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HomeMy WebLinkAboutTR-7533 Michael J. Domino, President 0f S0!/lTown Hall Annex John M. Bredemeyer III,Vice-President �O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski • Q Telephone (631) 765-1892 Greg Williams ��UyFax(631) 765-6641 NT`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 23, 2018 Mr. and Mrs. Michael Perivolaris 500 Jackson Landing Mattituck, NY 11952 RE: 500 JACKSON LANDING, MATTITUCK SCTM# 1000-113-4-7 Dear Mr. and Mrs. Perivolaris: The following action was taken at the Southold Town Board of Trustees Special meeting held on Friday, March 23, 2018: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit #7533 from Kathy Tsoumas to Michael and Kathy Perivolaris, as issued on April 20, 2011; and Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Bo--- .o J. Domino, President Board of Trustees MJD/dd A FEB 1 2 2018 R Pez4volaris I { goo Jackson Landing 4 ---1 Mat6tacko NY 1195.2 February 9, 2018 Town of Southold Trustiess Department Attn: Diane DiSalvo P.O. Box 1179 Southold, NY 11971 Dear Diane: It was a pleasure speaking with you today and thank you for all your assistance. I would like to let you know that Michael & Kathy Perivolaris residing at 500 Jackson Landing, Mattituck, NY 11952 are the new owners of Permit#7533 and Permit#4718. Please transfer our name to these permits. I have attached a check for$100.00($50.00 Each Permit). Per our conversation on the request to extend our dock, If there is a list of procedures you can send as well as the application to extend our dock, I would appreciate that as well. If you have any further questions, please don't hesitate to contact me at 631-298-3839.Thank you again for all your assistance. Sincerely, Kathy& ichael Perivolaris Attachment—Ck.#: 2076 f Fol Michael J Domino, President O�Q raa Town Hall Annex John M. Bredemeyer Ill,Vice-President �� y� 54375 Route 25 Glenn Goldsmith y z P.O. Box 1179 A Nicholas Krupski ® 7 Southold,NY 11971 Greg Williams y p! Telephone(631)765-1892 ��l �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: .3 1 R/ 16 I00 Completed infield by: e,;- Go /d/Swn; 44 MICHAEL & KATHY PERIVOLARIS request a Transfer of Wetland Permit #7533 from Kathy Tsoumas to Michael and Kathy Perivolaris, as issued on April 20, 2011. Located: 500 Jackson Landing, Mattituck. SCTM# 1000-113-4-7 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3 Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank- 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment >"Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: drN To - T-GnS YGr , I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J. Bredemeyer M. Domino c/ G. Goldsmith N. Krupski G. Williams Other Page-1 of 2 CogFF0t/ �. . Michael J. Domino, President O�Q �'�G Town Hall Annex John M Bredemeyer I11,Vice-President �� yam, 54375 Route 25 Glenn Goldsmith y z P.O.Box 1179 A.Nicholas Krupski 0 ® Southold,NY 11971 Greg Williams y p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: MICHAEL & KATHY PERIVOLARIS request a Transfer of Wetland Permit#7533 from Kathy Tsoumas to Michael and Kathy Perivolaris, as issued on April 20, 2011. Located: 500 Jackson Landing, Mattituck. SCTM# 1000-113-4-7 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a-shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams E. Cantrell D. Di Salvo Other Page 2,of 2 Jill M.Doherty,President so Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O. Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer Telephone(631) 765-1892 l`AOUNTi- Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0695C Date: October 18, 2011 THIS CERTIFIES that the installation of a 16'x32' in-ground swimming pool, patio and surrounding fence At 500 Jackson's Landing, Mattituck, New York Suffolk County Tax Map# 113-4-7 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated March 11, 2011 pursuant to which Trustees Wetland Permit#7533 Dated April 20, 2011 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 the installation of a 16'x32' in-ground swimming pool, natio and surrounding fence The certificate is issued to KATHY TSOUMAS owner of the aforesaid property. PA � uthorized Signator Jill M. Doherty,President �gpFFU�,�0447 Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �.