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HomeMy WebLinkAboutTR-8375A OF SoUT John M. Bredemeyer III,President Town Hall Annex�o�� yOIO Michael J.Domino,Vice-President 54375 Main Road P.O.Box 1179 James F.King,TrusteeAW Southold,New York 11971-0959 Dave Bergen,Trustee Telephone(631) 765-1892 Charles J.Sanders,Trustee O! • �� yCOUNN,��' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1049C Date: October 1, 2014 THIS CERTIFIES that the as-built±2F wide by±16.7' long reconstructed deck with t6' wide steps attached to dwelling;the installation of gutters to leaders to dr)Yells onto dwellin¢• a 6' wide non-turf buffer landward of existing fence At 1155 Aguaview Avenue East Marion,New York Suffolk County Tax Map#21-2-15 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 25, 2014 pursuant to which Trustees Administrative Permit#8375A Dated March 19, 2014,was issued and Amended on September 17, 2014 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 as-built±21' wide by±16.7' long reconstructed deck with±6' wide steps attached to dwelling,• the installation of gutters to leaders to dwells onto dwelling; a 6' wide non-turf buffer landward of existing fence. The certificate is issued to MOELLER FAMILY TRUST C/O MARGARET JESPERSEN owner of the aforesaid property. Authorized.Signature CC# : C14-24412 COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 06/10/2014 under Liber D00012776 and Page 965 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 06/10/2014 SUFFOLK COUNTY1 CLERK (;7- Q. r[J JUDITH A.PASCALE s '10 2014 __� SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 06/10/2014 Number of Pages: 4 At: 02 :20 :37 PM Receipt Number : 14-0075432 LIBER: D00012776 PAGE : 965 District: Section: Block: Lot: 1000 021 . 00 02 . 00 015. 000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20 .00 NO Handling $20 . 00 NO COE $5.00 NO NYS SRCHG $15 .00 NO TP-584 $0 .00 NO Notation $0 .00 NO Cert.Copies $5 . 00 NO RPT $60 . 00 NO Fees Paid $125 . 00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County Fil F21 RECORDED .01J, Ain 410 0220:37 Ptl Number of pages `±�' ' A. PGSCAI E LERK OF SUFFOLK COUNTY L D'C-1,00 i 76 This document will be public P 965 record. Please remove all Social Security Numbers prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recoding/Filing Stamps 3 1 FEES Page/Filing Fee rX Mortgage Amt. 1. Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. Vor EA-52 17 (County) Sub Total V Spec./Add. EA-5217 (State) TOT.MTG.TAX Dual Town Dual County R.P.T.S.A. Held for Appointment Comm.of Ed. 5. 00 m Transfer Tax Mansion Tax Affidavit ���' --.� The property covered by this mortgage is Certified Copy or will be improved by a one or two NYS Surcharge 15. 00r family dwelling only. Sub Total 17-) YES or NO Other (' Grand Total J If NO,see appropriate tax clause on )� page# of this instrument. r .0 1-/ 4 1 Dist. 2739720 1000 02100 0200 015000 5 Community Preservation Fund Real Property T I IIIIIII�II w Consideration Amount $ R Tax Service IIIIII�IIIII�III�IIIIIIIIII Agency 10-JUN-14 CPF Tax Due $ Verification Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: Vacant Land TD TD//";7//";7-3 .j TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co. Name www.suffolkcountyny.gov/clerk Title# 81 Suffolk County Recording & Endorsement