The URL can be used to link to this page

Home My WebLink AboutTR-7602 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hail 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 CERTIFICATE OF COMPLIANCE # 0755C Date June 6, 2012 THIS CERTIFIES that the demolition of the existing dwelling and sanitary system; construction of a new two-story dwelling on pilings; new sanitary system with fill; new permeable driveway; gutters, leaders and drywells At 170 Park Ave. Ext., Mattituck Suffolk County Tax Map #123-8-24.1 Conforms to the application for Trustees Permit heretofore f'ded in this office Dated 5/11/11 pursuant to which Trustees Wetland Permit #7602 was issued on 7/20/1 land Amended on 2/22/12 and conforms to ali of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for The demolition of the existing dwelling and sanitary system; construction of a new two-story_ dwelling on pilings; new sanitary system with fill; new permeable driveway; gutters, leaders and drywells. The certificate is issued to DAVID & LIBBY ROSS owners of the Aforesaid property. Authorized Signature S A M U E L S & S T E E L M A N March 27, 2012 Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 MAR 2 8 2012 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 Wetland Permit #7602 Dear Trustees: In order to comply with the details of the Stormwater Management Plan approved by the Town Engineer as required by the Building Department, whose intention is to minimize rain water runoff into road and the nearby wetlands, we have determined that additional clean fill is required to the above referenced project. There are several large drywells required and shown under the permeable driveway on the attached SITE PLAN, and required dimensions to groundwater. We initially indicated on our Trustees permit application that we would need approximately 500 cubic yards to fill the new sanitary system. We hereby request an amendment to the Trustees permit to add an additional 400+/- cubic yards of clean fill to adequately position and cover the required drywells. Attached please find three stamped revised SITE PLANs for the above referenced project. You will also find a check for $50. Please review the enclosed, and, if appropriate, issue a REVISION to the permit. S A M U E L S & S T E E L M A N February 1, 2012 Southold Town Board of 'Trustees Town Hall Annex Main Road Southold, NY 11971 F E g - 1 2012 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 Wetland Permit #7602 Dear Trustees: Attached please find three stamped revised SITE PLANs for the above referenced project. You will note a "bubbled" note to the lower left, describing a proposed addition to the previously approved open deck on the west side of the house (currently under construction) You will note that we propose to add 89 square feet to that deck, in a conforming location. You will also find a check for $50. Please review the enclosed, and, if appropriate, issue a REVISION to the permit. Thank you, Thomas C. Samuels, Architect enc. ARCHIIECIS 2,2/5 MAIN R()AD (LJq(IIOGUE, NbWY()RK 11%5 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 1197[ T¢lq~hone (63 I) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: /"/Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~A constructed Project complete, compliance inspection. O~.- ~ ~L--~ h~Ltt J~dl,~ % ~ INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 April18,2012 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Thomas c. Samuels, R.A. Samuels & Steelman Amhitects 25235 Main Rd. Cutchogue, NY 11935 RE: DAVID & LIBBY ROSS 170 PARK AVE. EXT., MATTITUCK SCTM#123-8-24.1 Dear Mr. Samuels: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., April 18, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #7602 to add an additional 400 cy. of clean fill for the new sanitary system, and as depicted on the site plan prepared by Thomas C. Samuels R.A. last revised March 27, 2012 and stamped approved on Apd118, 2012. This is not a determination from any other agency. Sincerely~ c~ James . K~ing, Preside~ Board of Trustees JFK:lms James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino PO Box 1179 Southold, NY 11971 Telephone(631 765-1892 Fax(631)765-6641 Date/Time: Southold Town Board of Trustees Field Inspection/Worksession Report /toot Samuels & Steelman on behalf of DAVID & LIBBY ROSS requests an Administrative Amendment to Wetland Permit #7602 to add an additional 400 cy, of clean fill for the new sanitary system. Located: 170 Park Ave. Ext., Mattituck. SCTM#123-8-24.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound __Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment ~Ad ministrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __J, King __B. Ghosio __ J. Bredemeyer Michael Domino Form filled out in the field by D. Bergen, D. Dzenkowski other Mailed/Faxed to: Date: James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 February 22,2012 BOARD OF~ TOWN TRUSTEES TOWN OF SOUTHOLD Thomas C. Samuels, Architect Samuels & Steelman 25235 Main Rd. Cutchogue, NY 11935 RE: DAVID & LIBBY ROSS 170 PARK AVENUE EXT., MATTITUCK SCTM#123-8-24.1 Dear Mr. Samuels: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., February 22, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #7602 to add 89 sf. to the previously approved deck, as depicted on the site plan prepared by Thomas C. Samuels, R.A. last revised February 1,2012. This is not a determination from any other agency. Sincerely, Jan~F. King, Presi"~'t Board of Trustees JFK:lms James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeycr Michael J Domino P.O Box 1179 Southold, NY 11971 Telephone(631 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Samuels & Steelman Architects on behalf of DAVID & LIBBY ROSS requests an Administrative Amendment to Wetland Permit #7602 to add 89 sf, to the previously approved deck, Located: 170 Park Avenue Extension, Mattituck. SCTM#123-8-24.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound -"l~ay ' Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 __other Type of Application: __ Wetland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission __.Violation Info needed: Modifications: Conditions: Present Were: ~J. King B. Ghosio ~"/D. Bergen, c~j. Bredemeyer ~ael Domino D. Dzenkowski Form filled out in the field by ~ , ~,,/'//,j & Mailed/Faxed to: Date: other S A M U E L S & S T E E I_ M A N August1,2011 Southold Town Board of .Trustees Town Hall Annex Main Road Southold, NY 11971 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 SCTM# 1000-123-08-24,1 Dear Lauren: Attached please find four stamped revised SITE PLANs for the above referenced project, showing exchanged locations of leaching pools and expansion pools, per your request. If this revision meets with your approval, please send stamped drawings and a permit for the project. Thank you, ~els, Architect ARC~ IfTECTS 2523~ MAIN ROAD {OGUE NEW YORK 11935 (631/ 734 6405 FAX (6131) 734 6407 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, Date: Re: Principal Planner _ LWRP Coordinator July 20,2011 ~ Proposed Wetland Permit for DAVID & LIBBY ROSS SCTM#1000-123-8-24.1 Samuels & Steelman Architects on behalf of DAVID & LIBBY ROSS requests a Wetland Permit to demolish the existing dwelling and sanitary system; construct a new two-story dwelling on pilings and install a new sanitary system with fill; and install new permeable driveway. Located: 170 Park Avenue Ext., Mattituck. SCTM#123-8-24.1 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 INCONSISTENT with following LWRP policy standard and therefore is INCONSISTENT with the LWRP. 5.4 Limit the potential for adverse impacts of watershed development on water quality and quantity. Protect water quality by ensuring that proposed expansion or intensification of existing watershed development results in: 1. protection of areas that provide important water quality benefits Limit the individual impacts associated with development to prevent cumulative water quality impacts which would lead to a failure to meet water quality standards. The septic profile indicates that the bottom of the leaching pool is proposed at a 2ft separation distance from groundwater. Subsurface flow of wastewater from the system would contribute further to degrading the quality of groundwater and eventually the water bodies Deep Hole Creek and Great Peconic Bay by contributing an increase in pollutant loads such as nitrogen. 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 Application :h~Wetland Permit Application __ Amendment/Trans fcr/EIctension '21~_Rece~vved Application:/~_/~/~ 4~&_Received Fee:$,~%-~O o~ --Completed Appficationf~J,~_ --Incomplete SEQRA Classification: Type I Type II__Unlisted Coordination:(date sent) ~WRP Consistency Assessment Form ~9 ~/CAC Referral Sent~.~_ ' ~',.~'D ate ofinspection:[,_~'p.~].tl __Receipt of CAC Report: ' __Lead Agency Determination: Technical Review: ~-.