The URL can be used to link to this page

Home My WebLink AboutTR-7610A 0 James F.King,President ( �Q(/f`_ Town Hall Annex 64875 Main Baud Bob Ghosio,Jr.,Vice-President ti P.O.Box 1179 Dave Bergen # * Southold,New York 11971-0959 John Bredemeyer Telephone(681)755-1892 Michael J.Domino Fax(681)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0800C Date: member 18,2012 THIS CERTIFIES that the replacement of the existing stone paving surrounding the existing pool in-kind and with a timber pile foundation to prevent settling At 2503 Camp Mineola Road Ext., Mattituck,New York Suffolk County Tax Map# 122-9-9.4 Conforms to the application for a Trustees Permit heretofore tiled in this office Dated July 21, 2011 pursuant to which Trustees Administrative Permit#7610A Dated August 24,2011 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 revlacement of the existing stonep@ving surrounding the existing 000l in-kind and with a timber pile foundation to prevent settling. The certificate is issued to ED &ARLENE FOX owner of the aforesaid property. 0,0 Authorized Signature James F.King,President ( Town Hall,53095 Main PA Bob Ghosio,Jr.,Vioe-President P.O.Box 1179 Dave Bergen Southold,NY 11971 John Bredemeyer Telephone(631)765-1892 Michael J.Domino Fax(631)7656641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: t ----�Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale linetsilt boomtsilt curtain 1st day of construction % constructed !�Project complete, compliance inspection. INSPECTED BY. J , COMMENTS: 0 7/ CERTIFICATE OF COMPLIANCE: 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 1 st day of construction ~ constructed ~/' Project complete, compliance inspection 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 Permit No.: 7610A Date of Receipt of Application: July 21, 2011 Applicant: Ed & Arlene Fox SCTM#: 122-9-9.4 Project Location: 2503 Camp Mineola Rd. Ext., Mattituck Date of Resolution/Issuance: August 24, 2011 Date of Expiration: August 24, 2013 Reviewed by: Trustee Jill Doherty Project Description: To replace the existing stone paving surrounding the existing pool in-kind and with a timber pile foundation to prevent settling. 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 Samuels & Steelman Architects dated July 19, 2011. 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 Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jill h Boa~ of Trustees Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town HallAnnex 54375MainRoad P.O. Box 1179 Southold, NewYork 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~ (~ C~LFI~(~ ~-~/~/~ Please be advised that your application dated /~ I~]J.I {~ has been reviewed by this Board at the regular meetir~g ~)f (~1 ~t~lti 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) v/ Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ ~'"'~, C~ BY: Jill M. Doherty, President Board of Trustees Jill M. Dohe~w, President Bob Ghosio, Jr, Vice-President James F Krug Dave Bergen John Bredemeyer P.O Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Samuels & Steelman Architects on behalf of ED & ARLENE FOX requests an Administrative Permit to replace the existing stone paving at southern end of existing pool with stone paving in kind and with a timber pile foundation to prevent settling. Located: 2503 Camp Mineola Rd. Ext., Mattituck. SCTM#122-9-9.4 Type~af area to be impacted: ~,S'altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part,pr Town Code proposed work falls under: _J~hapt.275 Chapt. 