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HomeMy WebLinkAboutTR-8078 James F. King, President Bob Ghosio~ Ir., Vice-President . Dave Bergen John Bredcmcycr Michael J. Domino Town Hall, 53095 Main Rd. ' P.O. Box 1179 8outhbld, 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 __ lS~ day of construction ½ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8078 DATE: FEBRUARY 20~ 2013 ISSUED TO: GWENDOLINE ANNE HARRIS PROPERTY ADDRESS: 1140 OLD WELL DRIVE~ FISHERS ISLAND SCTM# 7-4-9 & 10 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on February 20. 2013, and in consideration of application fee in the sum of $250.00 paid by Gwendoline Anne Harris & Seth Milliken and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to demolish existing single family dwelling, shed; and existing sanitary system to be pumped and filled with sand; and to construct a new single family dwelling, shed, deck, porch, retaining walls, gravel drive, re-grade area, install drywells, utility and water lines, and install a new sanitary system; with the condition to establish and subsequently maintain a 30' wide Non-Disturbance area landward of flagged wetland line delineated by Rob Marsh, NYSDEC; and as depicted on the site plan prepared by CME Associates Engineering, Land Surveying & Architecture, PLLC, last dated September 13, 2012 and stamped approved on February 20, 2013. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS 10. The Permittee Gwendoline Anne Harris, residing at 1140 Old Well Drive, Fishers Island, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 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 February 20, 2013 Mr. Glenn E. Just J.M.O. Environmental Consulting Services PO Box 447 Quogue, NY 11959-0447 RE: GWENDOLINE ANNE HARRIS 1140 OLD WELL DRIVE, FISHERS ISALND SCTM# 7-4-9 & 10 Dear Mr. Just: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, February 20, 2013 regarding the above matter: WHEREAS, J.M.O. Environmental Consulting Services on behalf of GWENDOLINE ANNE HARRIS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated December 10, 2012, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on February 20, 2013, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of GWENDOLINE ANNE HARRIS to demolish existing single family dwelling, shed; and existing sanitary system to be pumped and filled with sand; and to construct a new single family dwelling, shed, deck, pomh, retaining walls, gravel drive, re-grade area, install drywells, utility and water lines, and install a new sanitary system; with the condition to establish and subsequently maintain a 30' wide Non-Disturbance area landward of flagged wetland line delineated by Rob Marsh, NYSDEC; and as depicted on the site plan prepared by CME Associates Engineering, Land Surveying & Amhitecture, PLLC, last dated September 13, 2012 and stamped approved on February 20, 2013. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, James F. King President, Board of Trustees JFK/amn James F. King, President Bob Ghosio, Jr., Vice-President Dave Borgen John Bredemeyer Mi¢ha¢t I. Domino Town Hall Anaex 54375 Route 25, P.O. Box 1179 Southold, blY 11971 Telephone (631) 765-1892. Fax (63l) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated l Z.-/I Z~/,~ ~.--~ / has been reviewed by this Board at the regular meeting of 7.~/.