~'Public Hearing Held:~J/_ __Resolution: Administrative Permit Name of Applicant ~//~)c~ Clt3bq, Address ~ 2 ~o1~ ~, ~{~., PhoneNmber:( ) 203 Suffolk CounW Tax Map Number: 1000- J~ - O~ - ~. ProperWLocation: /70 f~AV~OE b~FC~S(~ , V'T PoL (~o~ide LILCO Pole ~, dis~ce to cross s~eets, a~d location) (If applicable) Address: Phone: Boa~of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. GENERAL DATA Yes V/ No Does this project require a variance from the Zoning Board of Appeals V/ If"Yes", please provide copy of decision. ~0~ ~ Prior permits/approvals for site improvements: Agency Date Yes No ~No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspenja~d by a governmental agency? VNo Yes If yes, provide explanation: Project Description (use attachments if necessary): (c~4,60[~'h ~!C ~-l'ffL(~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: '"~0 Area ofwetlands on lot; /-//qLO7 square feet Percent coverage of lot: / ~' 7 % Closest distance between nearest existing structure and upland - I edge of wetlands: ~ ~ ~/~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~fff/~_ 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? 5~)0 ~ cubic yards Depth of which material will be removed or deposited: Proposed slope throughout Ihe area of operations: d~) - 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 appropriate): Board of Trustees Application (print owner of property) AUTHORIZATION (where the applicant is not the owner) residing a[ G ~ ~)QB~ ,~' (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold~oard of Town Trus}ees on my behalfi {"Owner'; signature) ' Board of Trustees Application County of Suffolk State of New York BEING DULY Swov. N 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 1N 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. SWORN TO BEFORE ME THIS DAYOF ~ ,20Jj[_ Notary Public F&T[~[CIA RICHAED3 i~c~cry Public, State of New York I~o. 01RI6042467 Qualified in Suffolk County Cca~n~i~s~on Expires iVlay Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY L0C~TIO#: B~¢.T.M.#: THE FOIl. OWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ek~ '~ CERTIFIED BY A DESIGN PROFESSIONAL IN THE*STATE OF NEW YORK. a, Wi~at Is the Total Are8 of the Project Parcels? . (include Total Area of all Parcels located wllhln ~)~ ~LL~ [) '~./J./..~, ~ Will this Pro~ Retain All ~orm-Water Run-Off the Scope o~'Work for Proposed Construction) UcC. I (This item ~[I Include all runmff creethd by gteGenerated by e Two (2") Ir~h Rainfall on Site?/ r"~ b. whst is the Tstal Ama of Land Clearing ($,~,. / ~:m) ~/~,.¢~ ctearlng and/or constmc.~on activities as weiJ as all and/or Ground DIslurbance i'm'the p~oposed ~.~/~ Srte Improvements and the permanent creation of construction aclMty? Impe~ou$ surfaces,) ,s,./~, 2 D~es the Site Plan ancot Sun.~y Show N] pmpcoed ~[~ ~ROY]D~. ~ I~O~.~-~ D]E~Ci~3Jri'iON p,,v~ ~.~-~,e Drainage Stmcture~ Indlcaling Size a Location? This item shag Include all Proposed Grade Changes end ~J~.~5 ~ ~ £1[,Cl' ~g{,r(,~ ,u ~q h~[/C"~ nI~LU ~L40 0. 3 conb-olandDcos the Site Plan andlor Survey describe the erosionsedimentsite, eroslonCOntrolandPraCtlCeSstorm water disch~ges,that will be used tOThis~ r~l ~(.(~. 0~,..~;(~,~.~ OH pi[i~¢'~, ~l'~() ItemmustbemaintainedthmughouttheEn§m /~ C~lstructlon Pefled. Existing Grade Irwolvlng more than 200 Cubic Ya,-ds (J~,KC V'P~AJJ~[.~L ~Y~.~.. of Material wlthln any Parcel? O 5 W'dl this Appllcstfon Require Land DIsturbing,N:tMliss I'--'/1 , Encompes~lng an Area in Excoss of Five Thousand · (5,000 $,F.) Square Feet of Ground Surfaco? 6 Is there a Natural Wster Course Runnthg through the Site? Is this Project within the Trustees Jurisdiction V/ s~e ID P = orwlthlnOneHundmd(100')feetofaWellandor Islurbances~f~e{1}~rn~eac~; iadud!ngdi~fl~ac~ofle~l;l~ae~cm~hat 7 Will there be SIte pmparstJon on ExJsflng Grede SIopes which Exceed Fifteen (15) feet of VerUcaJ Rise to lncfluc~ng Conlt~=aon ac~4~ Invelvhg =~ d~tu~er~es ~ I~ Ih~n ene (1) ac, m where One Hundred (100') of HoKzontal Dislallce? L~J 2. The 5WPPP ~laB ~ I~e emal~l ~rld sediment (xmb~ p~llctk:es and v/ae~ 9 WIll this Project Require the Placement of Material, requlmd, po~-comln~llon~k~lwa~'managementprac~:~thatwilltmusedand~r RemovelofVegetat~onandlor~eConsthJ~onofany ~ /.. a~evcled to mCuce Ihe peliutana ~n m ~ dla~arga~ axt to usure Item Wlthln the Tovm RJght-~t'.Way or Road Ovmer and/or repmsentafiw of ~h¢ Owner or Owne~, and i~ duly authori~l to perform or hav~ l~rformed the ~aid work and to mak~ and file thi~ application; tha~ all *tatementa con~ined in fl~ appli~lion am m~e m d~¢ be~t ofhi~ knowledge and belie.~ and that th, work will b~ performed in thc nmner ~¢t forth in the application filed herewid~. Sworn to befor~ me thi~; FORM-O~IO PATRIClA RICHARDS Notary Public, State of New No. 01 RI6042467 Qualified in Suffolk Count~ Commission Expires May 30, 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION ~o be completed by A~)plicant or Project Sponsor) 1. APPLICANT/SPONSOR /2. PROJECT NAME 3. PROJECT LOCATION: Municipality ~0 4P/-~'/C2~.-/~ County 4. PRECISE LOCATION (Streat address and road intemections, prominent landmarks, etc., or provide map) t 7c;, ~,,,h~ ,4ubTw~: ~'Az"~%,~/,c,w, ~/Oo~eox, /_~:~ p~. E'.4oT ~F §. PRO~O,.~,IiD ACTION 18: ~ New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: P~g~ocx~ E~X/S r-/A/'6' ,PF3'/~6-z' C_.6 ~ .~,gz,17'-.'q~°l' ~ ~,'Sr'6Ih, ~ 6. ~u. PROPOSED ACTION COMPLY ~TH EX,STING ZON~N~ OR OTHER EX~S~NG ~O USE RE~rmD~ONS? ~. W~T IS PRESENT L~ND USE IN VICINI~/DP PROJECT? [~Residential [] Industrial [] Commercial [] Agriculture [] PaddFomstfOpen Space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FE_D.ERAL, STATE OR LOCAL)? [~Yes [] No If Yes, list agency(s) name and permltJapprovals: ~ooT-HooD -Mo_c~S-c-O-e-~.. .~OrL..~//V'-G- l.>o~:~,r ..~ cDt-/,-.C 11. DOES ANY ASPECT OF.. THE ACTION HAVE A CURRENTLy VALID PERMIT OR APPROVAL? [] Yes [~]/No If Yes, list agency(s) name and permffJapprovals: 12. AS A RESULT OF PRO~=OSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes ~No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ^pplicant/sponsornsme: '7'~'~.44('~ c- ~5-~U~--~ Date: Signature: '--'~///~' ~ IIf the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with ,s assessment I OVER 1 A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL FAF. [] Yes [] No B. W1LLACT~~NRECE~vEC~~RD~NATEDREV~EWASPR~~~DEDF~RUNL~STEDA~T~~NS~N6NY~RR'PART617~6? IfNo, anegative declaration may be superseded by another involved agency. DYes •No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, sudace or groundwater quality or quantity, noise lavels, existing traffic pettem, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, hiatodc, or other natural or cultural resources; or community er neighborhood character?. Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife sPeCtes, significant habitats, or threatened or endangered species? Explain b~fly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural raseurces? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Exptain b~atly: C6. Long term, short term, cumulative, of other effects nat identified in C1-C57 Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: D. W1LL THE PROJECT HAVE AN iMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? [] Yes [] No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explain b~iefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, la~;le, important or otherwise signiticant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (0 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 pert ii was checked yes, the determination of significance must evaluate the potential impact of~te proposed action on the environmentalcharactedstJcs ofthe CEA. [] Check this box if you have identified one or more potentially large or significant adversa impacts which MAY occur. Then proceed directly to the FULl FAF and/or p~pem a positive declaration. [] Ches~ this box if you have determined, based on the information and analysis above and any supporting documentation, that the pmposad aotior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments es necessary, the masons supporting thi= determination. Name of Lead Agency Date Print or Type Name of Responsible Officar in Lead Agency Title of Responsible Officer Signature of Rasponeibts Officer in Lead Agency Signature of Preparer (If different from responsible officer) PART II - IMPACT ASSESSMENT ITo be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD ~N 6 NYCRR, PART 617,4? tt yes. coordinate the review process and use the FULL FAF. ~lYes r~'j No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS iN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another invelved agency. [~J Yes r~'l No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing air quality, surfaco 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 neighbenhood character? Explain briefly: I C3. Vegetation or fauna, fishl shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain tihefly: I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natura~ resources? Explain briefly: I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdeflyl C6. Long term, sho-~ te--ml, cumulative, or other effect~'ho~ht~fied in Cl-C57 Explain briefly: C7. Other impacts linclodinl~ chanties in use"~f either cluantity or type of energy? Explain bhefi~/: ENVIRONMENTAL AREA {CEAI? IIf )'es, exl31ain brier)': E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~thenvisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban 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 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 ledge or significant adverse impects which NAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT resufl in any significant adveme envfmnmenfal impacts AND provide, on attachments as necessary, the reasons supporting thi~ determinafion. Board of Trustees Name of Lead Agency Jill M. Doherty P~nt or Type Name of Res, pgnsible Officer in L~ad Agency /f Signature of Respoi~51e Officer/i~_ead Agency President Title of Responsible Officer Signature of Preparer (If different from responsible officer) Certified F~e ~2.e~ ~ ~ Restricted Del~ve~ F .... ~% (Endorsement Required ~.