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HomeMy WebLinkAboutTR-8119A �pf S0!/TZ, Michael J.Domino,President �o� Ol® Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 Charles J.SandersP.O.Box 1179 cn �r Southold,New York 11971 Glenn Goldsmith ® yo Telephone(631) 765-1892 A.Nicholas Krupski �i�11OWN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1338C Date: May 8, 2017 THIS CERTIFIES that the construction of a front one-story addition with covered front entry porch where existing enclosed front porch exists; with the installation of gutters to leaders to drywells, to add 4' high fencing installed approximately 83' landward of the water, and to add 16' of fencing with a gate from the deck to the existingfence; ence; At 1425 Pine Neck Road, Southold Suffolk County Tax Map#1000-70-5-40 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 14, 2013 pursuant to which Trustees Administrative Permit#8119A Dated March 20, 2013, was issued and Amended on June 17, 2015, and Amended again on August 17, 2016, 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 construction of a front one-story addition with covered front entry porch where existing enclosed front porch exists; with the installation of gutters to leaders to drywells,to add 4' high fencing installed approximately 83' landward of the water, and to add 16' of fencing with a gate from the deck to the existingfence. ence• The certificate is issued to Elizabeth Pennisi owner of the aforesaid property. 0 Authorized Signature SOF SOUL" Michael J. Domino,President h�� ��® Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders U, Southold,New York 11971 Glenn Goldsmith ® �O� Telephone(631) 765-1892 A.Nicholas KrupskioI�C�U1411I Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: ct 6y�1 V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed uZ"Project complete, compliance inspection. INSPECTED BY: c h V�V l ej C't, 0—v 'S COMMENTS: -r�Q_ kew e-e- c o o siv.iciJ p/i a S c,er �y� �p� \", V\. �- e- i6l s fi 1-I . &o l b, "�— 39�X,e 1 I 0 1 S �� -V�lb 9 Q,Vv 1 t ,o W 0 5 o o a CERTIFICATE OF COMPLIANCE: ®�'��. John M.Bredemeyer III, President OaQf S® Town Hall Annex Michael J.Domino,Vice-President O 54375 Route 25 g�g P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Charles J. Sanders �jy�,®U .� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES August 17, 2016 TOWN OF SOUTHOLD Elizabeth Pennisi 1425 Pine Neck Road Southold, NY 11971 RE: 1425 PINE NECK ROAD, SOUTHOLD SCTM#: 1000-70-5-40 Dear Mrs. Pennisi: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 17, 2016: RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit#8119A to add approximately 16' of fencing with a gate from the deck to the existing fence; and as depicted on the project plan prepared by Salvatore Pennisi, received on July 12, 2016, and stamped approved on August 17, 2016. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, John M. Bredemeyer III President, Board of Trustees JMB/dd ( UMo PI04inas cj- t f o err�Na, � 910Z t lot ; n [ -`-vim G1OHi(1OS AQ. r SBISM1 J® org Ag C13AOSOV, S,t �7 yrs+ 4r••,., '�c� 7/a �! �i`ri/ S!X� G l 1,14 V r7 wcr_a�J � c a� -k MSS z7JC� n,B 7�a� M Ltl!Z/�J ! �' •� C? InJ ] t?P; m�q!Af-P ! U v,��.�:� to� ?f-a � �-� �`. a�.-.���✓ it^'�/s/x� - �,;�! ! ! ��,,, rn � r,. 1('"�.S�ZcO?� r}�/'r:: !