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Home My WebLink AboutTR-7662 James F.King,President SOF so Town Hall Annex Bob Ghosio,Jr.,Vice-President O� 54375 Main Road ` P.O. Box 1179 Dave Bergen Jf Southold,New York 11971-0959 John Bredemeyer H G Michael J. Domino �O Telephone(631) 765-1592 Fax(631) 765-6641 �y00UNT1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . CERTIFICATE OF COMPLIANCE #0808C Date: October 1. 2012 THIS CERTIFIES that the construction of a single-family dwelling associated water supply and sewage disposal facilities driveway, deck gutters to leaders to drywells on the dwelling. At 5808 Bayview Road, Southold,New York Suffolk County Tax Map# 78-7-5.6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated Member 8, 2011 pursuant to which Trustees Wetland Permit#7662 Dated October 19, 2011 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of a single-family dwelling associated water sunnly and sewage disvosal facilities driveway, deck gutters to leaders to drywells on the dwelling. The certificate is issued to JOHN PRIZEMAN owner of the aforesaid property. Authorized Signature James F.King,President ��FI'♦'J(� Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �� 1;z P.O. Box 1179 Dave Bergen W Southold,NY 11971 Y John Bredemeyer d !j� Telephone(631)765-1892 Michael J. Domino y��j � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: �Ls L__ _ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: r CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ Ist day of construction ~ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7662 DATE: OCTOBER 19~ 2011 ISSUED TO: JOHN PRIZEMAN PROPERTY ADDRESS: 5808 BAYVIEW ROAD~ SOUTHOLD SCTM# 78-7-5.6 AUTHORIZATION Pursuant to the provisions of Chapter 275 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 October 19, 2011, and in consideration of application fee in the sum of $250.00 paid by John Prizeman and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a single-family dwelling, associated water supply and sewage disposal facilities, driveway, deck and 250 cubic yards of f'dl; with the condition of the installation of gutters to leaders to drywells to contain roof run-off and in accordance with Chapter 236 of the Town Code-Storm Water Management, and as depicted on the survey prepared by Young & Young, last dated September 20, 2011, and stamped approved on October 19, 2011. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the mid Board as of this date. Dave Bergen - ~bsen~ TERMS AND CONDITIONS The Permittee John Prizeman, residing at 5805 Bayview Road, Southold, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that maybe required supplemental to this permit ' ' ~ ' , which may be subject to revoke upon failure to obtain same. Jill M. Doherty, President Bob Ohosio, 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 October 19, 2011 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. John Prizeman 131 Hicks Street Brooklyn, NY 11201 RE: 5805 BAYVlEW ROAD, SOUTHOLD SCTM# 78-7-5.6 Dear Mr. Prizeman: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 19, 2011 regarding the above matter: WHEREAS, JOHN PRIZEMAN 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 September 8, 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 4.1, 5, 5.2 & 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the installation of gutters to leaders to drywells to contain roof run-off and in accordance with Chapter 236 of the Town Code-Storm Water Management, and WHEREAS, a Public Headng was held by the Town Trustees with respect to said application on October 19, 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 JOHN PRIZEMAN to construct a single-family dwelling, associated water supply and sewage disposal facilities, driveway, deck and 250 cubic yards of fill; with the condition of the installation of gutters to leaders to drywells to contain roof run-off and in accordance with Chapter 236 of the Town Code-Storm Water Management, and as depicted on the survey prepared by Young & Young, last dated September 20, 2011, and stamped approved on October 19, 2011. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule. Fees: $ 50.00 Very truly yours, Jill M. Doherty I/ 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: JOHN PRIZEMAN Please be advised that your application dated September 8, 2011 has been reviewed by this Board at the regular meeting of October 19, 2011 and your application has been approved pending the completion of the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ Ist Day of Construction ($50.00) __ ½ 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: Final Inspection Fee- $50.00~,~ (° TOTAL FEES DUE: $ 50.00 BY: Jill M. Doherty, President Board of lrustees TO THEBOARD OF TRUSTmES TOWN OF SOUthold, NY W. JOEL WARNER JR. 270 Smith Drive South, Southold, NY 11971 631-765-6687 September 30 2011 ~ tu~ ~= OCT Sot:thoM Town Board of Trustees I am terribly id]stressed and very, very unhappy about the building that is described in the notice that you sent me. I came a year or so ago to the town meeting to verbally ob~ect to the then owner of this property desire to sell this piece of his ~and for the building of another house. Now the foundation of this house has already been built, and from my point of view (literally) it is TERRIBLE. As I sit here in my study on the second floor of my house, I look out over my lovely lawn and then the half acre or less of lovely ferns and sea grass and other vegatation. And THEN there arise this monstrous foundation (and the prospect of a one or two floor house). There is nothing from my property south toward Shelter Island but shoreland EXCEPT this foundation. I obj~ct! What a shame that the owner was allowed to sell this property for the purpose of buildi~g~,~ another house. You have invited my comments, so here they are,. I()w~nld come to ~he meeting on October 19th to personally voice my objection, but unfortunately my wife and I are out off, town. W.~W~rner, Jr. NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ~{///_~.~ /z~ '7'-~,~ 157-/41c'7- /ooo dclv / 01 b'7 6 2. That the property which is the subject of Environmental Review is located adjacent to your properly and is described as follows: That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME: ~'O ~/~ 1Dt12-..¢ ~--~--./~,4-/~ MAILING ADDRESS: !31 MI ~.)~'5 ~ _'T'?-.~'~--"I- PHONE~: ~l~ 0~ AGENT: MAILING ADDRESS: PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience. 3.85 Peter Young, Chairman Lauren Standish, SecretaW Town Hall, 53095 Main Rd. P.O. Box [ 179 Southold, NY 11971 T¢[cphone (63 I) 765-1892 Fax (63 I) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 12,2011, the following recommendation was made: Moved by Audrey Horton, seconded by Doug Hardy, it was RESOLVED to SUPPORT the Wetland Permit application of JOHN PRIZEMAN to construct a single-family dwelling, associated water supply and sewage disposal facilities, driveway, deck and 250 cy. of fill. Located: 5805 Bayview Rd., Southold. SCTM#78-7-5.6 Inspected by: Audrey Horton Vote of Council: Ayes: All Motion Carried Jill M Dohecty, President Bob Ghosio, Jr. Vice-President James F King Dave Bergen John Bredemeye~ PO. Box II79 Southold, NY 11971 Telephone (631 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: JOHN PRIZEMAN requests a Wetland Permit to construct a single-family dwelling, associated water supply and sewage disposal facilities, driveway, deck and 250 cy. of fill. Located: 5805 Bayview Rd., Southold. SCTM#78-7- 5.6 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 __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: J. Doherty B. Ghosio J. King_ __J. Bredemeyer__ D. Dzenkowski other Form filled out in the field by D. Bergen, Mailed/Faxed to: Date: OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, N-Y 11971 Telephone: 631 765-1938 F~_x: 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: October 19, 2011 Re: Proposed Wetland Permit for JOHN PRIZEMAN SCTM#1000-78-7-5.6 JOHN PRIZEMAN requests a Wetland Permit to construct a single-family dwelling, associated water supply and sewage disposal facilities, driveway, deck and 250 cy. of fill. Located: 5805 Bayview Rd., Southold. SCTM#78-7-5.6 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 the Policy Standards and therefore is INCONSISTENT with the LWRP. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. The following management measures to minimize losses of human life and structures from flooding and erosion hazards are suggested: A. Minimize potential loss and damage by locating development and structures away from flooding and erosion hazards. The proposed action is located in an AE elevation 6 flood zone. Further the proposed action does not meet Policy 5: Protect and Improve Water Quality in the Town of Southold. 5.2 Minimize non-point pollution of coastal waters and manage activities causing non-point pollution. Minimize non-point pollution of coastal waters using the following approaches, which are presented in order of priority. 1. Avoid non-point pollution by limiting non-point sources. Avoid activities which would increase off-site stormwater runoff and transport of pollutants. Control and manage stormwater runoff to: · minimize transport of pollutants · restore sites to emulate natural stormwater runoff conditions where degraded stormwater runoff conditions exist · achieve no net increase of runoff where unimpaired stormwater runoff conditions exist The proposal does not propose adequate storm water controls (gutters, leaders, drywells, pervious driveway). In addition, the impounded sanitary system grade changes and topsoil placement need to be evaluated to determine if all storm water will be retained on site. Note that the drainage of the site will be very poor due to clay soils (see test hole) and the file record shows evidence that the parcel is subject to significant flooding events. On September 11, 2006 a letter was submitted to the Planning Board by Mr. Douglas Adams, P.E. form Young & Young Engineering (attached). The letter analyzed the future build out of Lot 2 and concluded that the flooding on site or off site would not increase due to the construction of a residence. However, note that the details in the letter and the proposal need to be cross referenced for consistency. Further, also in 2006, the Board of Trustees recommended that the: 1. No disturbance to the Phragmites in order to keep a large buffer area... 2. That the house be placed on pilings in order to decrease the need for fill. 3. Require no turf in areas that flood. 4. Containment of all drainage in a French drain system if any fill placed on site. Declaration of Covenant and Restrictions were filed on the property in 2006 requiring that the driveway be constructed of pervious material. The material proposed (RCA) is not pervious. In the event that the action is approved, it is recommended that the Board require materials that would comply with the restriction. The document also requires that a NYS SPEDS permit be secured prior to any construction on lots 1 and 2. The subject parcel is known as Lot 2 in the subdivision. Figure 1. Subject parcel showing vegetated wetlands The ability to meet or further Policy 6.3. Protect and restore tidal and freshwater wetlands is unknown. A common reed dominated wetland system occurs to the northwest and west of the property; however, it is unclear where the Board agrees with the wetland line. The setback distances from the structures to this wetland, therefore, are undetermined. The new water proof wall is proposed to be constructed through the common reed. In the event that the action is approved it is further recommended that the application of herbicides and fertilizers be prohibited due to the close proximity of the wetlands. Pursuant to Chapter 268, the Southold Town Zoning Board of Appeals shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney YOUNG & YOUNG 400 Ostrander Avenue Riverhea~, New York 11901 Tekphone 631. 7~30ff~T- Facsimile 631-727-0144 adrainC~oungengineering, com HOWARD W. YOUNG, Land Surveyor THOMAS C. WOLPERT, Professional Engineer ROBERT C. TAST, Architect RONALD E. PFUHL, Landscape Architect DOUGLAS E. ADAMS, Professional Engineer HAND DELIVERED September 11, 2006 Charles R. Cuddy, Esq. 445 Griffing Avenue P.O. Box 1547 Riverhead, New York 11901 RE: Minor Subdivision HARK BAXTER At Bayview, T/O Southold, New York (02-0266) Dear Mr. Cuddy: Pursuant to your request for an analysis of the potential impacts of this project on neighboring properties, we offer to following comments. One lot includes the applicant home, the second lot, now vacant, is to be improved with a residence. Concerns have been raised as to placing fill on the second lot. The amount of the fill required for construction of the driveway, residence and