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HomeMy WebLinkAboutTR-8350A ,,,,, John M. Bredemeyer III,President �•"••1 s SO//45, - 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 t Dave Bergen,Trustee • G Q � ,t► . g Telephone(631) 765-1892 Charles J.Sanders,Trustee Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0979C Date: May 7, 2014 THIS CERTIFIES that the construction of a 13'x21' deck with a+/-7' high screening wall, outdoor shower, and benches onto the dwelling; install a hot tub on slab; and for the existing fencing surrounding the property. At 560 Sunset Avenue, Mattituck,New York Suffolk County Tax Map# 115-3-2.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated November 14, 2013 pursuant to which Trustees Administrative Permit#8350A Dated December 11, 3013 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of a 13'x21' deck with a+/-7' high screening wall, outdoor shower, and benches onto the dwelling; install a hot tub on slab; and for the existing fencing surrounding the property. The certificate is issued to SCOTT KLATSKY owner of the aforesaid property. dirit• ort, •66,10207,0..a Authorized Signature • i John M.Bredemeyer 111,President ,d',gU,,,,,, -_ Town Hall,53095 Main Rd. Michael J.Domino,Vice President P.O.C64: P.O. Box 1179 James F.King 1 y Southold,NY 11971■ Dave Bergen :WO y/ Telephone(631)765-1892 �=y�0 Sr 01 Fax(631)765 6641 Charles J.Sanders = 4 * * ,, ( ) BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: VfiY Z- r r ✓Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1s1 day of construction 1/2 constructed V Project complete, compliance inspection. INSPECTED BY: 4. JoA1 COMMENTS: 6 CERTIFICATE OF COMPLIANCE: . e 0 James F. King, President gpfFO(I Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vioe-President P.O. Box 1179 Dave Bergen Southold, NY 11971 W John Bredemeyer ~y~ • Telephone (631) 765-1892 Michael J. Domino Fax (631) 765641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1"(day of construction _ %constructed Project complete, compliance inspection James F. King, President a SOUjyo Town Hall Annex Bob Ghosio, Jr., Vice-Preside 54375 Main Road P.O. Box 1179 Dave Bergen # Southold, New York 11971-0959 John Bredemeyer G Michael J. Domino ~O Telephone (631) 765-1892 Own Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8350A Date of Receipt of Application: November 14, 2013 Applicant: Scott Klatsky SCTM#: 115-3-2.1 Project Location: 560 Sunset Avenue, Mattituck Date of Resolution/Issuance: December 11, 2013 Date of Expiration: December 11, 2015 Reviewed by: Jim King, President Project Description: To construct a 13'x21' deck with a +/-7' high screening wall, outdoor shower and benches onto the dwelling; to install a hot tub on slab; and for the existing fence surrounding the property. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by Joseph Kollen, received on November 14, 2013, and stamped approved on December 24, 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 adetermination from any other agency. James F. King, President Board of Trustees James F. King, President ~QF so Town Hall Annex Bob Ghosio, Jr., Vice-President Q~ y~l 54375 Main Road P.O. Box 1179 Dave Bergen * * Southold, New York 11971-0959 John Bredemeyer rn Michael J. Domino G • O Telephone (631) 765-1592 ~Fax (631) 765-6641 BOARD OF TOWN TRUSTEES 15 D V TOWN OF SOUTHOLD D To: Southold Town Building Department NOV 19 2013 Re: Verification of Building Department Permit Requirements BLDG. DEPT. TOWN OF SOUTHOLD SCTM#: S- 3-1 . Property Owner Name: (As Date Sent to Bldg. Dept.:.. The Office of the Board of Trustees is forwarding the above reference tien-for verification of the Building Department's permitting requirements state IQN D YES r NO DEC - 9 2013 ? ~pLitl the proposed project require a Building Pe it? Wi he proposed project require a variance determination from e Zoning Board of Appeals? l 'r Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: Signature o eviewer Date L- ,e F- h 47 _ r 4 t DTI r