HomeMy WebLinkAboutTR-7820A James F. King, President
Bob Ghnsio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 11971
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
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
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hail Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 7820A
Date of Receipt of Application: June 1, 2012
Applicant: Eric Klodnicki
SCTM#: 144-5-25.1
Project Location: 165 Sailor's Needle Road, Mattituck
Date of Resolution/Issuance: June 20, 2012
Date of Expiration: June 20, 2014
Reviewed by: Board of Trustees
Project Description: To remove the existing sanitary system located less than
100' from wetlands (in favor of an upgraded system to be located more than 100'
from wetlands); construct a pervious gravel driveway extension; replace portion
of existing asphalt driveway/parking area with pervious gravel; and install fencing
to enclose proposed swimming pool located more than 100' from wetlands.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code. The
issuance of an Administrative Permit allows for the operations as indicated on the
survey prepared by Nathan Taft Corwin III, last dated on May 17, 2012, and
stamped approved on June 20, 2012.
Special Conditions: None.
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.
Board of Trustees
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall Annex
54375 Route 25, P.O. Box 1179
Southold, NY 11971
Telephone (631) 765-1892
Fax (631) 765-6641
TO: ERIC KLODNICKI
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Please be advised that your application dated June
Board at the regular meeting of June 20, 2012
1,2012 has been reviewed by this
and your application has been
approved pending the completion of the following items checked off below.
__ Revised Plans for proposed project
__ Pre-Construction Hay Bale Line Inspection Fee ($50.00)
__ Ist Day of Construction ($50.00)
__ ½ Constructed ($50.00)
XX Final Inspection Fee ($50.00)
__ Dock Fees ($3.00 per sq. ft.)
Permit fees are now due. Please make check or money order payable to Town of
Southold. The fee is computed below according to the schedule of rates as set forth in
Chapter 275 of the Southold Town Code.
The following fee must be paid within 90 days or re-application fees will be necessary.
You will receive your permit upon completion of the above.
COMPUTATION OF PERMIT FEES:
Final Inspection Fee = $50.00
TOTAL FEES DUE: * 50.00 ~) ~l~t~ ~%6~'1
BY: James F. King, President
Board of Trustees
James F King, Prcsidem
Bob Ghosio, J~, Vice-President
Dave Bergen
John Bredemcycr
Michael J, Domino
P.O. Box 1179
Southold, NY 11971
Telephone (631 765-1892
Fax (631 ) 765-6641
Southold Town Board of Trustees
Field Inspection/VVorksession Report
Date/Time:
/2/:2--
Eh-Consultants on behalf of ERIC KLODNICKI requests an Administrative Permit to
remove the existing sanitary system located less than 100' from wetlands (in favor of an
upgraded system to be located more than 100' from wetlands); construct a pervious gravel
driveway extension; replace portion of existing asphalt driveway/parking area with
pervious gravel; and install fencing to enclose proposed swimming pool located more
than 100' from wetlands. Located: 165 Sailor's Needle Rd., Mattituck, SCTM#144-5-25,1
T~,~SSa of area to be impacted:
Itwater Wetland Freshwater Wetland Sound Bay
p~onCe of proposed work to edge of wetland
f Town Code proposed work falls under:'
__Chapt.275 Chapt. 111 other
Type of Application: "~Wetland __Coastal Erosion
__Administrative__Emergency Pre-Submission
__Amendment
Violation
Info needed:
Modifications:
Conditions:
.~_.resent Were: ~ King /"-B. Ghosio __
J. Bredemeyer / Michael Domino
D. Bergen,
D. Dzenkowski
Form filled out in t~e field by
Mailed/Faxed to:
Date:
other
ERIC KLODNICKI, 2C?~5
Figure 1. Looking southeastJ?om location of existing sanitary system to be removed at
e rtst · ' ~' be replaced with pervious gravel.
~ "lng asphaltparkmg/drivewal area to
southeast toward Sailor's Needle Road over locations of proposed
drivew~F e~ension and jt~ncing.
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
(cot. Main Rd. & Youngs Ave.)
