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Home My WebLink AboutTR-7698 James F. King, President o~*OF SOUjyo Town Hall Annex 54375 Bob Ghosio, Jr., Vice-President ~Q Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer G Q • ~O Telephone (631) 765-1892 Michael J. Domino OI~CQUN M Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0902C Date: SSe tember 13, 2013 THIS CERTIFIES that the renovation and expansion Mn existing single-family dwelling; for the existing deck attached to dwelling; installation of gutters to leaders to drywells; non-turf buffer between top of bank and bulkhead At 4030 Peconic Bay Blvd., Mattituck, New York Suffolk County Tax Map # 128-6-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated October 27, 2011 pursuant to which Trustees Wetland Permit #7698 Dated December 14, 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 renovation and expansion upon existing single-family dwelling; for the existing deck attached to dwelling; installation of gutters to leaders to drywells, non-turf buffer between top of bank and bulkhead. The certificate is issued to ALAN FIDELLOW owner of the aforesaid property. Authorized Signature 1 T James F. King, President O~gVEFD(,rCO Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President P.O. Box 1179 Dave Bergen Southold, NY 11971 John Bredemeyer Telephone (631) 765-1892 Michael J. Dominol Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE F INSPECTION: V 1 i 1 3 Id Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 151 day of construction ~/z constnJCted Project complete, compliance inspection. INSPECTED BY: COMMENTS: D~G CERTIFICATE OF COMPLIANCE: / CC # : C13-39018 b 4~-'f3~ 9e1ti,~ COUNTY CLERK'S OFFICE STATE OF NEW YORK COtJNTY OF SUFFOLK 1, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 09/0912013 under Liber D00012743 and Page 394 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 0910912013 SUFFOLK COUNTY CLERK p CEIVE p ~ a.,19~ SEP 1 3 2013 JUDITH A. PASCALE outhold Town SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 09/09/2013 Number of Pages: 8 At: 09:06:14 AM Receipt Number : 13-0112902 LIBER: D00012743 PAGE: 394 District: Section: Block: Lot: 1000 128.00 06.00 001.000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $40.00 NO Handling $20.00 NO COE $5.00 NO NYS SRCHG $15.00 NO TP-584 $0.00 NO Notation $0.00 NO Cert.Copies $5.20 NO RPT $60.00 NO Fees Paid $145.20 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County I" 2 Number of pages RECORDED 2013 Sep 09 09:06:14 AM JUDITH R. PRSME This document will be public CLERK OF SUFFOLK COLHTY record. Please remove all L DOW12743 Social Security Numbers P 394 priorto recording. Deed/ Mortgage instrument Deed/ Mortgage T14taMP Recording/Filing Stamps 3 FEES Page / Filing Fee Mortgage Amt. t. Basic Tax _ Handling 20. 00 2. Additional Tax TP-584 Sub Total _ Notation SpecJAssit. - EA-5217 (County)_ Sub Total or tJl-7 tJl-/ Spec. /Add. _ EA-5217 (State) TOT. MTG. TAX _ R.P.T.S.A. Dual Town _ Dual County Held for Appointment Comm. of Ed. 5. 00 Transfer7ax _ Affidavit • • Mansion Tax The property covered by this mortgage is crr 9 t~ or will be improved by a one or two NYS Surcharge Is. 00 family dwelling only. Sub Total Other YES or NO ' Grand Total If NO, see appropriate tax clause on (rte Page e,_ of this instrumem.. L 4T-Dist. 1000 RarHnn 12R ni= A i... 1 5 Community Preservation Fund Real Property 2565579 1000 12800 0600 001000 Tax Service Consideration Amount $ _ IHNaSa W P T S (I9t,ry~~,~~ Agency R DTY A I~ ® GPF Tax Due S Verification eBSEP-t7 Improved TPATRICIA tisfaai. RECORD & RETURN TO: Vaunt Land C. MOORE ESQ. TD 51020 MAIN ROAD - TD SOUTHOLD NY 11971 TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co. Name www.suffolkcountyny.gov/clerk Title a e Suffolk Count Recording & Endorsement Page This page forms part of the attached DECLARATION OF COVENANTS AND RESTRICTIONS made by. (SPECIFY TYPE OF INSTRUMENT) ALAN FIDELLOW BETH FIDELLOW JUDPTH The premises herein is situated in AFFIDELLOW, BARBARA VERCOLLONE SUFFOLK COUNTY, NEW YORK TO Inthe TOWNof SOUTHOLD _ TOWN OF SOU,O__ In the VILLAGE or HAMLETof MATTITUCK _ BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIORTO RECORDING OR FILING. over DECLARATION OF COVENANTS AND RESTRICTIONS DECLARATION made this I q day of August, 2013, by ALAN FIDELLOW, residing at 75 Granite Springs Road, Yorktown Heights, NY, BETH FIDELLOW, residing at 6 Ainsworth Road, Winchester, MA, JUDITH A. FIDELLOW, residing at 11067 Old Castle Road, Valley Center, CA; and BARBARA F. VERCOLLONE, residing at 26 Red Fox Lane, Brewster, NY, as owners, hereinafter referred to as the "Declarant". WITNESSETH: WHEREAS, the Declarant has title to certain land situate, lying and being at4030 Peconic Bay Boulevard, Mattituck, Town of Southold, Suffolk County, New York, SCTM 1000-128-6-1 said land being more particularly described in Schedule "A"which is attached hereto; and WHEREAS, the Property is situated in or adjacent to lands activities upon which are regulated by the Town of Southold Board of Trustees pursuant to Chapter 275 of the Town Code of the Town of Southold, as may be amended, and various activities conducted upon the property are subject to the jurisdiction, regulation and approval or disapproval of the Trustees prior to being conducted; WHEREAS, the Declarant has applied to the Town of Southold Board of Trustees for a wetland permit to renovate and expand upon the existing single family dwelling and for the existing deck attached to the dwelling, as depicted on the survey prepared by Peconic Surveyors, PC, last dated December 22, 2011 and stamped approved on January 24, 2012. WHEREAS, the Town of Southold Board of Trustees, as conditions for the issuance of such Wetland Permit, required certain covenants and restrictions be placed on the property as shown on the aforesaid plans. NOW, THEREFORE, this Declarant witnesseth: That Declarant, for the purpose of carrying out the intentions expressed above does hereby make known, admit, publish, covenant and agree that the said property herein described shall hereafter be subject to the following covenants which shall run with the land and shall be binding on all purchasers and holders of said premises, their heirs, successors, and assigns, to wit: 1. The non-turf buffer area between the top of the bank and the bulkhead is to be maintained; and as depicted on the survey prepared by Peconic Surveyors, PC, last dated December 22, 2011 and stamped approved on January 24, 2012. 2. These covenants and restrictions can be modified only at the request of the then owner of the premises with the approval of the Town of Southold Board of Trustees after a duly noticed public meeting. Adjoining property owners shall be entitled to notice of such public meeting by publication or as otherwise deemed sufficient by the Board of Trustees but their consent to such modification shall not be required. 3. It is the responsibility of any party having any right, title or interest in the Property to consult Chapter 275 of the Town Code of the Town of Southold, as may be amended, and to obtain from the Town of Southold Board of Trustees review and such approvals as may be required by Chapter 275 for activities regulated therein on the Property. 