✓1 WVv�vt� (-19 a/zrbe +1s WO scar? �`�� C2-1- , �� v�11 - !' �a�t n��ar a S s t S r, � -4 0y7L LZ 1 John M. Bredemeyer III, President ato pFFO(K�' Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 Glenn Goldsmith �y =� P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders 4, �5p! r� Telephone (631) 765-1892 r Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 1� Completed infield by: ` ELIZABETH PEN ISI-requests an Administrative Amendment to Administrative Permit # 8119A to add approximately 16' of fencing With a gate from the deck to the existing fence. Located: 1425 Pine Neck Road, Southold. SCTM# 1000-70-5-40 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: _100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: 6 Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer III, President ;o�pS�FF�(kCOG Town Hall Annex Michael J. Domino, Vice-President �� yam, , 54375 Route 25 Glenn Goldsmith o ` P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders Telephone (631) 765-1892 �lyd fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: ELIZABETH PENNISI requests an Administrative Amendment to Administrative Permit# 8119A to add approximately 16' of fencing with a gate from the deck to the existing fence. Located: 1425 Pine Neck Road, Southold. SCTM# 1000-70-5-40 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation'or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D.'s25% Expansion/Calculation Work Session Notes ' Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration s CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 /E Y OF LOT -1 OF PROPE R7*i" OF N '� -LLS i l l I LL IJit C,r�eek VEMBER 6, Ig0q, MAP No. 2q7 Joakey W E jf TF-: PINE NECK 5OUTHC3L1� - -�_ _ � � -- S )Lk COUNTY, NY tle line olo � -- , � E MEE D 04-01-2008 S8 erase h%igo .ter _ ' "861 COUNTY TAX # ---mi �� FE9 5 - 40wood X11B MiALTH LAND TfnZ 3 COMPANY .•.¢`%Vis'?APPROVED BY �_ ? •,�".,`w....,� �- 1 I I 5t some ®AR® OF TRUSTEES ----- ------ Hose � TOWN F S UTHO LDrE 12-0 t3 - - Shod ` 1 `• v wI. "oil - - i V *pF SO(/T�, John M. Bredemeyer III, President � Ol0 Town Hall Annex Michael J. Domino,Vice-President 54375 Main RoadP.O. Box 1179 James F. King, Trustee C Southold, New York 11971-0959 Dave Bergen, Trustee • p Charles J. Sanders, Trustee flyer Telephone(631) 765-1892 NFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 17, 2015 Elizabeth & Sal Pennisi 186 Driftwood Drive West Islip, NY 11795 RE: 1425 PINE NECK ROAD, SOUTHOLD SCTM# 70-5-40 Dear Mr. & Mrs. Pennisi: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, June 17, 2015: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Administrative Permit#8119A to add 4' high fencing installed approximately 83' landward of the water; and as depicted on the revised site plan prepared by Sal & Elizabeth Pennisi, received on May 20, 2015, and stamped approved on July 15, 2015. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, John M. Bredemeyer, III President, Board of Trustees JMB:eac �U�yvt� SURVEY OF LOT 7 "MAP OF PROPERTY OF N J. 1^ELL5 PH I LL I P5" Greek FILED NOVEMBER b, IcIO14, MAP No. 2q7 Jokey W E 51 TUATE: P i NE NECK TOWN: 5OUTHOLD g 5UEEOLK COUNTY, NY tle line 0104 , SURVEYED 04-01-2008 S�ro$ h!� Ovte.. �_� SUF>roLl� couNrr TAX # ����` � _ _� wood d - 1000 - 70 _ g - 40 - mi sad CBRTnm TO: - BAMM,ILC COMMONVIBALTH LAPID TnU INSURANCE COMPANY i 15to" ` a _ Fr am r / may..•-�--____ � e : HOV56 to _-x•70 r ` L7 M t I 1 Fr APPROVED BY o� � BOARD OF TRUSTEES TOWN OF SOUTHOLD 9.!' J t ��Q[QFFoo / I � � ri a ' r. ? I , I Lot a r I Lot -J l , Lot r ), 1 l 6 w Po• � � / `�` r r _ Y_! i O MAY 202415 rn1n' I r 1 � 1 � r � � 1 I 'r.i•, r r ' I ' I I ' O 1 virl. 1 pills A O G ' I1 N85 �0 V ' 1 \Nu*15*00wwgam,,, I em edge of pov ant iwa a.'�.cw nw,.•Qe�.w.�.a o. NOTE5: ».raw yoy.oeo wue MONUMENT FOUND ����jj 'fi.Wiwt�on woicoW nr�an.y"'IF w� O PIPE FOUND Road q wr ron rark 5u.ti.oc�io.m'.or«.ia.v� Line le W PM..R ler wean w vory.v.Po.o. OrV a.Iw b.rwl b W Ik..wnpvy gww.ry.. CONTOUR5 REFERENCE NCVD '29 DATUM °may�°�^°�^�°b"�'�»^»^q• b w w.r,v«or W b.en,huW.bn G.rtvko• Ibr T.ill bO.f�u b OGORbnp�.wlRrlbn Area = 46,516 JOHN C. EHLERS LAND SURVEYOR Area = 1.0679 Acres Acrres 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC SCALE I"- 40' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compagserver\pros\08\08-130 TOPO.pro i John Bredemeyer, President °�o%UFF91,te Town Hall Annex Michael J. Domino, Vice-President �° 2 54375 Route 25 James F. King y P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�ol ,� �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: z,d T— Z ;/X700 ev\, ELIZABETH PENNISI requests an Administrative Amendment to Administrative Permit #8119A to add 4' high fencing installed approximately 83' landward of the water. Located: 1425 Pine Neck Road, Southold. SCTM# 70-5-40 Type 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 Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: r Conditions: 147 Present Were: J. Bredemeyer /M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by 'C?� Q Mailed/Faxed to: Date: 71,) cy Trz-c,s Teks 7o 0-doO, 0 4, tz, 6,4-L/e, ,c fl;L-/<- 'I) o-z- 1- j"J (fd-4-57(,o(eKf .,Vf SA/ PNN/ MAY 2 1 2015 John M. Bredemeyer III,President fjf so�llyo Town Hall Annex Michael J. Domino,Vice-President '`� l0 54375 Main Road P.O. Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Telephone(631) 765-1892 Charles J.Sanders,Trustee `,oU Fax(631) 765-6641 BOARD OF TOWN TRUSTEESfAY 2 p 2015 J TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT DATE s/a 0l/'�- S4 S-1 4: - &a-K 4? OWNER A-/'Z �enl.0/ S + PHONE 631 - 77Y �Qo23� s MAILING ADDRESS /8'Lt b 2 s'F7-wooA b 2 . LZ• rs 1. Q AGENT PHONE ADDRESS PROPERTY LOCATION IV-2J— TAX V-2STAX MAP NO. O- 5� LN LI-2- ,F 34 / I/We request an Amendment to Permit# �� to 4 blD aL %ewc.e +r-) Sly/•Of / ,Z_a ee 27'-Y SF 83 Signed By: G/� James F.King,Presidentlluffa4'tepG Town Hall,53095 Main Rd- Bob Ghosio;Jr.,Vice-President P.O.Box 1179 �. Dave Bergen Southold,NY 11971 John Bredemeyerp� �� Telephone(63 t)765-1892 Michael J.Domino �Ql 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 I" day of construction % constructed Project complete, compliance inspection James F. King, President OF S0 Town Hall Annex Bob Ghosio,Jr.,Vice-President �`1` y�l 54375 Main Road O P.O. Box 1179 Dave Bergen .1[. # Southold, New York 11971-0959 John Bredemeyer y Michael J.Domino Q Telephone(631) 765-1892 �� Fax(631)765-6641 �ycourm,��' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8119A Date of Receipt of Application: February 14, 2013 Applicant: Elizabeth Pennisi SCTM#: 70-5-40 Project Location: 1425 Pine Neck Road, Southold Date of Resolution/Issuance: March 20, 2013 Date of Expiration: March 20, 2015 Reviewed by: Trustee Michael Domino Project Description: To construct a front one-story addition with covered front entry porch where existing enclosed front porch exists; with the installation of gutters to leaders to drywells. 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 site plan prepared by Eileen Santora, Residential Designer, last dated on December 20, 2012, and stamped approved on March 20, 2013; and also indicated on the project plan prepared by Eileen Santora, received on February 14, 2013, and stamp approved on March 20, 2013. 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 P.O_Bos 1179 Bob Ghosio,Jr.,Vice-President Q��� dy 'ti, Southold.NY 11971 Dave Bergen H Telephone(631 765-1892 John Bredemcper ,.. 7� Fax(63 1)765-6641 Michael J. Domino -� q `} Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: 3 ( / 3 Eileen Santora on behalf of ELIZABETH PENNISI requests an Administrative Permit to construct a front one-story addition with covered front entry porch where existing enclosed front porch exists; with the installation of gutters to leaders to drywells. Located: 1425 Pine Neck Road, Southold. SCTM# 70-5-40 Type 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: hapt.275 Chapt. 