�� P.O. Box 1179 James F. King o Southold,NY 11971 Dave Bergen a0 g r* Telephone(631)765-1892 John Bredemeyer Oy�O �a� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: OC i / 7 `t Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 15t day of construction % constructed Project complete, compliance inspection. INSPECTED BY: _ J. IC/,A)C-- COMMENTS: Acc sNo U c P Ala 7 SSE Pd iA) G✓ip 7VIC CERTIFICATE OF COMPLIANCE: 1 Jill M. Doherty, President ��Of so yo Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 James F. King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer %� i� Telephone(631)765-1592 1p�,�UNT'1,� 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 % constructed Project complete, compliance inspection 0 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7533 DATE: APRIL 20, 2011 ISSUED TO: KATHY TSOUMAS PROPERTY ADDRESS: 500 JACKSON'S LANDING, MATTITUCK SCTM# 113-4-7 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter I I I 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 April 20,2011,and in consideration of application fee in the sum of$250.00 paid by Kathy Tsoumas 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 install a 16102' in-ground swimming pool, patio and surrounding fence; and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated March 8,2011, and stamped approved on April 20, 2011. 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. h���gpFFO(,�cO y � o��ol TERMS AND CONDITIONS The Permittee Kathy Tsoumas,residing at 500 Jackson's Landing,Mattituck,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold 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. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. 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. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the 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. Jill M.Doherty,President _``�OF SOU�yO Town Hall Annex Bob Ghosio,Jr.,Vice-President �� �� 54375 Main Road y P.O.Box 1179 James F. King Southold, New York 11971-0959 Dave Bergen G C John Bredemeyer '�� Telephone(631) 765-1892 IyCOU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 20, 2011 Ms. Eve Millner Swim King Pools 471 Route 25A Rocky Point, NY 11778 RE: KATHY TSOUMAS 500 JACKSON'S LANDING, MATTITUCK SCTM# 113-4-7 Dear Ms. Millner: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 20, 2011 regarding the above matter: WHEREAS, Swim King Pools on behalf of KATHY TSOUMAS 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 March 11, 2011, 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 April 20, 2011, 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 KATHY TSOUMAS to install a 16'x32' in-ground swimming pool, patio and surrounding fence; and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated March 8, 2011, and stamped approved on April 20, 2011. 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 . Doherty President, Board of Trustees JMD/eac o�5UPF0�,�� • Jill M. Doherty,President - Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Route 25,P.O. Box 1179 James F. King �r Southold,NY 11971 Dave Bergen 'Jydl ����' Telephone(631)765-1892 John Bredemeyer * Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: KATHY TSOUMAS Please be advised that your application dated March 11. 2011 has been reviewed by this Board at the regular meeting of April 20, 2011 and your application has been approved pending the completion 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) % Constructed ($50.00) XX Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50.00 BY: Jill M. Doherty, President Board of Trustees C P.G.Box 1179 Jill M.Doherty,President �� O Bob Ghosio,Jr.,Vice-President Southold,NY 11971 James P.King y �' Telephone(631 765-1892 Dave Bergen 0 Fax(631)765-6641 John Bredemeyer Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: KATHY TSOUMAS requests a Wetland Permit to install a 16'X 32' in-ground swimming pool, patio and surrounding fence. Located: 500 Jackson's Landing, Mattituck. SCTM#113-4-7 Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound _Bay .� Distance of proposed work to edge of wetland SD Part of Town Code proposed work falls under: _�,6apt.275 _Chapt. 111 _other Type of Application: _Wetland _Coastal Erosion _Amendment —Administrative—Emergency _Pre-Submission Violation Info needed: ,ve ✓� a lG 7T9SI) Modifications: Conditions: Present Were: —J. Doherty B. Ghosio _/J, King _ D. Bergen, J. Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: • oSgUFFO(,f� • h� Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O. Box 1179 Southold,NY 11971 Telephone(631)765-1892 1 # Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., April 13, 2011, the following recommendation was made: Moved by Doug Hardy, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of KATHY TSOUMAS to install a 16'X 32' in-ground swimming pool, patio and surrounding fence. Located: 500 Jackson's Landing, Mattituck. SCTM#113-4-7 Inspected by: Doug Hardy, Jack McGreevy Vote of Council: Ayes: All Motion Carried New York State Department of Environmentakouservation ('�. ` • Notice of Incomplete Application -This is NOT a Permit Application/D: 1-4738-01555/00003 liatcti Number: 614598 . i Facility: TSOUMAS PROPERTY 500 JACKSON'S LANDINGISCTM 1000-113 4-7 MATTITUCK,NY 11952 Applicant:KATHY TSOUMA4S Owner ID: 1550092 500 JACKSON'S LANDING MATfITUCK,NY 11952 Permlt(g)Applied jbr: 1 -Article 25 Tidal Wetlands Ptvject Location: in.SOUTHOLD in SUFFOLK COUNTY Your application for Permit is incomplete. The following items are required: Only 2 copies of the survey/site plan were received. Please submit an additional 3 copies. In addition,the purvey indicates the pavers as pervious. 1 assume that the pavers were Dot included in the impervious lot coverage. Please explain the type of pavers that will be used which makes them pervious. If not pervious, they should be included in the lot coverage if they haven't been included already. ++ -if it is determined that they are impervious and must be included in the lot coverage,you mhy want to consider removing them as part of the proposal, reducing the size of the proposed pool, and/or removing an existii'tg impervious structure to keep the lot coverage at or below 20%. It is not likely that two variances (setback.and lot coverage) will be approved. Also,if the pavers are impervious, the setback front the tidal wetland boundary is 45 ft. and a greater setback variance is required. -If revisions to the survey are necessary, please submit 5 copies(not 2). ^�IU� •,___ -.._ - - Please su6tnitreq uestedinformation bV.•— . _�� -• L No further action can be falcon until all of these materials are received. C Sl' nature:-,� aa. DARLEEN M GERB �1 NYSDEC - � ._. Data: August 17, 2009 SUNY®ST034 Y BROOK150 CIRCLE RD STONY BROOK,NY 11790 Telephone Number: 6 �0 .� s NYSDEC Application ID: 1-4738-01555/00003 500 Jackson's Landing/SCTM 1000-113-4-7 Mattituck,NY 11952 Applicant: Kathy Tsoumas Owner ID: 1550092 500 Jackson's Landing Mattituck,NY 11952 Permits applied for 1-Article 25 Tidal Wetlands Project location: in Southold in Suffolk County Additions being submitted at this time: 5 new surveys showing new pool size location Lot coverage % change Asking for 661.1 variance for a 50' setback (75' can not be met) Photo evidence of staked proposed pool location as well as proposed dry well location 1 � 471 Route 25A Swim King Rocky Point, New York 11778 �dkl� Pools 631-744-8100 • Fax 631-744-8292 March 2, 2011 NYSDEC SUNY @ Stony Brook 50 Circle Road Stony Brook,NY 11790 Contact Person at last submission: Darleen M. Gerbino Application ID 1-4738-01555/00003 500 Jackson's Landing Mattituck,NY 11952 SCTM 1000-113-4-7 The last notice of incomplete application dated August 17,2009 gave us details about what would be needed to move forward. The homeowner has given thought to the items discussed and has changed to a very reputable swimming pool company who has been in business for over 20 years to complete the job. A letter of authorization is also attached signed by the homeowner,Kathy Tsoumas stating that Eve Millner is the agent or contact person. All contact phone numbers are in detail so that you can contact both the homeowner and agent. We are submitting 5 new copies of survey/site plan showing that we have changed the pool size from a free form shape to a 1602 Rectangle. The changes made since the first submission has given us a greater setback, then what we have first shown. We are requesting a 50' setback from the wetlands. The Part 661 Tidal Wetlands Land Use regulations 661.6 section(1)criteria will not be able to be met of a 75' setback. This is the only variance from the NYSDEC that is being sought. We are asking for Variance from the 661.1 we are asking for the minimum setback for the proposed swimming pool from the wetlands. There are no other alternative placements that can be made for the pool in the size of the parcel in question. The environmental impact of the residence and neighboring properties will not be in jeopardy. Protection of all onsite wetlands, and preservation of the non-disturbance-non-fertilization buffer landward of the wetlands already exists and will remain. A 4'wide path to the existing