4. Declarant grants the continuing right in perpetuity to the Town of Southold or any of its designated representatives to enforce the conditions and restrictions of the covenants. THE FOREGOING covenants and restrictions shall bind the Declarant, its heirs, successors and assigns, and any and all person or persons who shall succeed to the ownership of said premises of any part thereof by transfer or otherwise. IN WITNESS WHEREOF, the Declarant has duly executed this Declaration the day and year first above written. A 4 ALAN E. FIDELLOW TH A. FIDELLOW PDITHIDELLOW ARC. VERCOLLONE State of New York ) !J County of ss: p rA vsk On thisa/day ofd, 2013, before, the undersigned, personally appeared _Fx+xhA. I .V41LWione.. personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument, y~ Notary-Public r IASCARFLL ckwikMx; in APWnqM B1NpBS , cmv-• Tmn` .kft2'2f ' 1.201 +V /'7Ae-l l.. ~SC.JPFac / State of New York) ss; County of )utzt~tj T On this F day of , 2013, before, the undersigned, personally -appeared personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. Notary Public ~y'~1a.e~ sv n«,~ we4h `Al3/fi7 (Out of state acknowledgment) STATE OF M,4 ss.: COUNTY OF r c~~`P $P u On the (r y day of~/ u~` a 57~ 2013, before me, the undersigned, personally appeared /JG'7~'7 ~ ~rlTfll!J ~ ^"'~^^Atlu"^~::. F -proved to me on the basis of satisfactory evident a to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity and that by his signature on the instrument the individual, or the person upon behalf of which the individual acted, executed the instrument and that such individual made such appearance before the undersigned in the CtJ r Yk h~< r~ pyt (Insert the city or other political subdivision and the state or country or other place the acknowledgment was taken.). Notary Public S" LINDA ANN POPOVIC Ny"cm. iW E sepan+ (Out of state acknowledgment) STATE OF CA ss.: COUNTY OF (ZZ,,a *5 U On the 1y day of WWOUS11 2013, before e, the undersigned, personally appeared jrAedfk 4. F~4//oc personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me thatche executed the same in hiTapacity and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument and that such individual made such appearance before the undersigned in the 04e4-cr, sG 64 (Insert the city or other political subdivision and the state or country or other place the acknowledgment was taken.). z5n'l' Notary Public f,ee94140/to/® ALL-PURPOSE ACKNOWLEDGMENT State of California l County of SS. On 3 before me,._._... 1:~2j o-e4 &2w gL1 _ . Notary Public, OATH personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ilM, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing - - paragraph is true and correct. CURTIS DANIELS Court. q 1926623 ,p Ip NOTMY PUBBC.CAIIFORW WITNESS my hand and official seal. so DIEGO COUNTY MY COMM. ERP. MAR. 11, 2015 k N TARY'S SIONATI!RL• PLACENOTARY SHAG IN ABOVE SPACE OP'T'IONAL INFORMATION The information below is optional. However, it may prove valuable and could prevent fraudulent attachment of this form to an unauthori zed document. CAPACITY CLAIMED BY SIGNER (PRINCIPAL) DESCRIPTION OFATTACHED DOCUMENT ? INDIVIDUAL ? CORPORATE OFFICER TITLE OR TYPE OF DOCUMENT ? PARTNER(S) rrr E(S) _ ? ATTORNEY-IN-FACT ? TRUSTEE(S) NUMBER OF PAGES ? GUARI)tAN/CONSERVATOR ? OTHER:_ - DATE OF DOCUMENT OTHER SIGNER (PRINCIPAL) IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) RIGHT g THUMBPRINT SIGNER § 0 - - IS, ovzwa All of that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Laurel, Town of Southold, County of Suffolk and State of New York, said parcel being more particularly bounded and described as follows, to wit: BEGINNING;, at a point on the southeasterly side of Peconic Bay Boulevard, distant 432.4 feet as measured in a southwesterly direction from the division line between lands now or formerly of Van Brunt Tandy and Elizabeth Tandy, his wife, and lands now or formerly of Frederick Russell; RUNNING THENCE from said point and place of beginning along lands now or formerly of Anna Marie Dogherty and lands now or formerly of McAllister, South 15 degrees, 10 minutes, 00 seconds East a distance of 535.69 feet to a point and the mean high water mark of the Great Peconic Bay; THENCE along a tie line South 26 degrees, 54 minutes, 50 seconds West a distance of 118.57 feet to a point and the mean high water mark of the Great Peconic Bay; THENCE North 15 degrees, 16 minutes, 00 seconds West along lands now or formerly of Corydon and Sealy a distance of 551.46 feet to a point and the southeasterly line of Peconic Bay Boulevard; THENCE North 32 degrees, 54 minutes, 20 seconds East a distance of 108.10 feet to the point and place of the beginning. SAID PREMISES known as 4030 Peconic Bay Boulevard, Laurel, New York. TOGETHER with the appurtenances and all the estate and rights of the parties of the first part in and to said premises. TO HAVE AND TO HOLD the premises herein granted unto the parties of the second part, and their heirs, successors and assigns forever. r MARTIN D. FINNEGAN • SCOTT A. RUSSELL TOWN ATTORNEY Supervisor martin.fnnegan@town.southold.ny. ~QF sv(/Tjy 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 e e o ASSISTANT TOWN ATTORNEY 1 1 6 D lori.hulse@town.southold.ny.us OI~roU 10 D OFFICE OF THE TOWN ATTORNEY AUG - 9 2013 TOWN OF SOUTHOLD Soot od own Patricia C. Moore August 9, 2013 c/o Betsy Perkins 51020 Main Road Southold, NY 11971 RE: Alan Fidellow, Wetlands Permit No. 7698 Id$-~ -1 Dear Ms. Perkins, I have reviewed the Declaration of Covenants draft you submitted to this office with respect to the above referenced application concerning the area that is to be maintained as a non-turf buffer area between the top of bank and the bulkhead. Also referenced in the draft are gutters and leaders which are not required to be included in the covenants and restrictions under Chapter 275 of the Town Code. 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 swom 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. Hui Assistant Town Attorney Cc: Board of Trustees FORM NO. 3 NOTICE OF DISAPPROVAL DATE: February 17, 2012 TO: Suffolk Environmental for: Alan F. Fidellow P.O. Box 2003 Bridgehampton, NY 11932 Please take notice that your application dated February 10, 2012: For permit for demolition, reconstruction and addition at: LL ation of property: 4030 Great Peconic Bay Blvd., Laurel NY ~a County Tax Map No. 1000 -Section 128 Block 6 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed demolition, reconstruction and addition, on this conforming 43,494 sq. ft. lot in the R-40 District, is not allowed pursuant to Article XXII, section 280-116 (B), which states "All building or structures located on lots upon which a bulkhead ...exists... shall be set back not less than 75 feet from the bulkhead." The survey shows a setback of 37 feet from the bulkhead. In addition, pursuant to Article IV, Section 280-18, Bulk Schedule, the minimum side yard shall be 15 feet and combined side yards shall be a total of 35 feet. The survey shows a minimum side yard of 5.7 feet, and a combined total side yards of 25.1 feet. Authorized Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: Me, Z.B.A. FORM NO. 3 NOTICE OF DISAPPROVAL DATE: February 17, 2012 *Amended: 8/16/12 TO: Suffolk Environmental for: Alan F. Fidellow P.O. Box 2003 Bridgehampton, NY 11932 Please take notice that your application dated February 10, 2012: For permit for partial demolition, reconstruction and addition at: Location of property: 4030 Great Peconic Bay Blvd., Laurel NY County Tax Map No. 1000 - Section 128 Block 6 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed partial demolition, reconstruction and addition, on this conforming 43,494 sq. ft. lot in the R-40 District, is not allowed pursuant to Article XXII section 280-116 (B), which states "All building or structures located on lots Mn which a bulkhead ...exists... shall be set back not less than 75 feet from the bulkhead." The survey shows a setback of 37 feet from the bulkhead to the dwellin & a r x 30' to the rebuilt deck. ~F~_, In addition, pursuant to Article IV. Section 280-18. Bulk Schedule the minimum side yard shall be 15 feet and combined side yards shall be a total of 35 feet. e shows a minimum side and of 5.7 feet and a combined total side yards of 20.16 f et. Authorized Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: fide, Z.B.A. *Amended to reflect partial demolition only FORM NO. 3 NOTICE OF DISAPPROVAL DATE: February 17, 2012 *Amended:8/16/12 TO: Suffolk Environmental for: Alan F. Fidellow P.O. Box 2003 Bridgehampton, NY 11932 Please take notice that your application dated February 10, 2012: For permit for partial demolition, reconstruction and addition at: Location of property: 4030 Great Peconic Bay Blvd., Laurel NY County Tax Map No. 1000 - Section 128 Block 6 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed partial demolition, reconstruction and addition on this conforming 43,494 sg. ft. lot in the R-40 District, is not allowed pursuant to Article XXII section 280-116 (B), which states "All building or structures located on lots upon which a bulkhead ...exists... shall be set back not less than 75 feet from the bulkhead." The survey shows a setback of 37 feet from the bulkhead to the dwelling & =a rdx3 0' to + the rebuilt deck. In addition, pursuant to Article IV. Section 280-18. Bulk Schedule the minimum side yard shall be 15 feet and combined side yards shall be a total of 35 feet e shows a minimum side and of 5.7 feet and a combined total side ards of 20.16 f et. Authorized Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: Me, Z.B.A. *Amended to reflect partial demolition only FORM NO. 3 NOTICE OF DISAPPROVAL DATE: February 17, 2012 TO: Suffolk Environmental for: Alan F. Fidellow P.O. Box 2003 Bridgehampton, NY 11932 Please take notice that your application dated February 10, 2012: For permit for demolition, reconstruction and addition at: ation of property: 4030 Great Peconic Bay Blvd., Laurel NY County Tax Map No. 1000 -Section 128 Block 6 Lot 1 Is returned herewith and disapproved on the following grounds: The proposed demolition reconstruction and addition on this conforming 43,494 sq. ft. lot in the R-40 District, is not allowed pursuant to Article XXII, section 280-116 (B), which states "All building or structures located on lots upon which a bulkhead ...exists... shall be set back not less than 75 feet from the bulkhead." The survey shows a setback of 37 feet from the bulkhead. In addition, pursuant to Article IV, Section 280-18, Bulk Schedule, the minimum side yard shall be 15 feet and combined side Yards shall be a total of 35 feet. The survey shows a minimum side yard of 5.7 feet, and a combined total side yards of 25.1 feet. Z4" - Authorized Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file, Z.B.A. • Jill M. Doherty, President a SOUry~ Town Hall Annex Bob Ghosio, Jr., Vice-President h~ 54375 Main Road P.O. F. King l( . Box 1179 Southold, New York 11971-0959 Dave Bergen G Q John Bredemeyer Telephone (631) 765-1892 l`COUI Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD 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 BOARD OF'SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7698 DATE:, DTEt"1;114__ BEK 14, 2011 ISSUED TO: ALAN FIDELLOW PROPERTY ADDRESS: 4030 PECONIC BAY BOULEVARD,MATTITUCK SeTM# 128-6-1 AUTHOR14ATION 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 beceatber'14, 2011, and in, consideration of application fee in the sum of $250.00 paid by Alan Fidellow and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees' authorizes and permits the fod'tsvfn'g' Wetland Permit to renovate and expand upou the existing single-family dwelling, and for the existing deck attached to the dwelling; with, the conditions 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; the non-turf buffer area between the top of the bank and the bulkhead is to be maintained; and as; depicted on the survey prepared by Peconic Surveyors, P.C., last dated December 22, 2011, and stamped;approved on January 2402012. 1. IN WITNESS WHEREOF, he said Board of Trustees hereby causes its Corporate Seal to be affixed, and theseipresents to be subscribed) y s ruajority of the said Board as of ",,date. w Jill M, Dohe J U, _ ~pii'L r lr II L. 'qW V TENS ?i14b CU MItIdA The Permittee Alan Fidell6wi residtftg'at 4030 Pttt:Wc u Bh , hW94K New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims far damages, of suits arising directly or indirectly as resulf 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 par", and the said Permittee t assumes full liability with respect thereto, to the complete exclusion of the Board of ,`~f3r f , Trustees of the Town pf.Southold.'~ 2. That this Permit is valid for a period of 24 months, which is considered to be the estimates}; time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. ` 3. That this Permit should be retained iride> nitely, or 9s°long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspeption and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low watermarks. a' 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without, - ' expenses to the Town of Southold. r'. 8. The Permittee is required to provide evidence that a copy of this Truseec-permit has been recorded with ft Sitffalk County Clerk's Office as a notice QDvenarllt' acid deed restriction to the deed of the subject-parcel. Such evidence shall be pr, eta! (90) calendar day§ of issu~nee of this permit. 9. That the laid Board will he notified by the Permittee of thaoomple~a a work authorizCd. ` 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. t e ffifi • 0 Jill M. Doherty, President ~~Of so~lyo Town Hall Annex Bob Ghosio, Jr., Vice-President lp 54375 Main Road y P.O. Box 1179 James F. King T Southold, New York 11971-0959 Dave Bergen G C John Bredemeyer Telephone (631) 765-1892 I MUM Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 14, 2011 Mr. Matt D. Ivans Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932 RE: ALAN FIDELLOW 4030 PECONIC BAY BLVD., MATTITUCK SCTM#128-6-1 Dear Mr. Ivans: The Board of Town Trustees took the following action during its regular meeting held on Wed., December 14, 2011 regarding the above matter: WHEREAS, Suffolk Environmental Consulting, Inc. on behalf of ALAN FIDELLOW 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 October 27, 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, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 14, 2011, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 • ! WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS; the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of ALAN FIDELLOW to renovate and expand upon the existing single-family dwelling, and for the existing deck attached to the dwelling; with the conditions 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; the non-turf buffer area between the top of the bank and the bulkhead is to be maintained; and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated December 22, 2011, and stamped approved on January 24, 2012. 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, Jil . Doherty - I" WJ President, Board of Trustees JMD/eac • FQk4 9 Jill M. Doherty, President Town Hall Annex Bob Ghosio, Jr., Vice-President 54375 Route 25, P.O. Box 1179 James F. King Southold, NY 11971 Dave Bergen Telephone (631) 765-1892 John Bredemeyer Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ALAN FIDELLOW Please be advised that your application dated October 27. 2011 has been reviewed by this Board at the regular meeting of December 14, 2011 and your application has been approved pending the completion of the following items checked off below. XX Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 st Day of Construction ($50.00) '/z 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 //~~a TOTAL FEES DUE: $ 50.00 Y 3 1 5 BY: Jill M. Doherty, President Board of Trustees o~gpFFU(,fc Peter Young, Chairman Town Hall, 53095 Main Rd. Lauren Standish, Secretary P.O. Box 1179 fy 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., December 7, 2011, the following recommendation was made: Moved by Doug Hardy, seconded by Derek Bossen, it was RESOLVED to SUPPORT the Wetland Permit application of ALAN FIDELLOW to renovate and expand upon the existing single-family dwelling. Located: 4030 Peconic Bay Blvd., Mattituck. SCTM#128-6-1 Inspected by: Derek Bossen, William McDerrmott, Peter Young The CAC Supports the application with the Condition of a drainage plan for the roof run-off and a non-turf buffer area between the top of the bank and the top of the bulkhead. Vote of Council: Ayes: All Motion Carried OsvFFOCK Jill M. Doherty, President CD!', P.O. Box 1179 Bob Ghosio, Jr., Vice-President Southold, NY 11971 James F. King Telephone (631 765-1892 Dave Bergen Fax (631) 765-6641 John Bredemeyer m Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Ir~ --7 - ALAN FIDELLOW requests a Wetland Permit to renovate and expand upon the existing single-family dwelling. Located: 4030 Peconic Bay Blvd., Mattituck. SCTM#128-6-1 Type area to be impacted: I,ZaltwaterWetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: apt.275 Chapt. 11111 -other Type of Application: VWetland -Coastal Erosion -Amendment -Administrative-Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Pr se ere: _J. D h Ghosio ''J/~Ing LD. Bergen, J. Bredemeyer Dzenkowski (/other ~Gt f Form filled out in the field by Mailed/Faxed to: Date: d xX r~ R k _ 4 u ~ v1 7 ' ~y d 7t N r...~ ~ .1 Q d V1 .N-r ~ s - ~ , y~i,{•~i .~Y ,s~' i~ r e `Ai mom- mr% + - I a Il ~ Y ~14 nt as" On. 