed in the manner set forth in the application filed herewith. Sworn to before mc this; ............................................... dayof ............................................ ,20 ..... Notary Public: .......................................................................................... FORM - 06/t0 , . J.M,O,. ~nwronmenml Consult, ng Services To ~ ii m~y concern: Please be advised that am have authorized the firm of J.M.O. Environmental Consulting Sen4nss m ~ ~ our ~en~ on our behaff in applying for ~dain approvals Ihmugh your agan~-y and ot~ers involved w#h this projecL J.M.O. Consulting Services has been retained to coordinate MI npprovab ne(mssary through your and other involved agencies, as well as our architect, engineer and ¢~,-,~ ,~m. We request that all ~ommunicalions, com~pondance~, ~, approvals and calls be addreaaed directly ~ the offices of J.M.O. Environmental Consu~ng ~wioes. Phone (631) 653-0607 · Fax (631) 653-3348 121 Jessup Ave o 2nd Floor. P.O. Box 447 Quogue, New York 11959-0447 MAY-2?-2010 13:03 FROM:JMO 6533348 P.4 Board of Trus=ees Apl~lica~ion AUTHORIZ&TION (whcr~ the applicant is not the owner) (prim ow~ of propmb') (mailing address) ~lW~c0/~te4at ~n~t~liln~ to apply forpermit(s) from the Southold ~~ 7y Ix:half. (O~ces MAY-2?-2010 13:03 FROM:JMO 6533348 !123030~03 P.5 Board of True~ees Applic&=~on County State of New York En'c ki/odnicki .BEING DULY SWORN OSPOS~S AND,~mMS T~T ~S~S TIm,~,~,UCXSrr ~OR ~,~OV~ DESEXED PE~(S) ~ T~T ~L STA~S CO~D ~ ~ ~ TO T~ BEST OF ~S~R ~O~EDGE ~ BEL~F, ~ T~T ~L WO~ ~L BE DO~ ~ THE ~R SET FORTH ~ ~S ~P~TION ~ AS ~Y BE APPRO~D BY T~ SO~OLD TO~ BO~ OF ~Ug~Eg. ~ ~PLIC~ AG~ES T0 HOLD T~ T0~ OF SO.HOLD ~ T~ T0~ ~USTEES ~ESS ~ ~ ~OM ~ ~ ~L D~GES ~ ~S ~S~G ~ER OR BY ~T~ OF S~ PE~(S), ~ G~ED. ~ CO~LE~G T~S ~PLICATION, I H~BY A~HO~ZE ~ TRUSTEES, THE~ AGE~(S) OR ~SE~AT~S(S), TO E~R O~O MY PROPERTY TO ~SPECT THE P~SES ~ CON~CTION ~TH ~W OF S ~PLICATION. ' ' SWOR.N' TO BEFORE ME TI-~S. 2 '7 ~" DAY OF ~ ~ .20 ,P_ MAY-~?-~010 13:03 FROM:JMO 65~]~48 P.6 APPLICAN'F/AGENT/REPRESEN"fATIVE TRANSACTIONAL DISCLOSURE FORM Thc Town of Southold's CcdeJffEthics nrohibi~s conflicts ofinter~ on the nert of te~n office~ am/emoinv~. Tt~e ouranse of this form Is to orovide infononfion which can aler~ the town of oosslble conflicts of interest and allow it to take whatever action is K/odnicki/ Eric [Last name, fir~t r, ame, middle iaitla~ unless you ar~ al:ohdni in the name of somcone else or other anti,y, sudn as a company. If so, indicate thc other person'a or company's narac.) NAME OF APPLICATION: {Check all that apply.) VarianceTax g~ievan¢c Trusm:~uiMiag Chansc of Zonc Coastal B~aion Appreval of pta! Mooting Exemption from plat or official map Other (If'!Oth~r', aor~ ~he aciivity.) Do you personally (or tlvou~h y~ur company, spouse, 8ibliab p~c~t, or child) havo a relationship with any officer er employee of the Town of Southold? "Relationship" includes by blco~, maniag¢, or business in~r~sC "Bosiaess in~t' mea~s a busims.~ including a parmership, in which the,,own officer or employee has even a parila! ownership of {or employment by) a c~poration in which the town officer o! 6"rap loye~ owns mom tlum If you answered"YES", compinte thc balonce of this form and date and sign where indicatod. Name of per, on e~ployed by the Town of Soathold Title or 0osifion of that person Descn'be the relationship betweea yourself(the applican/ffage~/represant ative) and the tow~ officer or employee. Either chacl: the appropriate linc A) through D) and/or describe ia ~e space provided. The t~n officer or e~ployee o~ hi~ or ~ter spouse, sibling, pa~e~t, or ~hild is (check afl that apply): __A) Ol~ OVv~r of ~realer than 5% of the 5h~rcs of the cosponEe s~k of ~ a~li~t (when ~e ~ti~t ~ s c~m~): ~B) ~c lc~ or b~fi~ o~ of ~y ~t m a non.line ~fi~ (wh~ ~ ~}i~t is not a c~m~); ~ ~ offi~, ~ec~r, p~, or ~loyce of ~c appli~C or ~.D) ~ ~ ~li~nt. DESCRIPTION OF RELATIONSHIP For~ TS I P~tNamc ~ /- EV(c Klndr~icki' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethias orohibits conflicts of interest on the vart of town officers and emnloveas. The vurvose of ~ form is IlO provide information which can alert the town o ftmssible conflicts of interast end allow it to take whatever action is necessurv to avoid same. YOUR NAME: "~O ~4~ ~[,~ ox.