Southold, NY 11971
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
Telephone: 631 765-1938
Fax: 631 765-3136
To:
From:
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
MEMORANDUM
Jim King, President
Town of Southold Board of Trustees
Mark Terry, Principal Planner
LWRP Coordinator
Date: June 18, 2012
Re: Proposed Wetland Permit for ERIC KLODNICKI
SCTM#1000-144-5-25.1
Southh0id Town
Board of Trustees
En-Consultants on behalf of ERIC KLODNICKI requests an Administrative Permit to remove the
existing sanitary system located less than 100' from wetlands (in favor of an upgraded system to be
located more than 100' from wetlands); construct a pervious gravel driveway extension; replace portion
of existing asphalt driveway/parking area with pervious gravel; and install fencing to enclose proposed
swimming pool located more than 100' from wetlands. Located: 165 Sailor's Needle Rd., Mattituck.
SCTM#144-5-25.1
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
CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that
that the Board considers the following additional best management practice:
To further Policy 5: Protect and Improve Water Quafity in the Town of Southold and Policy 6; Protect
and Restore the Quality and Function of the Town of Southold Ecosystem.
If the action is approved, it is recommended that the existinq ve,qetat on (east of concrete wall
and frame qaraqe and adiacent to James Creek) be incorporated and preserved as a perpetual
non-disturbance buffer.
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
Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
John Bredcrneyer
Town Hail, 53095Main Rd.
P.O. Box 1179
Southold,NYl1971
Telephone (631) 765-1892
Fax (631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OFSOUTHOLD
Office Use Only
Coastal Erosion Permit Application
Wetland Permit Application ~t Administrative Permit
Amendment/Transfer/Extension
_~_Rece--~ved Application:
~_Received Fee:
~"~2ompleted Application-
Incomplete
SEQRA Classification:
Type I Type Il Unlisted
__Coordination: (date sent)
Consistency Assessment orm
fCAC Referral Sent: ~,~ a,
~_Date of Inspection: ~ [ I_
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
--'l~blic Hearing Held: I~
Resolution:
Name of Applicant ERIC KLODNICKI
Address 2350 DEEP HOLE DRIVE,MATTITUK, NY 11952
Phone Number: (9~3 856-3873
Suffolk County Tax Map Number: 1000 - 144-5-25.1
Property Location: 165 SAILOR'S NEEDLE ROAD, MATTITUCK
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: EN-CONSULTANTS
(If applicable)
Address: 1319 NORTH SEA ROAD, SOUTHAMPTON, NY 11968
Phone: 631-283-6360
Board of Trustees Applic~
Land Area (in square feet): 46,797
Area Zoning: R40
Previous use of property:.
GENERAL DATA
RESIDENTIAL, SINGLE FAMILY DWELLING
Intended use of property: NO CHANGE
Covenants and Restrictions: Yes X No
If "Yes", please provide copy.
Does this project require a variance from the Zoning Board of Appeals __ Yes X No
If "Yes", please provide copy of decision.
Will this project require any demolition as per Town Code or as determined by Building
Dept. Yes X No
Does the structure(s) on property have a valid Certificate of Occupancy X Yes No
Prior permits/approvals for site improvements:
Agency Date
__ 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):
Remove existing sanitary system located less than 100 feet from wetlands (in favor of an upgraded system to be
located more than 100 feet from wetlands); construct a pervious gravel driveway extension to provide access to
Sailor's Needle Road; replace portion of existing asphalt driveway/parking area with pervious gravel; and install
fencing to enclose proposed swimming pool located more than 100' from wetlands; all as depicted on the site plan
prepared by Nathan TaR Corwin III, Land Surveyor, last dated May 17, 2012.
of Trustees Applicati~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Driveway extension to provide ingress and egress via Sailors Needle Road and removal of existing
sanitary system in favor of upgraded system located out of Chapter 275 jurisdiction.
Area of wetlands on lot: 385 _square feet
Percent coverage of lot: <1 %
Closest distance between nearest existing structure and upland
edge of wetlands: <10 feet (garage)
Closest distance between nearest proposed structure and upland
edge of wetlands: 50 feet (driveway extension)
Does the project involve excavation or filling?
