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HomeMy WebLinkAboutTR-8357A oFSO�r John M.Bredemeyer III,President �'' �� y� - Town Hall Annex Michael J. Domino,Vice-President ,��� �O l0 `� 54375 Main Road P.O.Box 1179 James F.King,Trustee ; Southold,New York 11971-0959 lig Dave Bergen,Trustee @ �� ��� Telephone(631)765-1892 Charles J.Sanders,Trustee IyA � Fax(631) 765-6641 COU +*/•�''fi BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0965C Date: April 10, 2014 THIS CERTIFIES that the abandoning of the existing septic system and the replacement in-kind with (l) 1,000 gallon septic tank and(1) 8'x12' leaching cesspool At 335 Soundview Road, Orient,New York Suffolk County Tax Map # 15-3-5 Conforms to the application for a Trustees Permit heretofore filed in this office Dated December 13, 2013 pursuant to which Trustees Administrative Permit#8357A Dated January 22, 2014,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 abandoning of the existing septic system and the replacement in-kind with(1) 1,000 gallon septic tank and(1) 8'x12' leaching cesspool. The certificate is issued to Robert Schnoor owner of the aforesaid property. 169114". 'ft.\ easti~rtiir. Authorized Signature • • John M. Bredemeyer Ill,President ',Q, OFFOL4 Town Hall,53095 Main Rd. i ' G Michael J.Domino,Vice-President ;Q�y` P.O.Box 1179 y� James F. King y 1 Southold,NY 11971 Dave Bergen ;O . �� Telephone(631)765-1892 =y� `a�' '� 4 Fax(631)765-6641 Charles J.Sanders 1 �+ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION:: 9"t/ 1/%6647 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction '/z constructed N./ Project complete, compliance inspection. INSPECTED BY: ,e-ye1"-- COMMENTS: y71` -‘4'5-1 tee— I ,10 CERTIFICATE OF COMPLIANCE: .0 James F. King, President o~e~}Ef0( rco Town Hall, 53095 Main Rd_ Bob Ghosio, Jr., Vice-President = rly P.O. Box 1179 Dave Bergen Southold NY 11971, John Bredemeyer ~ydO Telephone (631) 765-1892 Michael J. Domino ' 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 Ist day of construction _ % constructed "Project complete, compliance inspection ~OF SOpj~, • Town Hall Annex John Bredemeyer, President 54375 Main Road Michael J. Domino, Vice President O P.O.Box1179 James F. King Southold, New York 11971-0959 Charles J. Sanders G Q • ~O Telephone (631) 765-1592 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8357A Date of Receipt of Application: December 13, 2013 Applicant: Robert Schnoor SCTM#: 15-3-5 Project Location: 335 Soundview Road, Orient Date of Resolution/Issuance: January 22, 2014 Date of Expiration: January 22, 2016 Reviewed by: John Bredemeyer, President Project Description: To abandon existing septic system and replace in-kind with (1) 1,000 gallon septic tank and (1) 8'x12' leaching cesspool. 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 Coastline Cesspool & Drain Services, received on December 13, 2013, and stamped approved on January 22, 2014. 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. John M. Bredemeyer, President Board of Trustees i • John Bredemeyer, President 0fF0(r Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanders ay Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Feld/Inspection/Work Session Report Date/Time: Coastline Cesspool & Drain Services on behalf of ROBERT SCHNOOR requests an Administrative Permit to abandon existing septic system and replace in-kind with (1) 1,000 gallon septic tank and (1) 8'x12' leaching cesspool. Located: 335 Soundview Road, Orient. SCTM# 15-3-5 Ty 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 Ty~f Application: Wetland -Coastal Erosion -Amendment -Administrative -Emergency -Pre-Submission -Violation Info needed: Modifications: k~ fL yJ~? Conditions: Present Were: J. Bredemeyer M. Domino J. King C. Sanders Bay Constable ~p , P~Other Form filled out in the field by c~ P/d& t Mailed/Faxed to: Date: a., b 1 • a f n n ' y p SCND 3F0 .35 LO iO M.D. 80 Pp 1010 p Pp.E`+ • wuxrvorsurrou J. ~ p P ~ y }r wxa 5 g 4 / Ye w3}} ~ .Ili 19, x a °y • ° Op as F, ay ~ ~ w s~>y ( ~ ~ ~ ~ d p n • ya • m ~ n ay ay 9 w- --D•p- -S ,aa~ O\\ 