111 other / Type of Application: [.,,-//Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: rrDoherty Ghosio __ B. D. Dzenkowski Form filled out in the field by J. King_ D. Bergen, other Mailed/Faxed to: Date: Fox Residence, 2503 Camp Mineola Road 6/23/11, 2:00 pm, #'~ View Southeast Fox Residence, 2503 Camp Mineola Road E×t. 6/23/11, 2:00 pm, #2 View East Fox Residence, 2503 Camp Mineola Road E×t. 6/23/11, 2:00 pm, #3 View South Fox Residence, 2503 Camp IVlineola Road E×t~ 6/23/11, 2:00 pm, #4 View Southwest Fox Residence, 2503 Camp l~ineola Road E×t, 6/23/11, 2:00 pm, #5 View Southwest Fox Residence, 2503 Camp Mineola Road E×t~ 6/23/1'l, 2:00 pm, #6 View West Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~'-C)~1~. DATE: ..N.~ EDWARD FOX ISSUED TO Pursuant to the I~'ovisions of Chapter 615 of the laws of fha State of New York, 18.93; and C_J~apter 404 of fha laws of fha Stale of New York 1952, and fha Southeld ToWn Ordinance tiffed ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REh4OVAL OF SAND, GRAVEL' OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:~. and in accordance wlfh fha Resolution of The Board adopted .at a meeting held on ..Q~..~.~.~ ....... 19. c~?..., and in conslderatlon of ~he sum of $...]:.5~.:.~ paid by . I~and ~.. E~oi?~! Se~?ices for Edwa~...~,x. ........................ of ......... N. ¥. end ,ubie t to *he Terms and Conditions listed on ~e reverse side hereof, of Soufhold Town Trustees authorizes and permlfs the following: Construct a single-family dwelling, deck and pool, and approx. 125 cy. of clean fill required /or proposed septic system with the condition that there be h~ybales at §5~,except for driveway,be~ort construction and shown on a new set of plans. all in accordance with the dotard specifications as presented in the originating appficefion. IN WITNESS WHEREOF, The said Board of Trustees here- by causes i~s Corporate Seal to be affixed, and these present* to be subscribed by ~ '.majorlf? of the said Board es of this dat~. 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: August 18, 2011 Re~ Proposed Wetland Permit for ED & ARLENE FOX SCTM# 1000-122-9-9.4 Samuels & Steelman Architects on behalf of ED & ARLENE FOX requests an Administrative Permit to replace the existing stone paving at southern end of existing pool with stone paving in kind and with a timber pile foundation to prevent settling. Located: 2503 Camp Mineola Rd. Ext., Mattituck. SCTM#122- 9-9.4 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 Office Use Only Coastal Erosion Permit Applica[io, n Wetland Permit Application ~ Administrative Permit Amendment/Trans fer/F, xtension ~Rece~vved Application: ~Received Fee:$~,~(.(.~. (d~..J ' ~/Completed Application _Incomplete __SEQRA Classification: Type I. Type 11 Unlisted Coordination:(date sent). ~'L~WRP Consistency Assessment Form __CAC Referral Sent. ~ ~r~te of Inspection: ~_ ! Receipt of CAC Report: Lead Agency Determination: Technical Review: Hearing Held: __Resolution: ¢ S0uthh01d T0'~, ~- Name of Applicant ED 'FOX & ARLENE FOX Address 455 EAST 80th ST. APT 8E Phone Number:( ) Suffolk County Tax Map Number: 1000 - 122 - 9 - 9.4 Property Location: 2503 CAMP MINEOLA ROAD EXT. (provide LILCO Pole #, distance to cross streets, and location) AGENT: Tom Samuels- Samuels and Steelman Architects (If applicable) Address: 25235 Main Rd. Cutchogue, NY 11935 Phone: 734-6405 of Trustees Ap~ Land Area (in square feet): R-40 Area Zoning: GENERAL DATA 63, 993 Previous use of property: Residential Intended use of property: Residential Covenants and Restrictions: Yes x No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals __ If"Yes",pleaseprovidecopyofdecision. Priorpermits/approvals ~rsiteimprovements: Agency TRUSTEES # 5084 DEC # 1-4738-02395 SCDHS # R10-00-87 BUILDING # 26982 TRUSTEES # 6878 w/Amendment Date 11/3/99 4/11/00 10/19/00 12/19/00 7/23/08 EXPIRED Yes x No __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a govemrnental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary): EXISTING STONE PAVING AT SOUTHERN END