a ~ J ~ f ~ fd's ss NAx y 1 }w f 91 . •'Y tiz ION me- y~~ gUFFl7( p James F. King, President P.O. Box 1179 Bob Ghosio, Jr., Vice-President ti Southold, NY 11971 Dave Bergen Telephone (631 765-1892 John Bredemeyer Fax (631) 765-6641 Michael J. Domino 'g Southold Town Board of Trustees Field Inspection/Work Session Report r/ ; y0 Date/Time: />GC -7 2o(3 Joseph Kollen on behalf of SCOTT KLATSKY requests an Administrative Permit to construct a 13'x21' deck with a +/-7' high screening wall, outdoor shower and benches onto the dwelling; and to install a hot tub on slab. Located: 560 Sunset Avenue, Mattituck. SCTM# 115-3-2.1 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: _2f apt.275 _Chapt. 111 -other Typp of Application: _ Wetland -Coastal Erosion -Amendment _Administrative_Emergency-Pre-Submission Violation Info needed: Modifications: Conditions: 6*2A-1, Y f Vr2 If T),' (2 7-1d 1-1,Y /.y C L 7 x15 7-1 6' /-'E,t/C oi? Pa)- Ht ; 7`' Present Were: J. King _B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: dy}'~ -it; T 114 "Apo y + . . 't'i;rt,rir API ra s 1. " ~ air 1. ' IVO ti~4 D E C_ NOV 1 4 2013 at N o AA L i r' r r, ILI. • GO x. tot 21 `1 t~ ~ F q~ t, rf ~ ~ ~ ~ r . ? ,y ~ ~ f _ - ~ r 4. • . y°. S T ,ter' 'i_ . 3 ,iG~ r _ ; , 3 ? S ~ ~ ~ ~ 1 I„ • •J J ~ti _y. e7 - ~ _ is k y! ~ ~ ~!'R ~ ~a. r.-, ,/f ~ ~ if 3~ r ' 4 ' r~s fi( ~ti. ~ ~7T ~~s ` .a _ ~7 Zr~r` 1, ~ Y. i { i.t~~'f~., ~ ~ ~l Vii' 'C :K.- -~.s. ~.L- ~yi'.7~. rs ~ ~ Q Sl ~ &GAL - e 4pgg` t + * - Zak ~1 K t I~`y ? rtPr,i, . JA t ,ate xu.• ~r.v~ _ ^.wa' ~ ~ rr yam w~ 1. .,A. FA © R6 A F ~ t \ ^ ] ~ b o ,we oww° QI C 5 "d F Y. p Vi I u~ " aw, y n _ as^ ~~yy .ter ' , r E •v w '•YM •,Y ^ rr I a i a .°w i a ^ a ~ spa / 4 Y iiW F a ^~~•W nA its - I a m P * \ w •.t -mil ya nO:.,A 'iK" n ' 9j vm ff.F~w ' 9 A mm® 4 A " b•,• E a r,w n.2rv uc 'P' •nbs. w.m u"e ? ~ ...~e"1 , n,µ+ Mx WUBi SUFFMK ® v - . eecmrxo P.Wil ySxxim Oyer a ".5 OFFICE LOCATION: ~~OF SO(/TyO MAILING ADDRESS: Town Hall Annex 1~ lQ P.O. Box 1179 54375 State Route 25 * Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 0 Telephone: 631 765-1938 Fax: 631 765-3136 Comm, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM D~ D To: Jim King, President DEC - 9 [013 Town of Southold Board of Trustees Suutl;oW inn f From: Mark Terry, Principal Planner LWRP Coordinator Date: December 9, 2013 Re: Proposed Wetland Permit for SCOTT KLATSKY SCTM#1000-115-3-2.1 Joseph Kollen on behalf of SCOTT KLATSKY requests an Administrative Permit to construct a 13'x21' deck with a +/-7' high screening wall, outdoor shower and benches onto the dwelling; and to install a hot tub on slab. Located: 560 Sunset Avenue, Mattituck. SCTM# 115-3-2.1 It is my recommendation that the proposed action is INCONSISTENT with LWRP Policy 6.3 (below) and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. A Wetlands Permit was issued in 2010 for the construction of a dock structure on the property. The dock structure was constructed. The permit conditions required the installation on a 15' non-turf buffer. The buffer is not shown on the current plans. In the event that the action is approved, it is recommended that the Board require that the nonturf buffer (vegetated recommended) be shown on the plans, referenced in the decision and in subsequent permits. To further Polices 5 and 6 it is recommended that the Board verify how the shower and hot-tub would drain. 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 oF sours Town Hall Annex Bob Ghosio, Jr., Vice-President 54375 Main Road P.O. Box 1179 Dave Bergen 1~[ Southold, New York 11971-0959 John Bredemeyer N Q Michael J. Domino Telephone (631) 766-1892 l~CO ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Permit Application -Wetland Permit Application Administrative Permit -Amendment Transfe /Ext nsion eceived Application: DI~eceived Fee /Completed Application IN ~j P ncomplete SEQRA Classification: Type I Type II Unlisted 0V 44 2013 Coordination:(date sent) ~-WRP Consistency Assessment Form 2 3 V CAC Referral