~.Z~/L~ 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) v/// Fir~al 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: TOTAL FEES DUE: BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., January 16, 2013 the following recommendation was made: GWENDOLINE ANNE HARRIS to demolish existing single-family dwelling and shed, existing sanitary system to be located, pumped and filled with sand, construct a new single-family dwelling, shed, deck, porch, retaining walls, gravel driveway, regrade, install drywells, utility and water lines and install a new sanitary system. Located: 1140 Old Well Dr., Fishers Island. SCTM#7-4-9&10 The CAC did not make an inspection, therefore no recommendation was made. $0utho[d Town ~oard 0 !ms_tees JAN ~ 8 2¢3 James F King. President Bob Ghosio..Ir., Vice-President Dave Bergen .Iohn Brcdcmcyer Michael J Domino PO Box 1179 Southold, NY 11971 l¢lephone (631 765-1892 Fax (63 I) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: J.M.O. Environmental Consulting Services on behalf of GWENDOLINE ANNE HARRIS requests a Wetland Permit to demolish existing single family dwelling, shed; and existing sanitary system to be pumped and filled with sand; and to construct a new single family dwelling, shed, deck, porch, retaining walls, gravel drive, re-grade area, install drywells, utility and water lines, and install a new sanitary system. Located: 1140 Old Well Drive, Fishers Island. SCTM# 7-4-9&10 Type of area to be impact..e4~l~ __Saltwater Wetland ~ Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland P~of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: ~etland__Coastal Erosion __Administrative__Emergency Amendment Pre-Submission Violation Info needed: Present Were: "&King B. Ghosio __ J. Bredemeyer Michael Domino D. Bergen, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (c0r. Main Rd. & Youngs Ave.) $outhold, NY 11971 MAILING ADDRESS: P.O. Box 1179 $outhold, NY ! 1971 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 JAN 1 8 2013 Sou ,old own Date: January 17, 2013 Re: Proposed Wetland Permit for GWENDOLINE ANNE HARRIS SCTM#1000-7-4-9 &l 0. J.M.O. Environmental Consulting Services on behalf of GWENDOLINE ANNE HARRIS requests a Wetland Permit to demolish existing single family dwelling, shed; and existing sanitary system to be pumped and filled with sand; and to construct a new single family dwelling, shed, deck, porch, retaining walls, gravel drive, re-grade area, install drywells, utility and water lines, and install a new sanitary system. Located: 1140 Old Well Drive, Fishers Island. SCTM# 7-4-9 & 10. 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 the following: If the action is approved to further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem it is recommended that: 1. A Nondisturbance Buffer is required landward from the wetland boundary to "edge of lawn shown" shown on the plans. Chapter 275 Wetlands and Shorelines defines Nondisturbance Buffer as: NONDISTURBANCE BUFFER A vegetated area, a minimum of 30 feet wide or as designated by the Board of Trustees, immediately landward of the wetland boundary, shoreline structure, or other line designated by the Trustees where no operations, maintenance, placement of signs or other activities may take p/ace, except that man-made debris may be removed from such area by hand without the permission of the Board of Trustees. [Amended 12-18-2007 by L.L. No. 23-2007] Pursuant to Chapter 268, the Board shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney .I James F. Ki~, President Bob Ghosio, Jr., Vic~-Prssident Dave Bergen John Bredemeyer Miclmel J. Domino Town Hall Annex ~4876 Main Road P.O. Box 1179 Southold, New York 119714~959 Telephone (6~1) 766-1892 Fax (631) 76§-6641 BOARD OF TOwN TRUSTEES TOWN OF 8OUTHOLD Erosiaa Permit Application Pm~it Applic~ion Admtaistw~ Pormit red Fee:S ~ ~-3~, 'i% ~ , ~EQ~ Cl~ifi~fi~: T~O I T~ II Unlis~ ~CAC~ 11~/~ ' ' ~ of ~C ~: ...... ~ ~ ~: NameofApp~cant Gwendoline Anne Harri.q Mailing Address P.o. BOX 272 Salisbury,CT 0606~honeNumb~r:( ) afin-a>d-777q Suffolk County Tax Map Number: 1000- 007-4-9 PropertyLocafion: 1140 Old Well Drive Fishers Island (pro~deLILCOPole#,distan~tocrosss~e~s,~dlomfion) AGENT: Glenn E. Just-JMO Environmental C~n~,,l~ing (If applicable) Ad~e~: P.O. ~ox 447 Ouogue, NY 11959-0447 Phone: 653-0607 DEC 10 2012 .Wd o£ ~ustees ~plioatioa · ~ Zo~it~. R-120 Previous use of pmk. Intemled use of property: GENERAL DATA 3.56 acres Single family dwelling Single family dwelling Cove~nts and Restrictions on property? If"Yes", plcase provide a copy. Yes x No Will this project require a Buildin8 Permit as per Town Code? x Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee rcvicw and Elevation Plans will bc required. Does this projest require a variance from tim Zoning Board of Appesls7 __ If"Yes", please provide copy of decision. Yes x No Will this project require any demolifio~ as l~r Town Code or as d~t~mined by ~,e Building x Yes No Does ~e s~uc~re (s) on pmper~ have a v~ Ce~ficate of Occ~mcy? x Prior permits/approvals for si~ improv~m~mts: Agency Date Yes No x No prior pcimiWapp~,vals for site improvemen~ Has any l~,.it/appmval ever been revoked or suspended by a govemmantal agency? x If ycs, provide explanation: No Yes Projcct D~cfiption(useat~chrn~tsifneccssa~):. Applicant proposes to demolish existing single family dwelling and shed, existing sanitary syste~ to be located. DumDed and filled with sand~ to construct a new single family dwelling, shed deck, porch, retaining walls, gravel drive, regrader install drywellsr utility and water lines and install a new sanitary s~em as per enclosed plans prepared by CME Associates dated 9/13/12 of Tz~u. lt:eel V~ETLANDfFRUSTKE LANDS APPLICATION DATA Purpo~of~hepmposed0pamfic~e. w single family dwelling Arenofwetlandsonlot:. 1 , 000 .sqlla~ fegt Percent ~overago of lot: n. a. 9% Closest distance between nearest existing stracture and upland edge of wetlands: 145 fec-t ~lb, o of w~gll~lds: 90 foc~ Does the ~oject ~nyo~ve exen~ o~ filltn~? No x Yes If yen, how mu..h rent-'iai will be ex¢~,sl~d? 30 cubic yards How much material will b~ filled? 0 cubic yin'ds Depth of which material will be removed or deposited: 10 Proposed slope throushout the area of operations: 1: 1 Manner in which material will be removed o~ deposited: Backhoe feet State~nent of thc effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (uso attachments if appropriate): AS proposed the project should have no negative impacts on waters or wetlands of the Town of Southold 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 12. PROJECT NAME Gwendoline Anne Harris / New single family dwelling 3. PROJECT LOCATION: Municipality Fishers Island County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 1140 Old Well Drive Location map and survey enclosed 5. PROPOSED ACTION IS: [] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to demolish existing single family dwelling and shed, existing sanitary system to be located, pumped and filled with sand, to construct a new single family dwelling, shed, porch, deck,retaining walls, gravel drive, to regrade, to install utility lines,drywells and a new sanitary system 7. AMOUNT OF LAND AFFECTED: Initially 0.4 acres Ultimately 0.4 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~U Yes [] No If No, describe bdelty 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Descd~]e:Reaidential [] Industrial [] Commercial [] Agriculture [] ParidForest/Opan Space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [~J Yes U No If Yes, list agency(s) name and permil/approvals: N,Y.S.D.E.C., Southold Town Trnstccs and SCDHS 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? U Yes [] No If Yes, list agency(s) name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes []No I CERTIFY T D THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: ~ , / Signature: If the action is in the Coastal Coastal and you are a state agency complete the )re proceed ng with this assessment OVER Reset PART II - IMPACT ASSESSMENT (To be completed by Lead A~lency) A. ooEs ACTION EXCEED ANY TYPE 13~IRESHOLD IN 6 NYCRR, PART 617.47 ff yes, coon:linata the m~ew process and use the FULL EAF. B. W~LL .