8 J ai- O 9 4 ~p a>ad I rs~l _ wxce COUNWOF SUFFOLK © > wTMa^ •°e OFFICE LOCATION: o~~OF SO(/ryO! MAILING ADDRESS: Town Hall Annex Q P.O. Box 1179 54375 State Route 25 # Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) G :bc Skr Telephone: 631 765-1935 Southold, NY 11971 Fax: 631765-3136 ~ycoum,~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM D EQ To: John Bredemeyer, President Town of Southold Board of Trustees JAN 2 1 2014 From: Mark Terry, Principal Planner LWRP Coordinator Date: January 21, 2014 Re: Proposed Wetland Permit for ROBERT SCHNOOR SCTM# 1000-15-3-5 Coastline Cesspool & Drain Services on behalf of ROBERT SCHNOOR requests an Administrative Permit to abandon existing septic system and replace in-kind with (1) 1,000 gallon septic tank and (1) 8'x12' leaching cesspool. Located: 335 Soundview Road, Orient. SCTM# 15-3-5 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. The property is not served by public water and relies on a private well for water supply therefore there is little ability to relocate the sanitary system to increase the setback from the top of bank/bluff. 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 Town Hall Annex James F. King, President SO/1tyo 54 876 Main Road Bob Ghosio, Jr., Vice-President r~ ~p P.O. Box 1179 Dave Bergen J} Southold, New York 11971-0959 John Bredemeyer Telephone (681) 765-1892 Michael J. Domino Fax (631) 765.6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only o -Coastal Erosion Permit Applicati _Weiland Permit Application Administrative Permit _AmendmentlCransfer ion V Received Application: q Received Fe 0 r KD r @~ ?ComplctedApplication I(3 -Incomplete _SEQRA Classification: C 1 3 2013 1 Type I Type II_UnlistedCoordination:(date sent) _ ~LWRP Consistency Assessment Form ' rAC Referral Sent: Date of Inspection: Receipt of CAC Reportf -Lead Agency Determination: Technical Review: 2Public Hearing Held: 2 Resolution: Name of Applicant PC ' f~MC Mailing Address C Q~- Phone Number.( ) Suffolk County Tax Map Number: 1000- i Location: \a\e 1 r- PnA Property (provide LILCOnPole distance to cross streets, and location) ll CQrK AGENT: n),(G t n n (If applicable) Address: 1') %X _X p 1 1 G 5 Phone: ~ard of Trustees Application. GENERAL DATA Land Area (in square feet): i I Area Zoning: ~SP c~k,c A~ I Previous use of property: Intended use of property: 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. i Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes ? No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date I No prior permits/approvals for site improvements. Has any permittapproval ever been revoked or suspended by a governmental agency.? y/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): eX1S~~nc4 S'PO~C tSkfnriULAc ~01R ep QV) Q nk ~ r~c~ W 1 ~ 1 c J, ~1\ongpoilcfimn'p, C!, b ?)XIa ncriru~ ee~ ~ i BId of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA ! i Purpose of the proposed operations: 9,Q~JS~rY C C1 Area of wetlands on lot: Q square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: C 1 feet Does the project involve excavation or filling? No- y'_ Yes ( . If yes, how much material will be excavated?__3Q_cubic yards How much material will be filled? p~ cubic yards ! Depth of which material will be removed or deposited: \l n feet Proposed slope throughout the area of operations: 1 A 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): i 617.20 Appendix B Short Environmental Assessment Form L Instructions for Completing f Part I - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses I. become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part I 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. r Part 1- Project and Sponsor Information eSs o Or > , Names of Action or Project. J ~ C- 1 Q V)Q \f Project Location (describe, and attach a location map): ~a Brief Description of Proposed Action: - I Ze Ojace \ r)c ~ rno\ wi h C 1)1 CXZ0 , S Q~r1; C- dC) x ~a 1-eaU-\ \.Y1cleesRoo I Name of Applicant or Sponsor: - Telephone: ccos-w~~ Cc C") Address: rJ C. U n . City/PO: I State: Zip Code: w~ ~ \Q 1. Does the proposed diction 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 u? may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 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: ? 