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Home My WebLink About1000-99.-1-10.1 OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MA1L[NG ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Leslie Weisman, Chair Members of the Zoning Board of Appeals From: Mark Terry, Principal Planner LWRP Coordinator Date: July 24, 2012 Re: Coastal Consistency Review for ZBA File Ref. MURRAY GAYLORD f~585 SCTM#1000-99-1-10.1 A site inspection was conducted on July 24, 2012. MURRAY GAYLORD #6585 - Request for Variances from Article XXII Code Section 280-116(B) and Article XXlll Section 280-124 based on an application for building permit and the Building Inspector's June 21, 2012 Notice of Disapproval for demolition and reconstruction of single family dwelling, at; 1) less than the code required bulkhead setback of 75 feet, 2) less than the code required minimum side yard setback of 15 feet, 3) less than the code required rear yard setback of 50 feet, located at: 765 Beechwood Road (adj. to Groat Peconic Bay) Cutchogue, NY. SCTM~1000-116-4-20.1 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 determination that the proposed action is CONSISTENT with the below listed LWRP polices and therefore CONSISTENT with the LWRP. 4.1 Minimize losses of human life and structures from flooding and erosion hazards. The following management measures to minimize losses of human life and structures from flooding and erosion hazards are suggested: Minimize potential loss and damage by locating development and structures away from flooding and erosion hazards. Move existing development and structures as far away from flooding and erosion hazards as practical. Maintaining existing development and structures in hazard areas may be warranted fo~. a. structures which functionally require a location on the coast or in coastal waters. b. water-dependent uses which cannot avoid exposure to hazards. c. sites in areas with extensive public investment, public infrastructure, or major public facilities. c. sites where relocation of an existing structure is not practicaL Due to the partial demolition of the existing structure, lot configuration and environmental sensitivity; relocation of the existing residential structure is not practical. The structure is located within an AE El 6 Flood Zone and the applicant proposed to raise the grade of the site and elevate the structure to reduce potential impacts from flood hazards. The Board of Trustees required the establishment of a naturally vegetated 10' wide, non- turf vegetated, buffer landward of the bulkhead under Permit No 7765 issued on March 12, 2012. Additional Recommendations: 1. Due to the environmental sensitivity of the parcel and water body - it is recommended that the Board consider prohibiting the application of fertilizer, herbicide and pesticide on the lawn area. Pursuant to Chapter 268, the Board shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Jennifer Andaloro, Assistant Town Attorney PROPOSED SEPTIC SYSTEM DETAIL ~'z FF 10, (~ m ~.~z~ ~ ., ................ /~.,,, /- . 6,. .,~. ] SURVEY OF PROPERTY ~' '~ ' ~ ' ~" .... , A T CUTCHOGUE II ~' ~. ~ ~.9'~ ",,~,~,S.4' [I ~' ~ ~{ ~,~..=~'"'~"~' "il -" ~' ~ Il/., t .,~. '~ ~.~ /~~t~.l _ SUFFOLK COUNTE ~ K ..... ~~, ~. -- '~ ,~~ / . ~.~.~ 1000-116-04-20.1 ~ ~ouo~A' SCALE' 1~30' BY, JOSEPH FISCHETTI, P.E. HOBART ROAD SOUTHOLD, N.Y. /t97/ (63/} 765-2954 v ~" ZONE AE v +4.0 v !6.1' LEACHING POOLS (~,) ( ) / Merch ZS, ~01~ (revisions) "~.~r~~3~ -"~ ~ June 12, 2012 (~ddllion~) SUBSURFACE SEWAGE DISPOSAL ~~~ ~ ,'"' % ELEVATIONS REFERENCED TO N.A.V.D. FLOOD ZONE FROM FIRM RATE MAP NUMBER 36103C0482H SEPTEMBER 25, 2009 I om fora/I/or with t'he STANDARDS FOR APPROVAL AND CONSTRUC770N OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES ond will chide by the conditions set forth therein ond on the permit to construct. The Iocotion of wells ond cesspools shown hereon ore from field observotions ond or from doto obtoined from others. AN)" ALFffRATION OR ADDISON TO THIS SURVEY IS A VIOLATION OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW.. EXCEPT AS PER SECTION 7209-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 S/GNA TURF APPEARS HEREON. ~OAD) 1555' NEW SUFFOLK ROAD TO BE WALL ROOF RUNOFF CALL ROOL RUNOFF CALCULATIONS AND DRAINAGE O=A~I~C O ' 2600 .~q. lt. "~" ~ I , O . 43~.~3 cu Il 6 e RING = ~.3 'sq;ft. 433.3/~B.3 . 