Sent: vn'I Date of Inspection:3 -Receipt of CAC Report: -Lead Agency Determination: Technical Review: ZPublic Hearing Held: Resolution: Name of Applicant Ito- /P1415 ('01eAl ~J g_Mailin Address ' 11 PhoneNumber:gl-7/0-96/1 Suffolk County Tax Map Number: 1000 - 115 - 3- c P. I l Property Location: ~b SvNS Vt - A *r, 1 417_- 1 k4ik /V. q_ (provide LILCO Pole distance to cross streets, and location) L wr P l? AGENT: gawp!, ko A J M w a v, (If applicable) -~i n rrvi E h, 1 ~ j IQ j o Address: /Jo g i f x-l tiU G~l~! So" OP W N. V. Phone: G3 " WJ" Rq7__ wr_cb) 63 1 793 - 3C405- (CO-</J rd of Trustees Applicatiols GENERAL DATA Land Area (in square feet): L1 / j~~ % 1 p ~ q Area Zoning: /2e.5 i e,1 L D ~w4~ Previous use of property: ",k 4,r rwnP2n Intended use of property: S, iol ic Covenants and Restrictions on property? Yes 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 J~N0 Does the structure (s) on property have a valid Certificate of Occupancy? x Yes No Prior permits/approvals for site improvements: Agency Date kJ 4 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? `x No Yes If yes, provide explanation: Project Description (use attachments if necessary): SCrIE} Sr ([iL Acs/~ 13/ Y02(, Cec'it2 O o u- -Aoo r- Svtffwal 9, x g~ ~ n ~au~ COIL C13~ X a ~ , r[Oukn5 ~2eAck_ I =i,34 Boffd of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: S' Area of wetlands on lot: © square feet Percent coverage of lot: (9 % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: / feet Proposed slope throughout the area of operations: l Manner in which material will be removed or deposited: / Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): NflWde- 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Information Name of >noryor Proje /C Project ALocation (describe, and attach a location map): I I' 's ?n( Sr Le' eF j vJ G_ Brief Description of Proposed Action: 0 "7) in pet is wea t f c7e c),; /-o u6G C ecQat A- / M~ ffVy 7N 1r 't ACI u CI ; ~4 I a ~J n9 x s I - b " t co n cn~~e SI ci Imo, t~+ }r,~J . 3 ou~t~oorskaw(m kg on Iw~~e.ck_ (inC~uc>'~~ ~vtc> Name of Applicant or SSp(Q~nsorry:/,, Telephone/,. 5~~ Z /Ki? V'C~ E-Mail: f-rJ/Ki? ~ fJ'+'ni/~.Ca Addre s: 1DD.5-- 71777 City/P104Ph4 S (p' Zi (/f 77 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO YES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that I may be affected in the municipality and proceed to Part 2. If no, continue to question 2. El' 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES If Yes, list agency(s) name and permit or approval: ' ? rV1 IDw-f 171 504ADId 3y,7~t~ ~eo'J 3.a. Total acreage of the site of the proposed action? acres b. Total acreage to be physically disturbed? / acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on, adjoining and near the proposed action. []Urban ?Rural(non-agriculture) []Industrial []Commercial &esidential(suburban) []Forest []Agriculture []Aquatic []Other (specify): []Parkland Page I of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ? ? b. Consistent with the adopted comprehensive plan? EF-0-91 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ? 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? NO YES If Yes, identify: V1 M 8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES b. Are public transportation service(s) available at or near the site of the proposed action? 10 ? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ® ? 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements, describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supplyA?/ NO YES - If No, describe method for providing potable water: E ? 11. Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment:~ ? 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? M ? b. Is the proposed action located in an archeological sensitive area? PSI El 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain NO YES wetlands or other waterbodies regulated by a federal, state or local agency? ? b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ? Shoreline ?Forest ? Agricultural/grasslands ?Early mid-successional .Wetland ?Urban ?Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? 16 1 ? 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge, either from point or non-point sources? NO YES If Yes, © ? a. Will storm water discharges flow to adjacent properties? ? NO ?YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ? NO ?YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: ® ? 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes, describe: ? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or NO YES completed) for hazardous waste? If Yes, describe: n ? 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLED 99 Applicant/spo so name- A4,( 44 Date: /Vt7 4113 Signature: Part 2 - Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action?" No, or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ~ E] regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ? 3. Will the proposed action impair the character or quality of the existing community? ? 4. Will the proposed action have an impact on the environmental characteristics that caused the r41 ? establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ? affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate F71' ? reasonably available energy conservation or renewable energy opportunities? LN 7. Will the proposed action impact existing: n ? a. public / private water supplies? b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, n ? architectural or aesthetic resources? IL~I 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, f'41 ? waterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 No, or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage ? problems? 11. Will the proposed action create a hazard to environmental resources or human health? ? Part 3 - Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered "moderate to large impact may occur", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. T Town of Southold - Board of Trustees ///2 Z/ 13 Name of Lead Agency Date J~f i.,, 5 , President / Print or Type Name of Responsible Offic in Lead Agency Title of Responsible Officer Si ure of Responsible Officer in ad Agency Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 Town of Southold ® Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY L(SAATION: S.C.TAt. k THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A I STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION PPEM # / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? - (include Total Area of all Parcels located within i' ~ q Generated this Project Retain PJI ISlorm nch Rainfall-Off the Scope of Work for Proposed Construction) (s.p e (This Item nerated will include (2 all 7 In runcoff reall Oon Site? ? .I ) created by site b. What Is the Total Area of Land Clearing clearing and/or construction activities at weti as all and/or Ground Disturbance for the proposed Site Improvements and the permanent Creation of construction actlvity9 (s.P. f Agss) impervious surfaces.) . 2 Does the Site Plan and/or Survey Show Proposed ~ ? PROVIDE BRIEF PROJECT DE4CRIPI'ION (pnwN.Aeatlmd arrr,ed,e Drainage Structures Indicating Size & Location? This MA~yq Item shall intrude all Proposed Grade Ganges and I Y'IR • I / / i /r !4 Slopes Controlling Surface Water Flow. ll ~^~~"~~lUU1~ 4 I 1 3 Does the Site Plan and/or Survey describe the erosion ~ GL~ ?~ylf~ I and sediment control practices that will be.used to ' control site erosion and storm water discharges. This Item must be maintained throughout the Entire Construction Period. SICt_6 4 Will this Project Require any Land Filling, Grading or (o1 X I _ tl Excavation where there is a change to the Natural ? Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 3 0 3~FR OQ r s aA- h A C' V 1 r\5 Will this Encompassing assinga an Area in Require Excess Land Disturbing Activities ? k t of Five Thousand C C (5,000 S.F.) Square Feet of Ground Surface? V, YL, -1 L 6 Is there a Natural Water Course Running through the ? SneT Is this Project within the Trustees jurisdiction General DEC SWPPP Reauiremenb: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving sold Beach? dlaaroances of one (1) or more acres: Including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ? are pad of a larger corms n plan that wt ultimately disturb one or more acres of land; hckK lup Construction acdvises Irndving sol disturbances of less than one (1) acre where which Exceed Fifteen (15) feet of Vertical Rise to the DEC has determined that a SPDES pemhit Is required ror storm water discharges. One Hundred (100') of Horizontal Distance? I SWPPPs Shall most the Minimum Requlraments of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious ? , for Storm Water Discharges from Construction activity - Puma No. GP440-001.) Surfaces be Sloped to Direct Stomp-Water Run-Off /T7(• t. The SWPPP shell be prepared prior to me submetel of me Not. The Not shall be Into and/or an the direction of a Town right-of-way? submitted to the Depemnent prior to to CprrxrlBnc~errlent of construction activity. 2. The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material. required, post-construction scam water management practices that wig be used andfor Removal of Vegetation and/or the Construction of any constructed to reduce me pollutants to storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terra and conditions of this permit. In addition, the SWPPP shell Areal rmr roan van xoT I,wluee uw ewarnwea of orivawq Aprme) Identify potential sauces of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer m Questions One through Nina in Answered with a Check Mark 3. An SWPPPS that require the post-construction storm water management practice in a Box and the construction sea disturbance Is baMwn;000 S.F. a 1 Auer In area, component shelf be prepared by a qualified Design Professional Licensed in New York a Stem-Water, Grading, Drainage a Erosion Control Plan 1. Required by do Town of that Is knowledgeable in the principles and practices of Storm Water Manegement Southold and Must be Submitted for Review Prior to Issuance of Any Building Paine. (NOTE: AChaQ It (,y) an .Amvwr fur cod,cueascn is Repaed for a Conpbar App4wmn) STATE OF NEW YORK, 5 VWN k,' COUNTY ttO11 F ...1../ SS That 1, ...SI.C. e. 'ln&M... t'...N,l............ being duly swo sand says that he/she is the applicant for Permit, me w lud Was signing, oom enq And that he/she is the ..............................................C.4?. IV 1, y III J (Omrer, Connector. Agent. Corporate Officer, eto.) 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 here ' Swom to before me this; (~~GI Ndl/61M Notary Public: LAJA 4 - .-AN f S. peR (SignatureaA ipn FORM - 06/10 Nr Q~olil1i ri '-Mp (y Ciimmisslon Expires Apui 3, 20 Bo of Trustees Application • AUTHORIZATION (where the applicant is not the owner) I, 4t-o* bCIA ~.v residing atw,t t,,,p~~V% (print owner of property) (mailing ad edf ss) N1/• 115 Qa do hereby authorize_:3oe kc~ llen (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) i Boo of Trustees Application • County of Suffolk State of New York Scc~~1 K10.-}-,sycv_ -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. !d'r`y Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF V tom( o - ,20 N tary Public JOSEPHINE CINOIJEMANI Notary Public, State of New York No. 4983831 qualified in Bronx Coun Commission Expires July 8, 2 t" APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold s Code of Ethics pSphibits conflicts of interest on the part of town officers and employees The ouroose of this corm is to provide information which can alert the town of possible conflicts of mterest and allow it to take whatever action is neeessarv to avoid same. /s 7 A YOURNAME: ~9Sef^? /T' /~/K~? V/` (Last name, first name, ipiddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the. other person's or company's name,) NAME OF APPLICATION: (Check all that apply.) - - Tax grievance Building X Variance Trustee ;~K_ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicantlagent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non-corporate entity (when the _ applicant is not a corporation); - C) an officer, director, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this & day of OG% 20j_1 Signature Print Name Form TS 1 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 significant 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, listine both supporting and non- supportine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# / ~nr'. PROJECT NAME S• _d l~P.G FN 0 V 1 4 2013 The Application has been submitted to (check appropriate response): Town Board ? Planning Board El Building Dept. P 1 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 an extent of action: Ca K~ v cfi S Q~ k- l' X 1 t Cede, M~ „~I ~1,~ 7' hau-> C-OnckaAe slQh b' x ~~-(o'' ICJ- 0 b ec(C v-~cloor Slt~w ~~clUA'l rtJ ~crlclti LV X 2 t can ns+~' Location of action: S?nlfG( Site acreage: Present land use: /eYS~ de~J' f i~ Present zoning classification: " /J, GAP ?f> ~4 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: ~J h Fz 116-f tel. (a) Name of applicant: -*)Se 4V (b) Mailing address: [ ~a.C 7-11 %7i, k, ,5o,1&l l - IJ, y 7i (c) Telephone number: Area Code- - 76 S- l7 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No r54, 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 LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ? Yes El No 54 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 ? Yes E] 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 Pa es S through 16 for evaluation criteria ? Yes ? No Policies W Pa 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 throu 21 for evaluation criteria ? Yes El No Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. ? ? Yes No Not Apoble 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 PrNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? No rNNot 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. ? Ye~:] No IrNot Applicable Attach additional sheets if necessary WORKING COAST POLICIEJ$ • 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 e Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ? Yes El No CNot 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. ? Yes ? No MNot 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 [5 5N Not Applicable PREPARED BY U O A l0"- TITLE aw~t DATE I OA S.C.T.M. NO. DISTRICT- 1000 SECTION: 115 BLOCK: 3 LOT(S): 2.1 LAND N/F OF TOWN OF SOUTHOLD ENCO r~ p n Y(Ml. I LAND N/f S8~3y 4D LE HAMN SCHECHJER ~ V 1 4 2013 *IRE wu!i.;..~..~:;'_.' °eneiwr Fj`'~ ~ _ 343 l2' ,F...,.;, . . 7.as L36•E SYt Jpr~. z ' • uorL e~ CIS M ~Rpa ti N h LAND N/F I x 190-53- OF y py rowN of S LrJniaD .W ^Y U.P. (fib JFy O . LAND F NIF N O ~(OP° i f HORNE "ry OWL, APPROVED BY E V°1 13 uP. 0-5 I,,T DuS~`k IA J. BOARD OF TRUSTEES M1,?-0 x TOWN OF SOUTHOLD ~a ss IR, 1~ O 'TPO ,Y q } ®r1. V a Ne ` ° ,k . ,F• 4 ~ry,~ I g 2, wH. k DATE fif L z ZOI ~i C Ltacic e d a ~ r i ~ LiWFJt wx - - N86'37. 40-W O \ LAND N/F 249.50• F OF L: REEVE THE WATER SUPPLY, NE'LLS: DRYII£LLS AND CESSPOOL LOCATIONS SHOwv ARE FROM FlELD OBSERVA 770NS ` ~ ^dJ AND OR DATA OBTAINED FROM OTHERS ` -:::7 ADD LOC. OF SANITARY do WELL 04-03-13 ^Sy~ * AREA: 45,418.97 SQ.FT. or 1.04 ACRES £L£VADOY DATUM: 4- To UNAUTHORMED ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA77ON OF SECTION 7209 OF THE NEW YORK STATE EDUCADON LAW. COPIES OF 7HIS SURVEY y -Z:7 -Z7 N MAP NOT BFAR/NG THE LAND SURWYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES /NOICAIED HEREON SHALL RUN ti ti v DAILY TO THE PERSON FOR MHD{f THE SURVEY IS PREPARED AND OV HIS BEHALF TO THE RTLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSI77UR0N pp; LISTED HEREON/. AND TO THE ASSIGNEES OF TIE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. 