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Home My WebLink AboutTR-7705A James F. King,President �oF Sorry Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O Ol0 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer cis ,c Michael J. Domino � � �OQ Telephone(631) 765-1892 O Fax(631) 765-6641 �ycouff ,�c� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0803C 1 30 I \ Date: September 20, 2012 Co �c2 r� o THIS CERTIFIES tj f trees along the west side of the driveway, the conducting of 1 SSkk C�S CA PAS illation of agravel driveway and storage area, and a 20' wide i W t R n e q t.- f �'C�Yt� The established and subsequently maintained from the established-.---.-a VYti-U=1io-Wc;zit-b-iuz and a 10' wide non-turf buffer to be established and subsequently maintained from the established wetland line on the east side of the property At 1940 Mason Drive Cutchogue,New York Suffolk County Tax Map# 104-7-16.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 26, 2011 pursuant to which Trustees Administrative Permit#7705A Dated December 14, 2011,was issued and Amended on June 20,2012 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 trimming and cutting of trees along the west side of the driveway the conducting of light grading and seeding installation of a gravel driveway and storage area and a 20' wide non-disturbance buffer area to be established and subsequently maintained from the established wetland line on the west side and a 10' wide non-turf buffer to be established and subsequently maintained from the established wetland line on the east side of the property. The certificate is issued to SCOTT AMBROSIO owner of the aforesaid property. Authorized Signature James F.King,President guFFO(�CO Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �� Gy P.O. Box 1179 Dave Bergen y Southold,NY 11971 John Bredemeyer 4y �•jC Telephone(631)765-1892 Michael J.Domino ��j � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: �17 l Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: `�e 5 MARTIN D.FINNEGAN SCOTT A.RUSSELL t TOWN ATTORNEY Supervisor martin.finnegan@town.southold.ny.us O��QF S�U�yOI JENNIFER ANDALORO Town Hall Annex, 54375 Route 25 ASSISTANT TOWN ATTORNEY P.O.Box 1179 jennifer.andaloro@town.southold.ny.us Southold,New York 11971-0959 LORI M. HULSE 'O Telephone(631) 765-1939 ASSISTANT TOWN ATTORNEY C0IINV Facsimile(631) 765-6639 lori.hulse@tow n.southold.ny.us I E C OFFICE OF THE TOWN ATTORNEY ' IIII f TOWN OF SOUTHOLD OCT — Z 2012 1 I..n. Southho!d Town Mr. Scott Ambrosio o er 2; t Trustees 25 Brian Lane East Northport, NY 11731 RE: Scott Ambrosio,Wetlands Permit No. 7705A Dear Mr. Ambrosio, I have reviewed the Declaration of Covenants draft you submitted to this office with respect to the above referenced amendment to a wetlands permit. The language in your draft does not reflect the language of the permit, and should be changed to the following: "a twenty foot wide non-disturbance buffer area to be established and subsequently maintained from the established wetland line on the west side" and a"ten foot wide non- turf buffer to be established and subsequently maintained from the established wetland line on the east side of the property. Please see the attached draft. The covenants and restrictions document must be executed and filed with the County pursuant to§275-10(K)of the,Southold Town Code. Please note that a copy of this document or,in the alternative, a sworn statement attesting to the filing is to be presented to the Office of the Board of Trustees within 90 days of issuance of the permit. Regards, Lori M. Hul Assistant To Attorney Cc: Board of Trustees Att DECL4RATION OF COVENANTS THIS DECITARATIOU made this _18— day of —September 2012_, by SCOTT AND SMAN AMBROSIO, residing at 1940 MMSON DRIVE bereinafter referred to as IiDECLARANT(S)": t4ITNES5ETH .' �q!HpREAS, DECLARANT(S) is/are the owner(s) of certa.in real property located on 1940 V-,ASON DRIVE CUTtHOGUS Town of Southold, county of Suffolk, State, of New York, described in the Suffolk County Tax s%P as District 1.000, Section _,104_p Block —7—, Lot 16.1-- whtch is mote ParticularlY bounded* and described as set forth In Schedule ,A" annexed hereto, hereinaf ter - referred. to as the Property; WHF,RtM, the prooer.