~ ~;~:~:~ -~'z;~7 ....... ;'""T ........... ~/o,~o'~;~o" I~ STATE OF NEW YORK COUNTY OF SUFFOLK ~i) k)d4,,.BI~ I IkJ~ , being duly swom, deposes and says that on the ~_ day of 7J'l)~ ,20 ~ , deponent mailed a tree copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at (_~ q U.~ ~ kJ-4 , that said Notices were mailed to each of said persons by (certified) (registere"'d) mail. I Sworn to [~efore me this c~/ Day of-Mix ~ ,20-~ ~ tN0t-ary Public LAUREN M. STANDISh Noten/Public, State of New York No. 01ST6164008 Qualified in Suffolk County. Commission Expires Apri! 9 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of DAVID & LIBBY ROSS COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at/dba ,~ g,~O0~ q~tO~ ~'-]~-/~ P'~ being duly sworn, depose and say: That on the It~ day of"O'~)~ ,201 , I personally posted the ~opertysknown as. by placing the Board of Trustees official poster where 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 heating. Date of heating noted thereon to be held Wed~ June 21~ 2011 on or about 6:00 PM. Sworn to before me this day o ~I'~°/~C20 /I gature) rqotary Public No,%ry Public, State of New Yo~;~ No, 0'1 RI6042467 Qualified in Suffolk County Commission Expires May 30, ~ LETTER OF AUTHORIZATION David and Libby Ross 68 Dubois Street Darien, CT 06820 April 18, 2011 We hereby authorize Thomas C. Samuels of Samuels and Steelman Architects or 25235 Main Road, Cutchogue, NY, to apply for all required permits from the Town of Southold, Suffolk County and State of New York, for the reconstruction of our residence at 170 Park Avenue Extension, Mattituck, NY. D~d Ross I~ate' / ' ~a!e./'-,)/'/ Boar~f Trustees Application County of Suffolk State of New York ~)Wl.Vi~'~ e~. 0~'~ BEINO 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 AN Y 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 ~.~VIEW OF THISQP~PPLICATION. Signamre SWORN TO BEFORE ME THIS J ] DAY OF /9~7 ,20 / / otary Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics t~rohibits conflicts of interest on the t~art of town officers and emolovees. The ooroose of this form is to provide information which can alert the town of unssible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, flint name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) 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 parmership, in which the town officer or eroploy%e has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5%~the shares. _ YES NO V 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 Desctibe the relationship between yourself (the applicant/agenl/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 applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-co.orate entity (when the applicant is not a co~oorafion); ___C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this Signature Print Name 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 Waterfi-ont 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 Waterfi'ont 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# 123 08 24 . 1 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: Demolition of existinq residence and abandonment of existing sanitary system, construction of new two story residence with new sanitary system. Location of action: Site acreage: Present land use: 170 Park Avenue Extension, Mattituck, NY 0.644 AC Single Family Residence Present zoning classification: R- 4 0 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: (b) Mailing address: Darien, David and Libby Ross 68 Dubois St. CT 06820 (c) Telephone number: Area Code ( ) 2 0 3 - 5 7 0 - 3 3 7 8 (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?. NYS DEC 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 [] N,o [] Not Applic,able Demolxshxng an exxsting, non~conforming structure and replacing it with a new structure, and sanitary system will improve the environmental situation on this beach and site. 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 ifnecessa~ Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No [-~ Not Applicable The new structure is in keeping with the style of all neiqhborinq structures. 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~lr~ No [] Not Applicable All rainwater runoff is and will be retained on site with the use of underground dr}wells. 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 IH -Policies Pages 16 through 21 for evaluation criteria [] Yes [] No [] Not Applicable All rainwater runoff is and will be retained within the upland, by use of underground drvwells. The sanitary system for the residence meets current SCHD standards for sanitary waste water. Attach additional sh~ts 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 Ill - Policies Pages 32 through 34 for evaluation criteria. ~-~ Yes [-~ No [] Not Applicable The development will not add pollutants into the air. All construction vehicles meet the Federal standards for air pollution discharge. The mechanical systems of the residence meet the federal standards for air Pollution discharqe. 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 11I - 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 recyclin9 center. Ail waste water "sanitary" will be discharged into an approved SCDMS 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 HI - Policies; Pages 38 through 46 for evaluation criteria. ~-~ Ye~ 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 IH - 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 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 This project will protect and preserve the living marine resources by maintaining 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 HI - Policies; Pages 62 through 65 for evaluation criteria. [] Yes ~ No [~ Not Applicable There are no agricultural lands on site. Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section IH - 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 PREPARED BY ~ Created on 5~5/05 11:20 AM S A M U E L S & S T E E L M A N May 11,2011 Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 SCTM# 1000-123-08-24.1 Dear Sir/Madam: We are requesting a WETLANDS PERMIT for the above reference project, for the demolition of an existing residence and the new construction of a residence on pilings, with sanitary system, driveway, and associated improvements. All drainage will be directed to subsurface systems. For your review we are submitting the following documents: 2. 3. 4. 5. 6. 7, 8. 9. Application Short Environmental Assessment Form Application Affidavit LWRP Consistency Assessment Form (3) SITE PLAN, FLOOR PLANS and ELEVATIONS Stamped current Survey Letter of authorization from Owner Check for $250.00 Five (5) photographs of existing site conditions Please call us with any questions or concerns. Sincerely, SAMUELS & STEELMAN ARCHITECTS enc. ARCHITECTS 25235 MAIN ROAD CUICHOGUE, NEWYORK 11935 (6~ I) 734 6405 FAX (6111734-6407 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 February 22, 2012 BOARD OF. TOWN TRUSTEES TOWN OF SOUTHOLD Thomas C. Samuels, Architect Samuels & Steelman 25235 Main Rd. Cutchogue, NY 11935 RE: DAVID & LIBBY ROSS 170 PARK AVENUE EXT., MATTITUCK SCTM#123-8-24.1 Dear Mr. Samuels: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., February 22, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #7602 to add 89 sf. to the previously approved deck, as depicted on the site plan prepared by Thomas C. Samuels, R.A. last revised February 1, 2012. This is not a determination from any other agency. Sincerely, Jam~F. King, Presi~t Board of Trustees JFK:lms S A M U E L S & S T E E L M A N Februaw 1,2012 Southold Town Board of Trustees Town Hail Annex Main Road Southold, NY 11971 F E B - 1 2012 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 Wetland Permit #7602 Dear Trustees: Attached please find three stamped revised SITE PLANs for the above referenced project. You will note a "bubbled" note to the lower left, describing a proposed addition to the previously approved open deck on the west side of the house (currently under construction) You will note that we propose to add 89 square feet to that deck, in a conforming location. You will also find a check for $50. Please review the enclosed, and, if appropriate, issue a REVISION to the permit. Thank you, Thomas C. Samuels, Architect enc. AR(HIIECIS 252)a MAIN ROAD CUiCIIOGUF, NEWYORK 119~5 (6H)734 6405 FAX <63 I ) 7 ~4 64()7 Jmnes F King, President Bob Ghosio, Jr., Vice-President Dave Bergen Johll Bredcmcycr Michael J Donfino P.O Box 1179 Southold, NY 11971 Telephone (631 765~1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: F£/¢ I ~ ~o / ~ Samuels & Steelman Architects on behalf of DAVID & LIBBY ROSS requests an Administrative Amendment to Wetland Permit #7602 to add 89 sf. to the previously approved deck. Located: 170 Park Avenue Extension, Mattituck. SCTM#123-8-24.