~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be supemeded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may I~ handwritten, If legible) C1. Exisang air quality, sud'ace or groundwater quality or quantity, noise levels, e~dsting ~affic peifem, solid waste ixnductiea or disposal, potential for emalon, drainage or tioo~ing problems? Ex~ain bdefly: C2. Anstheti~ agflcultura[, archaeological, histudc, or other natural or cultural resources; or community or neighborhood character? FJq~le bde6y: I C3. Vegetation jr fauna, fish, shellfish or wildlife species, significant habitats, m' threatened or endangered species? Explain bdeify: C4. A comm~ndy s existing Ideas or goals es officially adopted, or a change la use or intensity al' use of land or other natural res~u¢ces? Explaia Ixiefl~ C5. Growth, subsequent develepment, or related acl~ties likely to be induced by the proposed action? Explain briefly: I C6. Long term,:shoft term: cumulative, or other effectsnot identified in Cl-C57 Expiairi'briefly; C7.' Other impacts {includin~ dlan~les in use of either' <{uandty or tTpe of ener~;/? Explain brlafl;/: ....... D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTIC~ THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEA~? {if )'es, explain b tied),: ["-~ Yes r~No E IS'I~ERE, OR IS THERE LII(FJ_Y TO B~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If )'es exptsle: PART I# - DETERMINATION OF SIGNIFICANCE (To be completed bY Agency) INSTRU¢~ONS: F~eacbedversee~ectiden~edabeve~determthewhetheritissubeta~tia~arge~impertant~r~them~lsesignit-~canL EaCh effec~ should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probabircy of o~curdng; (c) duration; (d) irmvemibillty; (e) geographic scope; and (0 magnitude. If necessa~, add attachments or reference suppoding materials. Ensure that explanations contain sufficient detail to show that all relevant adveme impacts have been identified and adequately addressed. [f question d of part ii was choked ~es, the deten'nthation of significance must evaluate the potentiallmpac~ of the prepased ac~on en the envlronmental~arects~fsfics of the CEA. Check this bex If you h~¥e Identi~nd ans or more potendally lsrge or significant adveme Impacfa whleh II,AY e(x:u~'. 'l~e~ po3eand dlmc~y to the FULl EAF and/?r ixepare a p~i~ve dedaratiea. Cbed~ this box If~ou ha~ defan~ed, based o~ the fafo~nsflon and analysis atmve and any suppoding documenfa~n, that the proposed acllor WILl. NOT result la any slgnilleant ndveme environmental impacts AND provide, on attachments as nesossa~y, the reasons supf3~g ~ defannlnaflon. Board of Trustees N Name of Lead Agency Date President [] Prir~ or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signstum of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Jan 24 2013 11:38 HP Faxfi Utility Co 631 J~N-~-;=O13 05:57 J~m Bmde~m.,,y~-r Mich~ J. 788 7798 page 2 TO:7~E BOARD OF TOWN TRUSTEES TOWN OF SOUTIIOLD BOARD OF TRUSTEES: TOt,VN OF SOUTHOLD In the Mall~ of thc Application of GWENDOLINE ANNE FIARRIS COUNTY OF SUFFOLK) STATE OF NEW YOKe) AFFIDAVIT OF ~ug duly s~m~de~se ~d say: , by ~lucmR ~ ~d ol T~ o~or~ ~ wh~ ~ ~ s~ lh~ ~ h~ ~ai~ in pl~ for ~}~t (si~um) KARLA $, HEATH NOTARY PUBLIC, STATE OF NEW VORK NO. 01HEG222563 QUALIFIED IN SUFFOLK CO~JN]Y COMMISSION EXPIRES 05/24/2014 : ::' '::' :: '.: 'S P.E~2 '1'~ n Hall, 5,3095 Main Rst P.O. Bex 1179 i oa~eld, NY I {$?t that I have checked pul~{i~: heath8. NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be hel.d by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Ma~n Road, Southold, New York, concerning this properly. OWNER(S) OF RECORD:E~,,~r~oI~,',e/~//~r;.s SUBJECT OF PUBLIC HEARING: To demolish existing single family dwelling, shed; and existing sanitary system to be pumped and filled with sand; and to construct a new single family