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HomeMy WebLinkAboutTR-7550A Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375MainRoad P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD TO: lr)nc _a, P, cu c u / Please be advised that your application dated L//el ~//I has been reviewed by this Board at the regular me.eting of ,~'/l~Jll and your application has been approved pending the coh~pl~tion 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) ¼ Constructed ($50.00) v/ Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: TOTALFEESDUE:$ ~"-(.~,('~_ BY: Jill M. Doherty, President Board of Trustees Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 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 st 1 day of construction % constructed V/ Project complete, compliance inspection Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 766-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7550A Date of Receipt of Application: April 28, 2011 Applicant: Jonathan P. Wendell SCTM#: 65-1-20 Project Location: 355 Terry Lane, Southold Date of Resolution/Issuance: May 18, 2011 Date of Expiration: May 18, 2013 Reviewed by: Board of Trustees Project Description: To add a new 680 sf. slate upper patio to the existing structure; new 17'X 2' slate retaining wall; replace existing ramp with stairs in same location; and replace all existing brick retaining walls and lower patio with slate in same height and dimension. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Nemschick Silverman Architects last revised May 19, 2011 and stamped approved on May 23, 2011. Conditions: The installation of gutters, leaders and drywells to contain roof run- off and a 5' non-turf buffer landward of the bulkhead. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the $outhold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Boe~l of Trustees ~/ Jill M. Dohe~"Ly, President Bob Ghosio, Jr, Vice-President James F. King Dave Bergen John Bredemcyer P.O Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: Raymond W. Nemschick, RA on behalf of JONATHAN P. WENDELL requests an Administrative Permit to add a 680 sf. slate patio to the existing structure, new retaining wall, and to replace all existing brick walls with slate. Located: 355 Terry Lane, Southold. SCTM#65-1-20 T~s~Of area to be impacted: ItwaterWetland Freshwater Wetland Sound __Bay Distan9e of proposed work to edge of wetland Part,,ef Town Code proposed work falls under: '~hapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion ~Amendment ~Administrative__Emergency Pre-Submission Violation Info needed: Modification.~: '.... % ~7 Conditions: ~',~ ~~ ~ /~ /~~; ~. Ghosio D. Dzenkowski Pres~ent Were: ~J. Doherty __ ,-/J. Bredemeyer ~J'~King '/'D. Bergen, other Form filled out in the field by ~,¢,~) Mailed/Faxed to: Date: April 28, 2011 Town of Southold Board of Town Trustees 53095 Route 25, Town Hall Building P.O. Box 1179 Southold, NY 11971-0959 Re: Wendell Residence- Site Photos NSA Project # 10-1562 355 Terry Lane, Southold, NY 11971 1000 - 65 - 01 - 20 Nemschick Silverman Architects P.C. % . . the business of ARCHITECTURE," Photo #1 - taken 2/01/10 Photo #2 - taken 2/01/10 160 MAIN STREET · SUITE 200 · SAYVILLE, NEW YORK 117S2 631,563,2130 telephone 631.563.2139 facsimile http:/lwww.ns-arch.com Photo//3 - taken 2/01/10 Photo//4 - taken 2/01/10 160 MAIN STREET · SUITE 200 ,, SAYVILLE, NEW YORK 11782 Photo #5 - taken 2/01/10 160 MAIN STREET · SUITE 200 o SAYVILLE, NEW YORK 11782 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: May 18, 2011 Re: Proposed Wetland Permit for JONATHAN P. WENDELL SCTM#1000-65-1-20 Raymond W. Nemschick, RA on behalf of JONATHAN P. WENDELL requests an Administrative Permit to add a new 680 sf. slate upper patio to the existing structure; new 17'X 2' slate retaining wall; replace existing ramp with stairs in same location; and replace all existing brick retaining walls and lower patio with slate in same height and dimension. Located: 355 Terry Lane, Southold. SCTM#65-1-20 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 LWRP Policy Standards and therefore is CONSISTENT with the LWRP. 