HomeMy WebLinkAboutTR-7870A James F. King,President *16 S�U)y Town Hall Annex
Bob Ghosio,Jr.,Vice-President ,�0� ��� 54 Main 1
oay P.O.54375 Box 117979
Dave Bergen T # Southold,New York 11971-0959
John Bredemeyer
Michael J. Domino 'G.2 �� Telephone(631) 765-1892
ON� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0823C Date: December 11, 2012
THIS CERTIFIES that the installation of a 4'x5' Kohler power system generator along
the northerly side of the garage
At 525 Old Salt Road, Mattituck, New York
Suffolk County Tax Map # 144-5-17
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated August 1, 2012 pursuant to which Trustees Administrative Permit#7870A Dated
August 22, 2012, 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 installation of a 4'x5' Kohler power system generator along the northerly side of the
garag .
The certificate is issued to MICHAEL GERACI owner of the
aforesaid property.
Audiorized Signatur
0 0
Jill M. Doherty,President �QF souls Town Hall Annex
James F.King,Vice-President �O� 0� 54375 Main Road
P.O.Box 1179
Dave Bergen Southold,New York 11971-0959
Bob Ghosio,Jr. v+ ac
John Bredemeyer . �� Telephone(631) 765-1892
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION:
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1st day of construction
1/2 constructed
Project complete, compliance inspection.
INSPECTED BY:
COMMENTS:
C'V•4)fe1Coa9
CERTIFICATE OF COMPLIANCE:
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 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
1 s~ 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 Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 7870A
Date of Receipt of Application: August 1, 2012
Applicant: Michael Geraci
SCTM#: 144-5-17
Project Location: 525 Old Salt Road, Mattituck
Date of Resolution/Issuance: August 22, 2012
Date of Expiration: August 22, 2014
Reviewed by: Trustee Jim King
Project Description: To install a 4' x 5' Kohler power system generator along
the northerly side of the garage.
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
project plan prepared by Michael Geraci, received on August 1, 2012 and
stamped approved on August 22, 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.
James F. King, President
Board of Trustees
James F. King, President
Bob Ghosio, Jr., Vice-Presid~nt
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall Anaex
54375 Route 25, P.O. Box 1179
Southold, NY 11971
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Please be ad~sed that your application dated ~0~ ~ [~ DIA has been
reviewed by this Boa~ at t~e regular meeting of O~u ~ ~ ~ bl~ and
your application has been app~ved p~i~g th~ co~fi0n 0(the % ow ng terns
checked off below.
~ Revised Plans for proposed project
~ Pre-construction ~ Bal~ Line Inspection Fee ($50.00)
~ Is~ Day of Construction ($50.00)
~ ~ Constructed ($50.00)
Y Final Inspection Fee ($50.00)
Dock Fees ($3.00 per sq. ~.)
Pe~it fees are cow due. Please ma~e ~eok or money o~er payable to Town of
So.hold. The fee is ~mpu%d below aoco~ing to the schedule of rates as set fo~h in
chapter 275 of the Southold Town Code.
The %llo~ng fee must be paid ~thin 90 days or reBppli~fion fee~ will be necessa~.
You will receive your pe~it upon completion of the above.