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission __.Violation Info needed: Modifications: Conditions: Present Were: '~SJi King B. Ghosio ~'/D. Bergen, '>'JJ. BredemeyeE ~ael Domino D. Dzenkowski Form filled out in the field by ~ , // ~j & Mailed/Faxed to: Date: other 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 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7602 DATE: JULY 20~ 2011 ISSUED TO: DAVID & LIBBY ROSS PROPERTY ADDRESS: 170 PARK AVENUE EXT. MATTITUCK SCTM# 123-8-24.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on July 20, 2011, and in consideration of application fee in the sum of $250.00 paid by David & Libby Ross and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trnstees authorizes and permits the following: Wetland Permit to demolish the. existing dwelling and sanitary system; construct a new two-story dwelling on pilings and install a new sanitary system with fill; and install new permeable driveway; with the condition of the installation of gutters to leaders to drywells on thedwelling to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Management; and as depicted onthe site plan prepared by Samuels & Steelman Architects, last dated August 1, 2011, and stamped approved on August 5, 2011. IN WIT'NESS WHEREOF, tho said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority 6f the said Board as of this date. TERMS ~,~ND CONDITIONS The Permittee David & L~b¥ Ross, residing at 170 Park Avenue Ext., Mattituck, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released fi'om any and all damages, or claims for damages, of suits arising directly or indirectly a~ ~a result of any operation performed pursuant to this permit, and the said Pennittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said P~nfittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit i~,valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that maybe required supplemental to this permit, which may be subject to revoke up°tt fail,re to obtain same. Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375Main Road P.O. Box 1179 Southold, NewYork11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 July 20, 2011 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Tom Samuels Samuels & Steelman Amhitects 25235 Main Road Cutchogue, NY 11935 RE: DAVID & LIBBY ROSS 170 PARK AVENUE EXT., MATTITUCK SCTM# 123-8-24.1 Dear Mr. Samuels: The Board of Town Trustees took the following action dudng its regular meeting held on Wednesday, July 20, 2011 regarding the above matter: WHEREAS, Samuels & Steelman Architects on behalf of DAVID & LIBBY ROSS 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 May 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 5,4 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: relocate the most southerly proposed expansion pools to the north and relocate the most northerly proposed leaching pools to the south, the installation of gutters to leaders to drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Management, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 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, 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of DAVID 8, LIBBY ROSS to demolish the existing dwelling and sanitary system; construct a new two-story dwelling on pilings and install a new sanitary system with fill; and install new permeable driveway; with the condition of the installation of gutters to leaders to drywells on the dwelling to contain roof runoff and in accordance with Chapter 236 of the Town Code- Storm Water Management; and as depicted on the site plan prepared by Samuels & Steelman Architects, last dated August 1, 2011, and stamped approved on August 5, 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: $100.00 Very truly yours, Jill{~. Doherty ~lf President, Board of Trustees JMD/eac Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765~o641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: DAVID & LIBBY ROSS Please be advised that your application dated May 11,2011 has been reviewed by this Board at the regular meeting of July 20, 2011 and your application has been approved pending the completion of the following items checked off below. __ Revised Plans for proposed project XX Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ 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: Pre-Construction Hay Bale Line Inspection Fee - $50.00 Final Inspection Fee - $50.00 TOTAL FEES DUE: $100.00 BY: Jill M. Doherty, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., June 15, 2011, the following recommendation was made: Moved by Jack McGreevy, seconded by Meaghan Burke, it was RESOLVED to SUPPORT the Wetland Permit application of DAVID & LIBBY ROSS to demolish the existing dwelling and sanitary system; construct a new two-story dwelling on pilings and install a new sanitary system with fill; and install new permeable driveway. Located: 170 Park Avenue Ext., Mattituck. SCTM#123-8-24.1 Inspected by: Jack McGreevy The CAC Supports the application with the Condition gutters, leaders and drywells are installed to contain roof run-off. Vote of Council: Ayes: All Motion Carried Jill M Doherty, President Bob Ghosio. Jr., Vice-President James F. King Dave Bergen John Bredemeyer P.O. Box 1179 Somhold, NY 1197] Telephone (63 ] 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: DAVID & LIBBY ROSS request a Wetland Permit to demolish the existing dwelling and sanitary system; construct a new two-story dwelling on pilings and install a new sanitary system with fill; and install new permeable driveway. Located: 170 Park Avenue Ext., Mattituck. SCTM#123- 8-24.1 rea to be impacted: ~ay ter Wetland Freshwater Wetland Sound Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _L~apt.275 Chapt. 111 other Type of Application: ~¢~and __Coastal Erosion __Administrative__Emergency Pre-Submission __ __Amend ment Violation Info needed: Modifications: ~'~,~, ~'7.~ Conditions: Present Were: ~J. Doherty~. Ghosio "~. King __ ~J~ Bredemeyer__ D. Dzenkowski other F;ii~ ii; ,;~x i~: .~ field Date: by ~-DTBergen, Ross Residence, 170 Park Avenue Extension 4/14/11, 2:00 pm, #1 View South Ross Residence, 170 Park Avenue Extension 4/14111, 2:00 pm, #2 View East Ross Residence, 170 Park Avenue Extension 4/14/11, 2:00 pm, #3 View East Ross Residence, 170 Park Avenue Extension 4/14/11, 2:00 pm, #4 View West Ross Residence, 170 Park Avenue Extension 6/11/10, 10:00 am, #5 View West Ross Residence, 170 Park Avenue Extension 6111110, 10:00 am, #6 View North S A M U E L S & S T E E L M A N August1,2011 Southold Town Board of.Trustees Town Hall Annex Main Road Southold, NY 11971 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 SCTM# 1000-123-08-24.1 Dear Lauren: Attached please find four stamped revised SITE PLANs for the above referenced project, showing exchanged locations of leaching pools and expansion pools, per your request. If this revision meets with your approval, please send stamped drawings and a permit for the project. Thank you, ~els, Architect AKCHI FECTS 25215 MAIN ROAD (Uf(IIOGUE, NFWYORK 11 (631i744 6405 FAX (OH) 734 6407 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. 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: July 20, 2011 Re: Proposed Wetland Permit for DAVID 8, LIBBY ROSS SCTM#1000-123-8-24.1 Samuels & Steelman Architects on behalf of DAVID & LIBBY ROSS requests a Wetland Permit to demolish the existing dwelling and sanitary system; construct a new two-story dwelling on pilings and install a new sanitary system with fill; and install new permeable driveway. Located: 170 Park Avenue Ext., Mattituck. SCTM#123-8-24.1 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 INCONSISTENT with following LWRP policy standard and therefore is INCONSISTENT with the LWRP. 5,4 Limit the potential for adverse impacts of watershed development on water quality and quantity. Protect water quafity by ensuring that proposed expansion or intensification of existing watershed development results in: 1. protection of areas that provide important water quality benefits Limit the individual impacts associated with development to prevent cumulative water quality impacts which would lead to a failure to meet water quality standards. The septic profile indicates that the bottom of the leaching pool is proposed at a 2ft separation distance from groundwater. Subsurface flow of wastewater from the system would contribute further to degrading the quality of groundwater and eventually the water bodies Deep Hole Creek and Great Peconic Bay by contributing an increase in pollutant loads such as nitrogen. 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 Application :~/~_Wetland Permit Application Amendment~Trans fer/E}ctension '~Recei~ved Application:~ _)k_Received Fee:$ ~..~--'b °~--~---~ ~Completed Appl~cation~,~_ ~lncomplete ~ __SEQRA Classification: Type I Type II__Unlisted __Coordination:(date sent) ~4~. WRP Consistency Assessment Form ~ {[.~?{1 ~/CAC Referral Sent'~J_ ' ~x~--~Date of Inspection: [_~,ll.~./tl __Receipt ofCAC Repoh: ' Lead Agency Determination:__ Technical Review: ~-~l~ublic Hearing Held:~ __Resolution: Administrative Permit NameofApplicant d tJ//5)4 Address ~ ~ 2)l.4f~Ol,.~ ~T,.