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: Jennifer Andaloro, Assistant Town Attorney James F. K/ng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTItOLD Office Use Only Coastal Erosion Permit Application Wetland Pem'./t Application x~ Administrative Permit __AmendmenffTr aris fer/E~tension ZX Received Application: ~x_Received Fee:$ ~'-'O~- ~Completed AppliCation ~ !o~ e~ ] II ~' ~ ~l ] / ]l Incomplete __SEQRA Classification: Type I Type I1 Ulflisted Coordination:(date sent) --Sq'fWRP Consistency Assessment Form b"] eS}4 II CAC Referral Sent: ~'Date of lnspecnon:~ ] i I ] h __Receipt of CAC Report: '" __Lead Agency Determination: Teclmical Review: ~ublic tlearing Held: ~"~ t"~l I~ Resolution: Name of Applicant Jonathan P. Wendell Address 9 Greenwich Office Park, Greenwich, CT 06831 Phone Ntm~ber:( ) Suffolk County Tax Map Number: 1000 - 65-01-20 Property Location: 355 Terry lane, $outhold, NY '11971 (provide LILCO Pole #, distance to cross streets, and location) AGENT: Raymond W. Nemschick, RA (If applicable) Address: 430 Green Way, Cutcho§ue, NY 11935 Phone: (63'1) 563-2130 k~y-ll-2011 02:~6pm From.-FIEklSCHICK $1LYERI,~N ARCHITECTS 6315632139 · T-068 P.003/014 F-324 Land Area (in square feet): Are~ ~ming: R-40 DATA P~vious use ofpropcny: Residence Intended use of property: Residence Cove~aants and Resuictions: Yes pe No If"Yes", please providc copy. Does this project requi~e a variance from thc Zoning Board of Appeals If "Yea", please provide copy of decision. Phor permits/approvals for site improvements: Agency Date V' No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?. v' No Yes If yes, provide explanatioll: Project Description (use attachments if necessa~): It is the intention to add a new 680 sf slate upper patio to the existing structure, as well as a new 17'-0" long x 2'-0" high slate retainino wall. Additionallv. it is the intention to repla .cp the exlstina ramp with stairs In the same location and to replace all existing brick reteinir~ walls & lower oaflo with slate in same heiflh.t & dimension for all. Refer to site plan for additional information. Ma)~-11-2011 02:38pm From-NI=MSCHICK LYER~fl ARCHITECTS 631563Z130 Board oE Tru~ee~ A~lic~£on T-068 P.004/014 F-324 WETLAND/TRUSTEE LANDS APPLICATION DATA Ptupose oftheproposeti operations: It is the intention to add a new 680 sf slate upper paUo to the existing structure, as well as a new 17-0" long x Z-O" hiah slaW. re .talnina wall. Additionally, itis the intention to replace the existing romp with stairs in the same location and to replace all existtna brick retainin~ walls & lower patio with slate in same heiqht & dimension for all. Refer to site plan for additional information. Area ofwetl~ds on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existins sUucmr~ and up]and edge of wetlands: 14.7 feet Closest distance between ncar~st proposed structure and upland edge of wetlands: 14..7 fec~ Does the project involve excavation or v' No Y~s If ye% how much material will be excavated? cubic yards How much material will be/'filed? cubic yards Depth of which material will bo removed or deposited: Proposed slopc throu/hout Thc area of operation: s[ope to remain Manner in which material will be removed or deposited: feet State/neat of the effect, if any, on the wetlands and tidal waters of The town that may resVlt by reason of such proposed operations (use attachmants if appropriate): No advemp, impact is anticipated. May-og-zoI1 02:0gpm From-flEM$CHI "LVERMAN ARCHITECTS 6315632139 T-067 P.OOZ/OOZ F-319 Land Area (in square feet): Area Zoning: R40 31,642 GENERAl. DATA Previous use of property: Residence Intended use of property:. Residence Covenants and Resections: Yes I~ No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals If'Wes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date Yes ~* No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suzn~nded by a governmental agency? ~ No, Yes If yes, provide explanation: Project Description (use attachments if necessary): It is the intention to add a 680 sf slate patio to the existina structure, as well as a new retaining wall, & to replace all existing brick mtaini.n__~ walls with slate. Refer to_site plan for additional information. of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose oft.he proposed operations: It is the intention to add a 680 sf slate patio to the existin9 structure, as well as a new retaining wall, & to replace all existing brick retaining walls with slate. See site plan for info. Area of wetlands on lot: 0 _square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 14.7 feet Closest distance between nearest proposed structure and upland edge of wetlands: 14.7 feet Does the project involve excavation or filling? ~' No Yes if yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: slope to remain Manner in which material will be removed or deposited: 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 approphate): No adverse impact is anticipated. Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: It is the intention to add a t380 sf slate patio to the existing structure, as well as a new retaining wall, & to replace all existing brick retaining walls with slate. See site plan for info. Are wetlands present within 100 feet of the proposed activity? No ~ Yes Does the project involve excavation or filling? ~' No Yes If Yes, how much material will be excavated? .(cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) No adverse impact is anticipated. k~¥'-11-2611 62:66pm Fram-NEMSCH~ILVERMAN ARCHITECTS 6316632130 T-068 P.006/014 ;-324 Rm/mond W. Nernschi~, RA 617.20 APPENDIX C STAI~ ENVIRONMENTAL QUALITY I~e~lL~A' SHORT ENVIRONMENTAL ASSESSMENT FORM ~m' UNUSa~D ACTIONS ~ Wendell Residence ~ Suffolk 36~Te~y Lane, Se~ NY 11971 6. DESCRIBE PIQUED1' BRIEFLY: It is the intention to add a new 680 sf slate upper patio to the existing slructum, as well as a new 17'-0' long x Z-0" high slate retaining wall. Aciditionally, Jt Js the inte~Rlon to replace the existing romp with stairs in the same location and to replace all exJ~ng brick retaining walls & lower patio with slate in same height & dimension for all. Refer to ~.e plan for additional information. 7. AMOUNT OF LAND AFFECTED: 8. ~MLL PROPOSED ACTION COMPLy 1A~ EX~TING ZONING OR 01TtER REb'TRtCTIONS? I~'iYe~ [] NO h' no. aesP. ~ a. WHAT I~ ~ LAI~0 USE IN VlClNFI~ OF PROJECT9 (crmcv~e.em~ny,m~il:~,ly.) 10. DOE8 ACT~)H INVOLVE A PEP, Mff APPROVAL, OR FUNDING, NOW OR ULT1MATRLy FROM ANY OTHI~R AGENgY (FedS. ~m~ ~ 11. DOE~ ~ A~CT OF THE ACTION HAVE A CURRENTLY VALID PE~IT OR APPROVAL? i'-'lY, i~No If~tagenay nameand~rrnlt/,ppmv~: j lr~f~$ ~ [~ULT ~t~ PR~ACTToN WILL EXISTING PERMIT/APPROVAL REQUIRE MOOIFICAT~ON? t C.eRq'IFY YHAT THE IHPOf~IATION PROVIDED ABOVE 18 TRUE TO THE I~:~T OF MY Applamt I $lxesor Name X~_ oa~e: ~1/ ff~e ~n ~ a mi ~, ~a you are a ~e agency, ~ ~e Coas~l ~ment Fo~ ~re pr~lng w~ ~ls ~m~t kk,y-11~2011 02:35m Fr~ILVE~ ^ECHITTCT$ 6316632139 T-O~8 P.008/014 F-324 LWm' CO;~S~S~_,CY ~,ss~v~r ~ All sppiic~s for permit* indudint Town of $outhold agmcics, ~n complete tiffs CCAF proposed scl/om tha~ are subject to the Town ofSomhokl Ws~rfx~ ~ Rev/ew Law. Tiffs as.~,,,,,~ is immded to supplemm~t od~ imSarmat/on used by a Town of Sougmld ~cncy A copy of ~h¢ LWRP is available in ~he fo]loving places: onlin~ ~ ~e Town of Sou~hold ' s website (sou~oldtown.northfork.n~), ~he Board of'Pruste~ Offi~, ~h~ ph.~;.