15.3 VF USE 16 VF = ~-6'¢ DWs ~t' deep LOT COVERAGE DWELLING AFTE[i CONSTRUCTION - 3318 sq, ft. UPLAND AREA ~0~455 sq. ft. 33181Z0~55 . 16.2% WHOLE PARCEL . ~4,797 sq. ft. 3318/~4797 - 13.4% TEST HOLE DATA McDONALD GEOSCIENCE 4' WA~R IN MIXED SAND 7 WA~R IN BROWN BOG PT 8 WATER IN BROWN CLAYEY SAND SC ~ WA~-R IN BROWN FINE ~0 MEDIUM SAND /~,:.-;, ~: ~'.~2.4.,797 SO. FT. / ~:::,. ,,; ~'",,T~ LINES '"~?:~}g~/:'~5-5020 FAX (6J1) 765-1797 r ~ =~AND FLAG 1230 TRA~LEN STREET~ · :~o~u~,~ sou~o~o, ~.~ '~I OCTOBER 18, 2011 NOVEMBER 5, 2011 (LOC. WETLANDS FLAGS' DECEMBER 26, 2011 (TEST HOLE & SPOT ELEVATIONS) JAN. tl, 201£ ! NEW SEPTIC .FYSTEM) FEB. I, 2012 (REVISIONS/ FEB. 6~ 201~ (PROP ADDIT MATCH 7 en{c) 1.1 4 5 7 TOWN OF SOUTHOLD PROPERTY ~ORD CARD · /.~.c,'O-- //6 - '-/- ~ OWNER STREET '"~' ~:'~ VILLAGE DIST. SUB. RES.~//~ S~S. VL. ~, ) FARM CO~. CB. MICS. Mkt. Value ~ND · IMP. TOTAL DATE RE~RKS ~/~/~ . . , , AGE BUILDING CONDITION N~ NORMAL BELOW ABOVE FA~ Tillable FRONTAGE ONWATER W~land FRONTAGE ON ROAD Meadow~d DEPTH House Plot BULKH~D n~ 6WNER VI LLAGE LOT IMP. TOTAL LAND SEAS. DATE AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Farm Acre Value Per Acre Value Tillcb.le 1 Tillable 2 Tit, lable, 3 Woodland Swampland Brushland House Plot Total DISTRICT SUB. ACREAGE //./~:~ TYPE OF BUILDING COMM. iND. CB. I MISC. STREET VILLAGE LOT )RMER OWNER SEAS. LAND IMP. AGE NEW ~le, 3 ~pbnd oO W VL. 'FARM COMM. I N D. TOTAL DATE REMARKS 2600. BUILDING CONDITIOI, NORMAL BELOW ABOVE Acre Value Per Acre Value DISTRICT SUB. TYPE OF BUILDING CB. MISC.,. ~re~sion Foundation Basement Ext, Walls Fire Place , Porch ' Porch Both 'L Interior Finish He~ Attic Rooms 1st Floor Rooms 2nd Floor ~,.~rivewoy TOWN OF ~OUT~OLD BUII~INC DEPARTMEqT Tram Clmk'l OEiee SeathehL N. Y. Bio. Z~.9~ ...... Date ............... .~.eP~. .... 30.., lg.??. Tmn CERTIFIES that the builat~_, located at .Beaeh~d. P~...~(l~t) .... Street Map No. Beaeh~oolt. Block No ........... Lot No..xxx... Clii;eho~uee; 1~,¥, ....... conforms subst~mtially to the Application ~or Burial,,; Permit heretofore ~ed in this office dated ............. apr...19., 19.7.?. pursuant to which ~ Permit No.. St199Z, dated ............. Apl''-21' ', 19.??., was issued, and conforms to all of the roqutre. ments o! the applicable provisions of the law. The occupancy for whicl~ this cor;flfleate is issued is . .Pr:Lvate. one. £ami~..dve_Lling. w:Lth, addlt£cln ...... ............... The certificate is issued to ~ .&. Ers. ltarol~ .01sen .... 0~ners .... : .............. (owner, lessee or toaant) o! the aforesaid building. Suffolk County Department of Health Approval lleR, ............................... C'ntr zcA'n: .... ........... HOUSE NUMBER ...... 61.~ .... Street ... Baaeh~nod. ttoad ..... Cttt~ho&ue ...... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy no. ¥.?. ?..~... Da~e .. ~///;,.¢~i,;,.L..~( .(¢;¢3~ .... ~IS CERTIFIES that ~e b~d~g located at .................. : .... : .... Stre?t Map No..~ ~{~'~ Block No ........... Lot No. CO YC f, ~.' (~ ';, ~ conforms subit~ti~y to ~e App~ca~on' '~ for B~ld~g Pe~it heretofore ~ed ~ t~s. goffice~ ~" ~ ~7 7¢ . da~ed .......... : ............ , ~9 .... , ~as ~sued, ~d co~o~ ~o ali of ~he =~u~e ?k~ ~ifi~a k k~ ~ .. ~..... :'. ....... ' ....................................... (o~er, l~ee or tenant) of ~e afores~d buil~g. ~./C. Suffolk Co~ty Deponent of He~ Approv~ ..................................... HND[RWRIT~RS CERTIFICATE No... [. .... ~ .......... ~ .... J~ ..................... ItO~E ~E~ ............. $ir~ .................. ' ............................... Building Inspector FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,~-'...~.?.0..~... Date .. ~.~.~;~,.~..~;( .(~.~9 .... ........................ Strut TInS C~T~mS ~t the b~g ]~t~ at .... CV T~ 6 ~ ~v ~ ~ Map No. ~c ~ ~ O~ Bl~k ~o. . Lot No. conforms sub, s,tanti~lly to the Application for Building Permit heretofore filed in ~ office dated . ..~./.....4 .......... , 19 .... pursuant to which Building erm't o...O~. I~ ,, ! ~- 7 19 7~ was ~ssued and conforms to all of the r uire- dated ....................... , .... , ' , ecl ments of the applicable provisions of the law. The occup~cy fo~.w,hich this certificate is issuedis /~'% dF~--~.~ (~/ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .../: :./.~..: ......................... .o~s~ ~.... ~.z.-.~...~e;;.'..'.'.'~ ~.~:~.~.i~.~ 7.~i..<.