sanitary facilities is approximately 450 yards. This fill is to be utilized for grading purposes and will be a depth of one foot (1') along the driveway and, will have a depth of four feet (4') at the septic system. Fill in the area of the sanitary system will permit it to be constructed at a higher elevation than the surrounding systems. In contrast to the neighboring septic systems, this will minimize possible disruption of the system if the lot Is flooded during a storm. Fill along the driveway will be minimal, will not act as a barrier preventing run of from neighboring lands, nor will it channel water to neighboring properties. The fill will not have an effect on the rise of the sea level due to storm related coastal flooding. Planning Engineering Land Surveying Architecture Page 2 September 11, 2006 The home on the second lot will likely be constructed on pilings. Location of the home, as proposed, will not have an adverse impact on neighboring homes except as it may Impact the view of Goose Creek. In summary, the proposed subdivision will not increase flood damage on adjoining properties, the proposed home will have a sanitary system constructed to minimize flood damage and the development of this one additional lot will not result in an alteration which will increase potential flood damage. The wetlands have been delineated and the site has been inspected and reinspected by the Town Trustees and the New York State Department of Environmental Conservation. The landward limit of the tidal wetlands is appropriately reflected on the subdivision map. The landward clearing, grading and ground disturbance will not have a negative effect upon adjoining properties. We suggest that the proposed subdivision meets the Town's requirements and has been approved by the Town, County and State reviewing agencies. Under the circumstances we do not know of any adverse impact of the subdivision. If you have any additional questions regarding this matter, please contact us. DA/sit cc: Hr. Hark Baxter Very truly yours, Do~g~la~ Adams, P.E. 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 Fmx (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD ~Coastal Erosion Permit Application Wetland Permit Application Amendment/Transfer/Extension .,~eceiv~d Application: q~ ~ -./Received Fee:$ ~[~'~ "- ' '~ ~Completed Application_ Incomplete SEQRA Classification: Type I Type Il Unlisted Coordination:(date sent)_ ~7~,.WRP Consistency Assessment Form --JCAC Referral Sent: q [~')l ti ~/I)ate of Inspection: lO] ~ IJ Receipt of CAC Report:~ ' Lead Agency Determination: Technical Review: ~blic Hearing Held: }0!lq! [~ Resolution: Office Use Only Administrative Permit Name of Applicant Address 57--&~'ET'- Ote, OO~z.."/ld A:"{ tlz ot Phone Number:(~i 7 ~'g~ Suffolk County Tax Map Number: 1000- '-/~ $coc_. 7s~ /-OW ~, ~ Property Location: ~ O ~'~ /~/5"(qlEVd TOm/,] OF E O FFO L_ I~ Coo MT'"/ ~v~m "/oP-,N (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Bo~d of Trustee~ Application Previous use of property: Intended use of property: Covenants and Restrictions: GENERAL DATA Land Area (in square feet): /' /9 3 , 0~'0,q~.q'aFr, OK '7-~,'~d~-- Ac~' Area Zoning: ~ ~ ~ 0 Yes No If"Yes", please provide copy. Does this project require a v~ce ~om the Zoning Board of Appeals .~Yes No If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency - q-lDAC Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? "/. No Yes If yes, provide explanation: Project Description (use attachments if necessary): CO ~J ~' TIm-0 ~-T Boa~f Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA purpose ofthe proposed operations: 7~ Cfff(~ ~7~'~--(.J C-}"A Area of wetlands on lot: .5'~1 7 / '~--square feet ~w--/~ % Percent coverage of lot:_ Closest distance between n~arest existing structure and upland edge of wetlands: /(J 7~& .,feet Closest distance between nearest proposed~structure and upland edgeofwetlands: [~9 e feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated?_ How much material will be filled?. 4 Depth of which material will be removed or deposited:J Proposed slope throughout the area of operations:_ Manner in which material will be removed or deposited: cubic yards .cubic yards / oO 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): Town of Sou :hold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCA~roN: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN ~ DiStrict Sect~n BIo¢k Lot C~TIPII~V BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION [II.