COMPUTATION OF PERMIT FEES:
TOTAL FEES DUE:
BY:
James F. King, President
Board of Trustees
.lames F King, President
Bob Ghosio, .Ir, Vice-Presidcnl
Dave Bergen
John Bredemeyer
Michael J. Domino
P.O Box 1179
Southold, NY 11971
Telephone(631 765-1892
Fax (631)765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time:
Arlington Electrical Contracting, Inc. on behalf of MICHAEL GERACI
requests an Administrative Permit to install a 4'x5' Kohler power system
generator along the northerly side of the attached garage. Located: 525
Old Salt Road, Mattituck. SCTM# 144-5-17
Ty~ce of area to be impacted:
Saltwater Wetland Freshwater Wetland
Sound Bay
Distance of proposed work to edge of wetland
Part of Town Code proposed work falls under:
~,~-Chapt.275 Chapt. 111 other
Type of Application: __ Wetland __Coastal Erosion __Amendment
---Administrative__Emergency Pre-Submission Violation
Modifications:
Conditions:
Present Were:
__J. Bredemeyer__
b/'/JJ. King_
Form filled out in the field by
B. Ghosio
Mailed/Faxed to:
Date:
Michael Domino
__ D. Bergen,
D. Dzenkowski
other
I(OHI, R. POWER SYSTEMS
Mode s: 14/20RESA
Multi-Fuel
LP Vapor/Natural Gas
o9001
AUG - 1 2012
Features
generator set
[with optional Model RXT
Southho!d In w,,n
P,,lard of Tnlslees
The Kohler' Advantage
· High Quality Power
Kohler home generatom provide advanced voltage and
frequency regulation along with ultra-low levels of
harmonic distortion for excellent generator power quality to
protect your valuable electronics.
· Extraordinary RellablllbJ
Kohler is known for extraordinary reliability and
performance and hacks that up with an industry-leading
5-year or 2000 hour warranty.
· Powerful Performance
Exclusive PowerboostTM technology provides excellent
starting power. The Kohler 14 kW generator can easily
start and run a 5 ton air conditioner.*
· Corrosion-Proof Enclosure
The bold new Kohler design is completely corrosion proof,
even in harsh seaside environments, and is
impact-resistant even at -34° C (-30° F).
· Fast Response
Kohler's unique Fast-Response '" excitation system
delivers excellent voltage response and shod-cimuit
capability.
· Quiet Operation
Kohler home generators provide quiet, neighborhood-
friendly performance.
ned for today's most sophisticated electronics.
o ponds quickly to varying
o Digital voltage regulation protects your sensitive
electronics from harmonic distortion and unstable power
quality.
o Two-line, backlit LCD display with adjustable contrast is
easy to read, even in direct sunlight or Iow light.
· Kohler Command PRO Engine Features
o Kohler Command PRO® OHV engine with hydraulic
valve lifters for reliable performance without routine
valve adjustment or lengthy break-in requirements
o Powerful, reliable air-cooled performance
o Simple field conversion between natural gas and LP
vapor fuels while maintaining emission codification
· Designed for Easy Installation
o Polymer base eliminates the need for a concrete
mounting pad, reducing installation time and cost
o Hinged, locking reef
o Fuel and electrical connections through the enclosure
wall eliminate the need for stub-ups through the bottom
o Load connection terminal block allows easy field wiring
o Designed for outdoor installation only
· Certifications
o Meets emission regulations for U.S. Envireemental
Protection Agency (EPA) phase 2 small off-road engines
and CA 2006 and later LSl engines with both LP vapor
and natural gas
o UL 2200 listed (60 Hz model)
o CSA certification available (60 Hz model)
o Approved for stationary standby applications in locations
served by a reliable utility source
a Model 14RESAis also approved for non-standby
(off-grid) applications (18 month or 1000 hour warranty
applies for non-standby applications)