Page This page forms part of the attached //Ted-/ yAl made by: �- (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in f �S_ SUFFOLK COUNTY,NEW YORK. O / In the TOWN of Sou,--�t,p I a `o W �� In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12-0104..10/08kk (over) DECLARATION OF COVENANTS THIS DECLARATION made this `±f day of 20 _4A , YL residing at hereinafter referred to as "DECLARANT(S) II : W I T N E S S E T H WHEREAS, DECLARANT(S) is/are the owner(s) of certain real property located on Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section -I/ , Block Q , Lot /.'�_ which is more particularly bounded and described as set forth in Schedule "All annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT(S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that "non-turf buffer" adjacent to and landward of 4-, NOW, THEREFORE, the DECLARANT(S) do/does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and subsequently maintained 0 "non-turf buffer" as defined by Chapter 275 of the Town Code; and jas depicted on the / ��`— � ('°C.•����� /-'zt"'tl) ��-l:)� ,� '�ze �f"f' i �Gt�`' �� E ���� �`�O�Ci�•?;/�f"L l_ . f and 2) These covenants shall run with the land and shall be binding on the DECLAR.ANT(S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees. IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this day of 20 ' !+• ( .-- ' ERj SI TUR AE-)e4 .' _O E IS SIGNATURE STATE OFjL1f�\� ss: COUNTY OF >� ` On the n day of— )J'4 in the year 2014 , before me the undersigned, a Notary Public in and for said State, personally appeared \ML1 1oVr� --(Alld �10(Jl kgtojArsonally known to me or proved to me on the basis of satils�factory evidence to be the individual (s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature(s) on the instrument, the individual or the persons on behalf of which the individual (s) acted, executed the instrument. Notary "pub is JENNIFER L COHEN Notary Public-State of New York 2 N0. 01C06247209 Qualified in Suffolk C3unty My Commission Expires_ /.L SCHEDULE A Dist.: Sec: 21 Blk: 2 Lot: 15 County: Suffolk Address: 1155 Aquaview Avenue, East Marion,New York 11939 ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the East Marion, Town of Southold, Suffolk County,New York, bounded and described as follows: BEGINNING at a point on the northerly line of Aquaview Avenue at the northwest corner of the premises herein described, said point being 1140 feet from the easterly line of Rocky Point Road as measured along the said northerly line of Aquaview Avenue; from said point of beginning. RUNNING THENCE north 3 degrees 40 minutes 10 seconds west along the Land of Giblett 280 feet more or less to ordinary high water mark of Long Island Sound; THENCE easterly along said high water mark of Long Island Sound 42 feet more or less to land of Salamone,formerly Sands; - THENCE along said line South 6 degrees 10 minutes 10 seconds east 300 feet more or less to the northerly line of Aquaview Avenue; THENCE along said line north 69 degrees 10 minutes 10 seconds west 60 feet to the point or place of BEGINNING. • 0 John M. Bredemeyer III, President gufFot't Town Hall,53095 Main Rd. Michael J. Domino,Vice-President a� Gy P.O.Box 1179 James F. King y Southold,NY 11971 Dave Bergen Telephone(63 1)765-1892 Charles J.Sanders l � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE O INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale linetsilt boomisilt curtain 15t day of construction z constructed Project complete, compliance inspection. INSPECTED BY: eTi COMMENTS: X. CERTIFICATE OF COMPLIANCE: 0 John M.Bredemeyer III,President ��OF SUUj�o Town Hall Annex Michael J. Domino,Vice-President h0 lQ 54375 Main Road P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,Trustee Mum Fax Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 17, 2014 Mr. & Mrs. Al Jespersen 21 Camelot Lane Setauket, NY 11733 RE: MOELLER FAMILY TRUST C/O MARGARET JESPERSEN 1155 AQUAVIEW AVENUE, EAST MARION SCTM# 21-2-15 Dear Mr. & Mrs. Jespersen: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, September 17, 2014: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit#8375A to maintain a 6' wide non-turf buffer landward of the existing fence in lieu of an 8' wide buffer from of top of bluff landward; and as depicted on the revised project plan prepared by Al Jespersen, received on September 4, 2014 and stamped approved on September 17, 2014. 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:amn .,} 7 , ,.. • Iwa J •_ •- •-'mow. •• ,. r by • 4 .# Y,' 47 Moeller Family Trust c/o Margaret Jespersen 1155 Aquaview Avenue, East Marion 3/10/14 Aira x — F s_ r t • a > b fi f 1 a4: SEP - 42014 "'Out i4a.f � _ �. a ' S I a £ u s • } �F. �. Aye +�'�. *F I� ,I+' � �.,�r"` id i P v e .. Yo UAAdL Aw f v Aye '" .., - , AR r _ J �.a '�,�b a _� °� 1 � �:�k i •' _ e y Y� w s y v 44 �ftYa � 2 a }} 1 x N a yn} a - r w e a . ---------- 4F- 40, All n ': , w 44 ` §� � q' 5�, wok "�•' �y{� '"M '�l � � e • 5 - s � is G t � . f r .r i r� r � ., e. r INOW AMA, y y .. —0111� ....... ,rte �i Now � • u • ri�ri F x z* e � R � w r x� o a t i a. }3 ': �� ♦.a E;yN,e.. % �.Y y Fa ry k. m .d.,.nr,wvN.•- "E F r ,., y ". t{• 3k';> yB.•„ ,aas.a ' „mom 'F" _ _ F 0 0 John Bredemeyer, President �o0FF94Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King - P.O. Box 1179 Charles J. SandersSouthold, NY 11971 Dave Bergen ��o! ,� �a°' Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionMork Session Report Date/Time: �0 ^ l Albert Jespersen on behalf of MOELLER FAMILY TRUST, c/o MARGARET JESPERSEN requests an Administrative Amendment to maintain a 5' wide non-turf buffer landward of the existing fence in lieu of an 8' wide buffer from of top of bluff landward. Located: 1155 Aquaview Avenue, East Marion. SCTM# 21-2-15 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: 9 / "` t'f 6 � Nl Conditions: A Present Were:4J. Bredemeyer /M. Domino /J. King/C. Sander4 D. Bergen Bay Constable Other Form filled out in the field by V ��G� E.�'f�'�'t� ✓ Mailed/Faxed to: Date: RAI NAG E SYSTEMS LONG ISLAND SOON ? ' ORD. HIGH WATER MARK STEM#1 4?t —- �- - SEP - 4 2014 OOF AREA= 485 SQ.FT. 85 X 0.167= 80 CU.FT. SE(1)6'0 X 4'DEEP POOL= 89.36 CU.FT. SYSTEM#2 I1 ROOF AREA= 485 SQ.FT. 1 485 X 0.167= 80 CU.FT. 1 1)6'0 X 4'DEEP POOL= 89.36 CU.FT. 1 APPROVED BY I M I MW _ BOARD OF TRUSTEES ' TOWN OF SOUTH F-D Agcy, 1 ' DATE CU I 4"PVC FROM ROOF LEADERS F � 1 - >k PRECAST REINFORCED +1 SOLID DRAIN DOME. 030a0 N CAMPBELL FOUNDRY FOF NES 1 #1009 FRAME&COVER EXIST.WOOD STEPS IEXIST.WOOp FENCE GRADE ell— LANDSCAPED BUFFER �= LANm'.SCARi=O BUFFER b � AS PER TOWN OF `p40�uFF� 1 AS PER TOWN OF SOUTHOLD CODE SOUTHOLD CODE SECTION 268-3 —,. :SECTION 268-3 afp 1 ®®®® ®® a a a a o ❑ WOOD ®®®® ®® a a a C7 C] ❑ DRAINAGE SYSTEM 1 I aDECK 1 ®®®® ® a Ca a ao ❑ (PRE-CAST CONC. RING) �LEADER FROM ROOF10 ISI®L�3. I a o a o 0 o W 1 � i EXIST. 