dock will not be disturbed. This buffer from the wetlands serves as a screening to the west branch of the Mattituck Creek. The proposed swimming pool has been staked in the field by Swim King Pool as well as the proposed pool drywell location. All of these are depicted in the latest survey/site plan with this submission. Photograph evidence of these staking are also being submitted with this. The homeowner is also going to use a turfstone type of pervious paver around the pool area so that the lot coverage will remain in conformance and will not be over the 20%allowed. The existing stone driveway will be shorted for the proposed pool to be built and some of the existing walkway in the rear will also be removed. Thank you with all your help with regard to this matter. Your assistance was greatly appreciated hhen last/duty analyst on February 11 2011. E e Mil Milkier Swim King Pools Authorized Agent for Owner 471 Route 25A Swim .ARM King Rocky Point, New York 11778 VMM ;Vad4ceu 6 Pod's 631-744-8100 Fax 631-744-8292 go New York State Department of Environmental Conservation SUNY at Stony Brook 50 Circle Road Stony Brook,NY 11790 February 18, 2011 Application ID: 1-4738-01555/00003 Facility: Tsoumas 500 Jackson's Landing Mattituck,NY 11952 Permit Applied For: Article 25 Tidal Wetlands Please be advised that I authorize Eve B. Millner to act as the agent with regard to the permit application process. Eve works with Swim King Pools as the permit coordinator and will facilitate as the agent for my property. Thank you for all your help with regard to this matter. 7ath yTsoumas Property Owner 2�13. illner Agent for Owner sF ep R - ss p9j, s apses a ` a © E! Iqq1 ^ O e ' cPE • V - N- 2: N_ I � .rn BAN/ Gf yam. .oy� 22 2. I \\ a '\A y��. O • I I 1,1 i 9 �u ";I 1 I II II 11 I la 11 1 11 _j+'N J's " �j1 11 Iss Yl r, nl Isl e ' m 1 1 • y I •l CIFFiTTI II '+.. 3i J _ Mm ilA 1 1 1 1 d O`aW'°1 I VI 1 1 1 1 1 '1 11 wum ermi •uo ,�C tt4♦U, JI a.nem.e..v �y 6 ® it ,, Nonce COUNTY OF SUFFOLK © i SOUTxOLO s¢c*iou No (zll Q •- — — T­M Red Pr 1 Tax r —�— z oce Y a S6vice nge Y 113 IL=lIw.,)Is,w N%IW II, 11501 1000 aaovee,r uv OFFICE LOCATION: �r3F So MAILING ADDRESS: Town Hall Annex ��� Ol0 P.O. Box 1179 54375 State Route 25 yy yy Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) T T Southold, NY 11971 Cn Telephone: 631 765-1938 �p Fax: 631765-3136 ��'YOOUNTI 0� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM APP, , To: Jill Doherty, President4 .. Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: April 18, 2011 Re: Proposed Wetland Permit for KATHY TSOUMAS SCTM#1000-113-4-7 Swim King Pools on behalf of KATHY TSOUMAS requests a Wetland Permit to install a 16'X 32' in- ground swimming pool, patio and surrounding fence. Located: 500 Jackson's Landing, Mattituck. SCTM#113-4-7 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 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: Lori Hulse, Assistant Town Attorney Jill M. Doherty,President y Town Hall,53095 Main Rd. James F. King,Vice-President O . P.O.Box 1179 Dave Bergen y '� 'g Southold,NY 11971 Bob Ghosio,Jr. Telephone(631)765-1892 John Bredemeyer 1 y' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application r' Wetland Permit Application Administrative Permit _Amendment/Transer xtension Received Application: 31111 Received Fee: s- MAA 1 Completed Application 3 1 2��� �I _Incomplete 1 _SEQRA Classification: Type I Type I] Unlisted Coordination:(date sent) _ u . ;LWRP Consistency Asses ment Form ,/CAC Referral Sent:�1_I_�O Date of Inspection: II _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: __,Y'66lic Hearing Held: 1 _Resolution: C ')�""T��h✓ Name of Applicant K(lJVlJ IS(�( ((� ' ' t t'(Y I jig Address I V\n, h+LO PhoneNumbe(0'� — L-0I Suffolk County Tax Map Number: 100000 - 113- DL -'C)_7 Property Location:✓//W 6�b S l ov�t✓JCA Ma h64z,j:_e NW t1a52. qCj0,sb� Ecu+ of M(ll PSP (provide LILCO Pole#, distance to cross�s�d location) AGENT: 90i, M I I l nem (If applicable) S�1YV P�cD)S �d f \\ Address: � �' . �( ,A- /- IV Phonell�� I 5D ce ( I lord of Trustees Applicatio` ? GENERAL DATA Land Area(in square feet): ✓� J L o Area Zoning: Previous use of property: SI✓lYl �e PaAM i o 4 r c Intended use of property: f,,,O yYl P L u II 0� r7✓1� jSor� I Covenants and Restrictions: Yes � No If"Yes", please provide copy. / Does this project require a variance from the Zoning Board of Appeals Yes No If"Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date [mac_ I wol{llja an r vrv�r� J