Generator Ratings
Standby Ratings
Natural Gas LP Gee
Model Voltage Phase Hz Alternator kW/kVA Amps kW/t(VA Amps
120/240 1 60 2F5 12/12 50.0 14/14 58.3
14RESA
115/230 1 50 2F5 10/10 43.5 11/11 47.8
120/240 I 60 2F7 18/18 75.0 20/20 83.3
20RESA
115/230 I 50 2F7 14/14 60.8 15/15 65.2
Alternator Specifications
Alternator Specifications
PowerBoost" Generator
Specifications 1 -Phase
Manufacturer Kohler
Output reconnectable 120/240
Type 2 Pole, Rotating Field
Leeds, quantity 4
Voltage regulator Digital
Insulation: NEMA MG1 1.66
Material Class H
Temperature rise Class H
Bearing: quantity, type 1, Sealed Bell
Coupling Direct
Amartisseur windings Full
Voltage regulation, no-load to full-loed
RMS _+1.0%
One stap toad acceptance 100% of Rating
Peak motor sterang kVA @ 240 V:
14RESA 35
20RESA 40.5
Alternator Features
· Compliance with NEMA, IEEE, and ANSI standards for
temperature rise
· Self-ventilated and dripproof construction
· Vacuum-impregnated windings with fungus-resistant
epoxy varnish for dependability and long life
· Superior voltage waveform and minimum harmonic
distortion from skewed alternator construction
· Digital voltage regulator with -+1,0% no-toad to full-load
RMS regulation
· Rotating-field alternator with static exciter for excellent
load response
Application Data
Engine
Engine Specifications 14RESA 20RESA
Manufacturer Kohler
Engine: model, type CH740 CH1000
4-Cycle 4-Cycle
Cylinder arrangement V-2
Displacement, crn3 (cu. in.) 725 (44) 999 (61)
Bore and stroke, mm (in.) 83 x 67 90 x 78.5
(3.27 x 2.64) (3.54 x 3.1)
Compression r~io 9:1 8.8:1
Main bearings: quantity, type 2, Pareatt Material
Rated RPM
60 Hz 3600
50 Hz 3000
Max. engine power at rated rpm, kW (HP)
LP vapor, 60 Hz 17.6 (23.6) 23.0 (30.9)
LP vapor, 50 Hz 15.8 (21.2) 20.0 (26.8)
Natural gas, 60 Hz 15.3 (20.5) 20.2 (27.1)
Naturel gas, 50 Hz 13.8 (18.5) 16.8 (22.5}
Cylinder head material Aluminum
Valve materiel Steel/stellite®
Piston type and materiel Aluminum A~loy
Crankshaft materiel Heat Treated, Ductile iron
Governor: type Electronic
Frequency regala~on, no load to ~utl load Isochronous
Frequency regulation, steedy state ~0.5%
Air cleaner type Dry
Exhaust
Exhauat System 14RESA 2ORESA
Exhaust temperature exiting the
enclosure at rated kW, dry, °C (°F)
200 (500)
Engine Electrical
Engine Elecblcal Syatem 14RESA 20RESA
Ignition system Elec~o~ic,
Capacitive Discharge
Starter motor rated voltage (DC) 12
Battery (purchased separately):
Ground Negative
Volts (DC) 12
Baifery quantity 1
Recommeeded cold cranking amps:
(CCA) rating for -18°C (0°F) 500
Group size 51
Lubrication
Lubricating System 14RESA 20RESA
Type Full Pressure
Oil capacity (with filter), L (qt.) 1.9 (2.0) 2.8 (3.0)
Oil ltlter: quantity, type 1, Cartridge
Oil cooler Integrel
Fuel Pipe Size
Minimum Ga8 Pipe Size Recommecdatlon, in. NPT
14RESA 20RESA
Natural Natural
Pipe Gas LP Vapor Gas LP Vapor
Length, 193,000 203,000 281,000 340,000
m (ft.) Btu/hr. Bte/hr. Bto/hr. Btu/hr.
8 (25) 3/4 3/4 1 3/4
15 (50) 1 3/4 1 1
30 (100) 1 1 1 1/4 1
46 (150) 1 1/4 I 1 1/4 1 1/4
61 (200) 1 1/4 1 1 1/4 1 1/4
Fuel Requirements
Fuel System 14RESA 20RESA
Fuel types Nafural Gas or LP Vapor
Fuel supply inlet 1/2 NPT
Fuel supply pressure, kPa (in. H20):
Nature] gas 1.2 2.7 (5-11)
LP 1.7-2.7 (7-11)
Fuel Composition Limits * Nat. Gas LP Gas
Methane, % by volume (minimum) 90 min.
Ethane, % by volume (maximum) 4.0 max.
Propane, % by volume 1.0 max. 85 min.
Propene, % by volume (maximum) 0.1 max. 5.0 max.
C4 and higher, % by volume 0.3 max. 2.5 max.
Sulfur, ppm mass (maximum) 25 max.
Lower heating value,
MJ/m3 (Btu/It3), min. 33.2 (890) 84.2 (2260)
* Contact your local distributor for suitability and rating deratas based
on fuel compositions outside these limits.