-y is situated can lands within the jurisdiction of the Board of Trustees of the Town 'of sputhold .(hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southoad ..or Its sucdessoir, and vaiions activities conducted upon the property may thus be subject to the re.gulation ard approval of the Trustees prior to being conducted; WHEREAS, the 0ZCLzLRMr plication -to the Trustees for a ,1 (8) therefore made an ,,t wjrsuant to the We'la nds Law of the Town Of southold to undertake certain perm regulated activities; and ,6,IiBREAS, - as a condition of the granting af a Wetlands Permit to undertake - rN 2 t1f Such regulated activities, the Trustees .required t -_q that a 0 13UMV. ' adjacent to a.rdlandward. o f T.M-B AM-96- di'&V'rh otc-c' VV NT4, THEREFORE; tt-,e DECLAMANT(S) do./does hexeh- gorjrj� --n agree as follows: 12 TOWN ATTORNEY'S OFFICE TOWN OF SOUTHOLD Yv Upon the substantial completion Of the afore ntioned permitted Ir I activities there shall be establi2hed arid. subseque 1, -ly maintained ^r5r'rr-v--44�F -nonturf buffet- as defined by Chapter 275 Of the TO-On Code; and as depicted on the SUR%r.EyjsjT� PLM LA5,T D.ATED AND STAMPED APPROVED ON 6/20/12 and 2# These covenants shall run with the land and shall be binding on the DECLARANT(s) , his/her/thkeir heirs, assigns, purchasers, or successors in interest and may only be modified after a Public, hearing and upon resolution of the Trustees. i WITNESS WHEmEOF, the owner s) has/have duly executed' this instrument thi-5 N ( day -of 20 OwNsRIS SIGNATURE RIS 51=ATURE STATE OF COUNTY OF on the day of in the year 201 r before me the peEFo-nally appeared MMIC lir avld for said State' personally known to me or proved to me on the basis of ............................. be the individual(s) whose name(s) istare subscribed to satist4ctory evid6llce to me in the within instrument and acknowledged to me that he/she/they executed the sa_ his/hek/their CAPacityr and that by hWher/their signatu'AW on the . instrument, the 111dividual. or the persons on behalf of which the individual (s) acted, executed the instrMeht- Notary Public 4' J AMA Me 0 All ilk ' AL a� TO BE AUNDONEO firw x F�� st NMI °•' '50f TO d yf A ...mod r6 �O 23d• S p ORMILO" R '�, _ yy w•rwny� �lw * 14M21 .•"MAE i APP CATWAIX law top I .fit k � C ' James F.King,Presid t 'Jf sorry Town Hall Annex 0 54375 Main Road Bob Ghosio,Jr.,Vice-Pres ent P.O.Box 1179 Dave Bergen . Southold,New York 11971-0959 John Bredemeyer N Telephone(631) 765-1892 Michael J.Domino I �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0803C Date: September 20, 2012 THIS CERTIFIES that the trimming and cutting;of trees along,the west side of the driveway the conducting of light grading and seeding installation of a gravel driveway and storage area, and a 20' wide non disturbance buffer area to be established and subsequently maintained from the established wetland line on the west side and a 10' wide non-turf buffer to be established and subsequently maintained from the established wetland line on the east side.of the property At 1940 Mason Drive Cutchogue New York Suffolk County Tax Map# 104-7-16.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 26, 2011 pursuant to which Trustees Administrative Permit#7705A Dated December 14, 2011,was issued and Amended on June 20, 2012 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 trimming and cutting of trees along the west side of the driveway the conducting of li� t-gradi g and seeding installation of a gavel driveway and -- Rom•-.'uG-enC storage area an a 2, deenfl`ndisturl�anbuffer�ar eatbeestabhshed an subs uenfi inain�aine��fro -�the establislti✓d�etland lineon�t'e_�.est�Ld"e�d�:b �de nanttrf�buffeX�to be=.estalil shed dubs alentl�' maintain�oln�the=�stablls��vetlarid��i'n�e�on�.