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'. Btfilding Inspector BOARD MEMBERS Leslie Kanes Weisman, Chairperson James Dinizio, Jr. Gerard P. Goehringer George Homing Ken Schneider http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765~1809 · Fax (631) 765-9064 July 6, 2012 Southold Town Hall ~] 53095 Main Road ° P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex/First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 Mark Terry, Principal Planner LWRP Coordinator Planning Board Office Town of Southold Town Hall Annex Southold, NY 11971 Re: ZBA File Ref. No. #6585 (Gaylord) Dear Mr. Terry: We have received an application for demolition and re-construction in Cutchogue. A copy of the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and survey map, project description form, are attached for your reference. Your written evaluation with recommendations for this proposal, as required under the Code procedures of LWRP Section 268-5D is requested within 30 days of receipt of this letter. Thank you. Very truly yours, Leslie K. Weisman Chairperson /,~ Encls. FORM NO. 3 NOTICE OF DISAPPROVAL DATE: June 21,2012 TO: Murray Gaylord c/o Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932 Please take notice that your application dated May 23, 2012: For permit for demolition and re-construction at: Location of property: 765 Beechwood Road Cutchogue, NY County Tax Map No. 1000 - Section 116 Block _4 Lot 20.1 Is returned herewith and disapproved on the following grounds: The proposed demolition and re-construction, on this non-conforming 24,797 sq. fi. 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 side yard setback of 37 feet and a rear yard setback of 45 feet from the bulkhead. In addition, pursuant to Article XXIII, Section 280-124, non-conforming lots, between 20,000 to 39,999 square feet shall maintain a minimum side yard of 15 feet the survey shows 12.7' and a rear yard setback of 50 feet the survey shows 45 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: file, Z.B.A. Fee: $ Filed By: Assignment No. I APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS House No. 765 Street Beachwood Road Hamlet Mattituck SCTM 1000 Section 116 Block 04 Lot(s) 20.1 Lot Size 24,797 sq.ft. Zone R-40 I (WE) APPEAL THE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR DATED (a / ~1 / !Z~ BASED ON SURVEY/SITE PLAN DATED ~//Z ~' ! z~ Applicant(s)/Owner(s): Murray Gaylord Mailing Address: 765 Beachwood Road, Mattituck Telephone: Fax: Email: NOTE: In addition to the above, please complete belo~ if application is signed by applicant's attorney, agent, architect, builder, contract vendee, etc. and name of person who agent represents: Name of Representative: Brllce A. ADder$on___for ~Dwne~)ther:- Address: P.O. BOX 2003, Bridgehampton, NY, 11932 631-537-5160 Telephone: Fax: Email: bruce@suffolkenvironmental.com Please check to specify who you~h correspondence to be mailed to, po~Lthe above nantes: ~applicant/Owner(s), ~]authorized Representative, ~ Other Name/Address below: WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN DATED June 12. 2012 and DENIED AN APPLICATION DATED June 2~. 2~I~ Building Permit Certificate of Occupancy ( ) Pre-Certificate of Occupancy Change of Use P ermit for As-Built Construction Other: FOR: Provision of the Zoning Ordinance Appealed. (Indicate Article, Section. Subsection of Zoning Ordinance by numbers. Do not quote the code.) Article: x×, Section: :s0-~ Subsection: ~ Type of Appeal. An Appeal is made for: [7IA Variance to the Zoning Code or Zoning Map. A Variance due to lack of access required by New York Town Law- Section 280-A. Interpretation of the Town Code, Article . Section ~]Reversal or Other A prior appeal ~]has, [] has not been made at any time with respect to this propertv~ UNDER Appear No(s). Year(s). . (Please be ~ure to research before completing this quextion ol call our o/rice for assistance) File RI,ASON.