[~M # / WORK ASSESSMENT ] Yes No a. What is the Total Area of the Project Parcois? 1 Will this Project Retain Ail Storm-Water RumOff (Include Total Area of all Parcels located within the Scope of WorR for Proposed Construc~on) / ~) 0 f..I 0 .~' ~ Generated by a Two (2') Inch Rainfall On Site? b. What is the Total Area of Land Clea;teg (S.F. I Ac,~) (This item will include all run-off created by s~ cleadng and/or construction aclJvities as well as all and/orGroundDisterbancafortheproposed ['~_ I (~ (3 ~ ~'F' Sitelmprovementeandtheparmanentcreafionof construction activity?, impervious surfaces.) '(S.F, I Acres) 2 DoestheSitaPlanandlorSurveyShowAJlProposed J D PROV]I)E BRIEF PROJECT DESCRIFTION (~d~.;r~..r~,d) Drainage Structures lndicating Size&Lccation?This Item shall include all Proposed Grade Changes and /~/t/~_p/ ~j ~ ~ (~/~ ~"' Slopes Controlling Surface Wator FIow, : 3 Does the Site Plan and/or Survey describe the erosion ~1/ D /~,,~/~[~-~/ /~0~1'-/~' [ff("~f~ and sediment control practices that wilr be used to · ' control site erosion and storm water discharges. This -- [~1~7~--('~ ~*[~/FI~-"JIj ~,~[/~e~'~ ~/.~AC itemmustbemaintainedthroughouttheEntire Construction Pefind. /~,~ c_ / r~ ! 7-/£ ~'l P?/~/E ~u~'~ t 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural ~/~'~-~' F~_.)T~ ~,t~"~'~ //~/~ ExistingGradelnvoNingmorethan200CubicYards -- (.,/~ J..L/~J ff-~rl/~ ~ ,~ ~ v~'"~ , 5 Will this Application Require Land Disturbing Activities --.s~-_ .~ ~ ~ Encompassing an Area in Excess of Five Thousand -[ u'~ (5,000 S F ) Square Feet of Ground Surface? -- y,, 6 Is there a Natural Water Course Running through the O.7 / are Pa~ of a larger common plan thai will ultimately distu¢o one or mom acres of land; which Exceed Fifteen (15) feet of Vedical Rise to ~ STATE OF NEW YORK, "~ ,f'{'~.t ~, COUN .................. ss That I .......... ..~.~..~.....~..~..!..'~......~,,..~ ....................... being duly swbm, deposes ;md says thai he/she is thc applicam for Permit, And that he/she is the ........................................... ~-ig-:~;~iT~B~;;.'~]i .......................................................... i ..... Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained io this applica,9~EEl~elt~9~r~dh, best of his k~mwledge and belief; and that the work will be performed in the manner set forth in the applic~i{aqf~_. Ikefitafah~f New · No 01ST6164008 Sworn to before ~e this; Qualifl~J in e'"~' k Cou '"' ............................. ..... ! I-~ ~c.., ! FORM - 06/10 'PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 61720 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) I. APPLICANT / SPONSOR 2. PROJECT NAME SEQR 3.PROJECT LOCATION: County 4. PRECISE LOCATION: S~eet Addess and R~d Interactions. P~minent landmass etc -or 9mvide mad 5.1S PROPOSED ACTION: ~ New ~Expansion ~M~ifi~,on/alte~tion 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: ac.es U.i. ate y ac,es 8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? II'Yes [] No If no, describebdefly: [~VHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential r---llndustrial r--]Commercial []Agriculture [~Park/Forest/OpenSpace ~lOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or Local) F-'~Yes r~No If yes, list agency name and permit / apEroval: ~ ,--,, ~ 11.DOES A~ ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~No If yes. list agency name and permit / approval; 12. AS ARERE~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~'es[~ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Signature ~'"""/.~/..