~ Phone Number:( ) Suffolk Coun~ Tax Map Number: 1000- J~ - ~ Prope~Location: /7~ ~ ~V~ (provide LILCO Pole ~, distance to cross streets, and location) AGENT: ~ ~Ub~ (If applicable) Phone: Boa~of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. GENERAL DATA Yes V/ No Does this project require a variance from the Zoning Board of Appeals __ If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Yes No Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspenja~d by a governmental agency7 ENo Yes If yes, provide explanation: Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: --f'O /~ ~¥OA/~ 7-Aa&{ E~-' Area ofwetlands on lot: 4ti/~LO'7 square feet Percent coverage of lot: /~--~ 7 % Closest distance between nearest existing structure and upland - edge of wetlands: ~ ~' ~/~ feet Closest distance between nearest proposed structure and upland edge of wetlands: *'[ff?~ feet Does the project involve excavation or filling? No V/ Yes If yes, how much material will be excavated? (~ cubic yards How much material will be filled? ~00 -t/.~ cubic yards Depth of which material will be removed or deposited: Proposed slope throughout 3he area of operations: ~ ~ ~ ~7~ Manner in which material will be removed or deposited: WC bt,4q , t Od 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): 15 . ,e.F,, ov l u 6- fl,l; l,:xl //vvS F AVL> ,S'mvt T, qte,./ Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at ~ ~ ~)0~0[~' (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold:Board of Town T. ms~ees on my behalf. "{"Owner's' signature)" ' Board of Trustees Application County of Suffolk State of New York T,'~,/~/4-..~ O'O/3,//~0ff-~q5 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 TillS 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 /I DAY OF 0 Notary Public P~b[ic, State of New in Suffolk Counb, Expires ~lay ,~3, Town of Southold Erosion, Sedimentation & Storm.Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. ~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A SCOPE O~WO~ . PRO~S~ CON~U~ON fl'~ ~ / WO~S~S~ { Yes No a, ~at h ~e To~I Ams of the P~a P~{s? ' _~ the S~pe ofWo~ ~ pm~s~ ~on) ~u i~ - ~ ~ ~ ~ by a T~ (2") [~h ~ ~ Sl~? b. ~1 ~ ~ To~ Ama of L~d C~ ~j~ tieing an~or ~n ~or Gm,nd ~lu~n~ for ~e pm~s~~ ~,~ ~ Site Impmvemen~ a~ ~e ~a~ ~on of ~.,.,~l 2 ~ the Site Plan anWor ~ Show ~ pm~ed Rem ~all In~e all Pm~ Grade ~ ~ ' ' S~s Con~lllng Su~ Wa~r'Row. 0 , ~o} s~ erosion ~d a0~ ~r d[~. ~ls ~ating G~e I~Mng ~m ~ 2~ Cubic Y~ En~mp~ng ~ ~a In ~ of FNe 6 Is ~ere a NaOmi Water ~u~ Runn~ ~gh Site? Is ~ ~j~t w~ln ~e T~ JuHsdl~on ~ml DE ~ ~: or ~ln ~e Hu~red (100') f~t ~ a Wefl~ or FORM - 06/10 PATRICIA RICHARDS Not3ry Public, State of New York No. 01 RI6042467 Qualified in Suffolk County Commission Expires May 30, ~ 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION 0'o be completed by Al~plicant or Project Sponsor) 1. APPLICANT/SPONSOR ~2. PROJECT NAME 3. PROJECT LOCATION: Uunicipalily ~'C) 4)'F/~/C~/~ Count~ 4. PRECISE LOCATION (Street address and road intemections, prominent landmarks, etc., or provide map) 5. PRO~DACTION IS: ~ ~ ~ Ex~nsion D M~tion/a~emt~n 6. DESCRIBE PROJECT BRIEFLY: ?. ~OUNT OF ~ND AFFEO~D: Initially I/~ ac~ U~im~ely J/~ a~s 8. ~ PROPOSED A~I~ COMPLY ~TH ~ISTING ZONING OR OTHER ~ISTING ~ND USE RESTRICTIONS? ~Yes ~ No If No, des~ b~ 9. ~T IS PRESENT ~D USE IN VlClN~ OF PROJECT? ~ipenfial O Indus~.l D ~m~al O Agriculture D Pa~FomsFO~n ~s~: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [~Yes [] No If Yes, list agency(s) name and permit/approvals: 11. DOES ANY ASPECT OF.. THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~No If Yes, list agency(s) name and permitJapprovals: 12. AS A RESULT OF PROJ~OSED ACTION W1LL EX~STING PERMIT/APPROVAL REQUIRE MODiFiCATiON? DYes [~No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/%~n~rnsme: T'~,,¢~.,"~" ~'- ~-~U~ Date: ~f~//(~/{/ Signature: ~{' ~ IIf the action is in the Coastal Area, and you are .a sta~ agency, complete the Coastal Assessment Form before proceeding with ~s assessment I OVER 1 PART II- IMPACT ASSESSMENT (To~I~ completed by Lead A~lenc¥) ~ ~ A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review pmcoas and use the FULL EAF. I')Yes I'--I No B. W~LLA~T~~NRE~E~VE~~~RD~NATEDREV~EWASPR~~~DEDF~RUNL~STEDA~T~~NS~N6NY~RR~PART617~6? IfNo, anegative declaration may be superseded by another involved agency. DYes I-]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, if legible) CI. Existing air quality, surfaco 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, agdcuflural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character?. Explain bdefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A commuefly's existing pla~ or goals as officially adopted, or a c/nange in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or rela~d activities likely to be induced by the proposed action? Explain briefly: C6. Long term, shott terrn, cumulative, or other effects not identified in Cl-C57 Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? [] Yes [] No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explain briefly: 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 significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibil~; (e) geographic scope; and (t) magnitude. If necessary, add attachments or reference suppoffing 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 ofthe C EA. [] 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 decisrafion. [] Chect< this box it you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio~ WILL NOT result in any significant adverse environmental impacis AND provide, on attachments es necesos~/, the reasons supporting thi~ determination. Name of Lead Agency Date Pdnt or Type Name of Responsible Officer in Lead Agency Title of Rasponsibte Officer Signature of Responsible Offiser in Lead Agency Siguatum of Preparer (if different from responsible officer) PART II - IMPACT ASSESSMENT lTD be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? 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 617.67 If No, a negative declaraflon may be superseded by another involved agency. ~]Yes r~No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1.Existing air quality, sun<ace or groundwater quality or quantity, noise revels, existing traffic pattem, 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 briefly: C3. Vegetation (~rfauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I I ..... r r ? Ex lam briefly: C4. A community s exlshng plans or goals as officially adopted or a change m use or intens ty of use of and or other natural esou ces p I 1 ....... pm~nt related acti likely to be induced by the proposed acti n? Explai briefl~ ..... C5. Growth, subsequent develo , or vifies o n C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 Explain briefly: I C7. Other impacts lincludin~] chanties in use of either quantity or t~pe of energy? Explain brietiy: I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? llf )'es, explain briefly': r~] Yes r~-i No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritissubstantial~~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) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting roatedals. Ensure that explanations centsin 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 sig nifica nce must evaluate the potential impact of the proposed action on the environmental characteristics of the C EA. Check this box if you have identified one or more potentially la~ge or significant adverse impacts which MAY occur. Then proceed directly to the FUU FAF and/or prepare a positive declaration. Check this box if you have determined, based on the informatio~ and analysis above and any supporting documentation, that the proposed actio~ WtLL 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. Dohert¥ Plant or Type Name of Responsible Officer in L~ad Agency Signature of Respo'n~'~le Officer~Ja_ead Agency President Title of Responsible Officer Signature of Preparer (If different from responsible officer) $1.0~ ~,, postage $ $~..0~ Certified Fee 1~..~ ~ ~ Return Receipt Fee r~ Re urn Receipt Fe ~ Return R~eipt Fee ~ ~ (Endorsement Required) (Endorsement Required) $2.~ ~ Rest ri~ed Delive~ Fee ~ Restdct~ ~lve~ Fee ~ (EndorsementRequlred) ~.~ ~ ~ (EndomementRequ~red ~~ (Endorsement Requi~) ~=~ ~ VotalPostage&F~s $ $6.23 ~ ....... e --= ......... ....... ~F~r ~-: ..... ='-~; ............................ ~o." j ~ o" ' ' .......... = ...... STATE OF NEW YORK COUNTY OF SUFFOLK ~b O'fl'~J~ I tkJLxJ , being duly sworn, deposes and says that on the __ .~. dayof ~"UJ'~L. ,20 ~t ,deponent mailed atruecopyoftheNotice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said p~sons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~¢J~Jl~ q' I,~ , kJ-4 , that said Notices were mailed to each of said persons by (certified) (registere~) mail. Swomto ~efore me this c~/ Day of--~t ~ ,20// [Notary Public LAUREN M. ~rANDISh Notary Public, State of New York No. 01ST6164008 Qualified in Suffolk County, Commission Expires ApO 9 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of DAVID & LIBBY ROSS COUNTY OF SUFFOLK) STATE OF NEW YORK) being duly sworn, depose and say: AFFIDAVIT OF POSTING , residing at/dba That on the 1~ day of'~J'~) ('~-9--- ,201 , I personally posted the ~operty, tknown as b lac,n th~Board~fTOrr ?~4rJC--/~'-tx0~ ~T,..;~- ~O.