dwelling, shed, deck, porch, retaining walls, gravel drive, re-grade area, install drywells, utility and water lines, and install a new sanitary system. · ~ iME & DATE OF PUBLIC HEARING: If you have an interest in this project, you are invited fo view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours o[8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765-1892 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Nfll~c: Addre~, Nancy Ellen W. Parsons 1865 Bay Road 309 Vero Beach, VL 32963 ECE VE FEB 2 0 2013 Southofd Town Board of Truste(~ STATE OF NEW YOL~ COUNTY OF SUFFOLK Glenn E. Just ,residings' 121 Jessup Avenue Ouooue. NY , being duly sworn, deposes and says that on the 13thdayof February ,2013 ,d~'ponentmailedatmecopyoftheNot/ce set forth in th~ Board of Trustees Application, directed to each of the above nm'nod persons at the addr~ses set opposite the~e respective names; that tho addresses s~t opposite the nmnes of said persons are the address of said persons as shown on the current assezsment roll o£th¢ Town of Southold; that said Notices were mailed at the United States Pos~ Officeat ~adtnq ~±ver,NY , that said Noticcs w~'~ mailed to each ofsaid persons by CERTIFIED MAHYRETURN RECEIPT,~ Swom.to/bcforc me ~ /~ V, ALICE M. SHAUGHNESSY Notary Public, State of New York No. 52-4528113 Qualified in Suff, ef~ Coun~ . Commission Expire~/t/ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Please see attached FEB 2 0 2013 S0uth01d Town Boar~i of STATE OF NEW YORK COUNTY OF SUFFOLK ~..~,r~,cx ~_2, "~'- , residing at IZ>~ "~'~2.-q~ ~Q~/ [ ~t~ ~ , being duly sworn, deposes an~ says that on the ~ ~aybf~c{Or~ , 20 I~ deponent mail~ a tree copy of the Notice set f0~ in ~e Boar~ ~f T~t~e~Applic~tion, direct~ to each of the above nam~ p~ons at ~e addr~ses set opposite ~e r~p~tive nines; that ~e addresses set opposite ~e nm~ of s~d pe~ons ~e the address of s~d persons as shown on the cu~ent asses~ent mil of the Town of Southold; ~at s~d Notices w~e mail~ at the Unit~ States Post Office at~B~A~¢~, ~ , that s~d Notices w~e mailed to each of said persons by CERTIFIED MAIL~E~U~ ~CEI~. Sworn to,before me this Day ot~t. Ct a.~ , 20 Notary PublC~ ALICE M. SHAUGHNESSY Notary Public, State of New York No. 52-4528H3 Qualified in Commission F.~i~ Richard W. & Winifred W. Bingham 3098 Pacific Avenue San Francisco, CA 94115 James P. & Mary P. Rutherford 26 Courseview road Bronxville, NY 10708 David S. Johnson 61 Lincoln Lane Ridgefield, CT 06877 Nancy Ellen W. Parsons 1865 Bay Road 309 Vero Beach, FL 32963 Harris DF & JM Children's Trust c/o Hughes, Hubbard & Reed LLP One Battery Park Plaza New York, NY 10004 HL Ferguson Museum, Inc Attn: Robert J. Miller VP Day Pimey, LLP One Canterbury Square Stamford, CT 06901 FEB 2 0 2013 Southold Town Beard of Trustees APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Sa*rg~M's Cod~ of I]~Mcs ~blts ~ of~ ~ ~ ~ of~ O~ ~ m~ ~ ~ of ~ ~ is ~ ~ In~lon ~ ~ ~ ~ ~ of~ ~m of~ ~d ~ ~ ~ ~ ~ ~ ~ Y~N~: Just, Glenn, E. ,. ~ ~ ~e ~, ~ y6u ~ ~m ~ ~ of ~ne el~ ~o~, ~ ~ a~. If~ ~.~ ~ ~n's or ~m~'s ~.) NAM~ OF APPLICATION: (Ch~.k sll ~ spply,) Tax gr~van~e Building Variance Tr~ee Chs~e of ~ ~ E~ion ~ of ~ ~ng ~on ~m p~ or offic~ ~ P~ (If "0~, ~ ~ ~H~.) ~ you ~ly (~ ~ ~r ~p~y, ~ si~l~ ~ ~ i~ a ~ in wh~h ~ rowe o~ ~ ~ploy~ h~ even in ~ ~ to~ o~ or ~plo~ o~ ~ ~ 5% of~ ~. YES NO If you answered "YES'*, complele the bal.,ce of this form and dl~c ~d sign whe~ indical~cd. Namc of~crson employed ~ ~hc Town of Southold Title br position of that ~on Dcsc~be the ~lationship bctw~n yourseff(the spplican~/agcnttrcpfesentative) and the ~own officer or omployo~ Eithcr ch~ck the app~l~i~t~ I{n~ A) ~a~ough D) and'or des~be in ~he space Ixogidcd, The ~ow. officer or employee or his or h~ spout, siblin~ pa~ent, o~ al, lid is (check ~1 A) flu~ o~.ner of ~a~r ~mn 5% or,he sha~es of %%e oo~x)mte st~ck ofthe, applicam (v&en ~he ~.plicsm is n corpor~on); applicant ~s no~ a corporation); C) an oll~r, dhgctor. Pnl~er. or employ~ of ;h~ appli~t; ot D) the actual applicant. DE ~'~.IF~ON OF R~LATIONSH1P Form TS I Print Name - ,~ * ~ ,~,u~L APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the hart of town officers and emnlovees. The nm'pose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to ~ake whatever action is necessary to avoid same. YOUR NAME: (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other porson's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Vadanee 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, ma~iage, 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% &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 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 greeter 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, parmer, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this ~y of l'h~. 200 __ Signature~_. ~ l~'2~n~ Print Name · -x. · of Trustees Application County of Suffolk State of New York &lA)'e.~d_Oll~. A' ~rO~f'¥;,~ BEINGDULYSWORN 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 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 ~..6{ DAY OF Notary Public £1L££N Li~£ NOT~R r AU-I-~OI~IZATIObl (where the applicant is not the owner) (prifit ~wner of property) (mailing address) JMO Environmental Consulting do hereby authorize (Agent) to apply for permit(s) from the Southold Bo~d of Town Trustees on my belmlf. (Owa~s ~i~a~qre) Tow~ of S~u~old. A. INSTRUCTION8 All applicants for permits* including Town of Sou~old ag~uc'm% shall complete th~s C~AF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended ~0 supplement other infom~tion used by a Town of Southold agency in ,minor action list, policie~ and explauaiions of each policy contained in th~ Town of Southold Local Wal~fiont Revitalization Program. A urouosed action will be eva.hL~"d as to its beneficial and adverse effeas u~on the coas~ area (which includes all of Sou~hold TOWel). If any qu~tion in Section C on this form is ~ "yes" or "no", then the proposed action will "affect the achievement of the LWRP policy stamlards and conditions contained in the consistency review law. Thus, each answer must be explained in detail listina both s~pporting and non- mm~ortine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be tmdemken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.nortlffork.net), the Board of Trust~es Oflice~'the t~ ~nt~ alt , - l~, Dg.~'~I'IONOF~'i~ANDPROIN~fEDACTION SCTM# 1000 - 007 - 4-9 & 10 ~O~N~ New sinqle family dwellinq 2012 The Application has been submitted to (check appropriate response): TowaBoard [] Plsnnlng Board [-'"] Building Dept. [~] BoardofTmste~ [] Category of Town of Sou/hold agency action (ch~ck approprial~'response): (a) Aofion undemk~ directly by Town agency (e.g. capital · constm on,s a ivity, agency r gul oa, transaotion) (b) Finano' assistan (e.g. grant, loan, subsidy) (c) Petal% approval, license, certification: [-~ Nalum and ex~nt of action: Applicant proposes to demolish existing single, family dwelling and shed, to located existing sanitary system which will be pumpmd and filled with sand. tO construct a new sinqle family dwelling, porch, deck, shed retaining walls, gravel drive, regradJ, install dry we~ls~ water and utility lines and install a new sanitary system as per enclosed plans.prepared by CME Associates dated 9/13/12 1140 Old Well Drive{,.~.~shers Island 3.56 Single family dwelling Ptese~ z0nl.