111 _other Type of Application: Wetland Coastal Erosion _Amendment LA/dministrative_Emergency —Pre-Submission Violation Info needed: Modifications: Conditions: �� el a4 itv� Present Were: J. Ki _B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: y d r I �J Imp- .rias a �.I u If 11 1 w , " 9 144, s . x - ----- -- ----- 1 Ozifw C � M N b b L a4y �" 1 0 x�m-ff euman � � I, d •�a b - ` � �^ • � •. a a, « ,� � awn / m -� r ♦• a♦9 /! }I �• iiVel �.My W9 • A i . _ a '�«.. ', � �, t�,.z . ^"'• \\g `•f mei 4 � O uv rf , HHy• SOuixoto a.n, m ti r, n ' a � A ....n P� e4� . � e f � ' a �xp • ,. ^ 4 a ^a • 'P J IgA 4� .O v'gg �•• n�- '\ °' a ^ ' y sax � x ^ P w of » d ♦ 3 J�� '� — n. " z m rn g^ // ,a• - � -pyo A n Aa m. W.1 H.1 Ha`.i. ♦ .S _ �/�1��_ COUM OF SUFFOLK © w aoumoin sEcnoxxo Prop"Tu 3eninAp ^ s 0 0 OFFICE LOCATION: �f soujyo MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 .If, # Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) T Southold, NY 11971 G Q Telephone: 631 765-1938 iPS Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President R r I D Town of Southold Board of Trustees MAR 14 2013 From: Mark Terry, Principal Planner outhoid own LWRP Coordinator t r e Date: March 13, 2013 Re: Proposed Administrative Permit for ELIZABETH PENNISI SCTM#1000-70-5-40 Eileen Santora on behalf of ELIZABETH PENNISI requests an Administrative Permit to construct a front one-story addition with covered front entry porch where existing enclosed front porch exists; with the installation of gutters to leaders to drywells. Located: 1425 Pine Neck Road, Southold. SCTM# 70- 5-40 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that that the Board considers the following additional best management practice: To further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem. 1 If the action is approved, it is recommended that the board establish a landscaped buffer landward of the bulkhead. 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 so • Town Hall Annex Bob Ghosio,Jr.,Vice-President �O� ��� 54375 Main Road P.O. Box 1179 Dave Bergen 41 * Southold, New York 11971-0959 John Bredemeyer r/' 4-C G p� Telephone (631) 765-1892 Michael J. Domino p i Fax(631) 765-6641 OOUNTi,�c� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _ fdoastal Erosion Permit Applicatio Wetland Permit Application v Administrative Permit / Amendment/Transfe Extnsron V Received Application: 2Ij 3 114 Received Fee:$ 0 . b D FN E II�`,. Completed Application 13 II llI� Incomplete FEB 1 4 2013 �� f _SEQRA Classification: Type I Type ll__Unlisted_,_ �oordination:(date sent) WRP Consistency Assessment Form _ and of TrTstecs CAC Referral Sent: Date of Inspection Receipt of CAC Report: Lead Agency Determination:_ _ Technical Review: Public Hearing Held: U Resolution: Name of Applicant f= L I Z 1 F—L)�4 PEN M 16 1 Mailing Address ZU P-tTJd 0D UWE [N)b,JT ZSUP NCGJ 57m Phone Number:( 7D(] Suffolk County Tax Map Number: 1000 - Property Location: �`�2CJ P11 -IJF-C—IG �Zl� Sc��Jt} fpyp Y�(Y NOIZT-ft 'SIDE OP JIAlar n/E-CK. R'0 ?69 ' eA,<LAHi444 (provide LILCO Pole #, distance to cross streets, and location) AGENT: D L C— G N (If applicable) Address: W50 VA N S _0 �4 e.O Ct)i G i,+0 CLUE Phone: LP25 I —)-64 - al%l ' j p 06) Bo i of Trustees Application • GENERAL DATA Land Area(in square feet): �E- Area Zoning: Previous use of property: Z06 I DLJ T I A L/ Intended use of property: f i 0 r/\/7-( A L, Covenants and Restrictions on property? Yesy1 No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _V-' No Does the structure (s) on property have a valid Certificate of Occupancy? _ Yes No Prior permits/approvals for site improvements: Agency Date _zv iu I u U bc�cr� i7T--/-1 �j 1 l o✓ 25 Zoo No prior permits/approvals for site improvements. / Has any permit/approval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes, provide explanation: Project Description (use attachments if necessary): � D Col`1G­TpL)c - A F20+-1 I I ejToe( T, o W ,TH coilerOED rr20jur- �eiumY porzcq WPe 2C Exvs-ri N " PVC LCF:�rl;D F-12ow-r Frec 14 evAoTS Boar f Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: -To MA4 � A COV E C6n U—N-"eY CvL-Ae"'C— fear. ADD -Powf�)Ee Ljooq 'y o r=nTzy TC-,Y92 . TD T/",IC-e AWAY T=LAT at� S Area of wetlands on lot: square feet Percent coverage of lot: L Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: /• (a feet Does the project involve excavation or filling? No V Yes If yes, how much material will be excavated?