3.a. Total acreage of the site of the proposed action? 2 acres b. Total acreage to be physically disturbed?. c. Total acreage (projed site and any contiguous properties) owned or controlled by the applicant or project sponsor? _D-acres 4. Check all land uses that occur on, adjoining and near the proposed action. ? Urban []Rural (non-agriculture) ? Industrial []Commercial [BlEesidential (suburban) []Forest []Agriculture - []Aquatic ?Other(specify): []Parkland Page 1 of 4. f 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ? ? b. Consistent with the adopted comprehensive plan? ? 71 a 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ? l 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: ? j i 8. a. Will the proposed action result in a substantial increase in traffic above present levels? NO YES j 1 ? b. Are public transportation service(s) available at or near the site of the proposed action? IaI r}~ ? 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: ~y 10. Will the proposed action connect to an existing public/private water supply? NO YES If No, describe method for providing potable water: tJ ~'A ? 2 11. Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment: EJ ? i 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? FNO ? b. Is the proposed action located in an archeological sensitive area? f~f 1- 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain 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. Ide fy the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: L!TShoTeline ?Forest ?Agricultural/grasslands ?Earlymid-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? ? - j LIA 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 I . If Yes, p-]~ ? a Will storm water discharges flow to adjacent properties? MNO ?YES L:J b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: uNO [DYES Page 2 of 4 i 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 I' completed) for hazardous waste? If Yes, describe: j j 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname; Date: \j\ e,\A', Signature: j. 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 1 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 i,. occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ? 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? 1 ? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment ofa 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 -reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a. public / private water supplies? b. public / private wastewater treatment utilities? u ? 8. Will the proposed action impair the character or quality of important historic, archaeological, Er ? architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, Imo' ? waterbodies, groundwater, air quality, flora and fauna)? - U 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 r~/ ? problems? 1-11 11. Will the proposed action create a hazard to environmental resources or human health? a. ' 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, j duration, irreversibility, geographic scope and magnitude. Also consider the potential for short-tern, long-term and cumulative impacts. I' 1 I 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 im acts. Town of Southold - Board of Trustees Name of Lead A envy ate . / Resident Print or Name of Res nsible off n Lead Agency Title of Responsible Officer gn re of. a 1 le Offic to Le ncy Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 loo Town of Southold Erosion, Sedimentation 81 Storm-Water Run-off ASSESSMENT FORM _ PROPERTY IACATI : s.C.TJit k THE FOLLO HHO ACTIONS MAY REQUIRE THE SUBMISSION OF A sq, YI°- STO ATBR, GRADING RAINAOrr D BROS PLAN ' g - CERTIFIED BY A T STATE OF Njl4YT SCOPE OF WORK - PROPOSED CONSTRUCTION TEEM # / WORK ASSESSMENT Yes No a. What Is Me Total Area of the Project PalCete? 