#leb ast�sl�de�of � h� Qpert The certificate is issued to SCOTT AMBROSIO owner of the aforesaid property. Authorized Signature JUN 6 2012 APPRO~FD-BY_." IOWN OF $OOTHO[D DATE I NEW 4' PATH TO TO BE 1 "= 50' ICUNED ALW EX. TRODDEN PATH BE ABANDONED Board of Town Trustees Att: Lauren Standish p.o. box 1179 Southold, NY 11971 6/4/2012 Please find a copy of my amended plan (previously approved for land) clearing which now includes installing a gravel driveway/storage area for our personal boat and trailer storage. 1 have also included a $50.00 money order for permit costs. 1940 Mason Drive Cutchogue NY 11935 516-644-3710 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 June 20,2012 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Mr. Scott Ambrosio 1940 Mason Dr. Cutchogue, NY 11935 RE: ADMINISTRATIVE PERMIT #7705A 1940 MASON DR., CUTCHOGUE SCTM#104-7-16.1 Dear Mr. Ambmsio: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., June 20, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Administrative Permit #7705A to include the installation of a gravel driveway/storage area, as depicted on the plan stamped approved on June 20, 2012. This is not a determination from any other agency. Sincerely, Jame .~King, Presid~ 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 Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: SCOTT AMBROSlO requests an Amendment to Administrative Permit #7705A to include the installation of a gravel driveway/storage area. Located: 1940 Mason Dr., Cutchogue. SCTM#104-7-16.1 Type of area to be impacted: .~-.Saltwater Wetland Freshwater Wetland 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 __Administrative__Emergency Sound Bay Coastal Erosion Amendment Pre-Submission Violation Info needed: Conditions: Present Were: __J. King __B. Ghosio ~ D. Bergen, J. Bredemeyer___ Michael Domino D. Dzenkowski __ Form filled out in the f~ld, 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 __ 1st day of construction ~ constructed Project complete, compliance inspection Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7705A Date of Receipt of Application: October 26, 2011 Applicant: Scott Ambrosio SCTM#: 104-7-16.1 Project Location: 1940 Mason Dr., Cutchogue Date of Resolution/Issuance: December 14, 2011 Date of Expiration: December 14, 2013 Reviewed by: Board of Trustees Project Description: To trim and cut trees along the west side of the driveway and conduct light grading and seeding. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations indicated on the survey stamped approved on January 13, 2012. Conditions: A non-disturbance buffer area within 20' from the established wetland line on the west side and a 10' wide non-turf buffer from the established wetland line on the east side of the property. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jill k{[/Doherty, Presider~ Boa~ of Trustees Jill M. Doherty, Presiden! Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer P.O, Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report SCOTT AMBROSIO requests an Administrative Permit to trim and cut trees along the west side of the driveway and conduct light grading and seeding. Located: 1940 Mason Dr., Cutchogue. SCTM#104-7-16.1 TYL~salOf area to be impacted: twater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland P~chOf Town Code proposed work falls under: apt.275 Chapt. 111 other Type of Application: [~Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Pre ~o J. King D. Bergen, D other Form filled out in the field Mailed/Faxed to: Date: Jill M. Dohmy, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. 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 Office Use Only Coastal Erosion Permit Application Wetland Permit Application ~/~Administrative Permit Amendment/Transfer/Extension ""~Rece~ved Application: X.