~ I: OR A[l 1~,~ 1, (addmonal sh~ ~ ts mt~r be t ~ed wkh ?reparel s fi~uature} tRE4 I ?IRI !,'~('E (I) An undeskablt cba,ge will noi be produced in the ('IIARACIIR of the neighbi3rhond or a deJrimen~ to ne:',rbx properties if gr nled bec se: The applicant proposes to tear down the existing garage while expanding the house, therefore only increasing lot coverage on the site by less than 3% (2) l'bc benefit sought by the applicant CANNO'I be achieved by some mellmd tkasibJe lot ll~e Any expansion of the house will require a variance due to it's proximity to the wetland boundary. (3) l'be amount of re eJ 'eq ested s ~o~ snl gla~llial because: Because the garage on the property is being demolished, the total amount of lot coverage is minimized. The addition to the house is in character with the surrounding neighborhood, and all proper erosion protocols will be used to ensure no lasting environmental detriment. (5) }las ll~e alleged difficulty been sell:-created? l'~15 es, m' ~re there Covenants and Res~rk'twns concerning lhis land: ~ This is the MINIMIM thal is necessar3 and adeq~tate~and at chal'aClCr of thc ncJgbborl~ood ~ind the health, salk, ly, and ~xclfitl~e of dtc communlt3. ('/tuc~ ~ht,x ho.~ ~ tP i ~Sl: I.tRt IN(Z tS BETS(; RfiQLt SIk'D. t;~D Iq, I: ISE (O3?PLI:iT: HIE t'It t(7tED t'5't? ~ ,4RI4h(t. SI[t I:']': (lqeav~o~t hignature *ff Appellant or Amhorized Agem M~tfhew D. [vans Page 3 Application by: ........... Assigned Application No, Office Notes: Part B: REASONS FOR USE VARIANCE (if requested]: For Each and Every Permitted Use under the Zoning Regulations for the Particular District Where the Project is Located (please consult your attorney before completing): 1, Applicant cannol realize a reasonable return for each and every permitted use under the zoning regulations for the particular distlict where the property is located, demonstrated by competent financial evidence. The applicant CANNOT realize a REASONABLE RETURN because: (describe on a separate sheet), 2, The alleged hardship relating to the propeliy is unique because: 3~ The alleged hardship does not apply to a substantial poltion of the d[stdct or neighborhood because: The request will not alter the essential character of the neighborhood because: The alleged hardship has not been self-created because: 6 this is the minimum relief necessary, while at the same time preserving and protecting the character of the neighborhood, and the health, safety and welfare of the community, (Please explain on a separate sheet Jf necessary.) 7~ The spidt of the ordinance wilt be observed, public safety and welfare will be secured, (:nd substantial justice wJJJ be done because: (Please expJairi on o separole shee! if necessary,) ([--1) Check this box ahd complete PART A, Questions on pfevJous page to apply ARE~ VARIANCE STANDARDS. (P/ease consult you~ attorney.) Olherwise_,_~g_i_~ase..proceed to_~jh~ ~_Jg, nature and notar~ area below. Sworn to before nqe this day of .................. 200_ (Notary Public) Signature of Appellant or Authorized Agent (Agent must submit Authorization flora Owner) APPLICANT'S PROJECT DESCRIPTION (For ZBA Reference) Applicant: Bruce A. Anderson- Suffolk Environmental Consulting, Inc. Date Prepared: 6/28/1 2 I. For Demolition of Existing Building Areas Please describe areas being removed: The frame garage on the northwestern corner of the property will be demolished, as welt as the bay window area on the western side of the house II. New Construction Areas (New Dwelling or New Additions/Extensions): Dimensions of new second floor: N/A Dimensions of floor above second level: N/A Height (from finished ground to top of ridge):N/A Is basement or lowest floor area being constructed? If yes, please provide height (above ground) measured from natural existing grade to first floor: Y~s, the house will be raised to FF EL 10.0 Ili. Proposed Construction Description (Alterations or Structural Changes) (attach extra sheet if necessary) - Please describe building areas: Number of Floors and General Characteristics BEFORE Alterations: One story frame house, 3 bedrooms, First Floor elevation of 6.1 ft. Number of Floors and Changes WITH Alterations: One s or3' ame house, 3 bedrooms, first floor elevation 100 ft. new stoop on the norihern edge of he houser new stoop on the eastern edge of he house, bay window area replaced with screened in porch IV. Calculations of building areas and Itt coverage (from surveyor): Existing square footage of buildings on your property: 2957.37 sq.ft. Proposed increase of building coverage: 360 sq.ft. Square footage ofyour lot: 24,797sq.ft. Percentage of coverage of your lot by building area: Proposed: 13.4% ExistLng: 119% V. Purpose of New Construction: To enhance the existing residential improvement, VI. Please describe the land contours (fiat, slope %, heavily wooded, marsh area, etc.) on your land and how it relates to the difficulty in meeting the code requirement(s): 82% of the land is flat with slopes of under 5%, and either lawn or improved. 