Operation Requirements
Fuel Consumption
% Fuel Coneumptior~, mS/hr. (cfh)
Model Fuel Type Load 60 Hz 50 Hz
100 5.4 (193) 4.9 (175)
75 4.7 (163) 4.2 (148)
Natural Gas
50 3.5 (124) 3.1 (108)
25 2.6 (93) 2.4 (84)
14RESA
100 2.3 (81) 2.1 (74)
75 2.1 (75) 1.9 (68)
LP Vapor 50 1.8 (60) 1.5 (53)
25 1.2 (45) 1.1 (40)
100 8.0 (281) 6.4 225
75 6.9 (243) 5.4 189
Natural Gas
50 4.6 (161) 3.9 139
25 3.6 (127) 2.9 103
20RESA
100 3.9 (136) 2.9 102
75 3.1 (109) 2.4 85
LP Vapor
50 2.3 (82) 1.8 63
25 1.7 (59) 1.3 47
Nominal fuel rating: Natural gas: 37 MJ/rn3 (1000 Bfu/ff.3)
LP gas: 93 MJ/m3 (2500 Btu~.3)
LP gas conversion factors: 8.58 ff.3 = 1 lb.
0.535 m3 = 1 kg
36.39 ff.3 = 1 gal.
Sound Data
Model 14RESA sound level is 63 dBA during weekly engine
exercise and 67 dBA during full-speed generator diagnostics
and normal operation.
Model 20RESA sound level is 64 dBA during weekly engine
exercise and 69 dBA during full-speed generator diagnostics
and normal operation.
All sound levels are measured at 7 meters with no load.
RDC2 Controller
The RDC2 controller provides integrated control for the
generator set, Kohler® Model RXT transfer switch,
programmable ir~erface module (PIM), and load control module
(ECU).
The RDC2 controller's 2-line LCD screen displays status
messages and system settings that are clear and easy to read,
even in direct sunlight or Iow light.
RDC2 Controller Features
· Membrane keypad
o OFF, AUTO, and RUN pushbuttons
o Select and arrow buttons for access to system
configuration and adjustment menus
· LED indicators for OFF, AUTO, and RUN modes
· LED indicators for utility power and generator set source
availability and ATS position (Model RXT transfer switch
required)
· LCD display
o Two lines x 16 characters per line
~ Backlit display with adjustable contrast for excellent
visibility in all lighting conditions
· Scrolling system status display
o Generator sct status
o Voltage and frequency
o Engine temperature
o Oil pressure
c Battery voltage
c Engine runtime hours
· Date and time displays
· Smart engine cootdown senses engine temperature
· Digital isochronous governor to maintain steady-state speed
at all loads
· Digital voltage regulation: -+ 1.0% RMS no-load to full-load
· Automatic start with programmed cranking cycle
· Programmable exerciser can be set to start automatically on
any futura day and time, and run every week or every two
weeks
o Unloaded weekly exemise with complete system
diagnostics
o Unloaded full-speed exercise
o Loaded full-speed exercise (Model RXT ATS required)
· Front-access mini USB connector for SiteTechTM connection
· Front access mini~breaker protects the alternator
· Integral Ethernet connector for Kohler® OnCueTM
· Built-in 2.5 amp battery charger
· Remote two-wire startJstop capability for optional connectiee
of Model RDT or RSB transfer switches
See additional controller features on the next page.