~eceived Fee:$ ../Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) Consistency Assessment Form CAC Referral Sent: ~'~Date of Inspection: ~ Receipt of CAC Rep&i:'" Lead Agency Determination: Technical Review: ~l~blic Hearing Held: Resolution: Name of Applicant Address ~ c'Lc~o Suffolk County Tax Map Number: 1000- 1o¢- ~ '7 -- Property Location: [6tL(O 1~$c4~ ~. _ff~JaC~0lC'. (provide LILCO Pole #, distance to cr-~ss streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application Land Area (in square feet): GENERAL DATA Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes t~ No Does this project require a variance from the Zoning Board of Appeals __ If "Yes", please provide copy of decision. Yes Prior permits/approvals for site improvements: Agency Date ~//No __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? Yes If yes, provide explanation: \ Project DescriPtion (use attachments if necessary):_ --~'"'~i,~,. c_~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: _(~,~I vt-4, G~0 Area of wetlands on lot: ~.b,~ square feet Percent coverage of lot: ~0 % Closest distance betweentn~a,a~est existing structure and upland edge of wetlands: ]~g,~ feet Closest distance betwe%n~earest proposed structure and upland edge of wetlands: . .t~i~' feet Does the project involve excavation or filling? No / Yes If yes, how much mater/al will be excavated? O cubic yards How much material will be filled? ,.42 ~( -73/,o%c._ cubic yards Depth of which material will be removed or deposited: ,..? ~ feet Proposed slope throughout the area of operations: gS}tTod~/ Manner in which material will be removed or deposited: ~.tatement of_t_he e~ect, !f.~my, 9n th~ wet_l_a~_._ds an~ tid~! w.a__te3-s_ 9fthe town tha_t.._max r__e_s_u[[.b_y reason of such proposed operations (use attachments if appropriate): PROJECT lO NUMBER PART 1 - PROJECT INFORMATION 1. APP~CANT I SP/~NSOR 3.PRO ECT OCATI N: Municipality 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only To be completed by Applicant or Project Sponsor) 2. PROJECT NAME / . PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide mad SEQR . DESCRIBE PROJECT BRIEFLY: 7 AMOUNT O~.AND AFFECTED: ~/ Initially / ~...~acre s Ultimately / ~ acres 8. WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply ) ~esidentia, [~ ,ndustr,al E~ Commercial r~Agriculture E~ Park ' Forest / Open Space E~ Other (describe) 10' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fede.~, State or Local) ~Yes b~JNo If yes, list agency name and permit / approval: -11. U(Jt:5 ~~[HE AClION HAVE A CURRENTL? -~/ALID PERMIT OR APPROVAL? ~]Yes list agency name and permit / approval: RES OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E]Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponge ~ Date:/// Signature /O/~'''~> If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by* Lead A~lency) .,gL DOES ACTION EXCE-ED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 if ~,s. ce~dinate the revlew process aed use the FULL EAF. ['--]Yes [Z]No WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declam~ may be superseded by another k~o~ved agency. C. COULO ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH ~ FOLLOWING: (Answers may be handwdaen, if legible) C1. F-.~ng air quality, su~ana or groundwater qualit7 or quantity, noise levels, e3dstlng traffic pabem, solid waste production or disposal, pr~enlial fm erosion, drainage o~ flooding problems? Explain ~ I C2. Aesthetic, egdcultura[, archaeolnglcel, Iflstorlc., or ether natoral or cultural resoumes; or community or nslghtxxhood characb~? Explain bde~: C3. Vegetation m' fauna, r~n, ~'~elllish or wildlife species, signlf, cant habitats, or ~eatefled or endangered species? Explain beefly: C4. A communify'a existing plans or goals as oflldaliy adopted, or a change in use ~' Intwa$ity of use of laed ~ othe,- Mtuml msoumes? Explain bdefly: I C5. GrowUl, subsequen( development, or related activities likely to be induced by the proposed action? Explain briefly: I C6. Long tenn, shorttem~,c=umulaUve, o¢ other effects not identif~d tn Cl-C5? F-~lainbeefly: I C?. Other impacts (includi~i~ chan~es i~ use of either fluaetit'f or t~ of eries},? E~plaln beell~: O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL E. IS THERE, OR IS THERE UKELY TO BEt CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes -_ ,,~!