18% is wetland. Please submit seven (7) photos, labeled to show different angles of yard areas after staking corners for new construction), and photos of building area to be altered with yard view. 7/2002; 2/2005; 1/2007 QUESTIONNAIRE FOR FILING WITH YOUR ZBA APPLICATION Is the subject premises listed on the real estate market for sale? ~'[Y es JT-LN o Are there any proposals to change or alter land contours'? J-~No ~_Yes please explain on attached sheet. 1.) Are there areas that contain sand or wetland grasses? Yes 2.) Are those areas shown on the survey submitted with this application? Yes 3.) Is the property bulk headed between the wetlands area and the upland building area? Yes 4.) If your property contains wetlands or pond areas, have you contacted the Office of the Town trustees for its determination of jurisdiction? Yes Please confirm status of your inquiry or application with the Trustees: S°uth°ld Town B°arO °l Trustees Wetlands Permit approved 3i21112 and if issued, please attach copies of permit with conditions and approved survey. ls there a depression or sloping elevation near the area of proposed construction at or below five feet above mean sea level? Yes Are there any patios, concrete ban-iers, bulkheads or fences that exist that are not shown on the survey that you are submitting?No Please show area of the structures on a diagram if any exist. Or state none on the above line. Do you have any construction taking place at this time concerning your pre~nises? No If yes, please submit a copy of your building permit and survey as approved by the Building Department and please describe: N/^ Please attach all pre-certificates of occupancy and certificates of occupancy for the subject premises. If any are lacking, please apply to the Building Department to either obtain them or to obtain an Amended Notice of Disapproval. Do you or any co-owner also own other land adjoining or close to this parcel? If yes, please label the proximity of your lands on your survey. garage, pool or olher) eddna, Please list present use or operations conducted at this parcel existing single family and the proposed use same with expan0ecl ;>etch and stoop areas · (ex: existing single family, proposcd: same ~xith AGRICULTURAL DATA STATEMENT ZONING BOARD OF APPEALS TOWN OF SOUTHOLD WHEN TO USE THIS FORM: The Jbrm must be completed by the applicant.for any special use permit, site plan approval, use variance, or subdivision approval on property within an agricultural district OR within 500feet of a farm operation located in agricultural districa All applications requiring an agricultural data statement must be referred to the Suffol]~ County Department of Planning in accordance with Sections 239- m and 239-n of the General Municipal Law. l) Nallle of Applicant: Bruce A Anderson - Suffolk Environmental Consulting, Inc. 2) Address of Applicant: Po. Box 2003. Bridgehampton. NY. 11932 3) Name of Land Owner (if other than applicant): Murray Gaylord 4) Address of Land Owner: ?6g Beaohwood Road, Mattituck 5) Description of Proposed Project: The applicant proposes to demolish garage replace bay window area with a screened in porch create entrance stoops, and expand existing dwelling onto a podion of the existing porch footprint, while also expanding the porch on the south side of the house 6) Location of Property (road and tax lnap number): 765 Beachwood Road, Mat0tuck. 1008 - 116- 04 - 20.1 7) Is the parcel within an agricultural district?[7]No [~]Yes If yes, Agricultural District Number 8) Is this parcel actively farmed? ~']No I~Yes 9) Name and address of any owner(s) of land within the agricultural district containing active farm operation(s) located 500 feet of the boundary of the proposed project. (Information may be available through the Town Assessors Office, Town Hall location (765-1937) or from any public computer at the Town Hall locations by viewing the parcel numbers on the Town of Southold Real Property Tax System. Name and Address (Please use back side of page if more than six property owners are identified.) The lot numbers may be obtained, in advance, when requested from either the Office of the Planning Board at ~8 erda Zon~ag~ffoard of Appeals at 765-1S09. Signature of Applicant Date Note: 1. The local board will solicit comments from the ownel5 of land identified above in ord=r to consider the effect of the proposed action on their fam~ operation. Solicilation will be made by supplying a copy of this statement 2. Comments returned to ~e local board will be taken into consideration as pad of the overall review of this application. 