- 'k (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, tach as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Chengn of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activity.) Do you personally (or through your compeny, spouse, sibling, pi~ent, or child) have a relafiomhip 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 employraent by) a cospotafion in which the town officer or employee owns more than 5% of the shmres. YES NO ~ If you answered "YES", complete the balence of this form end date and sign where indicated. Name of person employed by the Town of Southold Title or position of that pev~on Describe the relmionship between yourself(the applicenffagent/representafive) end the town officer or employee. Either check the appropriate line A) through D) end/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 corporation); ___C) an officer, director, palmer, or employee of the applicmat; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Signature Print Name 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 (631 ) 765-I 892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ERIC KLODNICK1 COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~(~r~j3~. t~, ~'~ , residing at/dba being duly_s~om, ~depose and say: That on the day of ,2010, I personally posted the property known as,. .- by placi~g the Board of Trustees official poster wl~ere it~can e-asily b~'seen, ]nd that ! have checked to be sure the poster has remained in place ibr eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed. September,~22,fi~l) on or about 6:00 PM. Dated: ~/l,~ /' (signatde)~' ~~~' c~.~.~w ~ ar ~ to;'~ I¢e2~his //~6t~r-y'Public ' JANET M. TOOKER Notnp/Public.State of New Yor~ No. OiTO~n51905 Qualified in Suffolk Coun~ ~mmission ~pires November [3, r'~ Postage ~0.44 ~ Certified Fee Return Receip Fee (Endorsement Required) Restricted De~ive~ Fee (Endomement Required) Total Postage & F~s ~$ /s~r..~, A~i:~7-' ~'~-"~ ........... ~'7--~ ...... ~ .......... ~;~'~'-~;-'--T ............................................................. Addrest c~ , Rox 863 I~'r~;~;'~°''' 33 w~ ch.ur.c_.h._.._s.__~e-t .............. -'t Dorothy D. Peters 33 W. Church Street Cortland, N.Y. 13045 STATE OF NEWYORK COUNTY OFSUFFOLK Glenn E. Just , residing at 1 ;~1 Jessup ~,vonuo Quogue, N. Y. , being duly sworn, deposes and says that on the 1 3 th day ofs eDtember ,201 0, deponent mailed a mae copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current oa~ ;;;~a~n;;°ll, ~° f,. thh~e ~T~°Tn~7 fvS °uth,°tlhC'~t~aal~dot¢~ ~r;il~ilt;;atchthoe >;i~e~eSrsotatne: bPy°st (certified) (registered)-fiail.- .... ~. Sworn t~efore me this ~ ~2~ Day of,CB ~'J~',, ,20/4p // -' -~ot~'~ubflc .... ~" JANET M. TOOKER Notau Public.State of New York No. 01TOSnSlg05 Qualified in Suffolk County _ Commission Expires November 13, 20J~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfiront Revitalization Progranz 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 conta'med 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 ce~ified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCT1VI~ 123 - 04 007 The Application has been submitted to (check appropriate response): Town Board [] Planning Dept. ~-~ Building Dept. [] Board of Trustees 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: Applicant proposes to construct a 12'x18' elevated deck and 3.3'x13' stairs Locationofaction: 2350 Deep Hole Drive, Mattituck Site acreage:. 