-_~: PART III - D~:t ~RMINATION OF SIGNIFICANCE (To be complet~l by Age~-'y) . INSTRUCTIONS: Foreachadvarsee~ec~kJen~ndab~ve~determinewhethe~i~is~`~st~niia~orge~k11pertant~he~isesi~ni~canL Each effent should be -__-__-e~__~d in connection wl~ its (a) setting (i.e. urban or rural); (b) probeb~ of occutflng; (c) duration; (d) Irrev~; (e) geograplflc scope; and (0 magnitude, ff nesesemy, add attachrnenfa or reference suppodln{i mi. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequacy addressed, ff qUeStion d of part ii was checked F.N= and/or Ixepam a ~ dedaraben. WILL NOT result In any significant adverse em'lronmenfal Impacts AND prO~,~e, on attachments as nscessmy, the reasons supposing thl= defannlnaben. Board of Trustees Name of Lead Agency Dale Jill M. Doher[y President Pdnt or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible ~t in Lead Agency Signature of Preparer (If different from responsible officerJ Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCA ~ S.CT~a.~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A /~t ~nTM ~0~k'( ~//~1/ STORM-WATER, GRADING, DRAI,NAGEANDER.IONCONTROLPLAN CEKTIlFIEU BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. sCOpE OF WORK - PROPOSED CONSTRUGTION ~'ll~ ~ / WORKASSESSMENT ] Yes No (thdude Total Area of all Pamels located within ' I Will this Project Retsin Ail Storm-Water Run-Off the Scope of Work for Proposed ConsthJCfion) Generated by a Two (2~) Inch Rainfall on Site? b. What is the Total Ama of Land Cleadng (S.F./~es) (This item will include all run-off created by site clearing and/or construction acgvilJes as wall as all and/or Ground Disturbance ~or the proposed [~L Site Improvements and the permanent creation of construction activity?.Ff. ~'~:n)a imperious surfaces.) (s ) PROVIDE BRIF, F PRO. IF, CT DESC1UI~ON t~d.~.~a~.~..*~) 2 Does the Site Plan andlor Survey Show AJl Propeesd Drainage Structures thdicaUng Size & Location? This ,~ Item shall include all Proposed Grade Changes and "--~-l~'~k ~ (~'~ ~:~- '~ ~--~0~ Slopes Controlling Surface Water FIow. ~ O¢ 'J(~-- -~/i~.. t.~Z~, 3 Does thoSitePlanandlorSurveydescribetheeresion and sediment control practices that will be used to control site erosion and storm water discharges. This -- ~..ic.~j/~c- O~,t~"~ ~pOC~ ~ ~"~ ..~(H~¢-~ item mustbemaintsinedthronghouttheEngre Construction Pednd. 4Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic YardsI~1 -- of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? -- 6is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requl~ments: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is requb ed fo~ all Consbacban acth~ties invclving soil Beach? disturbances of one (1) or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ate part of a larger common plan that will ultimately disturb one Or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise to including Construction activiUes invoNing soil disturbar~es of less than one (1) acre where One Hundred (100') of Hodzontol Distance?I~1 -- the DEC has determined that a SPDES permit is required for storm water discharges. SWPPP's Shall meet the Minimum Requirements of the SPDES General Pemtit 8 Will Driveways, Parking Areas or other Impervious for Storm Water Discharges h'(x~ Construction acgvity. Permit No. GP-0.t0-001.) Surfaces be Sloped to Direct Storr~Wator Run-OffI~J 1. The SWPPP shall be prepared plier to the submiaal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way? -- submJtted to the Department prior to the commencement of consthJClJOn activity. 2. The SWPPP shall desc~ba the erosion and sediment contnd practices and where 9Will this Project Require the Placement of Material, required, post.consthJCtisn stc~n water management practices that will be used antler Removal of Vegetation and/or the ConstntCtion of any r~ constructed to reduce the po~utaofs in storm water discharges and to assure Item Within the Town Right-of-Way or Road ShoulderL~J compliance with the thm~s and conditions of this pa/miL In addhion, the SWPPP shall STATE OF NEW YORK, COUNa ' Or ........................................... ss llaat l,'~'~('~ ~ A .