~;P~.J~./.,~.,? y p ' g rustees official poster where 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~ June 22~ 2011 on or about 6:00 PM. Dat¢~/c~{/}} ~-~ Sworn to before me this 24 dayo 3f~d'~._20 iI iture) t'qotary Public No,~ry Public, State of New Yo~ No. 01 R15042467 Qualified in Suffolk County Commission Expires May 30, ;,~32 ,, LETTER OF AUTHORIZATION David and Libby Ross 68 Dubois Street Darien, CT 06820 April 18, 2011 We hereby authorize Thomas C. Samuels of Samuels and Steelman Architects or 25235 Main Road, Cutchogue, NY, to apply for all required permits from the Town of Southold, Suffolk County and State of New York, for the reconstruction of our residence at 170 Park Avenue Extension, Mattituck, NY. Da~d Ross Libl~y R~s Boar~f Trustees Application County of Suffolk State of New York 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 1N 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 VIEW ~OF THIS PLICATION. Signature SWORN TO BEFORE ME THIS J ] DAY OF /F~7 ,20 / / APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics t>rohibits conflicts of interest on the oart oftewn officers and employees. The oumg~ of this form is to orovide information which can alert the town oft~ossible conflicts oflntemst and allow it to take what~v0r llgfion is necessary to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) 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 employe9 has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than ~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 Tire 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 &% of the shares of the corporate stock oftbe 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 applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this '~/ dayof /4/1t~.74 Signature ~-~_ ¢.~ ~d PrintName .Thtvfl4~d O. 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 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# 123 08 24 . 1 The Application has been submitted to (check appropriate response): TownBoard ~ Planning Dept. [] Building Dept. [] BoardofTrustees [] 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: Demolition of existinq residence and abandonment of existing sanitary system, construction of new two story residence with new sanitary system. Locationofaction: 170 Park Avenue Extension, Mattituck, NY Site acreage: 0. 644 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: (b) Mailing address: Darien, David and Libby Ross 68 Dubois St. CT 06820 (c) Telephone number: Area Code ( ) 203-570-3376 (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? NYS DEC DEVELOPED COAST POLICY Polity 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 Demolishing an existing, non-conforming structure and replacing it with a new structure, and sanitary system will improve the environmental situation on this beach and site. 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 new structure is in keeping with the style of all neiqhborinq structures. 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 All rainwater runoff is and will be retained on site with the use of underground drywells. 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 IA~llY~%lin~C~er~rNu°tnoA~li?sbleand will be retained within the upland, by use of underground drywells. The sanitary system for the residence meets current SCHD standards for sanitary waste water. 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 indi~inous environment" . Atlach 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 discharqe. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [] Yes [] No ~-~ Not Applicable The construction and use of the residence will make use of the town's disposal and recycling center. Ail waste water "sanitary" will be 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. [] Ye~ No [] Not Applicable No public land involved. Littoral access unimpeded. At, ach 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 neighboring properties are residential in use and will 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 This project will protect and preserve the living marine resources by maintaining all rainwater discharge and sanitary flow from the residence on site by approved SCDHS sanitary system and dry-wells for rainwater runoff. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~-~ Yes [] No [] Not Applicable 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 III - 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 energy "enerc~ Star Program" and will use "NY State Energy Conservation and Created on 5/25/05 11:20 AM S A M U E L S & S T E E L M A N May11,2011 Southold Town Board of Trustees Town Hall Annex Main Road Southold, NY 11971 RE: RECONSTRUCTION OF THE ROSS RESIDENCE 170 Park Avenue Extension, Mattituck, NY 11952 SCTM# 1000-123-08-24.1 MAY 11 2011 ~e~t~h~td Dear Sir/Madam: We are requesting a WETLANDS PERMIT for the above reference project, for the demolition of an existing residence and the new construction of a residence on pilings, with sanitary system, driveway, and associated improvements. All drainage will be directed to subsurface systems. For your review we are submitting the following documents: 2. 3. 4. 5. 6. 7. 8. 9. Application Shod Environmental Assessment Form Application Affidavit LWRP Consistency Assessment Form (3) SITE PLAN, FLOOR PLANS and ELEVATIONS Stamped current Survey Letter of authorization from Owner Check for $250.00 Five (5) photographs of existing site conditions Please call us with any questions or concerns. Sincerely, SAMUELS & STEELMAN ARCHITECTS ~Architect enc. ARCHiTE( TS 2,2 I~ MAIN ROAD (Uf(II()GUE, NEW YORK N AREA=28,04,3 SO. FT. TO TIE LINES I om fomilior with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and w#1 (]bide by the conditions set forth therein (]nd on the permit to construcL The ideation of we/is ond cesspools shown hereon ore from field observations (]nd or from dot(] obtoined from others. 1 ST~. BUNGALOW SURVEY OF PROPERTY A T MA TTITUCK TO'tN OF SOUTHOLD SUFFOLK COUNTY, KY. 1000-1~$-08--24.1 SCALE: 1~$0' MA Y 30, 2007 MAY 4, 2010 AUGUST Jl, 2010 (LOCA TED SHEE77NG) NOVEMBER 24, 2010 (LOCATED ADDITIONAL SHEETING) APRIL 2S, 2011 (TIDAL WETLANDS LOCATION) ZONE VE el 7 GARAGE 100' o"W 121.81' EDGE OF TIDAL WETLANDS A T MEAN HIGH WA TER AS DELINEATED BY SUFFOLK ENVIRONMENTAL lNG, ON APRIL 26, 2011 LOT NUMBERS REFER TO "MAP OF MARRATOOKA POINT" FILED IN THE SUFFOLK COUNTY CLERK'S OFF/CE ON MARCH 9, 1927 AS MAP NO. 331. FOLD ZONES FROM ~RM RATEMAP 3610300482H SEPTEMBER 25, 2009 S =W¢TLAND FLAG LANDWARD OF TIDAL WETLANDS AS DELINEATED BY SUFFOLK ENVIRONMENTAL CONSULTING, /NC. MARCH 25, ELEVA~ONS AND CONTOURS REFERENCED 2010 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SEC770N 720gOF THE NEW YORK STAYS EDUCATION LAW, EXCEPT AS PER SECTION ?209-SUBDIVISION 2, ALL CERTIFICA770NS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES SEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIONA TURE APPEARS HEREON. (631) 765-5020 FAX (631) 765-1797 P,O. BOX 909 12J0 TRAVELER STREET SOUTHOLD, N.X 11971 UI--IIU SEPTIC PROFILE (N.T.S.) TEST HOLE TEST HOLE DA TA McDONALD GEOSClENCE A 5EPTIC~ ~ _EA~ /I TANK \ , , POC --IE. +~.eE' / I-- ~-I~. +5~5 / , EXISTING SITE AREA ~NDWARD OF TIDAL WET~ND~ ~PO~ ~L D~I~Y, 2~ ~, IO.4 · LOT ~PO~ ~Y5 ON ~E, I~ ~, 0.6 ~ L~ ~PO~ ~51D~TI~ 5~, I,q~ ~, 4.1 · LOT DRAINAGE CALCU~TIONS FOR AR~ OF NEW ROOF I 1~EFx (~12~J x I~ =~2~.~. ~, (5) ~' DIA~ x 4' HIgH POOL ~VI~ ~1~ D~INAGE CALCULATIONS FOR AREA OF NEW WAL~ 2~lE~Px (2A2 ~) x I~ = 45b ~. ~. ~, (4) ~' DIA~ X 2' HIgH POOL (4) ~' X 2~ 5TO~ ~IN RI~ = ~5~ ~U. FT. ~, (I) ~' DIA~ x 4' HI~ P~L (I) 5' X 4' 5T~ D~IN RIN5 = lee GU. ~. ~ ~. ~. > 456 ~U. ~. LINE ~=XIBTIN~ LOCATION MAP SITE DATA SCTM # 1000-123-08-24.1 PROPERTY: ADDRESS OWNER: 170 PaRk AVENUE EXTENSION MATTITUCK, NY DAVID & LIBBY ROSS 68 DUBOIS ST., DARIEN, CT 06820 28,043 SF = 0.644 AC 4,407 SF WETLANDS MIXED SAND AND LOAM 2.$o BROHfV SILTY BAND BM SITE: ]]5' WATER IN BROH/N SILTY SAND SM P~L FT ZONING: R-40 4IN® I I WATER/N BRO.~ ~NE SAND SP I I I ,1.. [ ~ 11' SURVEYOR: PECONIC SURVEYORS. PC · OF P~L ~.5 ~I' PO BOX 909 SOUTHOLD, NY 11971 ~.OUND ~IATEI¢ LICENSE # 49618 AUGUST .~1. 2010 (LOCATED SHE£17NG) ;.23~636 SF LOT NUMBERS REFER TO "MAP OF MARRATOOKA POINT" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON HIgH ~NATE~, MARCH 9, 1927 AS MAP NO. FOLD ZONES FROM FIRM RATE MAP ~E103CO482H SEPTEMBER 25, 2009 ~,~E. ~ =WETLAND FLAG \\ LANDWARD OF TIDAL WETLANDS AS DELINEATED BY )W-A -- SUFFOLK ENVIRONMENTAL CONSULT/NB, /NC. MARCH 25, 2010 %%% / /~TI~AL ~ETLAND5 AC / ELEVATIONS AND CONTOURS REFERENCED TO N.A. ~D. --X/ /FLAeSED BY 5UFFOL~ '~ / ENVIRONMENTAL OONEULTIN~, ~ N~ INC. HA~OH 25, 2010 ~ VAY & DRIVEWAY DW-B .