3. Copies of the completed Agricultural Data Statement shall be sent by applicant and/or the clerk of the board Io the properb¢ owners identified above, The cost for mailing shall be paid by the applicant at the time fhe application is submined for review. Failure to pay at such time means the application is not cmnplete and cannot be acted upon by the boald. I I4-09 APPLICANT TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY OWNER and OWNER'S AGENT) The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of Town officers and employees. The purpose of this form is to provide information, which can alert the Town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same YOUR NAME: Anderson, Bruce A. (Last name. first name middle initial, unless you are apply ng n he name of someone else or other entity, such as a company. If so. indicate the other person or company name.) NATURE OF APPLICATION: Tax Grievance Variance Special Exception if"Other", name the activity: Change of Zone Approval of Plat / Exemption from Plat or Official Map Other (Check all that apply.) [ J 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[ I Complete the balance of this form and date and sign below ~here indicated. Name of person employed by the Town of Southold: William Driee litle or position of that person: dustie@ Describe that relationshi between yourself (the applicant) and the Town officer or employee. Either check the appropriate line A through D (below) and/or describe the relationship 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 corporationl; [ [ 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 Brother-in-Law APPLICANT TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY OWNER and OWNER'S AGENT) The Town of Southold's Code of Ethics orohibits conflicts of interest on thc oart of Town officers and en~lovees. The marnose of this form is to provide information, which can alert the Tgwn of oossible conflicts of interest and allow it to take whatever action is neeessat~ to avoid same. YOV NAME: 13a¥1ord, Murray (Last name, first name, midge initial, unless you a~ applying in thc name of someone else or other antity, such as a company. If so, indicate the other person or company name.) NATURE OF APPLICATION: {Che4 r all Ii, at apply.) Tax Grievance [ Variance ~ Special Excq~inn If "O~er", n~rae the aedvi~: ChangeofZone [ [ ApprovalofPlat[ ] Exemption from Plat orOfficialMap [ ] Other Do you per~onally, (or through your company, spouse, sibling, paint, ur 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, includ'mg a parmership, in which thc Town officer or employee has even a partial ownership of (or employment by) a corporation m which the Town officer~ owns more than 5% oftbe shares. Complete the balance of this form and date and sign b~low where indicated. Name of person employed by the Town of Southold: Title or position of that Describe that relationship between yourself (the applicant) and the Town officer or employee. Either check the appwpriate line A through D (below) and/or d~scribe thc relationship in the space provided. The Town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): ~ A) thc owner of greater than 5% of thc shares of the corporate stock of the applicant (when the applicant is a corporation); ~ B) the legal or beneficial owner of any inte~t in a non-corporate entity (when the applicant is not a corporation); I C) an officer, director, partner, or employee of the applicant; or ~ D) the actual applicant. DESCRIPTION OF RELATIONSHIP OWNER'S ENDORSEMENT (TO BE SIGNED IF APPLICANT IS NOT OWNER) STATE OF NEW YORK) COUNTY OF SUFFOLK) SS: MURRAY GAYLORD. being duly sworn, deposes and says; I reside at 411 West End Avenue - Apmhnent 19B; New York City In the County of New York and the state of New York , and I am the (owner in fee) (officer of the Corporation which is owner in fee) of the premises described in the foregoing application and that I have authorized Suffolk Environmental Consulting, In~ to make the foregoing application as described herein. Signature If Corporation, name of corporation and Officer Officer's Title Notary Public ELLEN HERB Notmy Public, State of New Yor~ NO. 01 HE6163785 Qualhled in New York County