No X Yes
If yes, how much material will be excavated? TBD
How much material will be filled? N/A
Depth of which material will be removed d~Yei~d: TBD
Proposed slope throughout the area of operations: N/A
Manner in which material will be removed or deposited:
An excavator will be used to dig up and remove existing sanitary system.
cubic yards (as necessary to remove existing sanitary system)
cubic yards
feet (as necessary to remove existing sanitary system)
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):
The proposed pervious gravel driveway extension will have no adverse impacts on wetlands; and the conversion of the existing
asphalt driveway to pervious gravel within 50' of wetlands will have beneficial impacts on water quality and the adjacent wetlands
ecosystem due to the associated decrease in surface water runoff. The removal of the existing sanitary system in favor of an
upgraded system to be located more than I Off fi.om wetlands and out of Chapter 275 jurisdiction will have a beneficial impact on
the adjacent wetlands and tidal waters.
of Trustees Application
County of .......
State of New York
_rfo l< lodnieki BE,NO 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 1N THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF~THIS APPLICATION.
SWORN TO BEFORE ME THIS (~ [ ar
DAYOF
,20IZ
l~{ary Public
Norse/P,~"%. Sm~ of New
~'~l,'~. 31-8843070
C,:~itted ~n New Yo~k Co,Jnty
of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
Eric Klodn(cki
(print Owner of property)
residingat PO [50)(. }05~
(mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Cod~ of Ethics prohibits conflicts of interest on the part of town officers and employees. The purpose of
this form is to t)ro~ide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOU. NAME: Klodnickij Eric
(Last name, first name, middle inttial, unless you are applying in the name of
someone else or other entity, such as a company. If so, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other', name the activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) I~ave 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% oftbe shares.
YES NO ¢
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check
the appropriate line A) through D) and/or describe in the space provided.
The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):
__A) the owner of greater than 5% of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B) the legal or beneficial owner of any interest in a non-corporate entity (when the
applicant is not a corporation);
__C) an officer, director, partner, or employee of the applicant; or
D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
Submitted this
Signatare
Print Name
200
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
1. APPLICANT / SPONSOR
ERIC KLODNICICI BY MN-CONSULTANTS
3. PROJECT LOCATION:
Municipality MATTITUCK
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by ^ pplicant or Project Sponsor)
2. PROJECT NAME
County SUFFOLK
4. PRECISE LOCATION: Street Address and Road Intersections. Prominent landmarks etc - or provide map
165 SAILOR'S NEEDLE ROAD, MATTITUCK, TOWN OF SOUTHOLD, SCTM #1000-144-5-25.1
5.1S PROPOSED ACTION: [~ New [~Expansion ~Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
SEQR
Remove existing sanitary system located less than 100 feet from wetlands (in favor of an upgraded system to be located more
than 100 feet from wetlands); construct a pervious gravel driveway extension to provide access to Sailor's Needle Road; replace
)ortion of existing asphalt driveway/parking area with pervious gravel; and install fencing to enclose proposed swimming pool
ocated more than 100' from wetlands; all as depicted on the site plan prepared by Nathan Taft Corwin III, Land Surveyor, last
dated May 17, 2012.
7. AMOUNT OF LAND AFFECTED:
initially 46,797 s.f. acres Ultimately 46,797 s.f. acres
8. WILL PROPOSED 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.)
[~Residentia, Dlndustria, [~Commercia, [~Agriculture ~Park/Forest/OpenSpace []Other(describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
[~Yes [~ No If yes, list agency name and permit / approval:
DEC, SCDH
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[--']Yes [~No Ifyes, list agency name and permit / approval:
I~.~S A P,~,~LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
] I Yes ~ No
I CERTIFY T~AT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant / Spomor N~OBERT E. HERRMANN, COASTAL MANAGEMENT SPECIALIST Date: MAY 30, 2012
Signature ~ ~'-- ~
If the action is a Coastal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
PART 11 - IMPACT ASSESSMENT (To be completed by Lead Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF.