app IICa-,hon ID �- ` 730, _ 0r5b5- 00003 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or sus ended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): ILPV32-32 rrc faytol e p irv7iluuM /ice lila 12c«rVC4 �b�, vie-U��O�mCP�S Ly�s)de )(ard- yn46eduse 1 > d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: T.'41DVWM �h1i�lrVl i✓1� Ib� rte, is i l V) Area of wetlands on lot: r35 square feet Percent coverage of lot: / -9 % tl pqr co/ V. 52,c ,/-re�TH Closest distance between nearest existing structure and upland edge of wetlands: Q311 feet Closest distance between nearest proposed structure and upland edge of wetlands: 5-0 feet Does the project involveexcavation or filling? No %// Yes If yes, how much material will be excavated? i 0c) cubic yards How much material will be fillle? 20 cubic yards Depth of which material will be removed or deposited: 4 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: E s--eo val d 4- Iya,441✓ a !D wh-no let- Statement erStatement 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): Eu tLi-eflo4ct Ly t no hn, d atw-i2� s � C)ky, lick .weak as 6- +e�y. fieJ �� �y� scte . *d of Trustees Applicatio• COASTAL EROSSION APPLICATION DATA 1 ' Ind Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No '�/ Yes Does the project inv lve excavation or filling? No Yes If Yes, how much material will be excavated?0(cubic yards) )cfp- How much material will be p (cubic yards) Manner in which material will be removed or deposited: Lxcaoatd -f I nad rd ;0b a.., lv oheeler bnwahf Ln- -/V o AaIE Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) -Thi LA le-Havidi tv l / f74 be- d(s-M Lir I fIv i : ah l/ Jqe- 'r1T1 Cons �U fz�� Lco) nr od we'll as a. -�->° rn �,vt«, a-r�su.�td �n�tru� fiat Si 617.20 SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.P JECT NAME 3.PROJECT LOCATI Municipality ty 4. PRECISE LOCATION: Street Access and Road Intersections, Prominent landmarks etc :or provide map SOWW1 S)d e Of bac KSon s Ca✓id�rt� > �� . �(o East- M) 1) astM) 1) Rcvd, 5. IS PR SED ACTION: New ❑Expansion F]Modification/alteration 6.DESCRIBE 41ROJECT 8 EFLY: 1(o x 32- pn) osed lagybuj�j SLA-)) Poo/ l/m y/ I I n ed 1� W/if to PIC/ r-ebv- 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres Vr ZWILTPROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? es ❑ No If no,describe briefly: ���9....jjj..WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AC CY (Federal, State or Local) as ❑No If yes, list agency name and permit / approval: 11. DOES ANY A PECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? F-1 Yes El No If yes, list agency name and permit / approval: LC a 1ff2—. .1A,''S A E ULT OF P OPOSED ACTION WILL EXISTIN P RMIT/ APPROVAL REQUIRE MODIFICATION? ues LA No CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S sor Name j Dat . Signature / 1 1 ' If the 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 fTo be completed by Lead A en A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.47 If yes,coordinate the review process and use Bre FULL FAF. Yes Q No . e. VNLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by antler invoked agency. . 0 Yes Q.No . C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Hewers may be barn.if lglble) Ct. Existing air quafity,surface or groundwater qualky or qual ft n0l"levels,ehdstirg traffic pattern,solid wasle produopon or fgspo"L for emaloM drainage or soo ding problems? E)Valn briefly: No C2 Aestlie6G m(tM b",anchae041A hist &.or other natural or cam resources:or cornmuft fir neipNWhoW dhwader7 Explain briefly: No CS. vegetation or fauna,fish,shellfish orwoure species,signiscert habitats,or thteatenedor eMargered apedas?E)#aln Wiefly: No C4.A commwrryrs existing plans or goals as officially adopted,or a dww In use or edeasiy cruse of IoM or other nalwal seumse?Explain bdeflf: No Cit. Growth,subsequem dew wpn*nt or related;chides fikdy to be induced by the action?Explain briefly: No Co. Lang tern,short teen.wmhaadve,or other effects not Identified M C1-CW Explain-briefly:No C7. Other IrnpactsXholuding changes N use.ofelthar uantiy or type dehegy? Mtefly - No D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AICA CFA? r ain bne6 : Yes Q No E. IS THERE,OR IS THERE LIKELY TO CONTROVERSY RELIITED TO POTF7ITIAI.ADVERSE ENVIRONMiMAL IMPACTS? If ❑Yes f N° yes explain: PART NI-WTERAAINA'f10N OF SNiNIFICANCE(To be Completed by.Agency) NNSTRUCTIONS. Foreachadverse effedidentikedabove,determine whelherkiasubstari tlargee,knportantorolherwisestgnif7cant