~ Departm~t, all local ~ibraries and ~he Town Clerk's office. B. D~ON OF Si~E AND PROPOSED ACTION S~-]-o~ 65 O~ ~ ~20 PROJ~ NAME Wendell Residence (c) 1%~, ~,,,~1, ~ cerdfication: [] Nature and ma~t of a~tic~: It is the intention to add a.new 680 sf slam upper patio to the exist, rig structure, as well as a new 17'-0' long x 2'-0" h/gh slam retaining wall. Addltionaliy, it is the intention to replace If re existin; mmv with stairs in the same location and to replace all ~.n.t~ brick mteinlng walls & lower patio with slate in same height & dimension for a~l. ReTer to site plan for a~ditlonal Information. Ihy'-l?-~011 OZ:IOpe Frm-ffEI6~ILV~RI~ AI~HI~E~$ 6316632130 T"~ P.006/014 ~"324 (¢) Tdei~nonemml~.ATeaCodc( ) ¢6B1):S63-2130 (il) At~iic~on m, ifad. Yes [] No~-] Ify~, whichm~eorf~i~a]aSenc~? .... the form I~ r~'ur~d ~ ~. DEV O ED 'OLXer Policy 1, Foster a paffern of development in th~ Town ofSouthoM flutt adumees community dmructer, prefen, es op~ qmee, nmke~ efT.~m ue oflzdmstmcture, nLd~ bene~id~ a eommd ioemlm~ ami ~ adverse effecu o£ devdopmenc See LWRP SoffSon Iit- l~ieh~2 fe~ evabu~ion [~Yu [] No [] Not Appi/c~ble Pdiey 2. Lh-oteet ~nd pFeserve Idiotic pud ~rchaeolo~ rgsourcm of the Town of Seathold. See LWRP Se~on ]3I - lhdJefes Ps, es :3 tim)ugh 6 for evaluation critcrh 6316632139 T'"tl6 P.O11VO14 NATURAL COAST I~OLICI~-~ Policy 4. ~b'b~'e JOSS Of life, slructuru, ~ud natural resom-e~ from fJoodkq~ mai erosion. Seefion rn - Policies l~ges 8 through 16 for evtdmdton crtrerh [] Yes [] No ~-~ ~qot Applicable -Polla~ L"~g~ 16 tbreegh 21 for efldualiou criterb ':~ :~' ..... [] Yes [] ~o [~NotAppllclble PoUcy 6. Protect and resmre Ibe qn~a!~y md funcl/ott of eke To~vn of SoutheM eeos'FsMm8 ~ Sign~m Coasm/Fbh mad ~Yild]~ lhbttsu mtd w~r~,~s, Sec LWRI~ Sccthn Ill - Po~; ~ ~ Ma~ll-ZOll 02:40pm Frm'-NEM~H~[~ILVEI~ ARCHI'~CT$ ¥~ No Not Appkable 6316632139 T=068 P.011/614 F'-324 P~4ky ?. ~ a~ml improve a~ quality in ~he T~vn of ~ou~old. b LWRP S~on H~- P~4~s P~ ~2 ~h 34 ~w e~dua~om ~t+.e~a. A~h ndcllt~ s~s ~'nece~s~y l%lley 8. M~n~m~-e envi~nmental degrnda~on in Town of So~tlmM fv~m nM~d waa~e ~ hazswdous substanees smd wastes. ~ee LWRP Sec~on HI - l~olieie~; PUBLIC COAST POLICIES Policy 9. Provide for ImbUe access to, snd rtc~m~ional use o~, co~stal w~tm~, ~ ~ ami public ~esom~es of~e Town of ~m~old. ~-e L~RP ~.edon III - Polieles; Ps,ns ~8 th~ 4~ ~or ewlnnfion [] Y~ No [] Not Applicable T~ P.012/014 F-S24 Po~cy 13. FYomote appro~te ~e and devdopmmt of energy and rebel-ad Fesom'ces. ~ee L~EI) [] Yes [] NO [] NOt Applicable P't~AR~ ~¥ I~nymond, W.,N~em~,iGk, P-,,A 1'z'ZL,I~ PrinciPal . DATE 4/28/11 PROJECT ID NUMBER PART I - PROJECT INFORMATION 1. APPLICANT / SPONSOR Raymond W. Nemschick, 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2 PROJECT NAME Wendell Residence county Suffolk SEQR 3.PROJECT LOCATION: Municipally Southold 4 PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 355 Terry Lane, Southold, NY 11971 5 IS PROPOSED ACTION: [] New [] Expansion [] Modification t alteration 6 DESCRIBE PROJECT BRIEFLY: It is the intention to add a 680 sf slate patio at grade to the existing structure, as well as a new 2'-0" high retaining wall, & to replace all existing brick retaining walls with slate in exact locations & height. Refer to site plan for additional information. ? AMOUNT OF LAND AFFECTED: I,~itially .023 apres Ultimately .023 acres 6 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) F'~Yes ~]NO If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~]Yes [~No If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~Yes ~i~No I CERTIFY THA THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Signature If action is a Costal Area, and you are a state agency ~ complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEEO ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL FAF. E]Yes [~]No WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, s gn §cant hah tats, or threatened or endangered species. Expla n briefly I C4. A communtiy's existing plans or go~l~'as officially adopted, or a change in use or intens ty of use of and or o her