0.906 Present land use: Single family dwelling Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following infommtiun shall be provided: (a) Nameofapplicant: Eric Klodnicki (b) Mailing address: 2350 Deep Hole Drive Mattituck, NY 11952 (c) Telephone number: Area Code ( ) 917 -856 - 3873 (d) Application number, if any:. unknown Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ No~-] Ifyes, which state or federal agency?_ N.Y.S.D.E.C. 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 The proposalwill not negatively impact the character of the Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section IH - Policies Pages 3 through 6 for evaluation criteria [] Yes ~-~ No ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual q,,allty and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No [] Not Applicable The Proposed deck shnul~ nn~ ~mp~ the vi?2a! quality or thc scenic resources of the Town Attach additional sheets if necessary NATURAL COAST POLICIES PoUcy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes [-~ No [] Not Applicable The proposed Project does not involve Atlach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. Sec LWRP Section III - Policies Pages 16 through 21 for evaluation criteria [] Yes ['~ No ~ Not Applicable of potable water Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal l~sh and WiJdlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. [] Yes ~-~ No [] Not Applicable wetlands or any $iqnJficanf cna~f~l F~sh ~n~ Wi!~_!ife Habitats Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes ~-~ No [] Not Applicable The proposal shall have no impacts upon air quality Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~-~ Yes ~ No ~-~ Not Applicable 9'h~ prmpm~d prnjoct do~q no'l- involvo any solid or hazardous substances or waste 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 Southoid. See LWRP Section HI - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No ~-~ Not Applicable mh~ prnjocff will have ho impnnts upon public access tO, and recreational use oft coastal watersr public lands, or public resources of the Town Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section IH - Policies; Pages 47 through 56 for evaluation criteria. ~ Yes ~ No ~-~ Not Applicable The proposed project shall have no impact uponwater-dependent uses 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 Ili - Policies; Pages 57 through 62 for evaluation criteria. [] Yes [-~ No [-~ Not Applicable The project should have no neqative impacts upon livin~ marine resorces 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 Th~ proj~P d~p~ n~ ~nxTnlx,~ ~h~ ,,=~ ©f agricultural !and_~ 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 [] [] Applicable The project does not involve the use or development of enerq¥ or mineral resources Created on 5/25/05 11:20 ~.M NEw 4VENu~ N/F DICKERSON DEEp HOLE I I Dt?.IVE OOD EL 10 PAVEM£NT SURVEY OF PROPERTY $ITUA T£ MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-12,3-04-007 SCALE 1"=40' JANUARY 17, 2008 FEBRUARY 18, 2009 LOCATED WETLANDS APRrL 20, 2010 ADDED PROPOSED DECK & UPDATE SURVEY AREA = .59,455 sq. ff. 0.906 ac. CERTIFIED TO: ERIC KLODNICKI A??ROVED BY ~vo:~ YATIONS SHOWN Southhold lawn Board of Trustees HEREON ARE IN 1929 NGVD. PREPARED IN ACCORDANC~~UM STANDARDS FOR TITLE ED BY THE L.I.ALS. AN TITLE ASSOCIATIO UNAUTHOBJZED ALTERATION OR ADDITION TO ~-IIS SURVEY IS A VIOLAT)ON OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARIND THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTrTUTION LISTEDHEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION CERTIFICATIONS ARE NOT TRANSFERABLE THE EXISTENCE OF RIGHTS Of WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. N.Y.S. Lic. No. 50467 Nathan Taft Corwin Ill Land Surveyor Title Surveys -- Subdivisions PHONE (631)727-2090 OFFICES LOCATED AT 1586 Main Road Jamesport, New York 11947 Site Plans -- Construction Layout Fox (651)727-1727 MA~ING ADDRESS P.O. Box 16 Jamespo~, New York 119¢7