~ I ~XI~T ~OLE NYT ~1 IN BETk"IEEN~''7'~ N/O/F ROSS CDW~LUN~ WI PUBLIC P~-OPO~EO NE.N ~EPTI(--' FOP. A B 5EP~OOi.4 ~.EEIOENCE - ICC0 ~AL CEPTIC TANK (5) ¢' PlA x 2' HICH LEAOHIN¢ POOL - FUTURE LOOATION PO~ (~) g' PlA x 2' HIgH LEAOHIN¢ ~OOL (BXP) EXIETIN¢ ~ANITA~Y (~X) TO ~ ~EHOVED NEY~ FILL ZONE LINE FXISTIN®- HOU&E TO ~tE UTILIT~ LINE ZONB LINE AREA NEA FILL LP ~! I "StOA VEL I VEWAy II, Eel7I II I ZONE VE el 7 ZONE VE el 8 HAY 5ALE5 $ 51LT FENOE PURIN~ CONETRLIOTION OPEN P1ETAL 1INLET (2'x¢' PlA) FOg RAINWATER NEPI FILL UNDE~-G~OUND PROPANE TANK NZ2EP-.GP..OUND !,NATE P-. LINE NEI~+~3Ie, IN~ LOT 2 (OW~LLIN~ WITH PUBLIC W,~ DR'r'P4ELL (DPt) (4'x~' PlA) POI~ P..AIN~AT~P. P. UNOFF FROH 5U] ~ T~P LINE F: OF TIDAL !NE'TLAN~D5 AT HIGH AATEP-. A¢ DELINEATED ID"" 5UFFOL~ ENVI~ONh4ENTAL OONEULTIN¢, Ih,IQ. AP~-IL 2,&, 2011 N SITE PLAN SCALE: 1" = 20'-0" tEAT Pi=CONIC, OF TIDAL ~'NETLANP5 AT MEAN HIgH PLATBP. A~ DELINEATED BT' ~UFFOLK ENVIP-.ONMCNTAL E, ONEULTIN¢, INO. AP~JL 2~, 2011 APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE ~F_5~ i/ AUG - 1 2011 ~EVI5ION5 ~//11 PEf~ 'F~UE'F~E5 -']w. o~. <~1-. NO: 1002 DRAWN BY: UT CHECKED BY: TS DATE: May 10, 2011 SCALE: 1" = 20'-0" SHEET TITLE: SITE PLAN SHEETNO,: 1 PTIC PROFILE TEST HOLE LOCATION_MAP_ TEST HOLE DA TA McDONALD GEOSClENCE PROPERTY: 179 PARK AVENUE EXTENSION ADDRESS MA~ITUCK, NY ~ ~ ~ ~IX~ SAN~ XNO LOAM OWNER: DAVID & LIBBY ROSS ~~~I/4"~T. ~ Ll~ ~ATION ~ ~. . ~3, BRO~L~EANO~, ~ 68 DUBOIS ST., DARIEN, CT 06820Fill: 609 cubic ya~s ' SITE: 28,043 SF = 0.644 AC 5' WA~ /N BEO~ S/L~ SAND ~ 4,407SF ~ET~NDS ZONING: R~0 ~ ~ ~ ~ . ~ ~~ LICENSE~ 49618 LOT NUMBERS REFER TO 'MAP OF MARRATOOKA POIN~ EXISTING SITE AREA LANDWARD OF TIDAL WET~NDS: 23,636 SF FILED IN ~E SU~OLK COUN~ CLERK'S OFFICE ON ~P~ ~L ~EI~Y. =~e ~, IO.4 · L~ ~ MARCH 9, 1927 AS MAP NO, JJl. FOLD ZONES ~OM FIRM RA~ MAP J610JCO482H LANDWARD OF ~DAL ~ANDS'A~,DELINEA,~D ~NS FOR AREA OF NEW ROOF DW-A ~ SUmOLK EN~RONMENTAL CONSUL~G, IHt~ MARCH 25, 2010 (D~ I~ ~ x (~1~ ~ x I~ · ~ ~. ~. ~ ~ ELEVAEONS AND CONTOURS REFERENCED TO N.A.~D. '88. D~INAGE CALCULATIONS FOR AREA OF NEW WAL~AY ~-- ~ ~ PUBUC ~ / N/O/~ ~OSS (DWELLING W/ PUBLIC ~ T~R) NEIE~3f~IN~ ZONE [- ~) ~' CIA x 2' HI~ LE~HI~ POOL HIgH LE~HIN~ POOL ~) FLOOD ZONE LINE PILL ~-r~ (~ (~'~lx~' plA) FOR I:[AINI,~kTE~ I PILl PI~2P'ANE TANK. I I,'~IA ~ t=~ LINE ( ZONE LINE ~NEifl ~IELL (DJ~ (4'x~' pLA) POE RAIt~[/~IEt~. EiSIOFF PF~OH ~UI I~ ~ APPROVED BY BOARD OF I'RUS'fFEs ZONE t~E el 7 ZONE VE el 8 51LT FEF~E I~RIN~ C~:~ISTPJJ~TION LINE HIgH PIATE~ A5 DELINEATED BY E=UFPOLL !ENMII~ONIH~NTAL GONSULTIN~, lNG. A~IL 2~, 2OII SITE PLAN SCALE: 1" = 20'-0" PECONIC, E~A'r' OP TIDAL I~[ETLAND~ AT HEAN HIgH J~ATEf~ A~ i~ELINEAtED ~ E~-FOLt~ ENVII~C~NHENTAL ~C'NSULt[N~, lNG. AP~IIL 2~, 2OII PERMITS & BIDDING SET :~LU.== PROJECT NO: 1002 DRAWN BY: UT HECKED BY: TS DATE: 8/19/11 SCALE: I I' = 20'--0" SHEET TITLE: SITE PLAN SHEETNO.: 1 SEPTIC PROFILE (N.T.S.) TEST HOLE T~ST HOLE DATA McDONALD GEOSClENCE EXISTING SITE AREA LANDWARD OF TIDAL WETLANDS: 23r636 SF Pf~C~'O~E~ ¢~R. AV~L ~,IVE.mlAY', 2,4~0 9F, IO.4 ~, LOT C.47v'Lete..,~.~V~ ~ogiED W,,N_K, IflAY'~ ON E~e. ADE, 14~ 5P, 0.6 ~ LOT EX2~v:~kS, E P~.OPOOE~ I~--~I~;~'NTIAL 5"1'1~1.1¢ffi~ I,q~l E~, 4.1 · LOT ~OVm',¢~,le DRAINAGE CALCULATIONS FOR AREA OF NEW ROOF OW-k DRAINAGE CALCULATIONS FOR AREA OF NEW WALKWAY & DRIVEWAY DW-B ~ x F~INFA~.L x ~ Fh~TOf~ 2~15OFx (2/121=1'.) x I.O -4~CU.I="r. U~E, (4) ~,' DIAM=i~=m x .:2' HI~,H POOL (4) ~' X :2' .~,TOf~4 Df~,AIN RIN~ · ~ CJJ. FT. U~, (I) ~' Ol~ X 4' HIC~'H PO~L (I) ~" X 4' OTOf~4 ~IN RIN~ ' 10~' CJJ. FT. LOCATION MAP POLE II'cr 51 SITE DATA SCTM # 1000-123-08-24.1 PROPERTY: 170 PARK AVENUE EXTENSION ADDRESS MA'I-rlTUCK, NY OWNER: DAVID & LIBBY ROSS 68 DUBOIS ST., DARIEN, CT 06820 SITE: 28,043 SF = 0.644 AC 4,407 SF WETLANDS Fill: 609 cubic yards zONING: R~.0 SURVEYOR: PECONIC SURVEYORS, PC PO BOX 909 SOUTHOLD, NY 11971 LICENSE # 49618 MAY 30, 2007 MAY 4, 2010 LOT NUMBERS REFER TO "MAP OF MARRATOOKA POINT" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON MARCH 9, 1927 AS MAP NO. JJl. Hl~:~r,I~ FOLD ZONES FROM FIRM RATE MAP J610JC0482H SEPTEMBER 25, 2~09 \ LANDWARD OF TIDAL I~ETLANDS AS DELINEATED BY SUFFOLK ENVIRONMENTAL CONSULTING, INC. MARCH 25, 2010 \\\~4 If~ILANDS I ELEVATIONS AND CONTOURS REFERENCED TO N.A.V.D. '88. .?I '5. \\~.~ .L~TI_ANOS MAB 2 8 2012 ~ OILT FENCE ~IK~ C,~:::~TION NEI~H~3RIN~ N~DO/TM WELLING WI PUBLIC H^TC, H - I~OO ~AL. ~.,.,"'PTIG TANK - (9) ~" PlA x 2' HI?~+I LEAC~IN~ P~L (LP) - ~ LO~ATION ~ (9) ~' PlA x FLOOD ZoNE LINE (OW~LUNO PUBUC UTILITY' LINE AREA ~ FILL Pf~OPOSED FF EL 11.3 --3 NEW I \ / I II I ZONE t~E d 7 ZONE YE el 8 )F ~ FIII UNDER~ROUN~ J'~A m~, LINE ZONE LINE LOT 2 (DWELLING WITH PUBLIC WA t~Ad.E~ $ 51LT FENCE Dt.I~INI~ CON~TI~TION LINE ~ OF TIDAL I~ AT HIgH ~T~ ~ DELIt.,r~Ai~ ~4.,I~OLK EN~I R, ONHL=NI'AL CONSULTINg, lNG. API~IL 20, 2OII .= OF TID.a~.- J,~-'TLAN~ AT I'4~N HI~"t I,~kl~ A~ [;hE.I. INEAT~D ~'Y E~UF~OLI( ~ONOUt. TIN~, INC.. APRIL .25, 2011 SITE PLAN SCALE: 1" = 20'-0" ~f~EAT PEGONI~ ~A"r' PERMITS & BIDDING SET f~.EV'ISION5 2X/12 EXPAND' I~=C,K 9/2'IA2 A~DIT'AL PILL ~CALE: 1" = 20'-0" ~HEET TITLE: SITE PLAN HEET NO.: 1 ARE FEZENFILTERLLOTH HA l BALE 4 SILT I'ME GENERAL STORMWATER POLLUTION WMHAYEALE AREA DETAIL TRAFFIC BEARING, LOCKING, CAST IRON FREVENTION NOTES FRAME AND COVER TO ORADE m, p FINISHED GRADE SITE DESCRIPTION FLOM FETAL HIREFENLE Development activities For this project will consist of the demolition of on existing house and FILTERLLOTH 0 W/FILTERan the demolition of existing residence, installation of erosion control measures, construction of a 1-�AT*7ALPI10' TRAFFIC BEARING new residence; filling the site as shown along with all associated site work. The site work will } 'I MIN. 5`13 5RADE „ nr'" MAXERAGIN6 TOP SLAB r �, Include. grading of the proposed driveway, Installing the proposed drainage structures; Z /�- A - I� '� 0"i ,rye,,,,,, yy Installation of proposed sanitary system and water Tines and electric Tines. All Improvements are to conform to Federal, State, County and Municipal standards and specifications. GENERAL SEOUENGE OF SITE AGTI\IITIES FOR THE ENTIRE SITE W L) I. Installation of erosion control measures (silt fence barriers); () 2. Demolition of existing residence; Z 3. Glearin99 and re-grading to direct runoff to designated area; W -� ei " `" ¢ ,,,� INLET 4 Installation of naw piling foundation; Q ANGIP STAKE INTO MIN. 4" DIA4 �� 5. Filling and rough grading of site w/clean sand per SITE PLAN, PREVI0,5 BALE GLASS 2 A 6. Grading all and Installation of crushed stone surface; W r mrf fig¢ r LU T. Installation of drains a structures, Sanitary, water, and electric lines; �ri, 'rrjtl Ii� vr011e- 00k - N' J PIPE PITCHED L 8. Installation of remaining erosion control measures (Inlet protection w/filter fabric); Q aIIIIIIIIIIJ r o MIN. I/8"/I' 9. Construction/fromin of residence; U 2 REBAR,STEEL NL T5 OR JS g m yS r---� 10. Delivery/spreading topsoil and final Iandscop Ire/seeding; 0 =P PREFLIJ9NTOP-TIN6ROLflD a BACKFILL MATERIAL 11. Removal of the erosion control measures. O Z DRIVE ftUSN YU TOP OF BA ES 2' rrw TO 6GLL SAND' SITE DATA W O 80Rm HAYBAIES = u _ Site Area. 28,043 square feet (AOITTOAOJOININ68A1ETI6HTLY� ❑ o rw. Pre-Development Runoff Coefficient 30.00% (light vegetation) ~ a Post-Develo ment Runoff Goefficent: 32.2% p -- - 5011 Classification See test hole O �/ Q Hill-MALE TOBEEMEEDDEDINTO 501L MIN. ABOVE Receiving Waters: Low point on site Z W MINIMM OF 4`A0 5110IN65 FLAZ HORIZONTA Y >< G,ROUNDWATER POLLUTION CONTROL MEASURES O w ILL WAP 5ILTFENLEMRHAYBALE In accordance with the provislons of the U5EPA General Permit, storm water management, L) � 0 AND DRIVE 5TAKETHROW. BACKFILL MATERIAL TO BE b" MIN. PENETRATION erosion and sediment control measures Including, but not limited to, the following shall be Z Q 1- GLEAN SAND AND G,RAVEL IN VIRG,IN STRATA employed during construction: a' Z � A. Existing vegetation to remain shall be protected by Installation of construction fence or H OF SAND AND GRAVEL other approved means, and shall remain undisturbed. fn O 0 C ^ C TYPICAL STORM D RAI NAGE RING B. Clearing and Grading shall ea scheduled so as to minimize the extent a exposed areas O � , 1 Q C��7E� 1 G�'tTON FOR SILT FEN�E and the length of time that areas are exposed. A maximum of 5 acres shall be disturbed at () V Y one time unless written permission Is granted by the NYSDEG Graded and stripped areas W O Shall be kept stabilized through the use of temporary seeding as required. Seed mixtures O N.T.S. shall be In accordance with the soil conversation service recommendations DEFINITION and PURPOSE G. Bare soils shall be seeded within 14 days of exposure, unless construction well begin within A temporary barrier of geotextlle fabric (filter cloth) used to Intercept 21 days as sections are completed, or If construction on an area Is suspended, the area shall sediment laden runoff from small drainage areas of disturbed soll. The purpose be seeded Immediately. of a silt fence is to reduce runoff veloolty and affect deposition of transported a. Seed preparation - scarify sol] if compacted, remove debris and obstacles such as sediment load. Limits Imposed by ultraviolet stability of the fabric will dictate roots and stumps. the maximum period the silt fence may be used. b. Soli Amendments 1) Lime to ph 6 0 CONDITIONS WHERE PRAGTIGE APPLIES 2) Fertilize with 6600 lbs of 5-10-10 or equivalent per acre (14 165/100 sq Ft) SPEC I F I GATI ON FOR STRAW BALE ` S1) Temporary Seedling os A silt fence may be used subject to the following condltlons: C g U Maximum allowable slope lengths contributing runoff to a silt fence are: DIKE a. Ryegrass (annual or perennial) ® 30 Ids per acre (0.-1 Ibis per 1,000 sq ft.) SLOPE STEEPNESS MAX. SLOPE LENGTH b. Gertlfled "Aroostook" winter rye (cereal rye) ® 100 lbs. per acre (25 Ibs 2:1 50 O per 1,000 sq. ft.) use winter rye if seeding In October/November. Z 2) Permanent seeding - 5ee Landscaping plans 06 3:1 T5 ft DEFINITION and PURPOSE fn <- 4:1 125 ft. D The length and steepness of cleared slopes shall be minimized to reduce runoff velocities, 5:1 1,75 ft A temporary barrier of straw or simllor material used to Intercept sediment -J g• flatter than 5.1 200 ft, laden runoff from small drainage areas of disturbed soil. The purpose of a Runoff shall be diverted away from cleared slopes. 