Each eRed shoUK be assessed in connecoon with its(a)selling(Le.urban or nsmQ:(b)pobablflgr of oopNrklg:(C)dyratIM(d)( (a) gaograpldc scope:and(f)magnlludc t necessary,add attachments or refeferloa supporting ma(erials. Ensure that o"Ir usme Contain suR>dentrletaktoshow fhatoff relevant adverse padveeenentitied.arxlackqua(ghaddregsed, Nqueatlorhdofpadkwascfiedaed yes tlredeterminatonofaignificanc�amustevaluatetrepoimshatentlatknpabWdoftlreproposedadtononlheWWkWtme Wdmadm ticeofftCEA Chad*M boxkyou have idengfwdone ormorepoWnbly Iargeor,eignificardadw mepnpagswfhldh MAYooaa.Then proceed direglyto the EAF and/or prepare a positve_dedeagon. FLLII Check Ibis box tiyou have detemdned,based on the Information and analysb above end any,suppaNig.drarhhemation,that the proposed determination.WILL NOT minult W any sighdflcent adverse environmental hnpads AND provide,on sliednnenhts as necessary,the reasons supporting th Board of Trustees Name ofd Agency Date All M. Doherty President - 1 or Type ame?(Responsible Office in Lead Agency TWO of Responsible Officer - 'Signature a. k Office Luse Agency Signature of Preps Ir If difterent from responsible officer) QY'Z"NTown of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM ROPERTY LOCATION: s.C.T.M.u: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A / 33 vh STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN ism.7r bon oC O CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? I Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall on Site? J the Scope of Work for Proposed Construction) (This item will include all run-off created by site — ❑ (3.F./Acres) b. What is the Total Area of Land Clearing / clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed / Site Improvements and the permanent Creation of Construction activity? impervious surfaces.) 2 Does the Site Plan and/or Survey Shaw All Proposed /❑ PROVIDEmv BRIEF PROJECT DESCRIPTION (PiEe AtltlMbnel Ppea ea NeedeE) Drainage Structures Indicating Size 8 Location?This V Item shall include all Proposed Grade Changes and 1 - \l 3"1 ,-�r� Slopes Controlling Surface Water Flow. �{ (�—�- 3 Does the Site Plan and/or Survey describe thee ,L/ rosion /❑ and sediment control practices that will be used to control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. Q Will this Project Require any Land Filling,Grading or / Excavation where there is a change to the Natural V/ Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? tj Will this Application Require Land Disturbing Activities ❑ — Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet Of a Welland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ❑ are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for stomr water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-0.10-0Ot.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, ❑ required,post-oonstruction storm water management practices that will be used and/or Removal of Vegetation andlor the Construction of any constmoed to reduce the pollutants in stomr water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(This Nem will NOT lmluda the installation of pdvavpy AProro.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-cunstrocl'ion storm water management practice in a Bos and the construction site disturbance Is between 5,000 S.F.b 1 Acre in an; component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage S Erosion Control Plan is Rsquimd by th Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit NOTE: A cues)mRequimo,bra Canplete AppGstl STATE OF NEW YORK, NOTARY STATE OF NEW YORK COUNTY OF.. ... . ..�.. ..... . ............SS WOM000NTY That I, .. ... _ Ed C.. being du ' Anther he/sit is the applicant for Permit, .... ( individual signing Document) And that he/she is the �� ...... ntr . Agent.0 . . Officer,(Owner,Contractor,Agent Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this, t C ....................................1.1.. ..day of..........