OF EXISTING POOL TO BE REPLACED WITH STONE PAVING IN KIND, w/TIMBER PILE FOUNDATION TO PREVENT SETTLING of Trustees Ap~ WETLAND/TRUSTEE LANDS APPLICATION DATA Pu~ose of the proposed operations: EXISTING STONE PAVING AT SOUTHERN END OF EXISTING POOL TO BE REPLACED WITH STONE PAVING IN KIND, w/TIMBER PILE FOUNDATION TO PREVENT SETTLING Area of wetlands on lot: 4,750 _square feet Percent coverage of lot: 7.4 % Closest distance between nearest existing structure and upland edgeofwetlands: +/- 117' feet Closest distance between nearest proposed structure and upland edgeofwettands: +/- 117' feet Does the project involve excavation or filling? x No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: 0 Manner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): None PART 1 - PROJECT INFORMATION ~ 6~7~ SEQR t APPE NI)~X G J E4 R( E QUALITY REVIEW $~AI~ ~ V~ NM SHORT ENVIRONME~AL ASSESSMENT FORM for UNLIS~D ACT~NS O.ly Fox Residence S PROJECT OCAT ON 1 2503 C~P MINEOLA ROAD EXT. ED 1FO× & ARLENE FOX EXISTING STONE PAVING AT SOUTHERN END OF EXISTING POOL TO BE REPLACED WITH STONE PAVING IN KIND, w/TIMBER PILE FOUNDATION TO PREVENT SETTLING aces O ~imatety 0 . 01 acres Smtec Lo~l~ NYS DEC, Town Building Dept. Town Trustees 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 (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. [~Yes r~]No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may he superseded by another involved agency. [~] Yes r~No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WtTH THE FOLLOWING: (Answem may he haodwritten, 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: I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain b~efly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity o~ use of land or other natural resources? Explain briefly: C§. Gro~h, subsequent developn'~nt, or related activtiies likely to be indu~ by the proposed action? Explain briefiy: C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 E~plain briefly: C7. Other impacts linciudin~ char~es in use of either (~uantit~ or t~'~e of ene~}r? Explain D. WILL THE PROJECT HAVE AN IMPACT ON TH/ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEA/? /If }~es, explain bdefl~': E. IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~'es explain: I--lYes WINo] PART I1! - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) . INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritissubstantia~'~arge~imp~rtant~r~therwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irraversibility; (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 determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Cimck this box if you have identified one or more potentially la~ge or significant adveme impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive deciaretion. Check this hex if you have determined, based on the information and analysis above and any sspporUng documentation, that the proposed ac~io~ WILL NOT result in any significant adverse envimnmentsl impacts AND provide, on attachments as necessary, the reasons supporting thi: determination. Board of Trustees Name of Lead Agency Jill M. Doherty Prinl~ or. Type Name of Responsible Officer in Lead Agency ~igrlature of R~ponsib[e'~)fficer in Lead Agency Date President Title of Responsible Officer Signature of Preparer (If different fi.om responsible officer) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY kOC. ATIOH: S.C.T.M.~ THE FOLLOWING A~rSWION$ MAY REQUIRE THE SUBMISSION OF A STORM.WATER! GRADINGf DRAINAGE AND EROSION CONTROL PLAN U~td~t eaca~ .~c~ ~t CERTIFIED BY A DESIGN PROFESSIONJM. IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONEI'RUCI'ION ITEM# / WORKA~SF-~ Yes No a. What IS the Total Ama of the Projec~ Parcels? ' 0.cludeTotalAreaofallearca!srocatadwlthln ~)P~? 