1 Will this Project Retail All Storm-Water Run-Off (Include Total Area of all Parcels located within I Generated by a Two (21 Inch Ralolall on SBe? - the Scope of Work for Proposed COnsbucBon) 1 n r l e (This hem will Include all run-off created by site b. What Is the Total Area of Land Clearing- clearing and/or conchuctlon actlvlties as well as all andfor Ground Disturbance for the proposed Site Improvements and the permanent creation of i construction actiNtyl \ ( Impervious surfaces.) p~ewsAaanonlPasseNeedeO 2 Does the Site StPlan ructures Survey Show AHProposed It Drainage Structures Indicating >Raa 6 Location? This rnls PROVIDE Big PROIECr DESCRIPTION ? Item shall include all Proposed Grade Changes and ~Yt t f~ P 1 1 ~I CA corn/ C' Slopes Controlling Surface Water Flow. 11,~ 3 Does the Site Plan and/or Survey describe the erosion r7\0 Qr 44.~1L M. X-15-~(i 1 1 1 n k j nit and sediment control practices that will be.used to control are erosion and storm water discharges. This ~C nshumust ccton Perio~d. nee throughout the Entire (1 > ~ kA Cf1 n Cn 02S,, 1. 4 Will this Project Require arty Land Filling, Graft or Excavation where there is a change to the Natural Existing Grade involving more ten 200 Cubic Yards of Material within any Parcel? Activiti / 5 Will this Application Require Lard Disturbing Encompassing an Area in Excess of Five Thousand" ? (5,000 S.F.) Square Feet of Ground Surface? 6 Is tare a Natural Water Course Running through the Site? Is this Profectwthin the TmataeslurBAction ? I G naval DEC SWPPP Rsaalremenia: or within One Hundred (10(y) teat of a Wetland or - I Subnhebrh of a SWPPP Is reputed for all Ccatruclon modAn Invohire sot Beach? j dlabnbeloes of one (1) or more son; Including dhwrbonwa of hen Nan one ace cud 7 WIII there he Site preparation on 5deting Grade Slopee ? are pad of a larger caverns plan Met will uBmelay disturb one or mhos aces of land; which Exceed Fifteen (15) fee[ of Vertical Rise to ? dndumg Convauagn ac§W§n Involving not awwmneea of bes than one(f)acre where One Hundred (1W) of Hodmmal Distance? tin DEC hndetrtmwed Net a SPOES psma In required foratonhh water d ncharyn. (SWPPP's Shat maintain Blnanum Ilapuimmans, don SPOES General Pamit 8 Will Driveways, Padding Areas or other Impervious Tor Sam Water Discharges Nam ComdrucBon actift-Pent No. GP440401.) Surfaces be Sloped to Direct Slono-Water Runt ? 1/ 1. The SWPPP shall be prepared Prior to the wAaMM of ale NOI. The NDI shel be Into and/or in the direction of a Town dghtof-wsy! submitted to the Department Prior toNe oorrwernn med of construction a". 2. The SWPPPshall describe the erosion arm aadanerrtmrard practices and vAare 9 Will this Project Require the Placement of Material, raquire4 podtcondmrcdon storm water mnrgament pradioes that will be used andbr Removal of Vegetation andfor the Construction o :i _ comwrsdlomduce Uepoldenhinmmh welermechergnwWbD ate Item Within the Town Rlghtof-Way, or Road ShWWer v cenPllenm with Me tams and tondNOne of thin pernit. In addalon, ale SWPPP dial Arm?(mslms caw narwswae a,meNS,saenaq Ahes,al - - WenBypotential sources ofpoahtlorwhich mayreasonably ba sWaNd to affect do NOTE: NArny Aneewrb qucetloesQuaNreugh NlualaAcewees wNhe CThaesltark puaAty alms teat roq*elheppntcarehhstlonshc n Ina Soeend is construction ate di urban, to between 4001) BY. a1 Asa ra soon. compwwds bopropbpamdlhebya deagnmbubWwindaninNmewy Yam aSbrm.Waar,(kadlnA brininess a@nbn cordial Pan Is ttpWnd by eaTewnof vim la lanovdedpeahla WCakelps m In the pdrwpes as and an predicts ofSbmnWaterh'ISloomWeloor MedelrPpemhenht• Southold and NesA be BulanRlad for Rnlesr Prbrlo Issuance afAnythieft F 4 0IM: Aehe*MUk(,f)anw AN irssmCme Is PAwASdMaCwOMAgamd" STATE OF NEW YORK, COUNTY OF .~iAIWQ\ SS 17hat~... being duly, swum, deposes and says that he/she is the applicant for Permit, paeene dtedWdual agMq comment) And that he/she is the ...1~fC&&W.4ttl°.......Gt . r 'c - Nil Pf%.- l (OAnan (,lpntrader, Aped, CapaOla an, ete.) 