[~Yes [~No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative
declaration may he, 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)
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:
C2. Aesthetic, agticulturaL archaeological, historic, other naturaI or cultural resources; or community or neighborhood character? Explain briefly:
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endaagered species? Explain btietly:
I
C4. A community's exisfin~ plans or ~oals as officially adopted, or a chan~e in use or intensity of use of land or other natural resources? Explain briefly:
I
C5. Growth, subsequent development, related activities likely to be induced by the proposed action? Explain briefly:
C6. Long term, short, term, cumulative, or other effects not identified in CI- C57 Explain briefly:
I
C7. Other impacts (includin~ chan~es in use of either quantity or type of energy? Explain briefly.
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
~I~eOsNME~NoAREAICEA? If}~es, explainbriefly:
E. IS THERE, OR IS ~I4ERE LIKELY TO BEt CONTROVERSY RELA~IZD TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACrS~ If yes explain.
['--']Yes [~INo '
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, irapor rant 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 (0 magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA
Check this box if you have identified one or more potentially 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 Oflicer in Lead Agency
'g o esponsible Officer in L~ Agency
pignature ot
8
Date
Title of Responsible Officer
Signature of Preparer (If different from responsible otticer)
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.CT.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
1000 144 5 25. l STORM-WATER, GRADING, DRAINAGE AMP EROSION CONTROL PLAN
19tstnct Section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM #/WORK ASSESSMENT [ Yes No
a. What is the Total Area of the Project Parcels? 1 Will this Project Retain Ail Storm-Water Run-Off
(include Total Area of all Parcels located within
the Scope of work for Proposed Construction) 46,797 S.F. Generated by a Two (2") Inch Rainfall on Site?
b, What is the Total Area of Land Clearing (s.~d Acres)) (This item will include all run-off created by site
clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed Site improvements and the permanent creation of
comtruction adivity? impervious surfaces.)
~s~./^~te,) 2 Does the Site Plan and/or Survey Show All Proposed
PROVIDE BRIEF PROJECT DESCR[PTION (Provide Additional Pages as Needed))
Dca nage structures Indicating Size & Location? This
item shall include all proposed Grade Changes and
Remove existing sanitary system located less than 1 O0 feet fi.om Slopes Controlling Surface Water Flow,
thanWetlandslo0 feet(in favorfi.om of an upgraded system to be located more 3 Does the Site Plan and/or Survey describe the erosion
wetlands);
construct
pervious
gravel
and sediment control practices that will be used to
driveway extension to provide access to Sailor's Needle Road; control site erosion and storm water discharger. This
replace portion of existing asphalt driveway/parking area with Item must be maintained throughout the Entire
Comtruction Period.
pervtous gravel; and install fencing to enclose proposed
swimming pool located more than 100' fi.om wetlands; all as 4 Will this Project Require any Land Fillin.~ Gradin~ or
Excavation wherethere is a change to ~e Natura'l ~ X
depicted on the site plan prepared by Nathan Taft Corwin III, Existing Grade involving more than 200 Cubic Yards
Land Surveyor, last dated May 17, 2012. of Material within any Parcel?
5 Will this Application Require Land Disturbing Activities
Encompassing an Area in Excess of Five Tl~ousand ~ X
(5,000 S.F.) Square Feet of Ground Stir face?
6 is there a Natural Water Course Running through the
Site? ls this Project within the Trustees jurisdiction
General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or --
Submission of a SWPPP is required for all Construction activities involving 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
are part ora larger common plan that will ultimately disturb one or more acres of land~which Exceed Fifteen (15)feet of Vertical Rise to ~-~
Including Construction activities involving s011 disturb~mces of less than one (1) acre where One Hundred (100') of Horizontal Distance?
I I
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 Permit 8 Will Driveways, Parking Areas or other impervious
~or Storm Water Discharges from Construction activity - Permit No. GP-0-10-001.}
Surfaces be Sloped to Direct Storm-Water Run-Off
1. The SWPPP shall be prepared prior to the submittal of the NOI. The NO[ shall be into and/or in the direction of a Town right-of-way?
submitted to the Department riortothecommencementofconstructionactivity.