'IT j / 1 J. r _ J -1B y? •I? ~Jflf I r 1! if[ va~ ',+Irl~lr I~JJ~' 1,{!II g•. ~ ti ~t~ r dt~'a i w' * I t k s'~ ' '.r. > r S s ~r ii r Alan Fidellow 4030 Peconic Bay Blvd., Mattituck ; SCTM#t 128-6-1 12/7/2011 1 « ~i 4 11w; A 1-4 A 16. go A 3, F. k 'f" r •i. p i i-' ~ ~~r° f~i if j~ - { ate" At 1 ao y 1 FIDELLO W Property Situate: 1030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York SCTM 1000 - 128 - 06 - 001 (Photo taken on.ltgpst 10, 2011 1 I I Photograph indicating the existing frame 1 '/2 story frame House. Photograph taken from the southerly shoreline, along Great Peconic Bay, facing north. i FIDELLOWPro erty h Situate: 1030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York kTM 1000 - 128 - 06 - 001 (Photo taken on ,august 10, 2o1 1) ;;ter i i i Photograph indicating the existing frame 1 '/2 story frame House and the current conditions of the shoreline, including the existing bulkheading and the location of Mean High Water along the bulkhead. Photograph taken off the southeastern corner of the property, along Great Peconic Bay, facing northwest. AdIlk FIDELLO W Property Situate: 4030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York SCTM 1000 - 128 - 06 - 001 (Photo taken on Az~gmst 10, 2011) 4 r.r w R ~w I I I Photograph indicating the existing frame l 1/2 story frame House and the existing frame Garage & Cottage (to the right). Photograph taken from the southern half of the property, facing south towards Great Peconic Bay. i I7IDi_:.,',ILLOWProperty Situate: 4030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York SCTM woo-i28-o6-ow (Photo taken on Augaidst 10, 2011 _ IF dh r w A~ # `ML ° F . mow nlft 7r - i i Photograph indicating the existing frame Garage & Cottage, and the existing Shed (to the right). Photograph taken from the southern half of the property, facing south towards Great Peconic Bay. i I FIDELLOW Property Situate: -1030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York SCTM 1000 - 128 - 06 - 001 (Photo ta.kei? oil,9ugust 10, 2011) w a;f S Photograph indicating the current conditions of the shoreline, including the existing bulkheading and the location of Mean High Water along the bulkhead. Photograph taken off the southeastern corner of the property, j along Great Peconic Bay, facing southwest. i I I FIDELLO W Propert y Situate: 4030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York SCTM 1000 - 128 - 06 - om !Photo toAeti on August 10, 2011 r FIMF ,e V, V, AAA f r? W4 "r,~d,,,, , w t >f Photograph indicating the current conditions of the shoreline, including the existing bulkheading and the location of Mean High Water along the bulkhead. Photograph taken off the southeastern corner of the property, along Great Peconic Bay, facing west. li I I ~I FIDELLO W Property Situate: 4030 Peconic Bay Boulevard; Mattituck; Town of Southold, NY SCTM 1000 - 128 - 06 - 001 Proposed Construction SUBJECT PROPERTY Access Route No^.^.;. a Laurel +k) xs i i 10, i k s Great Peccn c Bay d Scu?1M wlrn'"c ~amesp Ind,an ;s!and County Park Flanders Bay Reeves Bay Reo G~ee~ .:1.., Port SUBJECT PROPERTY e~ po Z }f a ay+~ 90 'n .xx ac^ se -A__. u`e_ \\\x\\\ - :Wane _ f f9 N "Ewm.v o ' ; ,~a ga ~ I I o a i i ce I zV I i p c 1 s_ p, mre i t ~ i .I / Y O ern / 3 Y } e4 u d' I / d I ~ ^ De c/ %i / n y YrV( i / I a~ / n ,~u14 tl -INN I \ x J / ~I t~ 5 :oli U'V/" NOO /'\I'// Y ~P \ I 4O / NOTICE / COUNWOFSUFFOLK © wmau nroxxo EL= E - R l ETC," TU S M. naenn r s ss 128 IS • 0 Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street. P.O. Box 2003, Bridgehampton, New York 11932-2003 (631)537-5160 Fax: (631) 537-5291 Bruce Anderson, M.S., President January 19, 2012 Board of Trustees Town Hall P.O. Box 1179 Southold, NY 11971 Attn: Lauren Standish Re: FIDELLOW Property Situate: 4030 Peconic Bay Boulevard; Mattituck, New York SCTM 1000 -128- 06 - 001 Dear Members of the Board, As per the Board's approval resolution rendered on December 14, 2011, 1 enclose three revised surveys of subjKt-property, prepared by PECONIC SURVEYORS, P.C., last dated December 22, 2011 along with a check made payable to the Town of Southold in the amount of $50.00 covering the requisite final inspection application fee. As noted, the enclosed surveys contain the required drainage structures and calculations and label the areas below the top of the bluff as "NON TURF BUFFER" By way of this correspondence, and on behalf of the Mr. Fidellow, I request that you forward the requested permit to this office. Should you have any questions regarding this matter, or require additional information, please feel free to contact this office at any time. Thank you in advance for your cooperation. Sincerely Bruce . AXerson enc. cc: A. Fidellow 0 • OFFICE LOCATION: fjF so~Tyo MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) T Southold, NY 11971 G Telephone: 631 765-1935 ~4%V Fax: 631 765-3136 Comm, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 1 To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: December 12, 2011 Re: Proposed Wetland Permit for ALAN FIDELLOW SCTM# 1000-128-6-1 Suffolk Environmental Consulting, Inc. on behalf of ALAN FIDELLOW requests a Wetland Permit to renovate and expand upon the existing single-family dwelling. Located: 4030 Peconic Bay Blvd., Mattituck. SCTM#128-6-1 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 EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "II" which states: II. Additions to an existing building or rebuilt residential structure which results in no net increase in ground area coverage, except where the parcel is located in a coastal erosion hazard area; The proposed action is not located within the coastal erosion hazard area. 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 Dec 07 11 07:07p • p.l SUFFOLK ENVIRONMENTAL CONSULTING, INC. FAX 2322 Main Street • Newman Village P.O. Box 2003 • Bridgehampton • New York • 11932 (631) 537 - 5160 (office) (631) 537 - 5291 (facsimile) suffolkenvironmental@hotmail.com DATE: December 7.2011 NUMBER of PAGES (including cover): 2 TO: Lauren Standish COMPANY: Southold Board of Trustees FAX FROM: Matt D. Ivan RE: FIDELLOW PmRet ( Situate: 4030 Peconic Bay Boulevard: Mattituck: Town of Southold. NY) Lauren, Please find attached a revised Project Description for the Fidellow application. Chairwoman Doherty called Bruce this afternoon and told him that Mr. Fidellow should think about reconstructing his existing rear decking `cause it is in disrepair. Consequently, she told us to revise the project description and send it to the office. Accordingly, please find the revised project description. Let me know if you need anything else from this office. Take care, Dec 07 11 07:08p p.2 REVISED PROJECT DESCRIPTION for the FIDELLOW Application Situate: 4080 Peconic Bay Boulevard; Mattituck; Town of Southold, New York SCTM looo - 128 - oG - oo1 Applicant proposes to renovate the existing single family dwelling (1, 100 square foot± `footprint') and construct a 2nd _ Story Addition to same. Additionally, applicant proposes to reconstruct the existing Deck "in-kind/in place measuring 490 square feet Office Use Only Coastal Erosion Permit Application X Wetland Permit Application Administrative Permit Amendment/Transt'r/Extension Received Application: I~ al 1 Received Fee:$ A \-b Completed Application: 113 jai 14 Incomplete: SEQRA Classification: - - - Type I _Type II Unlisted_ Coordination(date sent) 2 7 1011 ?LWRP Consistency Ass s men Form: ?CAC Referral Sent: I1 ~LDate ofInspection: 1 Receipt of CAC Report Lead Agency Determination - Technical Review: ~ublic Hearing Held: t 11 Resolution: Name of Applicant ALAN FIDELLOW Address 75 Granite Springs Road; Yorktown Heights, NY 10598 Phone Number: (914) 584 - 2583 Suffolk County Tax Map Number: 1000 - 128 - 06 - 001 Property Location: 40301'econic Bay Boulevard; Mattituck, New York (provide LILCO Pole distance to cross streets, and location) AGENT: MATT D. IVANS 0 Suffolk Environmental Consulting Inc. (If applicable) Address: P.O. Box 2003; Bridgehampton, NY 11932 G, Phone: (631) 537 - 5160 l I Ooard of Trustees Application* GENERAL DATA Land Area (in square feet): 43, 494 square feet + Area Zoning: R - 40 Previous use of property: Residential Use Intended use of property: Same Covenants and Restrictions: Yes X No If "Yes", please provide a copy. Does this project require a variance from the Zoning Board of Appeals _Yes X No If "Yes", please provide a decision. Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): Applicant proposes to renovate and expand upon the existing Single-Family Dwelling. Please refer to the attached survey and project description for further specifications. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed activity: Applicant proposes to renovate and expand upon the existing Single-Family Dwelling. Please refer to the attached survey and project description for further specifications. Area of wetlands on lot: 900+ square feet Percent coverage of lot: 2.07%+ % Closest distance between nearest existing structures and upland edge of wetlands: 0.0+ feet (beach access steps off the seaward side of the bulkhead) Closest distance between nearest proposed structures and upland edge of wetlands: 43.0'± feet (East Corner of Renovation/ExpansiontoMHW@a bulkhead1etty) Does the project involve excavation or filling? No X Yes (Installation of new sanitary system) If Yes, how much material will be excavated? 100+ (cubic yards) How much material will be filled? N/A (cubic yards) Manner in which material will be removed or deposited: Typical Front-End Loader & by hand 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): No impact to the wetlands are anticipated due to the fact that the existing house has existed harmoniously within this proper for many years at this distance from the wetlands boundary without any form of adverse impact to the surrounding environment and that this proposed activity is to simply renovate and expand upon same within the "footprint" of this structure. All necessary measures will be taken to minimize any and all potential disturbance. Board of Trustees Application COASTAL EROSION APPLICATION DATA N/A Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes (i.e., High Water Mark along Peconic Bay) 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? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Suffolk Environmental Consulting, Inc. Newman Village, Suite E. 2322 Main Street, P.O. Box 2003, Bridgehampton, New York 1 1 932-2003 (631)537-5160 Fax: (631) 537-5291 Bruce Anderson, M.S., President December 5, 2011 i Ms. Lauren Standish Board of Trustees Town Hall P.O. Box 1179 Southold, NY 11971 - Re: Fidellow Property Situate: 4030 Peconic Bay Blvd.; Laurel; Town of Southold, NY SCTM 1000 -128-6-1 Dear Ms. Standish, As you know this Firm represents the owner of the property referenced above who is seeking to improve thereon. As per the hearing requirements of the Southold Board of Trustees I enclose herewith: ? Affidavits of Mailing dated December 1, 2011, with certified receipts attached to all abutting property owners. Please be advised that we will forward to you the green receipts cards as we receive them. Should you have any questions concerning this matter, please feel free to contact this office at any time. Thank you in advance for your attention and consideration. Sincerely, Diane K. Wassick enc. cc: Mr. Fidellow gpFF014, 0 Jill M. Doherty, President Town Hall, 53095 Main Rd. Bob Ghosio, Jr. , Vice-President P.O. Box 1 179 James F. King Southold, NY 11971 Dave Bergen Telephone (631) 765-1892 John Bredemeyer 1 # Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ALAN FIDELLOW COUNTY OF SUFFOLK) 4 STATE OF NEW YORK) AFFIDAVIT OF POSTING I, 221ef klkQ~4SUA residing at/dba ~CFF[7X ~V~ t'DJ am~~ak ,tu[~a?G /tt A3A. - k'141111 4~FSji-: y E Nl4wt~7e% u t~ being duly sworn, depose and say: That on the day of 201 , I personally posted the property known as f 3~ 91W~1,il Kh c_ t nr~ by placing the f3oard of stees official p ster whereit 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, December 14, 2011 on or about 6:00 PM. Dated: (signature) Sworn to before me this dayofl, PI Not ublic pn raw D I~,~es No1zYork Comic as~ La tc ~W' ai 2'L, 201` PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Joan Crosson 4080 Great Peconic Bay Blvd, Laurel, NY 11948 Kevin O'Rourke Joseph & Joan Chisholm P.O. Box 313; Laurel, NY 11948 Ausustus & Barbara Kelsey P.O. Box 405; Mattituck, NY 11952 Jane Bell Corydon James Cassidy 4026 Great Peconic Bay Blvd; Laurel, NY 11952 STATE OF NEW YORK COUNTY OF NEW YORK Diane K. Wassick c/o Suffolk Environmental Consulting, Inc., residing at 2322 Main St.; Newman Village Suite E; P.O. Box 2003; Bri eham ton NY 11932 being duly sworn deposes and says that on the day of 2011, deponent mailed a true 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 their 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 Bridgehampton , that said Notices were mailed to each of said persons by (certified) (registe d) ma 1. Sworn to before me this /sr day of 2011 Not r Public Mai+hPw D ivansYork Not' c n ~ nip' 0 20 ( T COPI~~ SSw E?~~ ~-J a~ 'S Lr_, U.S. Postal Service CERTIFIED MAIL; =GE-Vr-'T N m~ ~ (Domestic CO CCI 43 ~10 Postal Service [r- o Ir CERTIFIED MAIL RECEIPT M1 f`- Postage $ $0,44 M1 \M (Domestic Only; No Insurance Coverage Provided) w('/ p(C\.. -0 aO Certified Fee 02.85 r-q r-9 M O O O Retum Receipt Fee me PasMark - ' p u e ~x O p (E 0 p (Endorsement Required) $2.30 Here aE ®8® Poean DEC 2011 O O I O O s DelNeryFee Postage It $0,a~t M1 (E C3 Q (Endorsement Requlretl) 10.00 [[ff~G ~a O O O 0 Total Postage 8 Fees $ $5.$9 S?•+/ ~ rtifi ~ F~ Q• Poshnark^ C3 O '>3F~ Return Receipt Fee 4t O rl [S.nnf (Endosement Requited) $2.30 tHem 0-. Q' D"',, L',~,DSSdt~ I x.. Reamcled Dative Fee DEC - r ~11 rv 3 O C3 pt. No/ . (Entlorsement Paqulretl) p 0 O JZJ Ox NO. 7 oM/ ' - M1 C r` ie; ZiPi..."""""v"-~°t.[fe.aes'![._.{p-GX./L!- ,~.JJI Iy3- Tom! Postage B Fees ~ ntT l O -arreer,~Ab:d°......_S...d rl ( <j)4551 0 Il - - or PO BOx NO. D o . -----------Y - ~ sneer, Aar. RE; Le cry, stare, zr +a or PO Box No. l::.Zld -~'l ary, scare, zlv+a /34 PS Forc 3800 August 20D6 So, R~,,, fol A,14 11 L ~L Postal CERTIFIED MAIL RECEIPT • No InsUrancO Coverage Provided) U.S. Postal Service co tic Mail (Domes CERTIFIED MAIL RECEIPT insurance Coverage Provided) CO USE t4TO IF 110C m a. rv Postage $ $0.44 CIO G~N~MP L _ l C I AL USE 4 4 Postage age It $(1.44 T- Certified Fee f2',g$ W Postmadc rpwunark Retum Receipt Fee Here N Q (Entlorsement Required) $2.30 DEC -12011 Certified Fee $ 8e 0 Restricted Derry Fee iJCI. ~ nn(Endorsement Required) $0.00 0 (Endorsement Req~puFe $2,30 q. ,*,Qej O Torsi Postage 8 Fees $ $5.59 411 1 O Restdcletl DeFt ery,Fee C3 S? (Endorsement Requl $Q,00 °J ant o i / 7 Kt" cD Fe O ivOiz Q,,, 5v:!3 Total Postage8 es $ $j,59 O ---ea-- w CoGr1T~J re Ada No:i ~a o orPOBOx---------------•------- Er ant e an,sara,Ziv+a G p..~.Sr?.-?-.... f.~l..Sf1114~!~1--•-•---°..---••-- r 9 Z A Al Z3 Steen l 1 6 Aat.16°, " O or PO BOx bc~c --,3, N Clty, Stsfe; ZIP+4 Board of Trustees Application County of Suffolk State of New York BRUCE A. ANDERSON- Suffolk Environ. Consultine, Inc. BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMELESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY BIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S0, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TH APPLICATION. Signature SWORN TO BEFORE ME THIS t DAY OF / -,201/ of ry Public Matthew D. (vans Notary Puhlic of New York No. 011V6053859 Qualified in Suffolk County Commission Expires January 22, 20/ Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ALAN FIDELLOW residing at75 Granite Springs Road; Yorktown (print owner of property) (mailing address) Heights, New York do hereby authorize Suffolk Environmental (Agent) Consulting, Inc. to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) • i 14-16-4 (9/95)-Text 12 617.20 SEQR PROJECT I.D. NUMBER Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1- PROJECT INFORMATION To be completed b Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME Suffolk Environmental Consulting, Inc. FIDELLOW Property 3. PROJECT LOCATION: Municipality Town of Southold County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc. or provide map) 4030 Peconic Bay Boulevard; Mattituck; Town of Southold, New York (SCTM 1000-128-06-001) 5. IS PROPOSED ACTION: ® New ? Expansion ? Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to renovate and expand the existing Single-Family Dwelling. Please refer to the attached survey for all specifications. 7. AMOUNT OF LAND EFFECTED: Initial) < 0.2 acres Ultimate) < 0.2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes ? No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ®Residential ?Industrial ?Commercial ?Agriculture ?Park/Forest/Open space ?Other Describe: Private single family residences with related appurtenances. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ?No If yes, list agency(s) and permit/approvals Suffolk County Department of Health Services Wastewater Permit; New York State Department of Environmental Conservation Wetlands Permit; Town of Southold Building Permit. 