9 THE OFFSETS OR DIMEN901VS SHORN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT TO MONUMENT THE PROPERTY LINES OR TO GUIDE 7HE ERECTION OF FENCES ADDIRGNAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE S7RUCTURES RECORDED OR UNRECORDED ARE NOT CUARANIEEO UNLESS PHYSICALLY ENDENT ON THE PREMISES AT THE 711WE OF SURVEY LAND N/F~ v - SURVEY OF: DESCRIBED PROPERTY TOWN OF SOUTH'!S CERTIFIED T0: SCOTT KLA75KY; 1 MAP OF: CHRISTA L. KLATSKY; ~ ~ ~ ~ Z7 Z7 ~ JP MORGAN CHASE BANK, NA FILED: SITUATED AT: MA7TI7UCK FIRST AMERICAN TITLE INSURANCE OF NEW YOR TowN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design y4 P.O. Box 153 Aquebogue, New York 11931 FILE p 12-1 11 SCALE: 1 "=40' DATE: SEPT. 17, 2012 PHONE (e71)•LD8-ism FAX (0.11) YYa-0821 N. YS. LISC. Na 050882 m.inl.in{o~ the record. a Robert J. Nenn..y ! Renn.tb R. ~oJebuk S.C.T.M. NO. DISTRICT: 1000 SECTION: 115 BLOCK: 3 LOT(S): 2.1 LANG N/F ~E Atf a swNA. OF N n,s wu ~ qy.,,').jOw TORN OF SOUTHOLD 0R1"° .S.". J• oNiwr 1w LAND N/F ¢ 34J 2 OF HAHN & SCHECHTER t~0o'L w X I ~ 15 1 NJepMlRp W i r NOII. F..J ¢ 3DA V ARae X WELL N UP - MST Q%Mmr 343, j2• Jr • 1 - IrON. 3TS 7.275 LAND rpeE ••k.,EJtIAE x - OF I It X 188.3y P. TOWN OF SOUTHOLD { I y \ w 0.1. rI°wr IJO• / \ Obi~X//~ ` N /F N o d` 00 .lr 6A{'p HOWEE& WADELTON 2 ryo ' E ROOF Oym i [N"O V 1 4 2013 2.e = N 3 X 0 ° w 41 'S~'' ti'2e• WELL e. 82' IRL 3" \ BRICK ~i N`00H~ ABq 70, onnNn 1o%m, mnatmK~ \ ¢ 3LICA N8B•37'40'W O 249.50. F ¢ 30.4 ~ b 750' \ LAND N/F \ \EJ~ OF It 9y,1A REEVE WELL 16{°(AIm N inCN1 lY1D THE WATER SUPPLY, HELLS, DRYNELLS AND CESSPOOL ¢ ry j LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS >n AREA: 455,418.97 SQ.FT. or 1.04 ACRES ELEVATION DATUM: ASSUMED------------------ ` ¢ III 6 UNAUTHORIZED ALTERATION OR ADD117ON TO THIS SURVEY IS A VIOLATION OF SEC770M 7209 OF THE NEW YORK STATE EDUCAIIDN LAW. COPIES OF THIS SURVEY 1' \T MAP NOT 61 ARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COIPY. GUARANTEES INDICATED HEREON SHALL RUN ¢ 4.0 ONLY TO THE PERSON FOR NHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREOK AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. -tea THE OFFSEP.: OR DIMEN901VS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE oNOT INTENDED TO MOIVUA/ENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUDSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYWCALLY EVIDENT ON THE PREMISES AT THE 7IME OF SURVEY III Ice - BLAND N/F` - - I SURVEY OF: )ESCRIBED PROPERTY ~qrI- ~`Y 1, % CERTIFIED TO: SCOTT KLATSKY; owN OF Soun+a3- 1 ~ ``.1 X MAP OF: CHRISTA L. KLATSKY, Z f20 FILED. JP MORGAN CHASE BANK, NA; 1 1 1 1 i0"p FIRST AMERICAN TITLE INSURANCE OF NEW YORK; SITUATED AT: MATTITUCK TowN OF: SOUTHOLD m• KENNETH K WQYCHUK LAND SURVEYING, PLLC 1 SUFFOLK ('OUNTY, NEW YORK Professional Land Surveying and Design REVISE SWTAW LOCATION 00-02-13 y P.O. M Box 1SS 8-1560 guTA New Yob- 11951 LOC. NEIGHBORRIG HELLS AND CESSPOOLS 06-26-13 /r/ ADO LOC. OF SANITARY t WELL 04-03-13 FILE p 12- 1 I 1 SCALE: 1=40' DATE: SEPT. 17, 2012 t P)rt0A6 (~1)8YeI6Be iAZ (0.11) 2Y208-15M N.Y.S LISC. HG. 050682 melnwnrnK the Iecordo of Robert J. flenneny t Kenneth N. Voyckuk D EQ IVE V-ll NOV 1 4 2013 1 d I 1 HOT+LUB ON SIAB HoT B o sue I BV OTHERS ) U II II Z [Tj a oTHE s Il L--J 11 W L L J P4 P4 w xy H 2X8 Aco DIr o la o m16"Oc O x XI Vii; o I` 6'-6" T-8/4" 3'-9'/4" n lp PLANTING BED 41_0" 4X4 ACQ POST - ' PIERY BELOW GRADC(TVP) U'~' v1 OU M O' DECK D O SH ER U 0 XI _ PO TO NIA N r OUTSIDE n D1 NI rv ppp. SHOWER BENCH T N ~ N ,2C DI, X16OC U' 4X4 ACQ POST E5 m B ~ dj rv ON 2'%2'X1' N E 3 p EXIS EXISTING r r. CTBELOW O EXISTING C HC HOUSE GRADE (TYP.) nI~ L_ HOUSE " T HIGH WALL 61 -611 -6' 13'-O" FOUNDATION PLAN W FLOOR PLAN ~~ZT~ SCALE: 1/4" = 1'-0" V } Z (oZ~ SCALE: 1/4" = V-0" 0rn W <o c~ Z O~Om ~ 0 c oo U) W LL EX. HOUSE 5/4" DECKING AG a q.---- 2X8 DI @16"DC ® q+----""'^`- Q) 2X8 ACQ (2) 2X8ACQ LEDGER BOARD TO BE FASTEN ED GIRDER GIRDER I TO BUILDING WITH TIMBERLOK® n JDER SELF-000N ERS ZING SCREWS 9X4 POSE (2 SCREWS @ 16" OC TOP AND BOTTOM) - 1 11 ee dp M • tl ° rn _ 2'X2'X7I CONC FrG 2'X2'XPI CONC RG' xrxrl coNC G DRAWN BY: ]F Tuesday, October 1 OF NE SC SCALE: 1/4" = V-0" CROSS SECTION 7ION 9 2 SHEET NO: SCALE: 1/4" = P-0" = 1'-0" o o.os Sl FESON