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 befieE and that the work will be performed in the manner set forth in die application filed herewith. Sworn to before me this; i t2rSC Hgt Notary Publi ...TF: (11; NF (agnabre dApplewA) FORM - 06/10 -Registration No.OIGA6274028 - Qualified in Suffolk County Commission Bapims Dec. 24, 2016 i Board of Trustees Application • i i County of Suffolk State of New York f r Q~ BEING DULY SWORN DEPOSES AND AFFIRM THAT HE/SHE IS THE APPLICANT FOR THE ABOVE j 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. Signature ofd 0C'~iY~ D ( _,20_ SWORN TO BEFORE ME THIS X t DAY OF A\ No c Eve L. GA1Z-SCIiWAMEGRN NOTARY PUBLIC. STATE OF NEW YORK Regisvauon No.OlGA6274028 Qualified in Suffolk County Commission 6xpirea Dec. 24, 2016 Board of Trustees Application • i i AUTHORIZATION (where the applicant is not the owner) P__,, I, ~c7~ C (l (1C~~~ residing at ~z rr 9~ y e VAC , (print owner of property) (mailing address) do hereby authorize-C C~f V- (Agent) ~e5 r~ to apply for permit(s) from the Southold Bgerd of Town Trustees on my behalf. (O er's signature) I APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE, FORM i' no Town I of e to Code of Ethics prohibits conflicts of interest on the Dart of town officers and amolovees. The morose of ' this aform is to is information which lot the town of poa Ne conflicts of Interest and allow it to take whatever ad is necinstry to avoid same. YOURNAME: Loosk\ CeSS~aA ° Df' . SUC.. (Last name, first name, Middle Initial, unless you ate 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: (Cluck all that apply.) i Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activity.) Do you personally (or through your company, spouses sibling, parent, or child) have a relationship.with any officer or employe 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 I - Describe the relationship between yourself (the applicantlagentImpresentative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The low 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 employe of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this is f . Signature Print Nam ~]S_ Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I 1. 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 MMsed action will be evaluated as to its significant beneficial and adverse effects uoon 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 suunortm¢ and non- aMortina 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 SouthoId's website (southoldtown.northfork.net), the Board of Trustees O P "e local libraries and the Town Clerks office. I B.. DESCRIPTION OF SITE AND PROPOSED ACTION DEC 1 3 2013 I SCTM# PROJECT NAME c,- The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees I~ 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: QY~Cac~Cj cx~ ~o Oil ~ ~ as ~4. ~1ncP . r~Y ~ r)n n Location of action: ~ Qty 9 ~ e ~Q"~6 be k- Site acreage: 2 Present land use: 2 S 0 nl n n Present zoning classification: Q k 2. If an application. for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: I (a) Name of applicant: (b) Mailing address: ado l Y-) (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? i Yes El No a 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. 4 Incomplete answers will require that the form be returned for completion. IIII 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 aNot 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 El Yes El No 12yNot Applicable I . i i I 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 I_ ? 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 Ea Not Applicable I Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ? Yes ? No a 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. ? ? Ef Yes No Not Applicable i l i 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. I ? Yes ? No 9-Not Applicable Attach additional sheets if necessary i. Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous i substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ? Yes ? No ? 