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ? Yes ® No If yes, list agency(s) and penniVapprovals 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ? Yes M No 1 CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Matt . Ivans - Suffolk Environmental Consulting, Inc. Date: September 20, 2011 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II- ENVIRONMENTAL ASSESSMENT (To be completed b Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ? Yes ? No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.69 If No, a negative declaration may be superseded by another involved agency. ? Yes ? No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archeological, historical or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitat, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or change in use or intensity of use of land or natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-C5? 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 CEA? ?Yes ?No D. 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) 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 and 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 large or significant adverse impacts which MAY 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 action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different From responsible officer) Date 2 PART 11- IMPACT ASSESSMENT To be completed b Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? N yes, coordinate the review process and use the FULL EAF. ? Yes 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 involved agency. 0 Yes Q No C. COULD ACTON RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. I legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion. drainage or flooding problems? Explain briefly:. F -1 C2. Aesthatic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain hrW. C3. Vegetation or fauna, fish, shefltish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as omdany adopted, m a change in use or intensity of use of land or other, natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative. or other effects not identified in C1-C5? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? lain briefl : E D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEJ1 7 If s, a air briefl : Yes Q No E. IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? I Yes lain: Yes a No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, knportantorothenvisesignificant Each effect should be assessed in connection with its (a) selling (i.e. urban or rural); (b) probabiftty 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 detal to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part l was checked yes, thedetermination ofsignificance mustevaluate the potential impactofthepropoaed action on the environmental charaderisdce oftheCFA. Check this box Kyou have Identified one ermore potentially largaorsignificentadverse InpecswNdh MAYoccur. Then proceed directly lothe FULI EAF andfor prepare a positive dedareeon. Check this box I you have determined, based on ltre Information and analysis above and arty supporting documentation. that the proposed aoft WILL NOT resin In any significant adverse environmental Impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees Name of Lead Agency + Da t Jill M. Doherty President nt or Type Name Res orisible Officer in Lead Agency Tide of Responsible Officer let afore of pon bie Othc n Lead Agency Signature of Preparer (1 different from responsible officer Town of Southold Erosion, Sedimentation & Stonn-Water Run-off ASSESSMENT FORM fir' PROPERTY tOCATIO : s.C.T.M. s: TIC FOLL01MN0 ACT10Na MAY REMAII1! TM NOM MSMU OF A is-- y~ 1000 - 128 - 06 - 001 PLAN 'MW mar -Mi T11- SCOPE OF WORK - PROPOSED CONSTRUCTION rrEM p / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Panels? 1 WIN this Project Retain N Slfxm-Walar Ruin-0ff (Include Total Area of all Panxis located within 1.0 acres Generated by a Two (2) Inch Rah on Site? the Scope of Work for Proposed Construction) What Is to Total Area of Land F I AOY) (This ~ will Include all run-off acted try she b. Clearing clearing arndkr Construction n a cdvitlee as well as all anNa Ground Disturbance for the proposed < 0.2 acres Site improver ants and the pernanent creation of construction aco iby1 (S.F. I Acme) '1 0 impervious the site Silo Plans'andior ) PROVIDE BRIEF PROJECT' DESCRIMON wore. A dioceo w mnaquq Survey show Am Pro This Drainage Sbvcluea Indicating Size a Location? This ? Item shall Include all Proposed Grade Changes and Applicant proposes to renovate and expand upon the Slopes Controlling Surface Water Flow. Ina-Story of the existing Single-Family Dwelling. No 3 Does the Site Plan and/or Survey describe a* erosion e pansion of the "footprint" is proposed within this ~ ~"e't Control practl°" that Will be Used to Control Me erosion and storm water discharges. This application. Please refer to the attached Survey for all item mint be maintained throughout theEntire specifications. Construction Period. 4 Will this Project Require any land Filling. Grading or Excavation where dare is a charge to to Natural Existing Grade Involving more tan 200 Cubic Yards of Material within any Parcel? rj Will this Application Require Lad Disturbing Activities / Encompassing an Area in Excess of Five Thousand (5.000 S.F.) Square Feet of Ground Surface? 6 Is tare a Natural Water Course RwWng through the Sete? Is Oft Project within the Trustees Jimsdiction I - A Gmk" DEC SWPPP WeumemMe: or within One Hundred (100') feet of a Wetland or u - SudNSM of a SWPPP k equicd run so Cor4umbon adNwes inonvhp we Beach? desalanw of one (1) a mom come: erAMlq dknabenon of kn ruin one ace mw 7 Will there be Site preparation on Existing Grade Slopes ? ua per of a target common pan that wa urinM* dieasb one or mom aoss of wet: whip) Exceed Fifteen (15) feet of Vertical Rise to ? kx*G of g Construction ecnvitks kwolvi g sot detumenom of kn ruin one (1) are where One Hundred (tar) of Honfmnfd Distance? - the DEC Im datemtad mer a WM point is mquhM for alone weir dkearyas. (SWPPP'a shat mew no Binlman taqudrerraak of on sPDEs emwmi Permit 8 Will Driveways. Parking Areas or other Impervious / for Storm Water Dkaaaraaa from Comtrtrctton activity - Permit rim OP-0-10-001.) Surfaces be Sloped to Direct Slam-Water Run-OM -V/ 1. The SWPPP ether bo ; par W prior lonui subn 1h of me Nor. The Nor eat be Into andlor M to direction of a Town right-0-way? Submitted k ma OWWWwd Prior b the aomrwKertaM Of WnWUdkn acNty. 2. Tam SwPPP sholdeeoba nor sroskn end sedkwi acmla proton end whew 9 WR Lis Project Require to Placerrard of Maeral, / resin d. poaeanWu con scorn aauir mrag.nm pmcdm mat wSl be used andW Removal of Vegetation sndla to Construction of any oaamMM lomdree to peabnb F seta were doclarar coq w assae item Wain the Town Rightd-Way or Road Shoulder coaPdmuoa wet ms Mora Kid Writ- of w. permit. In aditk n, ate SWPPP shm Area? rnoe era em Nor larkda N dWaar„er our. Apwa) Merely Doter ' soaoa of Poarton which may mnorhaby be expcded 10 ~ me quYy of corm wakr ekdargn. NOTE: eery A mover tee oamdem one Nash term le Anawe me wah • CnerA Mark 1 N sMNPPs tut raP I da pollcplW Vdion storm o ism nanoganam predlos k a Lox mW as oamM1uadon man AWaherroa lehmwer, S.rea Ally. G i ism In anti OWPONei ire be praprad by a qualified n Ig Prdntoal Urerhew in New work a seonsw lm, OmdYq, Dr.lnp. a Ermmlen Coma Pion Is Ragmmd by as Tan of more k im mkidgeabte in to pahdpea w pmctlws of stem Water Mae"eme n. aeutlmM mW wm bo amaiamd ar Padew Pdw to i..umo.OlAny errddrrg Pmnrit. MOTE: Arad Sisk N)mrab Amarbmerh OuemmklkeYnbmOwrWaAppeafm) ~ SI'A7'EOFNEWYORK, SUFFOLK COUNTY OF SS BRUCE A. ANDERSON @ SUFFOLK 71oat I ENVIRONMENTAL CONSULTING, INC. being duly swum, deposes and says that he/she is the applicant for Pemut, (Nanad ihdvlduer afphY,g Ooomere) And that he/she is the AGENT Aoe....................................................................................... (t>wror, Conevdbl, mdor, Apra, Corponk Officer. coo) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed hercwi Swoon to before me this; 2/sr- Notary Public:.......... Matthew D. Ivans N.~tZN;, MIVC05'Vaw.York du05386g (sgn.k..aAbpcor.) FORM - 06110 CommisslonhExp eS January 22, 2Ul Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes", 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# 128 06 001 The Application has been submitted to (check appropriate response): Town Board ? Planning Dept. ? Building Dept. ? Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) ? (c) Permit, approval, license, certification: Nature and extent of action: Applicant proposes to renovate and expand (2"d Floor only) upon the existing Single- Family Dwelling. Please refer to the attached Survey for all specifications. Attach additional sheets if necessary • • Location of action: 4030 Peconic Bay Boulevard; Mattituck; Town of Southold NY Site acreage: 1.0 acre ± Present land use: Improved with single-family dwelling and related appurtenances Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: ALAN FIDELLOW (b) Mailing address: 75 Granite Springs Road; Yorktown Heights, NY 10598 (c) Telephone number: Area Code ( 914 ) 584 - 2583 (d) Application number, if any: N/A Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No ® If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ® Yes ? No ? Not Applicable As indicated within Policy 1, "Development that does not reinforce the traditional land use pattern of the Town of Southold would result in a loss of the community and landscape character of Southold.", this project is a proposal to construct a 2nd-Story Addition to an existing dwelling within subiect property, a property situated within a neighborhood consistina primarily of similarly-sized single-family dwellings within similarly-sized properties The proposal as designed will not result in adverse effects to the surrounding environment in that the project will not expand upon the "footprint" of the existing dwelling and will not encroach any further towards the surface waters of Great Peconic Bay to the southeast In addition the surrounding neighborhood is comprised of older residential dwellings which have existed harmoniously within this area for years and have not resulted in any form of adverse effects to the surrounding environment. Accordingly, we believe that this project is consistent with this policy. 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 Policy 2 is not applicable in that subject lot and the surroundina neiahborhood cannot be deemed a substantial historic and/or archaeological resources Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 5 through 7 for evaluation criteria ® Yes ? No ? Not Applicable Subiect proposal will not adversely impact the visual quality of the surrounding area in that the existing property has been improved with a single-family residence for many years without any evidence of resulting in adverse impacts to the neighborhood In addition the neiahborhood itself is comprised of similarly sized properties improved similarly for many years and which also has not resulted in any form of adverse impacts to the surrounding area. Furthermore, this policy could not preclude both the legal creation of this property as a building lot, or the improvement thereon. 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 Subiect property is currently improved with a bulkhead alona the southwestern section of subject property and has protected subject property from any and all flooding and/or erosion events since the improvement thereon. The proposal is to renovate and expand upon the 2nd-Floor of the existing dwelling and therefore cannot be applicable to Policy 4. 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 Subiect proposal will comply with Policy 5 in that a more efficient sanitary system is proposed to be installed thereon and which will conform with any and all conditions of the Suffolk County Department of Health Services. Accordingly, this proposal will not only maintain the water quality and supply within the Town of Southold, but will improve conditions within the site with the installation of the more efficient sanitary system. 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 Subiect proposal is not applicable to Policy 6 in that a renovation and expansion to the 2nd-Floor of the existing dwelling is proposed, and that no further encroachment to the wetlands will take place than which presently exists. 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 Subject proposal is not applicable in that a renovation and expansion to the 2nd-Floor of the existina dwellina is proposed which will not result in any form of adverse effects to air quality Accordingly, this proposal is not applicable with this policy. 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 Subject proposal is not applicable in that the proposal does not involve disposal and/or transportation of solid waste hazardous waste toxic pollutants petroleum products Attach additional sheets if necessary 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 Subject proposal is not applicable to this policy in that the proposal will not impede any access to the surface waters in and around subject property and/or become detrimental to the recreational use of the surrounding resources. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependence uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria ? Yes ? No ® Not Applicable Subject proposal is not applicable in that the proposal does not involve a water-dependent use (i.e., marina, aauaculture, etc...). 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 Subject proposal is not applicable in that the proposal does not involve any form of marine resource management (i.e. commercial fisheries, recreational fisheries aauaculture etc ) 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 Subiect proposal is not applicable in that the proposal does not involve agricultural lands (i.e, the conversion of farmland, the establishment and/or maintenance of new coastal agricultural production etc...) 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 Subiect proposal is not applicable in that the proposal does not involve the conservation of enemy resources on a commercial level and/or the promotion of alternative enerav sources proper maintenance of fuel storage facilities and/or the extraction of mineral extraction Attach additional sheets if necessary Created on 5125105 11:20 AM Dec 08 11 01:14p p.2 • • APPLICANT/AGENT/REPRESENTATPYE TRANSACTIONAL )DISCLOSURE FORM hlblm f'Ma dmmldmwn -aid wmtatwra Ths orauosOf side foam m Ytnsm..g'®wn w)ovh ekdme man doosv3krtf1^r~[aeda!mwkmeterl:mnsuetlim rs nommtg_arold area. XOURNAME: Jai (Lism (oar arpe, 6* vasse. middle oh es, m am applpogm the nom of SOmCpKdta or Or or Odw ter Cabb'. ]IIC71 m 8 WommY. PgpOry.If Use, a1dL'MC the new penon'Sm emepany~a pama) NAME OF APPLICATION: (Cheri, all that y:p1Y.) T. werossee Building V®ae Trustee x Chaw Ofzow Ceusat rMsion Appoval OfpW Mooring musupbesbam prtorofew mm Phoney 0dw pr"Ol nomeme activity.) Do you pusoalll, W mmnSiswt¢compeN'. SPOax, siblxg pmeot or child) I.-arelmiond" wbh MYOlgmmmpmYm ofdmTow O dSrrmMld?'7toledwurs~^ indudes bybloA nmiade, or business iOmrat "Srmhten imagist" manes abmiams, induding aymmaship, in whwhtro manof iserOr wnpmyroo hm oven apuaal ow 4rabip of(m mtpmywmrby) 0MPO"m in which du town olGm or ampb9sa awes sours elm 3% of the shares. YES NO X Ifyce aor v "M", semprm the bdmm athis soon and dame and sign when, indicated. Name dpeross atetpmyad by ilia Totes dSou so)d nle ar position of that person Dm lk the mlali=*bmwem yumself(nha applimotln@anrhapr®snutiva) and dm wm offivror ewptpyea Eldia Naelt the eppmpriate line A) through D) mdW describe: in the spme provided. Thetowe oBtar or employes or his or her spotre, sibling. parent, orohild is (eaeck all that apply): p) me o ,act orgesmer Wes 5%Ofine shores of the empomae sock ofd. "P*w (when the applieaot is aompmadon)i _S) the legal a beaebaal oe aofmy interest in a son-corM= ontity(when the appgernlR 6CmparWiaa): -C) MA O )pu, prhter, or mWmYte of the eppgmnt or _D) the amcnW e[ applih®t. DFSCRIEMON OF RA-•1,'AONS WP Submimd this d a 2011 Pda ALANF 'LLOW- Fmta TS 1 tdetnew 0. Ivans Now, POM-.. Of New York ti'-05'VG05U 9 Dbali M ScllO!a Cou12, 201 Commissio January 1 Dec 08 11 01:14p p.3 i QDITCLAiM DEED STAT[TTORY.Pow-D TM 8 A Y BINIDHVG $i4nWMBNT. IF NOT FULLY U 4TOOD, WE Alt,PA~TOT11k RanWbg EWfi D8NfM, WmU the 16th day of July, 2002, hatvsaa Iww L 1181nMmy Jr, of403d peovnic Bay B[vd, Laead,l~ty 1ltltk 11y48,, party oftha final pat, sad AIM Lr. Md hm of 73 (m=ite Sptisgs Read, Yorkoowtt Hw*ts, New Yak 1059& mod lk& A. rAdlOw, 6 Absswm& Rand, WWdwte~ M machm a 6189-, #ad JmM A. kfdfsw,11067 Old Cole Ro&4 V&Wy Cedar, Cditnia 92092 and Bwbft- a F. V==Runa;. 