2. The SWPPP shall describe t~et erosion and sediment control practices and where 9 Will this Project Require the Placement of Material,
required, post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ~ X
constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder
compliance with the terms and conditions of this permit, in addition, the SWPPP shall
COUNTY OF SUFFOLK ss
That I, ROBERT E. HERRMANN
- ~Naw~o~indlvld~a[s]gning Doc~me~t~ being duty sworn, deposes and says that he/she is the applicant for Permit,
And that he/she is the AGENT FOR OWNER
' (Own4r~Co~tractor, Agent, Corporate Officer, etc. '
FORM - 06~'0
BUALIFIEO tN SUFFOLK cOUNTY
ExPIR£S AUGUSF Z. 207~
06/01/2012 15:37 FAX 6312836135 EN-CONSULTANTS,INC. ~004
C~untyof~..~'
$~ of NewYork
Boa:cd o£ T~us~;ees App~£c~.4on
DEPOSES AND AFI:~MS THAT ~S~ IS ~ ~PLIC~ FOR ~
~~ P~¢(s) A~ ~T ~L STA~ ~ CO~~ A~
~UE m ~ ~'~ OF mS~ K~O~E A~ BELF~, ~ ~T ~ WO~
~ BE ~ ~ ~E ~ER SET FOR~ ~ ~S ~1~
BE ~PRO~ BY ~ SO--OLD TO~ BOA~ OF ~US~_
AO~ TO HO~ ~ TO~ OF ~0~ ~D ~ TO~
~ o~Y ~ o~ s~D PE~T(S), ~ ~D. ~ CO~E~
~~A~ ~(S), TO ~ 0~0 ~ ~RO~ ~ ~S~ECT
P~S~ ~ CON; ~C~ON WI~ ~EW OFf~S ~PLICA~ON.
SWORN TO BEFORE ME THIS
DAY OF ~""~
06/01/2012 15:36 FAX 6312836136 EN-CONSULTANTS,INC. ~002
Board of Trustees Application
Erie 1(Iodn(cki
AUT]?IORIZATION
(where the applicant is not the owner)
(print 6wner of pro gay)
residingat 1:~ ~ )O~l
(mailing address)
(Agent)
to apply for permit(s) from the
Southold Board ofTo~vn Trustoes on my behalf.
06/01/201~ 15:~7 FAX 6~28~61~6 EN-CONSULTANTS,INC, ~003
APPLICANT/AGENT/REpRESENTATIVE
TRANSACTIONAL DISCLOSURE IrORM
~' ofElhi · ibi n ' tsofint~ ~ the rtofto of
~ ~ nwhi~h n el~-t th n of s.~b fliers of in ~ ~e ~ ' '
Klodn{cki,
~ ~ el~ or
N~E OF AP~CATIC N: (C~ ~1
T~ ~cvan~ Build~
C~ge of Z~ ~ ~n
A~ ofp~
Ex~p~ ~m pl~ ~ o4 ~l map Pl~i~
in wh~ ~ ~ ~r,,r emp~ o~ m~
NO
N~ of~ ~by~d ~ ib~ To~ of 8ou~l~
~e a~ line A) ~ ~ D) ~or
B) the le~l ~ ~m ~ ~ of~y im~
~ an o~r, ~c ~, ~er, or ~xploy~ of ~ ~,, or
D) ~ ~1 ~lk~t.