--4—Cubic yards i How much material will be filled? cubic yards Depth of which material will be removed or deposited: r feet Proposed slope throughout the area of operations: 9 Manner in which material will be removed or deposited:---/i d Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations operations (use attachments if appropriate): 14 PROJECT ID NUMBER • 617.20 • SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME EUzA "r3Er14 PeN ,v151 FNNrs1 }2rMC7�IIN( � 3.PROJECT LOCATION: 14'Z5 P,kjlrNECK r2D gD(I1}fpCD SV��oc K Municipality / County 4.PRECISE LOCATION: Street Addess and Road Intersseecp�ons. Prominent landarksetc -or provide map 14 tllar� mOAl0P-T14 S1De 0iWenE llp A1G(i+NO 5, IS PROPOSED ACTION: Newxpansion modification/alteration rj{� 6. Pb0JT'VQ X DESCRIBEPROJECT BRIEFLY:Ly'LGT YkelD L�� (�� /G'l� Gv/T+�f AF �Cl2L l-� f�' 7-0 16AJOL) OCAID TD C7 ytt���L S 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 2vesidential ❑Industrial DCommercial ❑Agriculture ❑Park/Forest/Open Space Other (describe) 10, DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) �'as No If yes, list agency name and permit / approval: �gDO r1-fDLIJ /J I N (moi DEP 'REAM l7 �l✓PIZvYI L __- - _--- -T1-60ES ANY ASPECT IIF THEACTIOW [7—VALID PERMIT OR APPROVAL? Yes r, ro If yes, list agency name and permit / approval: 11I22,�, llA""S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [Dyes ❑No I CERTIFY THATTHEINFORMATION PROVIDED,ABOVE. IS TRUE TO THE BEST OF MY KNOWLEDGE,,22 2 Applicant / Sponsor Name niLE�h/ SgAITO Date: / 2r/ 2el✓ Signature l�(.&s ya1l / If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART It- IMPACT ASSESSMENT o be completed by Lead Agency). A. DOES ACTION EXCEED ANY TYPE t THRESHOLD IN 6 NYCRR,PART 617.47 If yes,coordinate the review process and use the FULL EAR ❑Yes a No 0. VNLL 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 a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten.if Legible) C7. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resburcas,or commundly or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfis of wildlife species.significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a-change in use of intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: CG I ong term,stwn term,emulative,or other effects not identified in C7 C5? Explain briefly: C7. Other impacts(includinga,a--- in use of either uantil or t e of ener ? Ex Iain brief :D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? if yes.ex Iain briefly: Yes In/ No E IS THERE,OR IS THERE LIKELY To UE,CONTROVERSY RELATED TO POTENTIAL SE ENVIRONMENTAL IMPACTS? If laln: -❑Yes a No PART NI-DETERMINATION OF SIGNMANCE(To be completed by Agency) INSTRUCTIONS:- For each adverse effectidentitedabove,determinewhetheritIssubstaogaLlarge.impotantorothetwisesignificant Each effect should be assessed in connection with its(a)setfing(Le.urban or rural):(b)probability of occurring;(c)duration;(d)imaversb Mtn:est geographic scope-,and(Q magnitude. If necessary,add attachments or reference supporting materials. Ensure at elgllanafions contain. suffidentdoW 10 showthat afl relevant adverse hnpads have been idenfiied and adequately addressed. Nquesi ion d of partt was dhgcked yes,dredetermination Ofsigntfcance mustevaluatethe potentialimpactofthe proposedadion on theeMiragnen(al eharacterieftafthe CEA. Check this box'(you have Identified one ormore potentially Wage orslgnificamadverse Impacts which MAYooax.Then proceed directlyto the FUU EAF and/or prepare a positive dedaralion. Check lilts box if youhave determined,based on the Information and analysis above and any supporting