KOHLER CO., Kohler, Wisconsin 53044 USA
Phone 920-457-4441, Fax 920-459-1646
For the nearest ssies and service outlet in the
US and Canada, phone 1-800-544-2444
KohterPoweccom
Additional RDC2 Controller Features
· Diagnostic messages
o Displays diagnostic messages for the engine, generator,
Model RXT transfer switch, programmable interface
module (PIM), and load control module (LCM)
o Over 70 diagnostic messages can be displayed
· Maintenance remindem
· System settings
o System voltage, frequency, and phase
o Voltage adjustment
o Measurement system, English or metric
· ATS status (Model RXTATS required)
o Source availability
o ATS position (normal/utility or emergency/generator)
o Source voltage and frequency
· ATS control (Model RXT ATS required)
o Source voltage and frequency settings
o Engine start time delay
o Transfer time delays
a Voltage calibration
a Fixed pickup and dropout settings
· Programmable Interface Module (PIM) status displays
o Input status (active/inactive)
o Output status (active/inactive)
· Load control module (LCM) menus
o Load status
o Test function
Generator Set Standard Features
· Battery cables
· CARB- and EPA-certified fuel system
· Corrosion-proof polymer sound enclosure
· Critical silencer
· Field-connection terminal block
· Fuel solenoid valve and secondary regulator
· Line circuit breaker:
14RESA: 70 amps
20RESA: 100 arnps
· Multi-fuel system, LP vapor/natural gas, field-convertible
· Oil drain extension with shutoff valve
· Premium 5-year limited warranty
· 18-month limited warranty for non-standby (off-grid)
applications (14RESA only)
· RDC2 generator set/ATS controller
· Rodent-resistant construction
· Sound-deadening, flame-retardant foam per UL94,
class HF-1
Available Options
Communication Accessories
~ OnCue® Generator Management System
Controller Accessories
~1 Programmable Interface Module (PIM)
(provides 2 digital inputs and 6 relay outputs)
[_j Load Control Module (LCM)
(provides 4 power relays and 2 HVAC relays)
Kohler Power Systems
Asia Pacific Headquarters
7 Jurong Pier Road
Singapare 619159
Phons (65) 6264-6422, Fax (65) 6264-6455
Available Options, Continued
Electrical System
Battery
Battery heater
Fuel System
Braided stainless steel flexible fuel line
Literature
General maintenance literature kit
Overhaul literature kit
Production literature kit
Starting Aids
Carburetor heater, 120 VAC (recommended for
reliable starting at temperatures below 0°C [32°F])
Fuel regulator heater pad (20RESA; recommended for
reliable starting at temperatures below -18°C [0°Fl)
Kohle~ Automatic Transfer Switch
Model RXT, see specification sheet G1t-121
Model RDT, see specification sheet Gll-98
Model RSB, see specification sheet Gll -101
Other Kohler~ ATS
Miscellaneous Accessories
Generator Set Dimensions and Weights
Overall Size, L x W x H: 1216 x 665 x 733 mm
(48 x 26.2 x 29 in.)
Shipping Weight: 14RESA 191 kg (420 lb.)
20RESA 243 kg (535 lb.)
L
w ~
DISTRIBUTED BY:
OFFICE LOCATION:
Town Hall Annex
54375 State Route 25
(cur. Main Rd. & Youngs Ave.)
Southold, NY 11971
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
Telephone: 631 765-1938
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
To:
From:
MEMORANDUM
Jim King, President
Town of Southold Board of Trustees
Mark Terry, Principal Planner
LWRP Coordinator
AUG ]3 20]2
B~ard of Trustees
Date: August 13, 2012
Re:
Proposed Wetland Permit for MICHAEL GERACI
SCTM# 1000-# 144-5-17
Arlington Electrical Contracting, Inc. on behalf of MICHAEL GERACI requests an Administrative Permit
to install a 4'x5' Kohler power system generator along the northerly side of the garage. Located: 525
Old Salt Road, Mattituck. SCTM# 144-5-17
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 "CC" which states:
CC. Structures less than 250 square feet in size that are accessory to existinq permitted primary
structures, and which accessory structures are qreater than 50 feet from a boundary of a natural
protective feature and freshwater or tidal wetlands;
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
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Ha~l 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
Office Use Only
Coastal Erosion Permit Application
~Wetland Permit Application ~ Administrative Permit
Amendment/Trans~r~xtension
]~ Rece~vved Application:
~_Received Fee:$ ~%.--O ~ t--
~ Completed Application
Incomplete
SEQRA Classification:
Type I Type Il Unlisted
Coordination:(date sent)
.~ LWRP Consistency Assessment Form. ~q] ]~, _
CAC Referral Sent:
~Date oflnspection: ,~i, l l.~-/ /a.~ -
__Receipt of CAC Report: t
__Lead Agency Determination:
Technical Review:
--Public Hearing Held' ' '
Resolution:
Name of Applicant
Address 595
Phone Number:( )
Suffolk County Tax Map Number: 1000- ] qLt/
Property Location: ~0~ /~ 0 ~, t~
- oS- /7
(provide LILCO Pole #, distance to cross streets, and location)
(If applicable)
Address: /'~- 0 ' ~X' ~
Bo~ of Trustees Application
GENERAL DATA
Land Area (in square feet): /~Oe' ~1[~ t
Area Zoning:_
Previous use of property:
Intended use of property:
Covenants and Restrictions:
If "Yes", please provide copy.