5,~. t WilithisProjeofaetai. AIIStorm-WaterRun-Off the Scope of Wo~ fcr P~posed Construc'don) (This item will include all run-off created by site b. What IS the Total Area of Laed Cisering c~earlng and/or co~,slmc"~on activities as well as all and/or Ground Distur'oance for the proposed //~200 c~ .~ Slta Improvements and the permaneflt creation of ~pe.,,iou$ surfaces.) cons~ctlon activity? (e~. ,~r~} 2 Does the Site Plan an~/or Survey Show ~1 Proposed pROVIDE'BRIEF PttOJECT DF~CRII~i'ION i~,~,~r~,~,~ OralnageStnlctureslndicatJngSize&Location?'l'his ~ [~] item shall include all Proposed Grade Changes and 4~,/4~( 0-c~/C//e~, C~-~ ?~-Or/~ 3 DoestheSitePlanand/orSur~eydesclibetheerosilx1 end sediment consol prac~ces that will be used to contr~ site erosion and storm water discharges. 'l~s /tX.h~ OAi~C.r~ e~ ~'/-~k~ 4 Wi]l*isPr°le~"ed'lro'~kandFKlin~,Oradlng°r E~eting Grade Involving more Iben 200 Cubic Yards · ·. , ~.~' ' ~/ 5 1~I~ this Appllcagon Redulro Land Oisturbthg AclJvilies ,I Encompassing an Area in Excess of Five Thousand V (5,000 S.F.) Square Feet of Gro~cI SuKace? 6 Is there a Netural Water Coume P, unn~g thro~Jgh the Site? Is this Project withth the Trustees Judsdicgon swPpP's 8hldl meet the Minimum RKlulrement~ of the SPDE$ ~eneral hm~lt 8 Will Dgveways. perld~g Areas or other Impervious ~ 1 / STAT~Or NEW¥ORI~, ~O~C~,///' COUI'CrY OF ............. L.L..~...I.I.~,..... SS "' d ................................................................................. And tlm he/~he i~ the ........................................................................... Owner and/or repre~ntalive of the Owner or O~raer~, and i~ duly authorized to peffom~ or have performed the mid work and to make and file thi~ application; that all ,tatement~ ¢on~ah~ett in dfi~ application are m~e to thc b~t of hi~ knowlcd~ and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; ~ i Nora7 Public: .~X...'.'.'.'.'.'.'.'.'~..~ i....~ FORM - 06110 Notary Pub;it, State ~f NaW Ym"~ No. 01RI60a2467 Qualified in Suffolk Cour~t, Commission Expires May 30, ~ of Trustees ApplicatioO AUTHORIZATION (where the applicant is not the owner) I, ED FOX & ARLENE FOX (print owner of property) residingat. 455 EAST 80th ST. APT 8E (mailing address) Tom Samuels of Samuels and Steelman Architects do hereby authorize Tom S amue 1 s (Agent) to apply for permit(s) fi'om the Southold Board of Town Trustees on my behalf. (Owner's signature) of Trustees ApplicatioO County of Suffolk State of New York ED POX & ARLENE FOX 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 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. Signature SWORN TO BEFORE ME THIS NO 0IVY(il 12140 :: ~LIFIED iN BRONX COUNTY MY L~L)MMiS,~ION EXPIR£S JUNE 28, 20 DAY OF ~.J c_5 1 y ,20 Ii APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. ]'he purpose of this lbrm is to provide inibrmation which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. Samuels, YOUR NAME: Thomas C. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. Il'so. indicate the other person's or company's name.) NAME OF APPLICA I ION: (Check all that apply.) /ax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption t¥om plat or official map Planning Other (If"Other", name the activity.) X 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 busincss 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. X YES NO If you answered "YES", complete thc balm~ce of this form and date and sign where indicated. Name of person employed by thc Town of Southold fitle or position of that person Describe the relationship between yourself (the applicant/agent/representative) and thc town officer or employee, Either check the appropriate line A) through D) and/or describe in the space provided. Ihe town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): ____A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); .... B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation): C) an officer, director, partner, or employee of the applicant: or __D) the actual applicmm DESCRIPTION OF REI.ATIONSHIP Form TS I Submitte~L.