~.~jO~ t{~ bein dui sworn deposes and says that he/she is the applicant for Permit, And that he/she is the .......................... ...~..~ Owner and/or representative o[ the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belie£; and that the work will be performed in the manner set £orda in the application filed herewith. . ........................... ........................ ....... FORM - 06110 JAN SCHOTfENFELD Nota~/Public, State o! New Yolk No. 4949213~ Nassau County Commission Expres Apd103, ~ of Trustees Applicat0 County of Suffolk State of New York ~x~ ~ ' ~a~r~g t (Z~ 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~dER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE 1N THE MANNER SET FORTH 1N TI~S 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 ~W OF THIS APPLICATION Signature SWORN TO BEFORE ME THIS 2~'~ DAYOF Ot.'[,'~.~ ,20t$ ~/Notary Public JAN SCHOTTENFELD Notary Public:,State of New York No. 494921o, Nassau County ~ Commission Expires April 03, J.O"'~ ~4:;)! r"' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FORM Thc Town of Southold's Code of Ethics orohibits conflicts of interest on the cart of town officers and cmolovccs. The ouroose of this form is to orovide information which can aler~ the town of cossiblc conflicts of intem~t and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name, first name,~piddle initial, unl~/ss 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 (I f "Other', name the activity.)~--'l~,l?Jl*-. Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest_ "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete the balance of this form and date and sign where indicated. : Name of person employed by thc Town of Southold Title or position of that person Describe the relationship between yourself(the applican~./agcnffreprasentative) and the town officer or employee. Either check the appropriate linc A) through D) and/or describe in thc 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 g[eater thwart 5% of the shares of the corporate stock oftbe applic0nt · (when the applicant is a corporation); __B) the legal or'beneficial own~ of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, partner, or employee oftbe applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I S u b mitted t h i~.~tc~j~v.~~ 20~_ Signature Print Name ~:~c,z tk i~.~rZ~fv~; t~-~ Town Qf 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" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- suooorting facts. If an action cannot be certified as consistent with thc LWRP policy standards and conditions, it shall not bc 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# [cO00 - i 0 Of - ~5) '7 "{ ((9, '( The Application has been submitted to (check appropriate response): Town Board ~ 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) Permit, approval, license, certification: Nature and extent of action:.._.~..r:,~V..p_p~_.~¢~ j "~-t.~ (2Ja~O~..Q } .~ 'Location of action: Site acreage: Present land use: 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: (c) Telephone number: AreaCode( ) ~{~,- ~_q, "~ '-/ ./(~ (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? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide ali 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 effec, t~ of development. See LWRP Section III - Policies; Page 2 for evaluation I I/lYes [~ No I ~ 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 Southoid. 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 III - Policies Pages 8 through 16 for evaluation criteria [~Yes ~-] No [] Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - PoliCies Pages 16 through 21 for evaluation criteria [] Yes[] No[-~N,Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Appl~e 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 foCvaluafion criteria. ~--] Yes ~-~ No L_~ 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~fL//I ca' 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.