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 ~ El Yednn ] No L `1 Not Applicable Attach additional sheets if necessary i 0 WORKING COAST POLICIES j 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 Not Applicable i Attach additional sheets if necessary I 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 2 Not Applicable I Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies;; Pages 65 through 68 for evaluation criteria. El Yes El No D -Not Applicable PREPARED BY TITLE f f Q S C]10 rl~ DATE It 13 as 24 _n 26 S9 6 1 TOP OF - 28 ' 6' Q 2&t CD t0_ FOUND PIPE , 20/ 30.9 2LZ V y^~ 14 • ~ \ IGf// Xa10..7 \X Y20 STONE \ • NE[J/!L'bCit~G WALL 1212 X; O X ST y ,11.2 31.6 STONE PARO ? W( I m 31.6 30.0' • S PS gi M ° 3.6' n 14,5' '11.5 5.3' `~B. c 1: ry0 0. 10.7" .7' 2.0' o ~ SS 1 t.9' S. 1 STORY FRAME HOUSE o N WKL ~r~i 1 2B.S 2 e'W. yYa=L s G ° ~ aA 36.3. F.FL 329 El p ROOF OVER in 3 WOOD PORCH 18.3' h O a O N WOOD ~ STEP BRICK 1 WALK • 1 n 1 s I ° 1 P 1 LAMP < o. ` • WELL POST 'W 1 I APPROVED~PY 11 0 N I BOARD OF TRU E$ 1 ° TOWN OF SOU LD 1 J 00 1 DATE 22-1 N • I \ n 1 FOUHO / / ~ e ~pE J I / J / Ot WIRE / • • 44 GUY • FOINO MOH, OVEa • o. WIRES CONC. E % . • W T0.m POL O p0 q FAIT23 / e e• a . / E .::u QY POL . r.l H • • . ~ 22 24 .bj~ 26 Bi TOP OF 28 O 10- 2U 14 / POUND IPE 16 22,7 / - _ 20 / / ? / Wove' 22 / / / y / / OEGK \ 24 26 / / 1Q 9 38 / \ X lu\ 29,2 \X STONE / WALL T23 X r, O JJA x Q J1.2 STONE PATIO T P D n 000 .2Lff 30.4 6 • STFPS gi COO o m 14.5' 31 s 0 5.5' .3.6, 0. 10.7' n .7' 2.0' 4 0 v. e xo 14.9 So' 1 STORY FRAME HOUSE m t, ~ 2as W~L 2!'W ? ap 4 36.3. a J m p ROOF OVER U ' C ± WOOD PORCH 183 MOO WOOD ° STEP 15.3, °a BRICK 1 WALK 1 p ECEpa<E D .m ~ 1 DEC 13 2013 o' R I 1 m ; P a F J L I ' LAMP ~ ar ' 3I 4-WE L POST W 1 J 00 N • I ° 1 ~ O)EO ' J I - J - . - gooo ° . W1REi GUY . FO INO AON. CEP ENO. a • c. WIRES 00NG. POLE uT110~ .4 4 0 41. SURVEY OF LOT 47 MAP OF ORIENT BY THE SEA n .P J~ Sq pS 1'30PM O] SECTION TWO FILE No. 2697 FILED MARCH 27, 1957 Vow wp1ER MM 100 05 SITUATE ORIENT POINT w TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK E WP~'piM H~ / N 1,02 0"`/ sa ED 1^0 RE/ - ~ S.C. TAX No. 1000-15-03-05 1-T- 6 c SCALE 1"=20' APRIL 27, 2011 -4 -1 -14 d ~ _ _ MI6 20 AREA = 22,549 sq. ft. 22 (TO TIE LINE) 0.518 CO. 24 - NO 26 ~n x TOP of BANIr - 29 O 2a I FFE PIPE ~f73g~ l -lS 3-~ 16 < is 22j/ 26/ 11 28/ / ]gs \ 321 NOTES: ao ~ \ 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:sa w\ x~-° 1 EXISTING CONTOUR LINES ARE SHOWN THUS: - - - -s- - - - N.\ F.FL. - FIRST FLOOR ]z a STONE c FL. - GARAGE FLOOR TE - TOP OF BULKHEAD \ /-WALL 51 h B B - BOTTOM OF BULKHEAD T.W. - TOP OF WALL O B W. - BOTTOM OF WALL 1 y STONE PATIO o s P ~r a .1a6 wr~oo ~ °g 31 6 30A' SiFPs }6 m 31 145 ` 55' lg o 1,0^p a, mr oo 20' F T 5 g' 1 STORY FRAME HOUSE o' O WALL 4 m lu ~ 4g s 36 T y W a W FE. J29 I El ROOF OVER I? m 3 woo0 PERCH 193' O a WOOD g SEEP °4 • U`~ 8 nDa 7-- • BRICK WLLH a I ° • `1 m ~ 1 Z 5 • ,o PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED WELL pp5i4 BY THE LLALS AND A YAND ADOPTED FOR SUCH USE BY e ATE LAND 3 TITLE ASSOCIATIO~( t!_ fl 9'p 4 Y gyp? O o y 1 N 'a 4 I V °an 11 J cl~ Tk c z N vM\N~ / N <n APE ~ N.Y B. To. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY 15 A VIOLATION OF SECTION 72G9 OF THE NEW YORK STATE EDUCATION 09 L~ J I EM W\PE~ i i a sWa i 1 pp pp~ a e. r. e< .O GAT UNO M 'GJs ; a r r a, Nathan Taft Corwin III COPIES OF THIS SURVEY MAP NOT BEARING WIPES GOA DIE e' L oN\tlT(p / e , r r e i THE LAND SURVEYOR'S INKED SEAL Land Surveyor EMBOSSED SEAL SHALL NOT BE CONSIDERED 20~OD }R`L LP IIa 0\.E r TO BE A VALID TRUE COPY. 3p, pp" EaLC of CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY r- 1 EIEM~ER, OLO OF4,V P PP r ! r 5 PREPARED, AND ON HIS BEHALF TO THE Successor To Stanley J soksen, Jr. L.S. TITLE COMPANY, GOVERNMENTAL AGENCY AND Joseph A. In9egno LS LENDING INSTITUTION LISTED HEREON, AND INSTI- TO THE ASSIGNEES OF THE LENDING Title Surveys - SubdIVI510ns - Site PIONS - ConsfNCflan Layout TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE 14 r e r <r r~ 1'~~ PHONE (631)727-2090 Fax (631)727-1727 ~0 THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING AGGRESS AND/OR EASEMENTS OF RECORD. IF 1585 Main Road P.O. Box 16 ANY. NOT SHOWN ARE NOT GUARANTEED Jomesport, New York 11947 Jancesport, New York 11947 31-031