documentation.that the proposed aetd WILL NOT result in any significant adverse environmental Impacts AND provide, on attachments as necessary, the reasons supporting tht determination. Board of Trustees D Na /jj/912 8 2-013 Name Lead Agency — Date J A ,lrf F• )�l jG President Print or Type Name of Responsible Offi r in lead Agency Title of Responsible Officer OS S1 alure of Responsible Officer in L d Agency Signature of Preparer(If different nom responsible officer) e� KTown of Southold ® Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.O: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A kk STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN r� 'SectTon -81- cT -U-t— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located Within 2 / /9 dam- Will this Project Retain All Stone-Water Run-Off the Scope of Work for Proposed Construction) / / f rJ Generated by a Two(2')Inch Rainfall on Site? (St s� ❑ (This Item will include all run-off created by site b. What is the Total Area of Land Clearing clearing andlor construction activities ✓as")I as all — and/or Ground Disturbance for the proposed 460 , 2-5"P Site Improvements and the permanent creation of construction activity? impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DFSCRIMON (Pnm i-Addaldna Peas•®Nsatletl) Drainage Structures Indicating Size&Location?This ❑ lI Item shall include all Proposed Grade Changes and — To C-0t4x`&TA? rte" C1 T=QO)- A- Z)(>) p o k1. Slopes Controlling Surface Water Flow. i n r A ' IY $ Does the Site Plan and/or Survey describe the erosion ❑ �(D /Q Tr LSV and sediment Control practices that will be used to control site erosion and stone water discharges. This FD n k9c-4 1 & i- l' x o l' 4 A2rA« item must be maintained throughout the Entire _ _ r Construction Period. 6W L� 0 7-2) q Will this Project Require any Land Filling,Grading or y l Excavation where there is a change to the Natural / Existing Grade Involving more than 200 Cubic Yards ✓ of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities ❑ / Encompassing an Area in Excess of Five Thousand v (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction / General DEC SWPPP Requirements: or within One Hundred(100')feet of a Weiland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less man one acre that 7 Will there be Site preparation on Existing Grade Slopes F-1are pad of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen It 5)feet of Vertical Rise to including Constmction activities involving sol[disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? me DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ / for Storm Water Discharges from Construction activity-Permit No.GP-0.10401.) Surfaces be Sloped to Direct Storm-Water Run-On V/ 1.The SWPPP shall be prepared prior to the submittal of the NOL The Not shall be into and/or in the direction of a Town right-of-my? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment cooling practices and where 9 Will this Project Require the Placement of Material, ❑ required,postconstmction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terns and conditions of this permit.In addition.the SWPPP shall Area?roue Item win NOT Include the Imbllaaon a Ddvewey APram.) Identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the postconstmctbn storm water management practice in a Boz and the cunstmction site disturbance is between 5,000 S.F.S 1 Acro In area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading.Drainage b Erosion Control Plan Is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior W Issuance of Any Building Permit (NOTE: Ached Merk(J)arwar Mswm breach Questidne Requked bre Oonhplele Appikeean) STATE OF NEW YORK, Sv r-j�oL� COUNTYOF...........................................SS That I,....... ....... " ..........being duly sworn,deposes and says that he/she is the applicant for PemtiS . ............... ...... (Name of Individual signing Document) - And that he/she is the �L.. T .........ale................................................. em, (Ovmer,Conlrector, ga OMcer, ...