DESCRIPTION OF P,.EL~ TION$~Ip
Form TS I
Submittal this .......~_~daylpf 200
Ktod cki
Town of Southold
A. INSTRUCTIONS
LWRP CONSISTENCY ASSESSMENT FORM
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 Iown 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-
su~ortinl~ facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: onlin~t.,~old's website
(southoldtown.northfork.net), the Board of Trustees Office, the~l-a)C]i~g [~el~r0e~
libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# 144 - 5 - 25.1
PROJECT NAME ERIC KLODNICKi of
The Application has been submitted to (check appropriate response):
TownBoard ~] PlanningBoard~] Buiiding Dept. [--] Board of Trustees [~ Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification:
Nature and extent of action:
Remove existing sanitary system located less than 100 feet from wetlands (in favor of an upgraded system to be located more than 100
feet fi.om wetlands); construct a pervious gravel driveway extension to provide access to Sailor's Needle Road; replace portion of
existing asphalt driveway/parking area with pervious gravel; and install fencing to enclose proposed swinuning pool located mom than
100' fi.om wetlands; all as depicted on the site plan prepared by Nathan Taft Corwin III, Land Surveyor, last dated May 17, 2012.
Location of action: 165 SAILOR'S NEEDLE ROAD
Site acreage: 1.074 ACRES
Present land use: RESIDENTIAL, SINGLE-FAMILY DWELLING
Present zoning classification: R-40
If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: ERIC KLODNICKI
(b) Mailing address: 2350 DEEP HOLE DRIVE
MATTITUCK, NY 11952
(c) Telephone number: Area Code 917-856-3873
(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?. NYSDEC
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 effects of development. See LWRP Section III - Policies; Page 2 for evaluation
criteria.
[~Yes [~] No [~ Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southoid. See LWRP
Section III - Policies Pages 3 through 6 for evaluation criteria
~] Yes ~] No [~ Not Applicable
Attach additional sheets if necessa~
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
~ Yes ~ No ~ Not Applicable
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 [~ Not Applicable
The removal of die existing sanitary system located less than 75' fi.om wetlands in favor of an upgraded system located almost 150' fi-om
wetlands and out of Chapter 275 jurisdiction will improve the quality of groundwater adjacent to James Creek and ultimately the quality
of the James Creek surface waters and thus the quality and function of the tidal wetlands and James Creek ecosystems, making this
project component consistent with both Policies 5 and 6. The proposed pervious gravel driveway extansion located no closer than 50
feet fi'om wetlands is defined by Section 268-3 as a "minor action" not subject to water consistency review (i.e., "DD. Construction or
improvements of pervious residential driveways, parking areas or walkways greater than 50 feet fi.om a tidal or freshwater wetland.");
and the conversion of the existing asphalt driveway to pervious gravel within 50' of wetlands will have beneficial impacts on water
quality and the adjacent wetlands ecosystem due to the associated decrease in surface water runoff, thus making this project component
also consistent with Policies 5 & 6.
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
See response to Policy 5 above.
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 ~ NopSI 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.
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation
criteria.
Yes ~ No~ Not Applicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's wa~r-dependent uses and promote sitin~I~of new water-dependent uses in
suitable locations. Sec LWRP Section III - Pohcles, Pages 47 through 56 for evaluation criteria.
~] Yes ~] No ~ Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Pecouic Estuary
and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
[--~ Yes ~] No [~ Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62
through 65 for evaluation criteria.
7-1 Yes 7-1 No Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Policies; Pages 65 through 68 for evaluation criteria.
[~ Yes [~ No [~ Not Applicable
PREPARED BY ~ ~.---
ROB . HERRMANN
TITLE COASTAL MGMT SPECIALIST DATEMay 30, 2012
Amended on 8/1/05
EN-CONSULTANTS
1319 North Sea Road
Southampton, New York 11968
631-283-6360
Fax: 631-283-6136
www. enconsultants.com
ENVIRONMENTAL CONSULTING
May30,2012
REOUEST FOR AN ADMINISTRATIVE WETI,ANDS PERMIT
Town of Southold
Board of Trustees
54375 Main Road
Post Office Box 1179
Southold, New York 11971
Attn.: Lauren Standish
Re:
Eric Klodnicki
165 Sailor's Needle Road, Mattituck
SCTM # 1000-144-5-25.1
Dear Ms. Standish:
In regard to the above referenced property, enclosed are the following for the Board of Trustees review:
Three (3) Wetland Permit Applications including
a) Short Environmental Assessment Form;
b) Authorization & Disclosure Forms; and
c) Site Plan.
Three (3) LWRP Consistency Assessment Forms including
a) Site Plan.