1 ®®®® ®® a a a a M I 0 coRY 0 1ST HOUS I a O a a a ❑ 0. I. 1 LEADER FROM ROOF ®®®® ®® a a a a o ❑ U. DRAINAGE SYSTEM 2 I : ®®®® ®� a a a a cm C3 0 (PRE-CAST CONIC. 10'-0". RING) I ®®®® ®lam a a a a o ❑ +�I a la a o o ❑ J ' 1 N I C] ❑ W RocKV TO a a o ❑ ai PrRo zl o ®®®® ®rte r ( O ®®®® ®® a a C7 C7 C] ❑ 1°<O pvq�iF 'ui V-0"DIAMETER q z 'q I/FAVF e69 1 GROUND WAT- t _ SOIL BEARING CAPACITY IS SUFFICIENT TO ALLOW FOR 0 THE ELIMINATION OF FOOTING RINGS ,� PROPOSED DRAINAGE & LANDSCAPE PLAN SCALE:1" =so' 2 DRAINAGE BASIN N.T.S. BASED ON A SURVEY BY MICHAEL K.WICKS,INC DATED SEPTEMBER 28,2009. p EC •P �� FEB 2 5 2014 11 NO. 099102 MOELLER RESIDENCE JOHN CUNNIFFE '- ARCHITECT JESPERSEN• DESIGN CONSULTANTS DATE 72721 - 11 BLUETOP RD.SETAUKET,NY 11733 DRAWN 11 Stony Brook Avenue cHKOP.A.T. Fast Marion New York Stony Brook, New York 11790 PHONE 631.834,8745 T 1.631.751.0590 P1E$PIOOPTONLINE.NET REV. DATE SUBMISSION F1.631.751.0592 02.20.14 ISSUED FOR FILING john@jdcarchitects.com Al and Margaret Jespersen Moeller Family Trust 21 Camelot Laner._., �`` a Setauket, NY 11733 f J 1 Sept. 4, 2014 SEP - 4 2014 i Board of Town Trustees Town Of Southhold Re: Final Inspection of 1155 Aquaview Ave. E. Marion Dear Sirs, Enclosed please find our application for an amendment to the wetland permit for 1155 Aquaview Ave. East Marion. We are requesting that a 5 foot wide landscaped non-turf buffer as measured from the existing fence is acceptable as per the original LWRP determination meeting of Jan. 5, 2012 Presently the landscaped non turf buffer is five feet from the fence. Please note as indicated on the survey that the bluff line is at minimum three feet behind the small fence. The non turf buffer in relation to the bluff line is eight feet. Enclosed please find pictures of the bluff and the dense vegetation on the bluff. We have made every attempt to be compliant and hope you will consider our request. Respectfully, Al and Margaret Jespersen (Moeller Family Trust) 0 • To: Town of Southold Board of Trustees From: Al Jespersen ( Moeller Family Trust) Subject: Final Inspection of 1155 Aquaview Ave. E. Marion Date: 8/08/2014 Enclosed please find the survey of 1155 Aquaview Ave. Please note as indicated on the survey the dotted line which indicates the bluff line. This dotted line is at minimum three feet behind the small fence. The non turf buffer in relation to the bluff line ( dotted line) is eight feet. Respectfully, 6 a.. Al & Margaret Jespersen AUG - 8 2014 Cell Phone# 631-834-1976 LONG ISLAND SOUND 42't 1 1 r \ r r �+ O O {i (On O O CA N r Q 1 r �+ 1 W L _ offs E wa 4 O 5.9' 1 ' O • I STORY t N o M Z � #11551, yr 4w 6.4' FM mcc.eaer 1 '� e 13.5' ns (G d.6L 1140.00' ""a me key ,E FL Kx N 69.10'1 p•ONS 4 QUA UI 60.01, w Ayy� p r 'Ifv 6 RE IB lYK A/$ 1�. nci.NoOWMa�.®ui an sa v WXKC o WWAwnm .. °. '°" .�"'° a SURVEY OF S": Michael m ON caeK Wicks,Inc. M� 1" = 30' �. LAND SURVEYING PROPERTY DATE: �..�..�.,�„ a.c- rwso wio a edwa m nc TME 0°°'"'.annnai owaw,m,wc"'r1O10- N v.5.LIC.#50390SITUATESEPT. 29. 