__Yes _~6~ No
Does this project require a variance from the Zoning Board of Appeals __
If "Yes", please provide copy of decision.
Yes '~ No
Will this project require any demolition as per Town Code or as determined by the Building
Dept. Yes x~. No
Does the structure (s) on property have a valid Certificate of Occupancy/><~ 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 suspetnded by a governmental agency?
~ No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Bo, of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: x,.._) .square feet
Percent coverage of lot: C~ %
Closest distance between nearest existing structure and upland
edge o f wetlands: feet
Closest distance between nearest
edge of wetlands: ~ ~"
Does the project involve excavation or filling?
~ No Yes
If yes, how much material will be excavated? c~) cubic yards
How much material will be filled? q-) cubic yards
Depth of which material will be removed or deposited: (2) feet
Proposed slope throughout the area of operations: 0
Manner in which material will be removed or deposited:
proposed structure and upland
feet
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by /
reason of such proposed operations (use attachments if appropriate): /
/
617.20
PROJECT ID NUMBER APPENDIX C
STATE ENVIRONMENTAL QUALtTY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor)
I APPLICANT/SPONSOR~"~ i~3.PROJECT LOCATIONi/C~-~'('~('"; /~.~r~i..'"'~/~r'~m'(~'~O'V(~.il~,.~r~('*' 2. PROJECT NAME
4. PRECISE LOCATION: Sb'eet Addess and Road Intersections, Prominent landmarks etc -or provide mad
SEQR
5. IS PROPOSED ACTION: .~ New [] Expansion [] Modification / alteration
6 DESCRIBE PROJECT BRIEFLY:
7 AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8 WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS?
'~]~es [] No If no, describe briefly:
9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
,.~DResidentia, []Industrial E~commercial E~Agriculture E]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)
E~Yes.~[~No If list name and permit / yes,
agency
approval:
11 UUE~ ANY ^SF';r-CI Ol- INE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[~Yes ~ If yes, list agency name and permit / approval:
12, AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I. . ?
Signature
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
PART II - IMPACT ASSESSMENT {To be completed by Lead A~lency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD iN 6 NYCRR, PA~T 617.47 If yes. coordinate the review process and use the FULL EAF.
~] Ye.s ~]No
B. WILL ~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
dectaratio~ 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, sun'ace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain bdefly:
I
C2. Aeslheflc, ag[icu tura, archaeological, historic, or other natural or coltural resources; or community or noighborhond character? Explain briefly:
C3. [egetation or fauna,'fish shellfish or w Idtife spedes, s gnificant habitats, or threatened or endangered spectss? Explain bri~.flyl
C4. A commun ty s ex st ng plans or goals as off~ially adopted or a change m use or intensily or use of land or other natural resources? ~iain briefly:
C5. Gro~h, ~ubcequent development, or related activities likely to be induced by the proposed action? E~plain b~fly: '" '"
Long term. short term, cumulative, or other effects not identified in C1 -C57 Explain bdefly:
C7. either
WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA,
~--] Yes r~No
E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: F~~eachadversee~ectidenti~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therwisesignif~mant~ Each
effect should be assessed in connection with its (a) setting (i.e. ud3an or rural); (b) probability of eccurdng; (c) duration; (d) irreversibility; (e)
geographic scope; and (0 magnitude. If necesea~, add attachments or referenoe 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 chect(ed
yes, the determination of sign'racance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Chec~ this box if you have Identified one or more petentlally large or significent adverse impacts which MAy occor. 11'~en ~ directly to the FULL
FAF and/or prepare a positive declaration.