~ cla~gfic~on: R- 120 ff an application, for the proposed action I~ been filed vdth the Town of Soulhold agency, the ~llowing ~$ion shall be provided: (a) Nmneofap~kmnt Gwendoline Anne Harris ~) Mailing address: P.O. mox 272 Salisbury, CT 06062 (c) Telephonenumbcr:ArcaC°de( ) 860-8-~-7729 Unknown (d) Application number, if any:. Will the action be directly undcrtakc~ require funding, or approval by a state or federal agency? Yes [~] No[] Ifyes, wllichstate0rf~dcx~lagono~Q N.Y.S.O.E.C. C. Evaluate the project to the following policies by analyzing how 1he 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 n coastal location, and minimizes adverse effects of development. See LWRP Section III- Policies; Page 2 for evaluation [~Yes [] No [--] Not Applicahle the character of the community_ 'Tk consistent with this policy · A~ sdditk~l she-ts ffne~e~ary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWI~P Section I~ ~ Policies Pages 3 through 6 for evaluation criteria ~/~IA_~ Yes [] No [] Not Applicable-- The project will have no impact upon anv historic or ar,chaeological resources. It is felt that this project is consistent with this policy Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section IH - Policies Pages 6 through 7 for evaluation criteria [~ Yes [-] No [] Not Applicable The project will have"n0' impact upon any sceni'~"resou~ces or~mpac~ any of the visual quality of the Town ARach additional sheets if nocessazy NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section m - Policies Pages 8 through 16 for evaluation criteria [] Yes ~ No N Not'Applicable The project will not impair any wet~and habitat. It is felt that the project is consistent with this policy Almch addi~onal sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of $outhold. See LWRP Section HI - Policies Pages 16 through 21 for evaluation criteria ~/Yes [] No ['"~Not Applicable Of ootable water. It is felt that this Project is consistent with this policy Attach additional sheets if necessary Policy 6. Protect and restore the quality and fnnetion of the Town of Southold eeosystems including Significant Coastal Fish and Wildlife Habitats and weflnnds. See LWRP Section HI -Polieies; Page~ 22 through 32 for evaluation eriterin. No Not Appli~l~ function of any wetlands~ ~cosystem~ ~r' ~reas of Siqnificant Coastal Fish and Wildlife habitats. I~ i~ felt that this project is consistent.with thi. s policy Policy 7. Protract and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~Yes N No [] Not Applicable The project will have no impect upon air qualitY. It is felt that this Drogect is consistent with this n~olicv Attaoh additional sheets if necez,~qry Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section IH - Policies; Pages 34 through 38 for evaluatio~ criteria. ~ Yes [--] No [] Not .applicable of hazardous substances or waSTE~. ~h~ m~r(=l F~m the demolished structures sh~l] b~ di~pn~d of properly~ 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 ITl ~ Policies; Pages 38 through 46 for evaluation ~J-~ No~ Not Applicable The project will not impact public access to, or the recreational usa of, coastal w~t~r~: p~]bllr lands ot fha . .~ub~c resources of the Town of Southold. It is felt that this Dro~ect is consJs~n~ w~h ~h~ DO]iCy WORKING COAST POLICr~ Policy I0. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section l~- Policies; Pages 47 through 56 for evaluation criterla~ Th,e project will have no impact upon Southold's water-dependent uses or the siting,of new, felt that this project i,s consistent with this pol, icy Policy 11. Promote sustainable use of living marine resources in Long Ld,nd Sound, the ?eeonie Estuary and Town waters. See LWRP Section TH - PoLicies; Pages 57 through 62 for evaluation criteri~ ' The pro~ect will not have any impacts upon substainable use of livinq marine resources. It is ,felt that this project is consistent with this policy Policy 12. Protect agricultural lands in the Town of Southoid. See LWRP Section IT! - Policies; Pages 62 through 65 for evaluation criteria. [--]¥e~ [] NO~?