One (1) set of site photographs.
Application fee of $50.00 wetlands.
I trust this information shall allow you to process our permit request. Should any additional information
be required, please do not hesitate to contact our office.
Sincerely,
Robert E. Herrmann
Coastal Management Specialist
/khs
Enc.
SURVEY OF PROPERTY
SITUA T£
MATTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-144-05-25.1
SCALE 1"=20'
DECEMBER 6, 2011
MAY 17, 2012 REVISE SITE PLAN
TOTAL AREA = 46,797 sq. ff.
(TO TIE LINE) 1.074 ac.
WETLANDS AREA = 585 sq. ff.
UPLAND AREA = 46,712 sq. ff.
BOARD OF TRUSTEES
TOWN OF SOUTHOLD
DATE Uw A-' r~ 20 ~-0/2_
DESCRIPTION AREA ~ LOT COVERAGE
EXIST. HOUSE 1,796
EXIST. PORCH 2DO sq. ff. 0.7%
EXIST. DECK 415 sq. ff. 0.9%
EXIST. GARAGE 699 sq. ff. 1.5%
EXIST. ASPNALT DRIVEWAY! 4,205 sq. fi, 9,0%
TOTAL EXIST, 7,414 sR. fi. 15.9%
BROWN FINE TO MEDIUM SAND SP
GROUND WATER
11'
PROPOSED SEPTIC SYSTEM DETAIL
(NOT TO SCALE)
APPROVED PIPE 1/
,~v ~[, , -.~
SEPTIC TANK
I MIN[MU~ SEPTIC TANK C^pACfflES FOR ^ 4 BEDROOM HOUSE IS ],2D(~ G^LLONS
LEACHING POOLS (6~
1. ELEVATIONS ARE REFERENCED TO N.A.V.D, 1988 DATUM
EXISTING ELEVATIONS ARE SH(~y~ THUS: B 0
2. LOT NUMBERS SHOWN THUS: £GT~ REFER TO
MAP OF SALT LAKE VILLAGE
FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY
ON MAY 10, 1940 AS FiLE No. 1S10
S. LOT NUMBERS SHOWN THUS: £oTJ~Q~EEFER TO
~P OF ~DIA BARTLEY
FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY
ON JULY 27, 1922 AS FILE No. 770
4. FLOOD ZONE INFORMATION TAKEN FROM:
FLOOD INSURANCE RATE MAP No, 3610300402H
ZONE AR, BASE FLOOD ELEVATIONS DETERMINED
ZONE X*: AREAS OF 0.2~ ANNUAL CHANCE FLOOD, AREAS OF 1~ ANNUAL
CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT
OR WiTH DRAINAGE AREAS LESS THAN 1 SQUARE M~LE,
AND AREAS PROTECTED BY LEVEES FROM 1~ ANNUAL CHANCE FLOOD,
5. MINIMUM SEPTIC TANK CAPACITIES FOR A 4 BEBROOM HOUSE IS 1,200 GALLONS.
1 TANK; 0' BIA, X 4' EFFECTIVE DEPTH
B, MINIMUM LEACHING SYSTEM FOR A A BEDROOM HOUSE IS SOO sq ff SIDEWALL AREA.
6 POOLS; 2' DEEP, 8' dia.
PROPOSED 50% FUTURE EXPANSION POOL
(~ PROPOSED B' DIA, X 2' DEEP LEACHING POOL
(~ PROPOSED 1,200 GALLON SEPTIC TANK
7. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS.
8, EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND
REMOVED IN ACCORDANCE WITH S.C,D,H,S. STANDARDS.
x~
o]
%% 79'0
L=62,83'
HOLE
/
b
9
THE EXISTENCE OF RIGHT OF WAYS
PREPARED IN ACCORDANCE WJTH THE MINIMUM
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
By THE
Nathan Taft Corw n III
Land Surveyor
SuccessDr To; Stanley d Isaksen, Jr L,S Joseph A, Ingegno LS,
PHONE (651)727-2090 Fox (B~1)727-1727
31-14