4 & o bale dike Is to reduce runoff velocity and affect deposition of the E. Sediment shall be trapped on the site and not permitted to enter wetlands, adjacent W J• 0 Z i 2) Maximum drainage area for overland flow to a silt fence shall not exceed Yz transported sediment load. 5traw bale dikes have an estimated design life properties, public roads, or drainage systems. Sediment barriers shall be installed along the W' acre per 100 feet of fence; and of three (3) months. limits of disturbance prior to the start of construction, and shall be maintained until 3) Erosion would occur In the form of sheet erosion; and construction is complete. 2 W. 4) There Is no concentration of water flowing to the barrier CONDITION WHERE PRACTICE APPLIES ?F. A stabilized construction entrance shall be maintained? to pre??vent soil and loose debris Q ~ o Provide straw bale dike where: from being tracked onto local roads. The construction entrance shall be maintained until the to tq• CRITERIA FOR SILT FENCE MATERIAL5 site is permanently stabilized. Any sediment tracked onto public roads shall be removed or 1) No other practice Is feasible cleaned on a daily basis. I) 511t fence fabric shall meet the following specifications unless otherwise 2) There Is no concentration of water In a channel or other dralnage way approved by the appropriate erosion and sediment control plan approval over the barrier G. All runoff shall be retained on site in accordance with local regulations and approvals. authority. Such approval shall not constitute statewide acts tante. 5totewlde Drainage Inlets Installed on site shall be protected from sediment bulldup through the use of pp P 3) Erosion would occur In the form of sheet erosion appropriate inlet protection. acceptoblllty shall depend on field and/or laboratory observation and 4) Length of slope above the straw bale does not exceed these limits: evaluations. GRADE OF SLOPE PERCENT OF SLOPE SLOPE LENGTH H. Appropriate means shall be used to control dust during construction. ,�E CF NEWy 2:1 50% 25 ft. FABRIC PROPERTIES MIN. ACCEPT. VALUE TEST METHODt/ I. Sediment barriers and other erosion control measures shall remain In place until upland `i��pSC Sq,O, 2pf grab tensile strength 90 Ids. ASTM V1682 72 40% 50 ft. disturbed areas are permanently stablllzed. Following permanent stabilization, paved area s� m elon tion at failure 50% A5TM D1682 3:1 33% T5 ft. shall be cleaned of soil and debris and drainage systems shall be cleaned and flushed as * m g mullein burst strength 190 psi ASTM D3"186 3/2.: I 30% 100 Pt. necessary. —_ puncture strength 40 Ids. ASTM D151 4:1 25% 125 ft. J. The owner/contractor Is responsible for Inspection and proper maintenance of erosion e slurry flow rate 0.3 gal/min/sf control measures. Inspections must be performed by a certified erosion control speclallst, equivalent opening size 40-80 US 57 solve GW-00215 Where slope gradient changes through the drainage area, steepness refers licensed ` ultraviolet rad stability 90% ASTM G-26 to the steepest slope section contributing to the straw bale dike. The professional engineer or a trained technician working under the supervlslon of a licensed PROJCT NO: professional engineer every seven calendar days and Immediately after periods of rainfall 1002 practice may also be used for a single family lot If the slope Is less than 15 greater than one half Inch. Malntenance measures are to Include, but are not limited to, DRAWN BY: 2) Fence posts (for fabricated units): the length shall be a minimum of 36" long. %. The contributing drainage area In this Instance shall be less than one cleaning of recharge basins, sediment traps and dalls,rywcleaning and repair of sediment UT Wood posts will be of sound q,uollty hardwood with a minimum cross sectional acre and the length of slope above the dike shall be less than 200 ft. barriers, repair of berms and runoff diverters, and cleaning and repair of inlet protection devices. The owner/contractor Is requlred to maintain copies of the NOI, 51,NPPP d General CHECKED BY: TS area of 3.0 sq. inches Steel posts will be standard "T" and "U" section Permit on site at all times NOI and General Permit shall be posted at all times. welghing not less than 1.0 pound/lin. ft. CONSTRUCTION SPECIFICATIONS: DATE K During construction, the contractor will comply with all local regulators concerning the 10/13/11 U Bolas shall be placed at the toe of a slope or on the contour in a row 9 p y 9 g 3) Wlre fence (for fabricated units): wire fencing shall be minimum14 yz gauge disposal of solid waste, debris, and toxic and hazardous waste, as well as sanitary sewer and SCALE: with a maximum 6" mash opening, or as approved with ends tightly abutting the adjacent bales. septic system regulations. Temporary fencing shall be erected around the perimeter of the 1" = 20111 2) Each bale shall be embedded In the soil a minimum of 4" and placed so site along with the placement of dumpsters to control the buildup of debris The contractor the bindings are horizontal. shall periodically clean up any debris accumulated along the temporary fence and empty the SHEET TITLE: 4) Prefabricated units ENVIROFENGE or approved equal may be used In lieu 3) Bales shall be securely anchored In place by either two stakes or dumpsters regularly OF above method providing the unit Is Installed per details shown. re-bars driven through the bale. The first stake In each bale shall be driven 9 After the project Is complete, the owner will be responsible for filing a Notice of SITE GON5TRUGTION 5PEGIFIGATION5 f toward the previously llbale at an angle to force the bales together. T Termination Stakes shall be driven flush with the bale. (NOT) with the NYSDEG to close out the open SPDES General Permit No 6P-0-08-001 for DRAINAGE 1) Woven wire fence to be fastened securely to fence posts with wire ties or 4) Inspection shall be frequent and repair replacement shall be made Storm Water Runoff from the constructlon activity. NATES staples. promptly as needed. M The contractor must complete the construction sequence schedule in the report with start 2) Filter cloth to be fastened securely to woven wire fence with ties spaces 5) Bales shall be removed when they have served their usefulness so as not and end dates. every 24" at top and mid section. to block or Impede storm flow or drainage. 3) When two sections of filter cloth adjoin each other they shall be overlapped N. Unless otherwise directed by the owner, the contractor is responsible for maintaining the SHEET NO.: b 6" and folded. necessary records of construction activities, preparation of inspection reports, and reporting 9 release of pollutants to the proper authorities as necessary to comply with the Nationwide 4) Maintenance shall be performed as needed and material removed when it Permit. The contractor will report any required modifications to the SWPPP necessitated by has served Its usefullness. field conditions or construction activities to the Architect For revision of the 5WPPP where 1 b appropriate. PERMITS & BIDDING SET SEPTIC PROFILE (N.T.S.) I~lAdJ- FF EL I1~ FT LINE P-'I PVATION ~ PT. LINE FI PN~ATION -+'/PT. -- I' MIN. :2' MAX. 5~=PTIC, TANK-. SOT OF F~3L B.5 PT EXISTING SITE AREA LANDWARD OF TIDAL WETLANDS: 23~636 SF l=~Of~O'3~ ~AVFJ_ D~JVEYiAY', :2A~6 E~, IO.4 ~ LOT COVEf~N~E ~".---D PiALKJ~tA'r'5 ON ~H~::~E, 14q 5e, 0.6 ~ LOT ffi DRAINAGE CALCULATIONS FOR AREA OF NEW ROOF DW-A DRAINAGE CALCULATIONS FOR AREA OF NEW WALKWAY & DRIVEWAY DW-B TEST HOLE TEST HOLE DA TA McDONALD GEOSCIENCE a/25/ o MIXED SAND AND LOAM 2' BROlffll SILTY SAND SM 2.3' WATER IN BROItfll SILTY SAND U S' WA~"R IN BROIffV FINE SAND 11' LOCATION MAP EXIST POLE NYT ~1 SITE DATA SCTM # PROPERTY: ADDRESS OWNER: SITE: 1000-123-08-24.1 170 PARK AVENUE EXTENSION MATrlTUCK, NY DAVID & LIBBY ROSS 68 DUBOIS ST., DARIEN, CT 06820 28,043 SF = 0.644 AC 4,407 SF WETLANDS Fill: 609 cubic yards ZONING: R-40 SURVEYOR: PECONIC SURVEYORS, PC PO SOX 9O9 SOUTHOLD, NY 11971 LICENSE # 49618 MAY ,~0, 2007 M,4 Y 4, 20t0 AUGUST .,~1, 2010 (LOCATED ,.W'EETING) LOT NUMBERS REFER TO "MAP OF MARRATOOKA POINT" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON MARCH 9, 1927 AS MAP NO. ,331. FOLD ZONES FROM FIRM RATE MAP .3610,,'3C0482H SEPTEMBER 25, 2009 ~ =~ETLAND FLAG LANDWARD OF TIDAL WETLANDS AS, DELINEATED BY \\\\~4 ItE'TI. ANDS t SUFFOLK ENVIRONMENTAL CONS. ULT~NG, /NC.' MARCH 25, 2010 ELEVATIONS AND CONTOURS REFERENCED TO N.A.V.D. '88. ~L~' / ENVIRONMENTAL ~TINE~', / ',~'..~ ~. MA.C~ =5, =, . \\X'Xe~O~, WTL4NDS F[ B - 12012 t~AI F~ I SILT r-=NC, E C, ONE,'I3~UC, TION I ¢OWEZ. UNe PP. OPOE;,ED ~,~1 sF ADDITION TO PRE',/IOUSL'r' APPt~.OVED OPEN DECK ZONE LINE 8 / '~-'x6' J F ~ PILL NEW I~,C~PAI'~. thl~( l~lA~ ~-t~ LINE / I ZONE t~ et 7 ZONE VE el 8 LOT 2 (DWE'I..LING WITH PUBLIC WA FILL e ,~lLT I=E'NC,,E ~:~I~IN~ CX3N~TI~UC. TION BOARD OF TRUSTEES TOWN OF SOUTHOLD HIgH J'N,~,i~ ~ DELINEA'T'E~ ~ 51.JFFOLK EN',/II~ONt,4ENTAL C. ONSLILTIN~, INC.. AP/~.IL :2~, 2Otl SITF PLAN SCALE: 1" = 20'-0" 5P. EAT ~ OF Tidal W~ET1.AND~ AT MEAN HI~"H ~lA~E-m At3 DELINEATED ~ E~OLK~ EN~II~ONIvlENT~L C, ON.~JLTIN~, lNG. AP/~.IL ":'~, ;2OII PERMITS & BIDDING SET ~.,EV'ISION5 ~~~co.~.~. OF NE~/ p0 PROJECT NO: 1002 DRAWN BY: UT CHECKED BY: TS DATE: 8/19/11 SCALE: 1" = 20'-0" SHEET TITLE: SITE PLAN SHEET NO.: 1