Chec~ this box if you have determined, based on ~ Information and analysis above and any supporting documentation, that the proposed actior
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessa~/, the reasons suppo~ng this
determination.
Board of Trustees PI
Name of Lead Agency Date
President ~
Prinl or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERLY( LOCATION: S.C.T.M.S: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STOI~4-WATER~ GRADING~ DRAINAGE AND EROSION CONTROL PLAN
D~c~ s~on moc~ ~ 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 o! the Project Parcels? I Will this Project Retain All Storm-Water Run-Off
(Inciude Total Area of all Parcels located within Generated by a Two (2') Inch Rainfall on Site?
the Scope of Work for Proposed Constmction) (This item will include all mn-off created by site
b. What is the Total Area of Land Clearing (S.F. / n='~) clearing endlor construction act/vibes as well as ali
and/or Ground Disturbance for the proposed Site Improvements and the permanent c. mation of
construction activity? impervious surfaces.)
(s.~.,~,,) 2 Does the Sits Plan and/or Survey Show Ail Proposed
PROVIDE BRIEF PROJ'EC~ DESCRIlr~ON (P~,~ ~ P~ - ~ Drainage Structures Indicating Size & Location? This
Item shall include all proposed Grade Changes and --
/%¼&v slo cen o,,lo surface wster,ow
"/ 3 Does the Site Plan and/or Survey describe the erosion
C,~ff'~ ~.~'- ~5;~W' ~ ~0 ~e~, and sediment control practices that will tm used to
- ¢:~ control sRe erosion and storm water discharges. This
~ fd ~ ~)~ ~)Y-Y~ itceornn.~mUcSttiobnen ~ea~no~ined thr°ugh°utthe Entire
~7 ~-~.e_~7 ~ i,-d~y,~ [.~4.~ }'~ 4 Will this Project Require any Land Filling, Grading or
Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards
of Matedal within any Parcel?
5 Will this Application Require Land Disturbing Activities
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.) Square Feet of Ground Surface?
6 ts there a Natural Water Course Running through the
Site? IsthisProjectwithintheTrusteesjudsdistion[~ ..~
General DEC SWPPP Requirements; or within One Hundred (100') feet of a Wet/and or
Submission o~ a SWPPP is required for all Construction activities involving soil Beach?
disturbances of one (1) or more acces; including disturbances of less than one acre Ihat 7 Will there be Site preparation on Existing Grade Slopes r~
are part of a larger common plan ~ha~ will ultimately dieturb one or more ac~es of land; which Exceed Fiff.e, en (15) feet of Vertical Rise to I I.~
including Conslmctiea activities involving so~ disturbances of less than one (I) acre ,them One Hundred (1 O0 ) of Horizontal Distance?
the DEC has determined that a SPDES permit is required for storm water dlscharges.
SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious r~
for Storm Water Discharges frcm Construction activity - permit No. GP-O-16-001.) Surfaces be Sloped to Direct Storm-Water Run-Off
1. The SWPPP shall be prepa;ed pc/or to the submittal of the NOI. Tr~ NOi shal~ he into and/or in the direction of a Town right-of-way?
2. The SWPPP shall describe the erosie~ and sedie~nt control practices and where 9 Will this Project Require the Placement of Matedal,
STATE OF NEW YORK,
COUNTY OF ................................. , ......... SS
qhatl. ~'~' ,-- O~ ~ b be dui swom d
' . ......................................... %._ lng y , ClX)SCS and says that he/she is the appl cant for Penpib
And that he/she is the ...... ~..../..i....,~.......~....... em4~.~..5~i...~.~ ...~.. .......... ~; ~...~. _ ...~....!....~
Owner and/or representative of the Owner or Owners, and is duly authorized to peffom~ 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 anc~ belief; and
that the work will be performed in the manner set forth in the application filed herewith.