Term Expires April 2, 2011 14-16-4 (9/95)-Text 12 617.20 [ PROJECT I.D. NUMBER ; Appendix C i State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION (To be completed by Applicant or Proiect sponsor) I. APPLICANT/SPONSOR 2. PROJECT NAME Suffolk Environmental Consulting, Inc. GAYLORI) Property 3. PROJECT LOCATION: Municipality TownofSouthold County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent land marks, etc or provide map) SEQR 765 Beachwood Road; Mattituck; Town of Southold, NY (SCTM #: 1000 116 04 - 020.1) 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Applicant wishes to improve upon the existing single-family dwelling thereon. Please refer to the attached Project Description for speofications. 7. AMOUNT OF LAND EFFECTED: Initially 0.1 acres Ultimately 0.] acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If No, descdbe briefly The proposed expansion will not comply with Zoning Setbacks for wetland buffers. 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? []Residential r--]Industrial r--]Commercial ~lAgriculture r--]Park/ForesFOpen space r--]Other Describe: Private single family residences with related appt~tenances. l 0. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes I'--~No If yes, list agency(s) and permit/approvals Suffolk County Department of Health Services approval; New York State Department of Environmental Conservation. I I. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No If yes, list agency(s) and permit/approvals 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MOD F CATION9 [] Yes [] No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Matt D. ~ Suffolk Environmental Consulting, Inc. Date: February 16, 2012 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 PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 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 be superseded by another involved agency. [] Yes [] No C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, i f 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 s pecies? Explain briefly: C4. A community's existing plans or goals as officially adopted, or change in us e or inten siiy of use of land or natural re sources? Explain briefly: C5. Growth, subsequent developm ant, 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-C57 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 [-INo D. iS THERE, OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL iMPACTS? [] Yes [~ No If yes, explair~ briefly PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, imporfant, or otherwise significant, Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurbng; (c) duration; (d) irreversibility; (e) geographic sc ope; and (f} magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse i m pacts have been iden tiffed and adequately addres sad. 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 detenmned, based on the reformation and analysis above and any supl~ming documentation, that the proposed action WILk NOT result ~n any significant adverse enviromnental impacts AND provide on attachments as necessa:y~ the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer Signature of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer (if diffe~ etu Froln responsible officer) Date 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", 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, ali local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 116 04 020.1 The Application has been submitted to (check appropriate response): Town Board [] Planning Dept. [] Building Oept. [] 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: Attach additional sheets if necessary Location of action: 765 Beachwood Roadi Mattituck~ Town of Southold~ New York Site acreage: 0.613 acre ± Present land use: Residential Present zoning classification: R - 40 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: MURRAY GAYLORD (b) Mailing address: 411 West End Avenue - Apt. 19B; New York~ NY 10024 (c) Telephone number: Area Code ( 917 ) 623 - 5607 (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?. NYSDEC 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 IH - 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 proiect i s a proposal to improve upon the existing single-family dwelling within an almost entirely developed neighborhood. The proposal, as designed, will not result in any adverse effects to the surrounding environment in that the project will include improvements to a dwelling that has existed harmoniously herein for many without any form of adverse impact to the surrounding community. 