•............ Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Swom to before me this; ......................1. ..................day . ..... �� ..... ...20.1 Notary Public: ............ . ..... �L...�. ...... ............... Hew (Signature of Applicant) FORM - 06110 Qualms in SIIBDIk Count�yy Cvommisslnn Expires)ukr 28. Boar f Trustees Application County of Suffolk State of New York �u ZA P7O� pt�N tile)( BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES 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. gnature of Property Owner SWORN TO BEFORE ME THIS DAY OF �6t�^ 20 %0 WN ��Y ,�of Now York Cpo�Nnlp'n ftpgw / 141 ( � ezz1)l/ 2vzwL,, Notary Board f Trustees Application • AUTHORIZATION (where the applicant is not the owner) PEN N I S.I . 1 g49 Z)I /�ZtW Z) ��OF [, � I l > T+� --residing at (print owner of property) (mailing address) do hereby authorize Ei Lel✓ (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf Owner's signature) Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its si iirg ficant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" 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- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: onlin h o website(southoldtown.northfork.net), the Board of Trustees O t It local libraries and the Town Clerk's office. U B. DESCRIPTION OF SITE AND PROPOSED ACTION F 1 4 3 SCTM# 17C - T' - ut old Town PROJECT NAME 'I C IVti is t 1495 P"Vf 16 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LJ 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: Location of action: J4 �fVc77c Site acreage: /'7a/C'ffs Present land use: L— Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: n (a) Name of applicant E/ i� /✓ik_r 7 (b) Mailing address: (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No❑ If yes, which state or federal agency? 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 LWRP Section III—Policies; Page 2 for evaluation criteria. / ❑Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LW�RjP Section III—Policies Pages 3 through 6 for evaluation criteria 1J Yes ❑ No ❑ Not 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 jJ Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria a 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. ❑ 0 Yes No Not Applic. • 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 Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and waste-s. See LWRP Section III — Policies; Pages 34 through 38 for evaluation criteria. 1:1Yes ❑ No R} Not 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. ❑ YeD No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES . • 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. ❑ Yes ❑ No ❑ of 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. ❑ Yes ❑ No PNot Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. 1:1Yes ❑ No d Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable F& 2a/3 PREPARED BY E������ tc�y� �iC> -z. � r TITLE DATE 5URVEY OF LOT 7 MAP OF PROPERTY OF N J. WELLS PHILLIf'511 Greek FILED NOVEMBER 6, 1909, MAP No. 297 Jockey WE 51TUATE: PINE NECK — TOWN: 5OUTHOL D _ S 5UFFOLK COUNTY, NY 110 Ilse alo 1 } _ SURVEYED 04-0I-2008 She age high water SUFFOLK COUNTY TAX # ----I f 100 TWM 105 - 40 , - - pwoodbyl �d - - = _ = D E C E I VY-I, BAW UC �'��T r FEB 1 4 2013 IIdSQRARMCOWANY - - - - - Southcid Town • and of Iruts_o; APPROVED--- I ' _ �°`� BY -- 3----- BOARD OF TRUSTEES TOWN OF SOUTHOLD I DATE 7 - Z F K� 17 wn Lot 8 Lot 7 '7 �I Lot 6 I � I n� o I eiie I G1 . U 4 & r ,,N84°15-00 0 MONUMENT FOUND Neck R(Dad O PIPE FOUND CONTOURS REFERENCE NGVD '29 DATUM ea�`w����rt Area = 46,516 5. F, Area 1.06"19 Acres JOHN C. 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