na ura resources? Explore bne~: I C5. Growth, subsequent development, or related activities likely to he induced by the Proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain brietiy: I C7. Other impacts (including changes in use of either (~uantity or t~,~e of ener~)'? Explain briefly': D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? IIf )'es, explain bdefl~': E~] Yes r~N°I E. IS THERE, OR IS THERE LIKELY TO SE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise sig niflcant. Each effect should be assessed in connection with its (a) setting (i.e. ud:)an or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude, if necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the detem~ination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directh./to the FULl FAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any suppo~ng documentation, that the proposed actio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees Name of Lead Agency Jill M. Doherty Print or Type Name of Responsible Officer in Lead Agency ignature o Rc~ol%'ffble Office~n Lead Agency Date President Title of Responsible Off~cer Signature of Preparer (if different from responsible officer) PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART617.47 If yes, coordinate the review process and use the FULL EAF. E~Ye$ ~No WILl_ ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If NO, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, ir legible) C1 Existing air qualiiy, sudace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly; C2 Aesffiefic, agricultural, archaeological historic, or other natural or cultural' resources: or community or neighborhood cha;acter? Explain briefly: C3 Vegetation or fauna, fish, shelffish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A communily's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5 Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or othe; effects not {dentil~ed in C1-C5?' E×plaih bri~l~: c7 0~? i'mpac~ {including chan~es in use of either quantit7 or t~e of energy? Ex~lain bdeflT: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAl7 !M.F~_AC~'S? If ~es ~_~_!a_in: r-~ Yes PART III. DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~det~rminewhetheritissubstan~a~~~arge*im~~rtant~r~therwisesignificant~ Each effect should be assessed io connection with its (a) setting (i.e. urban or rural}; (b) probability of occurring; (c) duration; (d) irreversibtiity; (e) geographic scope; and (0 magnitude, tf necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacls have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive decJaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed acgor WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thL' determination. Nemschick Silverman Architects P.C. Name of Lead Agency Raymond W. Nemschick, RA Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency 4/28/11 Date Principal ~ ./~ f~t¢/~~ Officer //gnaT'/ re,are, 'di"e,--t' ,,esponsib'eo ,o r, Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM  PROPERTY LOCATION: $.C.T.M.~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A '~'~ ~e?~ s~'~l~lk ',~2 STORM-WATER~ GRADING, DRAINAGE AND EROSION CONTROL PLAN D;~rict ~a~ (~"~, ,r,~u BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. a. Whatisthe To~alAreaoftheprojectParcels? (leslude Total Ama of ati Pamels focated within /(/~7~ 1 Wi!l this Pr°ject Retain NI Storm-Water Run-Off the Scope of Work for Pfopceed Construction) ~'"~ / ~ Generated by a Two (2') Inch Rainfall ou Site? · b. What Is the TotalArea of Land Cloarlng ~.F.l~n~) clearfng('rhis item witiinclude all run-offcreated by siteand/or constmcUon activities as woll as all ~ D and/or Ground Disturbance for the pmpesed ,~ ~4 ,~ Site Improvements and the permanent oreafian of constmctfon activtly? ~ ' (S.F. IAcm~) impervious sun'aces.) PRO'CID[ B]RI~..~ PROJ'~--'T D]F_.B~ON ~P*e.