` ( C 2 0(.1 / . ......., Notary Public: _i_. Pj..../ )� .................... XL�LSC� (Sign turgor ppNeanq FORM - 06/10 Board of Trustees Application County of Suffolk State of New York 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 HISMER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. X re �J etrw�e� SWORN TO BEFORE ME THIS r I DAY OF 20 / MOWN B PAVAQW NOTARYMM STATE OF NEW YORK SIIFFOLKCWNIY UC./01 T7 CDwW.EXP. /J Notary Pubtic (, i Oard of Trustees Applicati, AUTHORIZATION (where the applicant is not the owner) I, :J�SQUQO � residing at �CL 7GLf` (print -� �Owner of proper y) (mailing addr ss) M4L�Q ?'lCi[ LA ICA i fjkO do hereby authorize ( ✓�e (Agent) kL - to apply for permits) from the Southold Board of Town Trustees on my behalf. (Owner' s signature) 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the cart of town officers and employees The ouroose of this form 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: eyt, ,22 M I I I r,,to� im Zx h,24T/` 674 (Last name,first name,ipi d e initial,unless you aro applying in the name of -73ou 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.) r Tax grievance Building Variance Trustee Change 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 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 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/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicont (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 MENLYN 8 PRAW ( � NOTARY K*UC STATE OF NEW YORK /U o one, SUFFOLK COUNTY LIC, 1 Re 0 7 COMM.EXP Submitted is day of Signature L�� fj �f�— Print Name Form TS 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: to � Jae h Nci -gerrhr� N1/6(08 p 6(d er. try y 1 DUO 6 Kotn'i9 31 W-klaw n b( - C6rnnlaCkJ 1i ODD I - Gj - �j �(IyyIPE$1y �� ►J21 5155 7aJC<o4S ��✓L�a �. �►�5 JJ a STATE OF NEW YORK COUNTY OF SUFFOLK n lresiding bein duly sworn, deposes and says that on the 1 ti day of 20 , deponent mailed a true copy of the Notice set forth in the Board o 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 assessmen oll f th own f Southold; that said Notices were mailed at the United States Post O at that said Notices were mailed to each of said persons by (it! (register d mail. T c-f trn r-ecttP{- Sworn t before me this `I Day of , 20jj�:j — Not ary Public am M" i p owerawrwww • ��ypgpfFO(,�coG JZ� Jill M. Doherty, President H - Town Hall,53095 Main Rd. Bob Ghosio,Jr. ,V ice-President q. ,� P.O. Box 1 179 James F. King Southold,NY 11971 Dave Bergen '�/� ��� Telephone(631)765-1892 John Bredemeyer 1 �' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of KATHY TSOUMAS COUNTY OF SUFFOLK) STATE OF NEW YORK) r1II �n 1, I AFFIDAVIT OF POSTING / 1, GVH 1" 1 ` l✓�� residing at /dba C��/�t�r� t'1p( ad — I�/l �t I fi �1 neer y3U I l L o being duly sworn, depose and say: That on the 1 c ay of i14Nn 20111 personally posted the property known as 5-oo [ oj- c{,✓�a by placing the Board of Trustees official posterAvhere it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed, April 20, 2011 on or about 6:00 PM. ated:l 6 2O, (signatur ) Sworn to before me this a(� ' day of*1 2011 JONlEM WIMWIO t1W MK"VAXOFIEWYON( V IW 001" tary Public 0m, Town of Southold 9 9 LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. 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. 2. 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 Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listine both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 113 -04- O 1 PROJECT NAMETSLOUrYlLIS P�L�Yr�c� ,1 YCi 1►/l(� 1 The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. �/ Board of Trustees LrJ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant,loan, subsidy) (c) Permit,approval, license,certification: Nature and extent of action: ITIyaMAM �cn?lry►m�✓l� � OP`yy1l7L Location of action: \J C) VL Site acreage: Present land use:—,��/ i dLwd . Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: T`l 6 UM (b) Mailing address: � JOJQL' YL 1 /612' 1N 1 J (c) Telephone number: Area Code DEC /�/ r (d) Application number, if any: /T��rm-.Q,R }t DEQ.OnrDU Will the tion be directly undertake` req re Yilftg, r pprovff\ /b� e o�agency? Yes YNo❑ If yes, which state or federal agency? ��Ied QJre45�dy � (� r C. Evaluate the project to the following policies by analyzing how the project will further orrt ot`/ 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 E/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 t/ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—ZZNot 'es Pages 6 through 7 for evaluation criteria 1-1Yes 1:1 No Applicable Attach 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 QNot 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 16th(rroouh 21 for evaluation criteria El Yes 1:1 No K7ot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III —Policies; Pages 22 through 32 for evaluuaatioon criteria. ❑ 1:1 - 1—W Yes No Not Apple 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�!f Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and waste . See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No IgNot 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 w ters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No S Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No EyNot 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 BYTITL & DATE -5/3/ I K{q 9�iD N / L L �O SCDHS Ref.