~ ~/~ ,/~,~ If the action is a ~ostal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART I1 - IMPACT ASSESSMENT (To 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. I~1 Yes I'~No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative dedaratiort may be superseded by another involved agency. F~[ Yes I'~1 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwrittsn, if legible) C1. Ex]sting air quaaty, surfaco or groundwater quality or quantity, noise levels, eidsting traffic pattem, solid waste production or disposal, potential for emslco, drainage or flooding pro/olems? Explain bdofly: I I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or naighborhsod charsctsr? Explain briefly: I, C3. Vegetation or fauna, fish, she fish or wildlife species, significant habitats, or threatened or endangered species? Explain btietiy: C4. A community's existing Hans or goals as officially adopted or a change in use or intensity of use of land or other natural resources? Explain tslefiy: I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6 L '"" ' .... · ong term, shod term, cumulative, or ofher effects not identified in C1 -(:;5? Explain briefly: C7. Other Impacts Ilnciudin~] c;langes in use of either cluaetity or t~pe of energy? Explain tsiefly: I, D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED/HE ESTABLISHMENT OF A CRITICAL E. iS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If }ms explain: PART III - DETERllIIINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadvefseeffectidenti~edab~ve~determinewhetheritissubstsntia~~~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) irrevemibiltiy; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference suppoding materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If ques[ton d of part ii was checked yes, the determination ofsignificsnco must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box If y(~u have Identified ona or mom potentially isrge or significont edverse impacts which MAy occur. Then Ixocssd directiy to the FULl. EAF and/or prepare a positive declaration. Chec~ this box if you have determined, based on the information and analysis above and any supporting documerdatlco, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on atfachnlents as necessaw, the masons ~ppoding thi= dets~reinaflon. Board of Trustees Name of Lead Agency Date Jill M, Doherty President Pdnt or Type Name of Responsible Officer in Lead Agency Title of Respo~sible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer} Jill M. Doherty, Presidcm Bob Ghosio, Jr. , Vice-President Jmnes F. King Dave Bergen John Bredemeycr Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD 7 ..... In the Matter of the Application of · ' ~_L. JOHN PRIZEMAN COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING l'i?K'J¢fi, %'/:lb ,/'~ , r/esiding a,t/dba /~ J //~'~'~-'%, being duly sworn, depose and say: Thatonthe? day'of ~) , 201/ l pcrsonally posted the property known 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 tbr eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed~ October 19~ 2011 on or about 6:00 PM. Dated: Sworn to befbre me this ,~0**'-day of,~0t 20 tr' N~ta/rr3) Pdblic PROOF OF MAILING OF NOTICE J ,fi f CJAL USE Postage Re~lm Receipt Fee (Endom)ment Required) Restricted Dellvew Fee (E~dorsement Required) CERTIFIED MAIL RECEIPTS Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,residingat I%1 /V I II'?-° } being duly sworn, deposes and says that on the day of ,20 , deponent mailed a tree copy of the Notice set forth in the Board of T-rustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names &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 , that said Notices were mailed to each of said persons by CERTIFIED MAILfRETURN RECEIPT. Sworn to b~efore me th!s d3 Day of..~ .3~ otary Public LAUREN M. STANDISH Notary ..Pubic., State of New York no. ulS16164008 Cluallf ed in Suffolk County / Commission Expires Apdl 9, 20J_~_ Board of Trustees Application County of Suffolk State of New York ?tz BEING DULY SWOR DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. / ' -Signamr4 -2] SWORN TO BEFORE ME THIS DAY OF ,.~.D j - ,20 l/ Lq~'dtary Public LAUREN M. STANDISH Nota~ Public, State of flew Yor~ ' No 01ST6164008 ,~ aH~inSuffoikCoun~, t'- %m~-i,;J.~'~n Expires h~fi~ 9.20/~. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the oart of town offieem and emnlovees. The ouroose of this form is to provide information which can alert the town of ~ossible conflicts of integst and allow it to take wbat~w~' action is n to a id same. YO N, : 'TO t "' of (Last name, fu'st name,~niddle initial, umess yOU are applying m me name someone else or other entity, such as a eompeny. If so, ndicat0 the other person's or eompeny'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 Of"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a mlatioaship with any officer or employee of the Town of Southold? "Relationship" ianludes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title Or position of that person Describe the relationship between yoursalf {the applicant/agent/representative) and the town officer or employee. Either check the appmpriato line ^) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (cheek all that apply): __^) the owner of greater than 5% of thc shares of the corporate stock of the applicant (when the applicant is a ~orporafion); __B) thc legal or beneficial owner of any interest in a non-corporate entity (when thc 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 day of. 200 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 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 Waterfxont Revitalization Program. A proposed action will be evaluated as to its si~c~ificant 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" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ lisfin~ both supporting and non- suDoortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.norttffork.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 The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board ~ Building Dept. ['~ Board ofTrustees ~ 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) Nature and extent of action: Permit, approval, license, certification: Locafionofacfion:/(/O~'/-~ 5'/fi~--' O~'-~/~/M ~~ ~ - V- Siteacreage: 10~[0~1 ~ / 0~ ~,3~Acg~~0~' 9Ov~N t ~7~t~-~ Presem use: Presem zo~g cl~sificafion: ~ ~ 0 If ~ appli~fion for ~e proposed ~fion h~ b~n filed ~ ~e To~ of Sou~old ~ency, ~e follo~g ~o~afion sh~l be prodded: (a) N~eofappli~t: ~0~ ~[~N (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~-] No[~ Ifyes, which stateor federalagency? :~ C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes ~ NO ~] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 3.. Enhance visual quality and protect scenic resources throughout the Town of Sonthold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria 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 Ill - Policies Pages 8 through 16 for evaluation criteria Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ~'~ Yes ~ No [] Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore thc 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 App{~ble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~-] Yes [] No ~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No [] Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes ~ No L_~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes ~ No ~ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. Yes [] No ~ Not Applicable PREPARED BY 5J~flJ P~ ~_~./~/~r ~j TITLE N S TEST hOLE COL) (~ / · THI~ PLOT PLAN :?I=\/ELOPE:2 UTILITIN¢ AEI~IAL PNOTO~PJ~PN'f, CONVENTIONAL E:~Ut~VE"C'IN¢ '¢EONNI(~UE~ AND P-.E~,O~ I~ATA. Ata4~A = 2.B,~,~4 U~LANP AREA = 1.1'"/¢1 · 5UBI2IVI~ION - "'f'4AP-J(- t~,AX"I~R" FILl=I? IN THE O~FIC, E OF THE OLEt~.K OF ~LIFFOL'~'-- C. OUNT¥ ON NOV. 14, 2OO~ A~ FILE NO. 114(24 · VERTIC, AL DATL)~ = N.~.V. I?ATt.)M (M.5.L. I':q2':q) MLI~I (ALl, q) :' ~.4~o Young & Young 400 Ostra~der Aven~e, Biverhead, New York 11901 63 ~- 727-2303 Howard ~. Young, Land Su~eyor Thom~ C. ~olpert, Profes~nal Engineer Dougl~ E. Ada~, Professorial Engineer Bobert C. T~t, ~reh~tect JOHN PI IZEHAN LOT ;2 "I"4'A~K BAX'TEt~" At, t~oyvle~, To~n o'1' ,~:2ut, holct ~,u'~olk C, ount,~, Ne~ "'fork C, OUn~¢~ T~IX ~'¢[C2p District JO00 Section -~ Block 0-~ Lot 5.~2 ' ':,'H OF $OUT[;C ~:) JO~ NO. 2011-00'/2 D~. 2002_02~_O02-200"l-02~rf_tc~p-plon_l~'_~dec I OF ,2 N !\ 3.85 I ~ 5_)7-~/ // + 3.73 +3 OF I00 ~..Y'.+ / TOF~-~91L I=N~,INI~I=I~'5 GEI~TIFIGATION F~.,~I~ C, Of.~'R~='T~ I~-'"I'AININi~ Young & Young 400 Ostrander Avenue, Riverhead, Neu) York 11901 63 ~-727-2303 Howard F. Young, Land Su~eyor Thom~ C. Folperf, Professorial Engineer Dougl~ E. Ada~, Professorial Engineer Robert C. T~t, Architect .JOHN F:~IZEMAN LOT 2 "MAt~.K BAx'r"~t~." At t~a~lvlov~, Tovm oF 5outhold ~FPolk ~oun[~, Ne~ ~o~k GOUn~ TOX ~Op District I000 Section ~ Block ~ ~, ,',' N OF SOUTHOLD 152- I ~/- II ..... MAP ~ ~,~F:~". 20, 2011 ~ NO. 2011~0~2 D~. 2002_02~6_O02_200~_02~_~_plan_B_d¢¢ 20~ 2