~N.aud) 2 Does the Site Plan and/or Suntey Show AJl Propesed \/r"'l Drainage Stmcturees Indicating Size & LocaUon? This ~-'~ ~.1~-~1']~_...~ p,~C) .~ ,,em shall thcludo all Propseed Gmde Changes and Slopes Controlling Surface Water Flow. ;~l~Jl~Jcg h/~(~ 1' )~© 3 DoestheSitePlanend/orSurveydesc~ibetheerosion and sediment control practices that will be used to control Site erosion and storm water discharges. This 4~J'~ ~"',J(,~'~ ~j~'~ ~"~'~ _~.~])~>1 item must be maintained thmughout the Entire '~ · Construction Period. ~ ~ ~ I ~ ~ ~ ~ I 4 WiJl this Project Require any Land Filling, Grading or ' i I ExcavationwherethereisachangetotheNatural [~ ~ Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 15.000 $.F.) Square Feet of Ground Surface.'? Site? Is Ibis F'roiect within tho lrustc~.~ judsdiction which Exceed Filt.e, en (15) feet of Verlical Rise to i I req~md, post-~onstructionsto~rnwatermauagernentpmcticesthatvalbeusedandl~r RemovalofVagetatiouandlortheC~ostmcflonofany [~ ~ STATE OF NEW YORK, /__ -~.~ ~ ~t / ~hat I, .~ .'..r.I....i~.~.~i.~hi~.~.l. ................... bein~ duly ~wom, deposes and say~ that he/she i~ the applicant [or Permit, Owner and/or representative of the Owner or Owner~, and is duly authorized to perform or have performed the said work and to make and [de thi* application; that all statements contained in this application are m~e to fll~ ~1~1~ and I~lief; and that the work will be performed in the manner set forth in the application filed here~. *~u~ __[u~}~'S~I~'~~ . ~ ~. ~k. dayof ~,, a'.~' Com m[s$io3)ff_xpims Ap r~li~t, l,~ 21 FORM - 06/10 TOWN OF SOUTHOL' 'CHAPTER' 236'- STORM WA ER MANAGEMENT STEORMWATER POLLUTION PREVENTION PLAN (SWPPP) General Town of 8oulhol~ SWPPP Reqn.k, ements: (For La~d Disturbance between 5,000 SF and 1 acre in area) 1. Thc SWPPP shall be.p~'ed. prior to tho. app~ation, for Buildiug Pemdt. 2. The SY~PPP ~ d~.~n'bc tho.erosion and sedim~t control practieesandv~hererequir~d,'" post-cor~imc~inn stom~ wat~ managoment-practice~ that will'ho uSed'and/or constructed to reduce ' lite pollutants ia aonn wat~ d/~c/mrgez ~ad.to assvr, o comoliancc with tho ~orms and conditions of ' Town.Cocl~ Chapter 236 for Storm Water Management prior to the issuanCe of a Town But~ing Permit. In addition, tho SWPPP shall identify potential sources of pollution which may reasonably expected, to affect thc quality of storm water discharges, 3. 321 SWPPPs. that require, a.post-construction storm Water managem0nt practice. eonip°neni shall be prq~arcd.by a qualified deMgn ~rofessional that is knowledgeable in tho principles and practices of storm watermanag~nent and.treatment. 4. Tho'o~vner, contractor or operator IInlgt keep the SV~PlP ClnT¢ilt sO thatitat ali times accurately documents thc erosion and sediment control practices that are being used or will be use~ during construction, and all post-coustmction storm water management practices that will bo constructed on tho site. At a Ininlmllm, the owner, contractor or operator shall ~lll0Ild the a. whenever the current provisions prove to be ineffective in ~miigng pollutants in sierra water discfiarges from tho site; fb~ whenever there is a chaog~in Clesign, construation,:Qropeltation a[ th~.e/0nsmicgon site that hasor coatd have an effect on tho discharge of pollutants; and c. to address i~sues or deficiencies identified during an inspection by.~ Bttilding inspector, or other regulateD, authority. ' 5. The Budding ~)epartmen~ may notify tho owner, contractor or OPerator at any time that.tho SWPPP 'does not -moet o~!o or moro of tho minlmum req~fi~.~mlent~ of the ~.,.;m..~ ..~_:; ............ ye m .wrmn§~aaa menmy mc pro.vlsmna o~th~ SW~PP that ~.mod~n. Withiu fom'tcen (i4) calendar da'lal 0fauch notification, or.aa othotwis~/ndicat~dby'.th6 Town, theowner, contractor or operato~' shall make th~ required.changes to the SWPPP and submit wtittm notiii~atio~ t~ file Town tchoZ~U~ht~ Z~o h_a.v_oi~fi~t.made~, ff tho,awn. ~.er, contractor or operator do" not r~pOnd to the'Town's ;~t ~,o~; ~; ume.!mme, mo lown may issue a stop v,~ork order aniVor zu~p~md-tho 6..Prior-to tho commencement of construction actt¥ity, tho owner, contraetor or op~'ator mtlat identify tho coati'ac}or(e) and subcontractor(s) fllat will b~ r~0o~st'bl~ for it~al~, constm~ag' ,~plac~ in~ tmd'maintaini.g file erosion and sediment contro{ praetices iaOlu~led in the SWPPPi aud gao.~oalraotor(s}and sub~0ntracter(s) that will be responsibl~ for constructing thc post- construction storm water management -praetices included in the SWPPP. The o~ner., contractor or operator shall.~v each ortho contractors and ~ubcontractors identity at leasi one person .fgom their company that wilt be responsible for implementation of tho SWPPP. h. The dimensions, ....'l~e?ficafi°nsLinstallation details, an~operation and ' ' .., rcqmmmen~s io~ aa erosion and sediment co-'---' ~_z ... '- . . , maintenance sizing of an,~ tem,,o,-~,-, -,~:---, t -' ,"~ ~prac, u. Ces. mcmiio tho location and a l~ 'mi' o~,~JdlllCll[ oa~lns arl([ sir[lc[lira] practices that will be used to divert flows fi-om exposed soils; i. A maintenance hx~pection schedule for'the contractor(s) to ~sure continuous and effective oP. era. tion of the erosion and sediment.control practices. Tho,~-;,-, . scaedule shall be m acc/mtm~ w~fr, m ............ · - .. ,~.~,- ~.='.tmremen[s m mo most Clh'm~ wasion of th, toclmical standard, New York State stiindard~ and Speci{qcations for,- '" - j. A dezcrtp~on ~f the. po..l~u~o,, preventie~'~- fl~at: Will"be ~ed consllllction.chemlcals and conslllle, finn a,-h,-;- =-- - . . ,u ~u.~.l u~er, · ---~- .... = ~tom oecommg a'potlatant soUrCe in the . . . .storm water discAarges;. B.-~..rm.~ae, Pollull..., i, ~ ": (For La~d Dlsfili~balt~ibetween $i MINIMUM'SITE .pLAN REQUlR~NTS~ _. 1. Applicant information: Provide name,' legal address, and te!ephone.number:, 2. Common address, Suffolk County Tax Ma~). No'. and legai description of site. :3. Signature and stamp °f registered De~i[ln Pl~ofessional (Architect / Engineer l Surveyor) and/or design/owner certification. ' 4. Vicinity map 5. ExiSting.and proposed mappi~gand plans [Maximum scale ~r 1' -: 50' or gr~a, ter detaiti which i lUstrate at a minimum: Existing and proposed topography (minimum Of 2.foot contours recommeeded); Perennial and intermittent streams anct/ot Natural Wat~r Course; (~ MapPing °f pred°minant soils and location .of test: hole or site_specifiobo[ehole Cl investigatlon~ that have.been performed; "·" ......... ~oundaries of existl .ag' predominant vegetation and pr°P°s d i ' · · O :LOOationandbounda~esOfreSO~m~.,,~,~,,_~ruP~..se !.mLts.of~ .~. '~§,. septic setbacks); ' ,. -=-, ~,,,~,~- ~ utotem, a~lqlrtg water well setbacks, O L°cati°n °f existing and proposed roads, buildings, and other structures; O Location of existing and proposed utilities (e.gl, watei', sewer, a easements; . . · , g. s, electric) and O Location of existing ,and proposed COriveyanCe Ayafems Such as grass ~nnels,, swales, storm dramsor other stormwater ~' .': - . 0 Fiow'paths; 0 Location of floodplain/floodway limits.aad m[atlOmhlp~tffSt~,to.Upstream a~d downstream properties and drainages; 0 Location and dimens, iOnsOl.preposed~anrlel modifications, such as bridge or culvert crossings where applicable; 0 Location, size, maintenance access, and limits of disturbance of proposed structural storm water Management practices; Board o~ '~'tmtees &pp].ia~t:fon AU'£~rOl~ ZATI(H~ (where the applicant is not the owner) Jonathan P. Wendell (print owner of .uro13ert~r) residing at c/o Nassau Point Investors 9 Greenwich Office Pa~k Greenwich, CT 06831 do hereby author fze Raymond W. Nemschick, RA (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. Board of Trustees Application County of Suffolk State of New York _Raymond W. Nemschick, RA BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AN]) THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THElR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIE~DF THIS APPLICATION. SWORN TO BEFORE Notary Public cONNIE D. BUNCH NotaW public, State of New Yofl~ *' ~,.. 