~ daye~ ~t~d~ Signature ~IA~{~ ~ PrintNam~8 C. Samuels 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. *Excep! minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard ~lrea. 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). If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review' law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 12 2 0 9 9 . 4 The Application has been submitted to (check appropriate response): Town Board [] Planning Dept. [-~ Building Dept. [-~ Board of Trustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification Nature and extent of action: EXISTING STONE PAVING AT SOUTHERN END OF EXISTING POOr, TO BE REPLACED WITH STONE PAVING IN KIND, w/TIMBER PILE FOUNDATION TO PREVENT SETTLING Locationofaction: 2503 CAMP MINEOLA ROAD EXT, Southold, NY 11971 Site acreage:. 1.469 AC Present land use: Single Family Residence Present zoning classification: R- 40 If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: ED FOX & ARLENE FOX (b) Mailing address: 455 EAST 80th ST. APT 8E (c) Telephone number: Area Code ( ) (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [-~ No [] If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes ~ No [] Not Applicable Renovating an exmsting terrace preserves open space around the existing terrace and makes efficient use ot the existing property. 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 There are no historic or archeological structures on property. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No ~ Not Applicable The terrace is at ground level and will not obstruct any views 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 [-~ Not Applicable During construction hay bales will be placed between the construction and the shore, to keep runoff spoils on the site. 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 Ail rainwater runoff is and will be retained within the upland, by use of underqround drywells. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes ~ No ~ Not Applicable No development will take place in the "protected" or "natural indiginous environment". Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No [] Not Applicable The development will not add pollutants into the air. Ail construction vehicles meet the Federal standards for air pollution discharge. The mechanical systems of the residence meet the federal standards for air pollution discharge. At~ach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes [] No ~-~ Not Applicable The construction and use of the residence will make use of the town's disposal and recycling center. All waste water "sanitary" is discharged into an approved SCDHS sanitary system. 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 No public land involved. Littoral access unimpeded. 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 There are no public or commercial activities or uses on site. Historically this property and neiqhborinq properties are residential in use and will remain residenYi~l, 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 Ill - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~ No [] Not Applicable This project will protect and preserve the living marine resources by maintaininq all rainwater discharge and sanitary flow from the residence on site by approved SCDHS sanitary system and drywells for rainwater runoff. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section Ill - Policies; Pages 62 through 65 for evaluation criteria. [] Yes [~ No [] Not Applicable There are no agricultural lands on site. Atlach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section Ill - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [-~ No [] Not Applicable The construction will be using equipment approved by the Federal government for energy usage. The residence will meet Federal standards for conserving enerqy "enerqy Star Proqram" and will use "NY State Enerqy Conservation and C~n~rll~n Code" for ~trll~ti~m PREPARED BY~ Created on 5/25~5 11.'20 AM TITLE ARCHITECT DATE JUNE 24, 2011 S A M U E L S & S T E E L M A N July 19, 2011 Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 RE: RENOVATIONS AT THE FOX RESIDENCE 2503 Camp Mineola Road Mattituck, NY 11952 TAX MAP # 1000-122-09-9.4 Dear Sir/Madam: We are requesting an AMENDMENT to current permit #7443. The project has been significantly scaled back to include only the replacement in kind of existing stone paved swimming pool terrace (with timber piling support) and installation of power generator. Both these items are covered in the existing permit, along with other work. 2. 3. 4. 5. 6. 7. Trustee Permit Application Affidavit LWRP Consistency Assessment Form (3) SITE PLANS prepared by Samuels & Steelman Architects Current Survey Letter of authorization from Owner Check for $50 Please call us with any questions or concerns. Sincerely, SAMUELS & STEELMAN ARCHITECTS C~-~els' Alchitect enc. ([J[( IIO(;LJ[, NEW Y()RK TEST HOLE DA TA TEST HOLE DUG BY McDONALD GEOSCIENCE ON dUNE 2, 1999 o~ -~ ~ EL. EL. 2.0' IN MIXED .SAND, LOAM ¢ OLAY Y, IATB'~ IN BROPIN BO¢ pt: J, NATER IN ~REh' C, LAYE'Y 5AND 5C J."~Tr~R IN EP-.OPtN C.,LA"r'E'Y t~0¢ PI: !.flATEP. IN 5REh' CLAYEY 5AND 20' 2,3' I~IATE~. IN PALE BP.O~N PINE 29' "FELEF ELECq ELECq I~EPLACE 55TONE PAVINE, IN KIND, ~frlMBE~ PILE55 t~ELO~ TO 55ETTL IN~ - ~ONE JUNCTION BOX RIC., JUNCTION E~OX R I C.., METER ./ SITE DATA SCTM # 1000-122-9-9.4 lt,~r.r, ra~ J*. ~JP. il, rO LAND~CAPED PROPERTY: ADDRESS 2503 CAMP MINEOLA ROAD EXT. MATTITUCK, NY OWNER: ED & ARLENE FOX 455 EAST 80th ST. APT 8E NEW YORK, NY 10021 ZONING: R-40 SURVEYOR: NATHAN TAFT CORWIN III LICENsERIVERHEAD'# 50467NY 11901 / / / S D4'50'50" W S 84-'50'50" W CO_ VER_ A6 E SITE AREA 63,993 SF -- 1.469 ACRES NOTES: / . .. EX. HOUSE & 2,107 SF ~ / JUNE 24, 1999 POOL HOUSE AUGUST 2, 1999 ADDED PROPOSED HOUSE EXI55TIN~ AUGUST .30, 1999 SET LATH FOR N.Y.S.D.E.C. INSPECTION " .~/ UNI:;'EI~.~ROUND JANUARY 12, 2000 REVISED SITE PLAN EX. POOL & 3,297SF PUELIC Y<ATEP. JULY 11, 2000 ADDED PROPOSED WATER SERVICE STONE PAVING ~: 55ERV'ICE LINE JANUARY 30, 2001 UNDER CONSTRUCTION SURVEY APRIL 8, 2002 FINAL SURVEY JUNE 14, 2002 REVISED CESSPOOL MEASUREMENT JULY 31, 2002 REVISED CESSPOOL MEASUREMENT AUGUST 19, 2002 ADDED ROOF OVERHANG AT POOL HOUSE JUNE 27, 2003 SET MONUMENTS & RE-BARS JUNE 16, 2004 SET RELOCATE H.W.M. & SET RE-BARS AT 75' & 100' SETBACKS DECEMBER 7, 2007 UPDATE HIGH WATER MARK LOCATION & STAKE 100' SETBACK EX. COVERAGE 5,404 SF = 8.4% ~ LEACHIN~ POOL55 / / O TO EXI55TIN¢ TI ME~E~. RETAININ~ Y, IALL TO REMAIN EX155TIN~, .' ,: EXI55TIN~ VEDETATED EX155TIN,"'m POOL 8,6' EXI55TI N~, MAEONRh' RETAININ~ I/~ALL, TO REMAIN EXI55TIN¢ 55ANI TARh' BLDg. TO REMAIN ---pROPO55ED HAh' BALE55 ~ 551LT PENCE DUAINO CON55'rRJJCTION EXI55TIN~ PENCE TO REHAIN 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS=.tm~ 2, WETLANDS IF ANY ARE HOT SHOWN 3. FLOOD ZONE INFORMATION TAKEN FROM.' FLOOD INSURANCE RATE HAP Ho. $$105C0482 G ZONE /~E: BASE R. OOD E!..L~VA~ON$ DESERMINED APPROVED BY [;OARD OF TRUSTEES TOWN OF $OUTHOLD DATE d~[ 21 2011 Southllold Town LOCATION MAP DEAC.,H GREAT PECONIC SITE PLAN SCALE: t" = 30' -0" BAY REGULATORY APPROVALS ,,,111 DRAWN BY: CHECKED BY: DATE: SCALE: SHEET TITLE: SITE PLAN SHEET NO: 0511 TCS 7/19/11 1"=30' 1