26 Red Fax Lance Bmwdw, NewYork 16509, all m joie TWO parties offt second part Nffm=78, aa~ parlY oftlm first part, = aaasldemdon alma dour ,ad otbm good and valuableooa=hrvtia% b wful money oftho UnWd Sk* pad byilta pa du oftba *omd pat, does haaby rank--, release, add gaitclsiattheptirtlea ofthesecandptat, tend aas~af0reva,atati}eertb~daaaieaet fie .n ame A? sac Grwrr {psrq a~1 P~1 a tssarjwd, a~ r6aeeea.rpegrmP B1idtr,vkaci is anti 4amt of All aflbd retain platrt piece a pared of Ind wi* Ste bwldlmgr mad oa my mm%&mvW awWd. s9uate, i]'i¦8 and ttemg m Lsttt~l, Town ad 9ontQald. Googly ofSuffoAtand Sflti- ofNew Yadt, mid panel being more pa8eallarq headed a»d~asaibed sa folbwa, to wlC BEGIN1~t0 at a poletF am the wettheaslerly side of Peeoai0 Bay Houlevad, dmdea 432.4 feat n sm anncd in a aoatbrnGWKIy 4tt0Wou find the dtvmm lieu between lade nwr orfomaalty GeV= &"at Towy and Eliz+ P. Tandy, his Witt, MA W& stow or famaly ofPradul* RuswM; s R1tNMM TMNCE Sow sad pond and place of bVmiivg afmg lauds 116Nharfpmtrly of Amm 1olsrle Doondy and lands now orfo • of McAilistar sonar 15 depum 10 mb utea 00 seeamda East a dtAaooe of 535.69 feat to apoktwdas whigh weeerMaltoft60Greetpew,&Bay, num,E along a tie line South 26 dagteea 54 WNW 50 mea Ws Walt a distance of 11857 feet to a poimt and the mean high water hnstk oftba Gma Pacm w Bay; THME North 15 duress, l6 mWRW OD sOM& West along ba& now or fotttterly of Corydon and Sealy a distance of 551 A6 feetka a poid and the wu[hea-tefly knee ofpeowo Bay Boulevard; THRICE Nm&'32 de ea 54 rpinotm 20 -6oWds East a dim of 108,16 Rat to the potent and pbm of the BWM4 NG. SAW PR$MISP.S tmotun 85 4030 Peeonic Bay Baulavatd, Lawei, New York TOM M with the a+ppwknmtcw and all *e mate and rights ofthe patty oftbe &at pat in "d t0 said xMism i Dec 00 11 01:14p • • p.4 ros~va ~ xo~OlD'j0,. p~eas®as beam ~Oa.ue aapttka aftbsseoeadpst,adawt~sfiteaar. ffWMMWJ=W ,tkpwgOf wEatpmb..hamaflOm*Usb.d.dndlodWadymfist sbo~e wdlha iega..e. oL _ f-v, i ~ ail. ~ - °bwltaaaroeaE (iraa~Eot: ~ t L i 1, aPaeoaWftt mMawYanksbft STA19CWNBWYV ask COUN1'XaF4)?YrtNj- Oatb6 ~dayOfHIYhkIpsyaer200I 11 nfaa0.fietaDdea~Sd,PlmoigR7a~yquedI$(~ILId ,a7E paaoed~ybawwntomeorpgvedtomaaatbobussafsdktw tayavidemoadobathsir Oe1wbwatarB saUsorbs1110do diaisetuisaaotedet4aowibe dsa=%mbaameAtodibesaesibiais1 sald,adl4as 0ybulre~osaraas1bebekt~asSthepbdNWULarthepmmupon bcWofwbiob9oio b*%dwm4 ~ioM[gvad. i RW 1bt . . Ngaeylhddc a~l1Y1rINa~> ~a.~ p~` . section 128 Record and Retnm to:' Block 6 Lot 1 Town of Southold aioha7rd W. 9eroolloag, Beg. .26 Aeyl Foil Lana County of Suffolk Brevste>a, Nam York 10509 f i I Ded OB 11 01:I5p • • p.5 E G , F X I I r ~P• 3~ 1 { Pi.,a ~ ~ 1~'.Lfi 1 I ALM& SWUM mm pmwmmwvk&mmwmwKmAA0w4mdfi I ! ! logl>~~as~t1o7R0eno~e i,w1~0a~o[b~1~ i~nlwwlp~pai~. ~ wrrl87~¢~aim~ialueQblidp~adlea Gl~plt i ~l~~~d+lrt~gt~w~i~eeaals,.wiaraif~iiilrl,A*eleerVsr/SlA~~M~ 1MO~b oi~~ll~~wdi'IabCit~ii~i~adl~fdie!,tbai~wRdrlur~aiiir~w91>,lwbe detlaf(i~~ICR i i i 7 I Dea 11 O1: iSpjk' t 1 t i x ra: INS I ~i F ' 1kR - L + *M' Pl! ~ ~ 1' 4 i f wN S VAAMM~ Man (ENO.) PLPTAA. 2g n.asn,. b ste.q Cmoaa[39dt.~ se Atkk* ~aMea9ee ar i 4 li~dla • eie ie_ Now* Apr ~ aa. iy.:. ' ic~od7Yed fIRfc" [moo { low "Wo owo ooaaoo ILt2n#~0'Onom l7rL6A6iee .l.nq t -1 i4s 7iF ec6 Pax 46".V* L ar 105V7 t 7 Mac 0- 1" i JCD.N~ ~Air ~b~l~~4S ~'+EUM Yf~~ x~BQP iM6 YfC ac~sranmovYaaa~_ Tb ~Le10Mm1ipa .~i4.r1TxRa7 m HUSEro! ~ z~anr~rtne~ar~~oeexvmoeTaD~o~a+Qauxs~. li Dec 08 11 01:13p • ~ p.l SUFFOLK F IRONMENTAL SULTING, INC. FAX 2322 Main Street • Newman Village P.O. Sox 2003 • Bridgehampton • New York • 11932 (631) 537 - 5160 (office) (631) 537-5291 (facsimile) matt@suffolkenvironmental.com DATE: December 6 2011 NUMBER of PAGES (including cover): 7 TO: Lauren Standish COMPANY: Southold Board of Trustees FAX (651) 765 - 6641 FROM: Matt D. Ivans RE: FIDEL OW Application 4030 Peconic Bay Boulevard; Mattituck New York SCTM 1000 - 128 - 0 - 001 Lauren, As per our discussion yesterday regarding the above referenced application, please find attached: (l) Town of Southold Transactional Disclosure Form: and (2) Deed regarding subject property. Kindly review and retain within your records. Should you have any questions, please feel free to contact this office with any questions. Thank You as always for your attention and consideration. Sincerely, ..7 i • • Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street, P.O. Box 2003. Bridgehampton, Ncw York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson. M.S., President October 26, 2011 Ms. Jill Doherty, Chairwoman Board of Trustees OAT 2 7 c011 Town Hall P.O. Box 1179 Southold, NY 11971 Re: FIDELLOW Property Situate: 4080 Peconic Bay Boulevard; Mattituck, New York SCTM 1000 - 128- 06 - 001 Dear Ms. Doherty, This Firm represents Mr. Alan Fidellow, owner of the property referenced above, who is seeking all required regulatory approval to further improve thereon. In that the property is burdened by wetlands, a wetlands permit is requested from your Department. Please find enclosed herewith for your review: (1) Town of Southold Trustees Wetlands Permit Application (original and two [2] copies); (2) Short Environmental Assessment Form (original and two [2] copies); (3) Local Waterfront Revitalization Program application (original and two [2] copies); (4) Town of Southold Erosion, Sedimentation & Storm-Water Run-Off Assessment Form; (5) Location Map for reference (three [3] copies); (6) Photographs of subject property, indicating the conditions thereon, as well as the staked location of the proposed dock assembly (three [3] sets); (7) Survey of subject property, prepared by PECONIC SURVETORS, P.C., last dated October 21, 2011, indicating the conditions thereon (three [3] prints); and Hammarth/ , • 2 (8) Check made payable to the Town of'Southold in the amount of $250.00 covering the requisite application fee. By way of this correspondence, and on behalf of the Mr. Fidellow, I request that you commence review of this application and schedule before the next available Trustees Board meeting for discussion and subsequent permit issuance. Should you have any questions regarding this matter, or require additional information, please feel free to contact this office at any time. Thank you in advance for your cooperation. Sincerely, Matt D. [vans enc. CC: A. Fidellow e~~P 9 q Wrya o SURVEY OF PROPERTY AT LAUREL TOWN OF SOUT14OLD SUFFOLK COUNTY, N.Y. y~e 1000-128-08-01 1 SCALE: P= 30' ~P~@ OC AUUT T.21, EOIl(NEW SEPTIC A WATER LINE) p Dea. 22, 2011 IDRYWELLS) tiG Joy G0~ e , 4rV bry° ~ry Z a-TROVL, ;l y"y ~ F z FI ,Ri'. OF TRIJ`1,F's n TOWN Of SQL' 'OLD DOSE O c Z DATE Jy~ ay zoAz se s f o o- ~ c o ~ m ~ m N a \ % o O v L i~9S'i Sx \ STORM WATER RUNOFF PLAN 1$ DWELLING = 1084 Sq.FI. 2" RAINFALL 10B4 1 OJ7 = 184 Ca.FI. \ USE 2- 6'0 = 4' Deep $ Drywe& P 1;t~ h5T F IL ¢1.Y - Z N L i p \ 7 b o O R ap \ T C m F \i Z y NEW SEPTIC SYSTEM O Z ( B BEDROOMS 1 - - - .m A C1 she S, I - 10'0 • 4' LIQUID DEPTH 2000 gal. O - - PRECAST SEPTIC TANK _ O D X 'S L 2 - 8'0 • 12' DEEP LEACHING POOLS O WITH A 3' SAND COLLAR (SWI 3' U O G m mlL ABOVE GROUND WATER A. ) ? ` \ S \ E~ o Lp LP e s' PROn'cf"Sra' \ \ I~ sr I i. x=s e.i fR, GFR: \ \ K 4. \ GD'RAGE~ '29 p B.RCDMS, f\~ TEST HOLE DATA z \ McDONALD GEOSCIENCE - E%SSpooL SB0 \5 \ \ E, \ e/e/t t All < rD oEVFn~Lf, Ile o.eE 1, EN OP F BROWN SANDY SLT ML TU y 0 II!, io BROWN slLtt SANDY sa a \ -se B r,A.i / PALE BROWN FINE SAND SP Nm 4t °4 rm°° .em n' NO WATER ENCOUNTERED AREA=43,494 SO. Ff. T© TIE LINE tlry, / o~ti CONT~UR LINES FROM TOPOGRAPHIC MAP FIVE EASTERN TOWNS AV 0 OF NeW)" r %}r / d O~ i, MET c l am familiar with the STANDARDS FOR APPROVAL Ctm~~' AND q'ONSTRUCTION OF SUBSURFACE SEWAGE DISPO¢AL SYSTEMS FOR SINGLE FAMILY-RESIDENCES o / ~W/ yP and Will abide by the conditions set forth therein and on the ^ s permit to construct. e The I cation of wells and cesspools shown hereon are from }yield observations and or from data obtained from others. / LAND ANY ALPERA OR ADDITION TO THIS SURVEY IS A VIOLA N Y. S. LIC. NO. 49618 5ry OF SEC{'70N 720 72090E THE NEW YORK STATE EDUCATION LAW. W. o ECONIC SVOWYORS, P.G. EXCEPT. AS PER SECTION SUBDIVISION 2. ALL CERTFICATIONS (631) 765-5020 FAX (631) 765-1797 HEREON ARE VALID FOR THIS HIS MAP AND COPIES THEREOF F ONLY IF NO00 'cm SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR P.O. BOX 909 WHOSE LSIGNANRE APPEARS HEREON. M=MONUMENT S1230 TRAVELER OUTHOLD, N.Y. 7 971 T 98-291