01BU61850~0 ,,v. SUtfOtk County commiSSlo~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts &interest on the nan of town officers and emnlovecs. The nuranse of this form is to provide information which can alert the town of uossib]e conflicts of interest and allow it to take whatever action is ~?¢~ssary to avoid same. Your N^ME: Raymond W. Nemschick, RA (Last name, first name, ~iddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Trax grievance Building Variance Trastee Change of Zone Coastal Erosion Approval of plat Mooting Exemption from plat or official map Planning Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? '~Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or e~nployee 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 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 betwcen yourself (the applicant/agent/representative) and tbe town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or Child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicont (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, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 S u bmii~ed thi.~l~f~gf~ .~ 20~_~ Signature Print Na~¥~'~nd Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront RevitaliT~qtion Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold To;~m). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- suDoortin~ facts. If an action cannot be certified as consistent with thc LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the follo;ving 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 SCTM# 65 01 2O PROJECT NAME Wendell Residence The Application has been submitted to (check appropriate response): TownBoard [~ Planning Board [-"] Building Dept. [] BoardofTrustees [-~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken direcdy 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: It is the intention to add a 680 sf slate patio at grade to the existing structure, as well as a new 2'-0" high retaining wall, & to replace all existing brick retaining walls with slate in exact locations & height. Refer to site plan for additional information. Location of action: 355 Terry Lane, Southold, NY 11971 Site acreage: .7264 acres Present land use: Residential Present zoning classification: R-40 If an application ~br the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Raymond W. Nemschick, RA (b) Mailing address: 430 Gresen Way, Cutchogue, NY 11935 (c) Telephone number: Area Code ( ) (631) 563-2130 (d) Application number, if any:.__ Will the action be directly undertaken, require ftmding, or approval by a state or federal agency? Yes [] No [] If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ~]Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [~ Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Sonthold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [~ No [] Not Applicable Ailach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [] Yes ~-~ No ~ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria [] Yes ~-] No [] Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section 1II - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [-~ Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section 1II - Policies; Pages 34 through 38 for evaluation criteria. [--] Yes [] No [] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [] Yes~] No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [] Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~ Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section II1 - Policies; Pages 62 through 65 for evaluation criteria. [] Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [] No [] Not Applicable PREPARED BY Raymond W. Nemschick, RA TITLE Principal DATE 4/28/11