~ ~ ~Nol Ye~ . No 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. SeeLWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. ~ Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy I1. 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 F-~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 fm eva~ation criteria. I lYes I ] Nol~'1 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; P~es 65 through 68 for evaluation criteria. [ lyes I I No[ ,~ Not Applicable PREPARED BY ~C'O ~( . ~7~ tf'D TITLE ('~ - DATE N z?PROVED [~OARD OF TOWN OF $OUTHOLD SURVEY OF PROPERTY AT EAST CUTCHOGUE TO'tN OF $OUTHOLD SUFFOLK COUNTY, 31.15. I000--I04-07-I~.I SCALE.. I'=40' D£CWEB[?? 14. 2006 AREA-~2,612 80. FT. TO llE I..1~8 c~c~,r ~s ~7~ .c~ z2og--sz~w~oi~ z ~ c~,r~c~r~o~v$ ~Z,4X (6,11) 765-1797 DEEP HOLE DRIVE STONE DRIV£WAY 1" = 40' 4' x 78' FIXED DOCK TO BE REMOVED 20' RAMP AND 6' x 40' FLOAT) DOCK cREEK i40LE_.~ r~o~, W~z".,, ~*RD·) PIt~ 20' FLOAT ~.l~ at, 2::50PM on 4-~-I0 wg~ ~ fa% C, orwl~, IlL bS. ProJ~ bcafloa: 1710 Peep Hdc FF. OPOF::E:::P POCK I~PLAL::P. MP. NI' FOR PENN5 ~ II, NB KP. API' ON PP. BP HOL~ CI~BK. MAfflfL!CK. 51JPPOLK C0.. NY Jaw.~ F. K/ng, Prezideat Jill M. Dol~rty, Viee-Pr~sident Peggy A. Dicker~on D~ve Bob ~ho$io~ ~r~ Town HI~II Annex 54375 Ma/n Road P.O. Box 1179' Southokl, New York 11971'-0959 Telephol~e i6~1) 76.5-18~2 Fax (631) 76/5-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE Date~ THIS CERTIFIES that 'the renlacement of the.siding_ windows, doors, and iast~!!ati0n of two(2~, new windows on the cxist/n~ dwelling_ tr/mmin~ of trees uoland of w~'la~ds, removal of [fallen tree. 10' non-tuff/no-mow zone landward of wetland boundary, and ~mmino. i f Dhraamites by hand to 12" At 1940 Mason Dr., Cutohoeue Suffolk Coun/y Tax Map # 104-7~ 16, I Conforms to the application for a Trustees Permit heretofore filed in this office dated 1 !/3/08 pursuant to which Trustees Wetland Permit #7002A .Dated 11/19/08' ~i.~ was Issued and conforms to all of the requiremen~ and conditions of the appi/eable pro~isions of law. The Project for which this certificate is being issued is for the reola~emen~ of siding, windows, door. and installation of two(2) new windows on tho /:xistin~ dw¢:llin~: trimmine of tree.5 ~oland of wetlands, removal of a fallen tree. 10' n9~, t~rf/non-mow zone landward of we~I~-d b0una~, and t~:"~",jna of ohrz _~m!t,'s by h*~,4 tO 12"i The e~rffile~te is issued to .~e,,_~Qrf'I'.~M._~,)~,OSIO owner of the aforesaid property. Authorized Signature ~0/g0 39~d 9NIHN~-~ t,~N~3~ /~I9~6~9I~ LE:80 HENRY REBMANN · PLM1'~BINC~.HEATINO.AIR CONDITIONING ' GENERAL CONTRACTING 844 #ZLLIS AV~iUE, ALBERT$ON NY 11507 TEL: (516) 746-5678 FAX: (~26),294-614~ PAGE I of CONFIHM FAX: YES NO '~ ' THE NUMBERS LZST~0 ABOVe, n 3~d ~NI~nTd SURVEY OF PROPERTY SlTUATE CUTCHOGUE I OWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-104-07-i6.i SCALE 1"=40' AUGUST 19, 2009 JULY 31, 2010 UPDATE SURVEY AREA = 62,613 sq. ff. (TO TIE LINE) 1.437 ac, CERTIFIED TO__ SCOTT AMBROSIO 1. [LEVATION~ ARE REFERENCED TO MEAN ~OW WATER ELEV. 0.0 EXISTING ELEVATIONS ARE SHOWN T~US:~ EXISTING CONTOUR LINES ARE SHOWN THUS: ..... I -- -- t~t~ OAD WA T~t~,,~ COVE Nathan Taft Corwin III Land Surveyor PHONE (631)727-2090 Fox (651)727 1727 SURVEY OF PROPERTY $ITUATE MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-1i5-12-25.1 SCALE 1 "=$0' FEBRUARY 12, 2010 AREA = 19,518 sq. ff. 0.4~8 ac. CERTIFIED TO: DENNIS E. KRAFT IRENE M. KRAFT FIDEETY NATIONAL TITLE INSURANCE COMPANY TOWN OF SOIJTHOLD .~/ / / / / / / Nathan Taft Corwin III Land Surveyor nt~ Sur~ye - sue¢~ - ~ ~r~ - Co~eucUm~ ~ PflON[ (6;~1)727-2090 Fa~ (651)727-1727 0 ~ '~ 37,9 N 77 2 7 2011 NOTES: SURVEY OF PROPERTY SITU.4 T£ ,J CL TCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-104-07-16.~ SCALE ~ "=40' AUGUST 19, 2009 JULY 31, 2010 UPDATE SURVEY AREA = 62,613 sq, (TO TIE LINE) 1,437 t~I?OA.D}i'A ~ ~,.,&,:' CO Vk7 CERTIFIED TO: SCOTT AMBROSIO 1, ELEVATION5 ARE REFERENCED TO MEAN LOW WATER ELEV. EXISTING EL£VATIONS ARE SHOWN THDSrJ~0 THE EXISTENCE OF RIGHTS OF WAY AND/DR EASEMENTS OF RECORD, IF Nathan Taft Corw~n III Land Surveyor