~ Not Applleable The project does not involve agricultural lands. It is felt A~h additional ~*ts ffneces~ary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP See~on iii - polieies~ Pages 65 *rough 68 for evaluation criteria. FI Yes [] No~r/~ Not Applicable" The project does not involve the use of or the developme'nt of'energy or mineral resources. · It is felt that this policy is not applicable to the project PREPARED BY Glenn E.. Just TITLE Agent DATE11/19 ? // // LIMITS OF TIDAL WETLANDS AS FLAGGED BY G, JUST OF JMO ENVIRONMENTAL CONSULTING HAZARD UNE (SEE MAP REFERENCE No.2) NOT TO SCALE QUALITY CONTROL CERTIFICATION GROUP REVIEWED DATE - AUCE w, .AX, 6" MESH JOHN HARRIS =-~ ~-'~ % FAMILY R BIDE CE HE,CHT DF · kk ~ PUBLIC WATER- ON SITE SEPTIC) mLTER = 16" MIN, HIGH WATER ~ ~ k__] OVERFLOW _MIN, 8" SOiL COVER O~R ~ ~ EMBED FILTER ~ ~.~ ~. ,. ~o~.~ 90' BEND h_xx SLOPE AS SCREENED DRAVEL A MIN. OF 6"IN GROUND 33-5 N/F DAVID S, JOHNSON (SINGLE FAMILY RESIDENCE PUBLIC WATER- ON SITE SEPTIC) UMITS OF FRESHWATER WETLANDS AS FLADGED BY R. MARSH. NYSDEC-- ON MARCH g, 2011 COVER TO GRADE IF DROP 'f' USED KNOCKOUT INLET AND ~- OUTLET OPENINGS RIBS--INSIDE ~ CAST CONCRETE j COVERS Pb N LOCKING CASTING FINISHED GRADETO GRADE % -~ x 4 12.6/12,6 GA. IRE MESH x 6 5/6 GA, WIRE MESH IUTLET 1000 GALLON SEPTIC TANK NOT TO SCALE '/ NOT TO SCALE COMPACTED EMBED FILTER CLOTH 38-5 ~7-11 JMITS OF FLOOD N/F ONE AE E1.EV.-g HENRY L, FERGUSON MUSEUM BLOCK 38 LOT 7 (VACANT LAND) CONSTRUCTION SPECIFICATIONS 1. WOVEN WiRE FENCE TO BE FASTENED SECURELY TO FENCE POSTS WITH WIRE TIES OR STAPLES, POSTS SHALL BE STEEL EITHER "T" OR "U" ~YPE OR HARDWOOD. 2. FILTER CLOTH TO BE FASTENED SECURELY TO WOVEN WIRE FENCE WFrH TIES SPACED EVERY 24" AT TOP AND MID SECTION, FENCE SHALL BE WOVEN WIRE, 6" MAXIMUM MESH OPENING, 3, WREN TWO SECTIONS OF FILTER CLOTH ADJOIN EACH OTHER THEY SHALL BE OVER-LAPPEO BY Six INCHES AND FOLDED, FILTER CLOTH SHALL BE EITHER FILTER X, MIEAFI 1DOX, STABILN}(A T~4DN, OR APPROVED £DUIVALENT, ~. PREFABRICATED UNITS SHALL BE GEOFAB, ENVLROFENCE, OR APPROVEO, EQUIVALENT 5, MAINTENANCE SHALL 8E PERFORMED AS NEEDED AND MATERIAL REMOVED WHEN "BULGES" DgVELOP IN THE SILT FENCE LOCATION MAP SCALE 1"=400' %) SURVEY MAP PROPER~Y OF ADRIAN B, CORBIERE, JR. & DOROTHY CORBIERE; FISHERS ISLAND, NEW YORK; SCALE; 1"=50 FEET; CHANDLER, PALMER & KING; NORWICH, CONN,; OCTOBER 10, 1987, 2.) COASTAL EROSION HAZARD AREA MAP, TOWN OF SOUTHOLD. SUFFOLK COUNTY. NEW YORK, SCALE 1"=200' SHEET 46-FI OF 49 PHOTO No.40-1179-85 DATED 08/29/88 PREPARED BY THE NEW YORK STATE DEPARTMENT .OF ENVIRONMENTAL CONSERVATION, 30' 15' 0 30' / x fT,0 PROVIDE A IFLON PiPE N 1163. 13 mouMo) W 1155.2,4 PARKING %) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED ELECTRIC ~ HEREON, ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO  BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE PROVIDE BURIED ENGAGEMENT. 'SEI~4TNLU~LmE~ i% ~,k~~>~.k~ ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN _~NEDgT(R4)O~FRY~ ITEM IN ANY WAY, 5.) SITE s IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000, SECTION DO7, BLOCK 4, LOTS 9 & 10 ~]~/CHMARK ~ /~ 6,) TOTAL AREA = 3.56- ACRES, ~ ~% ' / 7,) SITE IS LOCATED iN R-120 ZONE. PRC~iED / / ZONE AE (EL.=IO & 9) AS SHOWN ON FIRM, FLOOD INSURANCE RATE MAP BY', R, STROUSE P.E,,L,S, (08/17/12) / PROVIDE 1000 GALLON SEPTIC TANK PROVIDE 1 DISTRIBUTION 80X PROVIDE 2 - ~'6"' X 6"5" LEACHING POOLS (SEE DETAIL) EXISTING SEPTIC SYSTEM TO BE LOCATED, PUMPED AND , WITH SAND, "APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD FF FIRST FLOOR " ELEV ELEVATION DATE SF SQUARE FEET x 12~ EXISTING SPOT GRADE -- -- ~2 -- -- EXISTING CONTOURS 0 ¥ E mq PROPOSED CO. OURS x 14,5 PROPOSED SPOT GRADE DEC I0 2012 EXISTING BRUSH LINE --~_ BUILDING SETBACK LINE PROPOSED BURIED UTILITIES B.__O INVERT ELEVATION i i WLF// LLMITS OF FRESHWATER WETLANDS I;~ DEC 10 2012 ~E DATE: SEPT· 13, 2012 SCALE: 1" = 30' PROJECT #2011806 SHEET 1 OF 1