# R10-96-0112 , N P water in 5 t ✓ ^ rs, c well /r S ac 41.20' N- �� -3,04, 00 0 . ei N N MLL � , fei G. � / rI •cagy S J+gyp be, ! 0000, 0/ / Y ,3 M SITE �0) � A rT/TUQr C � ��p�j i £•! > i e I U ,,,, LOCATION MAP _ � L•3°i r« ti Z � h t � L_OT COVERAGE � � 'Y.sae� ( �`�� ` 2y.o' 4 HOUSE, DECK 8. WALKS O AREA - 3378 sq.ft. AREA OF UPLANDS = 19505 so./l. �/ a o %' /J N {O CP7C u 'b 3,127/97 3378/19505 =.1,7.3% (v Test Boring PROP. POOL`. 512•e q,ft.41 h r R eci ! 0' 512119505 2,6� �} P �o rs.o ' t Dr. Br. loam LOt COVERAG,' SOT O8 `--.� OL % 411 ,� cerx s .�,�� Br, Sony Loam Q Pern,pQ7� � o�IXer ,�u'yZ'I OL ,.� 41 �' �'"?ron 6�E. O ct• UkW ! 2' Br. Loamy Sun .n/ - ✓ r- ,., vy we -_ 0 Fofe Br. line '` --2 to medlum 6 N L.,,i y, \ Fr.;rw Sand SP nr � T 07 Water /n po% o� �C/ br. line to medlum Sand 13'- �e- �\ \ 9y 4n� = WETLANDS FLAG O0,* � APPROVED BY i WETLANDS AS DELINEATED BY SUFFOLK /J' o° 'ENVIRONMENTAL CONSULTING, INC. 'Q j` N.. 85'04'4A", �SOARD OF TRUSTE[5 JUNE 24, 2009 �� ��y39-;� ti TOWN OF SOUTHOLD ELEVATIONS AND CONTOUR LINES ARE CREE) ' ,I' REFERENCED TO N.G.V.Datum. 1. RAMP 2.5'x 24. i I FLOOD ZONE FROM FIRM COMMUNITY PANEL NO. FoLOA7W SURVE OF 360813 0112 E e .2a. LOT 5 AREA = 23,570 sq ft. to tie lines JACKSON'S LANDING" FILED MAR. 28,1969 FILE NO. 5280 The locaons of wells and cesspools AT MATTITUCK shown hereon are from field observations TOWN OF SOUTHOLD and or from data obtained from others. SUFFOLK COUNTY, N. Y. 1000 - 113 - 04 - 07 Scale. 1" = 30' I 'am familiar with the STANDARDS FOR APPROVAL Jan. 271997 AND CONSTRUCTION OF SUBSURFACE SEWAGE 27, 1997 SYSTEMS FOR SINGLE FAM/LY RESIDENCES JULY 2 2009 and will abide by the,condllions set forth therein and on the JULY/3, 1009 !PROP. POOL! p -l°cy 22 2009 M�g�r,p permit to construct. SEPT. 1, 2009 (pYop. poa SEPT. 150 2009 (revisions) 71 OCT. 15+ 2009q(revisiionn) � r At �, 20111/IIRE (M ANY ALTERATION OR ADDITION TO THIS SURVEY/S A VIOLATION OF SECTION-7209 OF THE NEW YORK STAT£EDUCATION LAW EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERT/FICAboviS /y J nl Y LIC ,NO. 49618 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF MAR 6 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. 1.30. BOX 90920 FAXy�ex) ?65, 1797 ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM ALTERED BY" MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY C_. ... 1P30 TRAVELER STREET OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS 'INSPECTED' AND -' 1230 TRAVELER LE TRE 96-27 Q BROUGHT-TO-DATE' ARE NOT IN COMPLIANCE WITH THE LAW. 10" 32' 1, 101 ' ' `� L 1; FILTER VVALVE a F PLMP o Z ALV 10 c, LLI f CID - �l h'AR 1 1 �� O /CHECK VALVE / W } 7v _ Z Q �.lFh 1 CHECK VALVE O z Ln A Q 'O 4' b' 6' 'O 16' 1 Z V 00 IF � CONCRETE WALLS e PLAN PLUMBING SCHEMATIC N E NOTTO SCAI£ 5CALE:1/9"=1'-0" 16 x 32 Rectangle IA WATER LINE GRADE FORMED CONCREFESTEP5 ROLLED FOAM BETWEEN LINER AND CONCRETE :y WATERLINE FORM TIES i 3500 PSI POVRED CONCRETE VINYL LINER ry 2"TO4"SAND - I a 2"to 4"SAND BOTTOM WALL SECTION SECTION A `ry NOTES Q�> c Y 1. ALL CONSTRVCTIONISTO BE ANDI ECCO0.p NCE SPI-Si NTH THE ANVA510FORA IIPMO V IN=VNK5WIMFFXC POOLS HEAN51/NSI PGCE-N 5TANDA0.05fO0.RESIpENTIAL O INGROVND SWIMMING POOLS FORATVPEII PJOL W_ 2.AMAC IJEI5 DESIGNED FOR bSEBEIOWORADEANDONLVINARWINHERETHE TOP OF WALL CROVNDWATR0. BLEISAMINIMOMOF6'-S'BELOWIEPWM5EDANI5HEDG0. 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INACCORDANCE WITH THE NYS BVILDINOCODE APPENDIX O.SECTIONAEIM SECTION BPEkMANENrENCMSUREMWBECOMPLMDWiN NIN M1DAAFEERTHEDATFOF ^O y / COMM ENCEMENT OF CONSTRUCTION B' 9.THEREISNOMAINDRAININTHI5PCOL 5UCTONFO ROOLWATEKORCVIATION 4 ISP C=EDBYTHESKIMME0.50NLV.THIS MEE60.FOVIRFMEN150f RC-SETION ACIC6 I PoRENTMPMENTPPOTECTION. 10.TH 15 POOL SHALL BE EOVIPPED WITH AN APPROVED POOL ALAMM WHICH J5 CLASSIFIED Date' 2-21-2011 1 BY VNDE0.W1TE0.5 LABORATORY,INC TO REFERENCE STANPAIDA5TM PXH EMITLED 'P�•R. STAN DARD SPECIFICATIONiOR POOLAIARMS'gS PLOPFEpIN Hi`]. YS' 11.A TEMPORARY ENCLOSURE OR d FT FENCE 5HALL BE INETALLEDAND REMAIN IN PLACE 5cd e: As Noted y 'J: THKOUCHOLTTHE PERIOD OF CONST0.UCTIONOFTHESWIMMINGPOO4 F f VNTILTHECOMPLETIONOFAPERMANENTENCMVkE.