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 subiect lot and the surrounding neighborhood cannot be deemed a substantial historic and/or archaeological resources. Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of $outhold. 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 sub[ecl parcel is already improved with an existing single-family dwelling which has not impeded visual qualit~ or the value of local scenic resources. This policy could not preclude both the legal creation of this proper~ as a building lot, the legal construction of the existing dwelling thereon, or the proposed improvements to the existing dwelling thereon. Therefore, we feel that the instant proposal fully complies with this Policy. 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 lll- Policies Pages 8 through 16 for evaluation criteria [] Yes [] No [] Not Applicable The proposal is for improvements to the existing dwelling within subject properS, which has existed thereon for many years without loss of life, structures and natural resources from flooding and erosion. Thereforej we feel that the extant proposal fully complies with this Policy. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section 111 - Policies Pages 16 through 21 for evaluation criteria [] Yes [] No [] Not Applicable This proposal is for various improvements to the existing dwelling, which has existed on this site for years, and which has in itself, not resulted in any form of adverse impact to water quali~ and/or supply. Additionally, the existing residential improvements within the surrounding neighborhood have existed harmoniously within the immediate environment also without adversely impacting the water quality and/or supply within the Town of Southold. Therefore, we feel that the instant proposal fully compli es with this Policy. 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 Again, this proposal is for various improvements to the existing dwelling, which has existed on this site for years, and which has in itselfL not resulted in an,/form of adverse impact to the surrounding ecosystems. Additionally, the existing residential improvements within the surrounding neighborhood have existed harmoniously within the immediate environment also without adversely impacting these ecosystems within the Town of Southold. Therefore, we feel that the instant proposal fully complies with this Policy. 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 Policy 7 is not applicable in that the proposal will be for various residential improvements to the existing single family dwelling with related appurtenances thereon which will not result in any form of adverse effects to air quality. 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 Policy 8 is not applicable in that the proposal does not involve disposal and/or transportation of solid waste, hazardous waste, toxic pollutants, and 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 Ill - Policies; Pages 38 through 46 for evaluation criteria [] Yes [] No [] Not Applicable Policy 9 is not applicable 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 HI - Policies; Pages 47 through 56 for evaluation criteria [] Yes [] No [] Not Applicable Policy 10 is not applicable in that the proposal does not involve a water-dependent use (i.e. marina, aquaculture, eta...). 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 Policy 11 is not applicable in that the proposal does not involve any form of marine resource management (i.e. commercial fisheries, recreational fisheries, aquaculture, etc...). Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section Ill - Policies; Pages 62 through 65 for evaluation criteria. [] Yes [] No [] Not Applicable Policy 1 2 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 Policy 13 is not applicable in that the proposal does not involve the conservation of energy resources on a commercial level and/or the promotion of alternative energy sources, proper maintenance of fuel storage facilities and/or the extraction of mineral extraction. Attach additional sheets if necessary 1 Eileen 5ant, ora. Resilient, iai Desi,jner 651-7D¢-27941.. Cut, c, ho(lu¢, NY Jo~Fh Fi~hd;ti, FF. 172~ Hobart. ~a.l. 5o,~hol~. i'~ 11971 '1 'i ,^~',: I ' O~ - I'Z. '.