Swom to before me this; .~. ,,~ ,. //
.............. ................ ...................... q,'/- - -- /1
........ ..........
FORM - 06/10
of Trustees Application
County of Suffolk
State of New York
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH 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 TRUSTE~ES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF.,~HIS APPLICATION.
SWORN TO BEFORE ME THIS ~ ] DAY OF '~O/,~ ,20.
of Trustees Application ~
AUTHORIZATION
(where the applicant is not the owner)
Fo,
(/Ltl. c_. ~' ('-c'--~L, residingat ~"~ ~ 0 1{'3
(print owner o-l'property) (mailing address)
~' to apply for permit(s) from the
Southold BoardTown Trustees on my behalf.
(Owner's signature)
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics vrohibits conflicts of interest on the mat of town officers and emolovees. The oumose of
this form is to vrovide information which can alert the town of t~ossible conflicts of interest and allow it to take whatever action is
(Last name, first name, x~aiddle initial, unless you are applying in the name of
someone else or other entity, such as a company. If so, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other", name the activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business,
including a partnership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
YES NO ~
If you answered '~YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title Or position of that person
Describe the relationship between yourself(the applicanffagentIrepresentative) 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 ownS' of any interest in a non-coq~orate entity (when the
applicant is not a corporation);
__C) an officer, director, partner, or employee of the applicant; or
__D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS I
Submitted this ~day of, ~--~ I L/ 20~ ~.
Signature ~..~.~5~. / ~
PfintName ,~'~.~' c93~.llP_.
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
If any question in Section C on this form is answered "yes" 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-
suooorfin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's
website (southoldtown.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
The Application has been submitted to (check appropriate response):
Town Board D Planning Board [-~ Building Dept. ~-~ Board of Trustees~
Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c)
Nature and extent of action: ~ q-%}O L~-
Permit, approval, license, certification:
Location of action:
Site acreage:
Present land use:
Present zoning classification:
If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:
(b) Mailing address: ,5~-
(c) Telephone number: Area Code ( )G~ l -- ~>'q
(d) Application number, if any:. ~
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes [] N~) If yes, which state or federal agency?.
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LV~ Section III - Policies; Page 2 for evaluation
criteria.
Yes [~ No-~ot Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
~-] Yes ~ N~t Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
~-] Yes ~ No~. Not Applicable
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 ~ N~otApplicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
Yes ~-~ No'Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore 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 App~le
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 ~-~ N~ Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
Yes [] No~L~ot Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluatiOn
criteria.
[] Yes~ No~Notapplicable
Attach additional sheets if necessary
WORKING COAST POLICIESO
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria.
D Yes [] NO'~ Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for evaluation criteria.
~ Yes ~ No~ Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Policies; Pages 65 through 68 for evaluation criteria.
~ Yes ~ No-Tq Not App.cable
TITLE
N
LOT 8
·
CER T/F/ED TO:
MICHAEL GERACI
ALPHA ABSTRACT LLC
· =MONUMENT
AREA=20,414 SO. FT.
TO TIE LINE
LOT NUMBERS REFER TO "MAP OF SALT
LAKE VILLAGE" PLATE NO. I OF 2. F/LED
IN THE SUFFOLK COUNTY CLERK'S OFF/CE
ON MA Y 10, 1940 AS FILE NO. 1510.
ANY ALTERATION OR ADDITION TO THIS SUR!/fZY IS A VIOLATION
OF SECTION 72090F THE NEW YORK STATE EDUCATION LA~
EXCEPT AS PER SECTION ?209-SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WHOSE SIC. NArURE APPEARS HEREON.
LOT 7
yACHT.
BASIH
S79'05 0oSALT
OLD
SURVEY OF PROPERTY
A T MA TTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-144-05-17
SCALE: 1'---,80'
NOVEMBER 25, 2009
AUC -12o'
Beard of Trustees
APPROVE
BOARD OF TRUSTEES
TOWN OF SOUTHOLD
DATE /'~,/~-
p/O LOT 6
p/O LOT 6
79.50'
i~OAD