2O0 ae MA aAOM M"m� SB P.O.6OX 493 UNDENHUR5T,NY 11757 TOWN OF SOUPAOLD n.mrF a�oaus)=,�.M MIK MMUN�m ac SUFFOLK COUNTY, NY ,,,�, ,,5�„� � � VOICE:631.874.0156 WO-021-02-15 SHEET: " MCK Donnas m r.urtfOt w�wn aaei me as anewucao. FAX:631.909.3845 1 OF 1 ROCKY POINT ROAD 11 O o N 03640'10" W 280,0± ALO rufar woao it S 06°10'10' E 300.0± 1 J b FROM : AL JESPERSEN PHONE NO. 5166893882 Apr. 04 2014 12:04PM P1 Margaret and Albert Jespersen qp 21 Camelot Lane 2 n [ y East SMauket, NY 11733 Illjvn[ul (631) 751-1157 APR - 4 2014 Tr Board of Town Trustees Town of Southold 54375Main Road P.O. Box 1179 Southold, New York 11971-0959 April 4, 2014 RE: Request for change in storm drainage pool location Permit Number. 8375A Applicant: Moeller Family Trust C/O Margaret Jespetaen SCTM#: 21-2-15 Project Location: 1155 Aquaview Ave, East Marion, NY To Whom It May Concern: Upon further review of existing site conditions, I am proposing to mortify the proposed storm drainage basin location as indicated on the approved drawing LS-1 dated 02 20.2014. In lieu of installing two (2) 6'-0" diameter by 4'-0" deep pools on the west side of the house, I would like to install one (1) 8'-0" diameter by 4'-0" deep pool. Please refer to the attached sketch and storm drainage ring capacity chart. Respectfully. Mawet Jespe AlbcrtJcspetsen I~o~ o ~ ~ I A I 1 1 IapIB®DM - an ® ® O t wx°®® 0 0 0 0 0 0 3 DRAINAGE SYSTEM 1 Il i 0 0 0 (PRE-CAST CONC. RING) D t- { o o c o 0 0 40' 1 LEADER FROM ROOF ® E® Q3 o 0 0 0 0 o a ITI i 1 m ii L BY 0 0 0 0 0 0 of N ~j Me ous [man in o u- o c~ c a z I IM ® ® o 0 0 0 0 o O DRAINAGE SYSTEM 2 LEADER FROM ROOF ® u 1 o coooo co (PRE-CAST CONC. RING) 1~-O M®®GM z `~1 I I In®®@®® ° o 0 0 0 o O 1 J\ cl 0®®17M®® o 0 0 0 0 0 v 7140 I`)j N, 0®1M®®® oc~ooo~ U R0 r0 o ~w ®®®®®t~ o 0 0 o a a W qn ®1»~®®® o 0 0 0 0 o Z Y~/ Im m 9' ` 1N -0" DIAMETER o a 9 _ GROUND WATLR - (n I J~ T SOIL BEARING CPPACITY IS SUFFICIENTTO ALLOW FOR m A~ n - 70 1 ` ~ THE ELIMINATION OF FOOTING RINGS W W U y6- i< i) g l X `I~ 1 UY~-Y POOL, - Kc `5 60 - F ! r r00o P OPOSED DRAINAG LA AP N SCALE: 1" =30• DRAINAGE BASIN NTS BASED ON A SURVEY BY MICHAEL K. HACKS, INC DATED SEPTEMBER 28.2000. E F I V E APR - 4 2014 A ro A. A. N M JOHN CUNNIFFE -ARCHITECT JESPERSEN • DESIGN CONSULTANTS ---tea- 3 OELLER RESIDENCE . East Marion 11 Stony Brook Avenue 11 BWEIOP RD. SETAUNET, NY 11733 F&I New York Stony Brook, New York 1179D PRONE 631.834-8745 w T 1.931.751.0690 REV- DATE SUBMISSION F1.931.751.0582 PJESP10OPT•ONLINE.NEr FROM AL SESPERSEN PHONE NO. 5166893882 Apr. 04 2014 12:05PM P2 GENERAL NOTES: 1. Concrete to Test 4000 P.S.I. ® 28 Days. 2, Welded Wire Mesh Meets A.S.T.M. A-185 A A All - 4 2014 i OPENINGS REQUIRED FOR J SPACING & HANDLING PLAN SPECIFICATIONS AREA Dimensions A 8 C LEACHING M403 VOLUME WEIGHT 8'-0"0 4'-0"0 100 S.F. 1258 46010'-0"9'-4"e 3'-0"0 94 S.F. 1536 4300 10'-0"0 10'-0"0 W-4"0 4'-0"0 126 S.F. 2048 5800 10'-0"0 9'-4"0 5'-0"o 157 S.F. 2559 7300 12'-0" 11'4"0 3'-0"0 111 S.F. 264 475 12'-0"® 12 -0" 11'40 4'-0"0 150 S.F. 3018 6500 12'-D" 11'-4"0 5'-0"e 189 S.F. 505 3772 9125 12'0" S,t_, p - "0 9R S.F. 605 4527 9750 ~A..~ 8 4" --}r' 10 Y"' -d yT j p.L o e e e r= ee m e m U ~61'~..~1 r SECTION A-A LEACHING BLOCK DETAIL 0 Okk as b Precast` SDR Stonn Drain Ring Arm DIM" FU NWE 334ESLSDR_GHART Issue once January. 2004 Gallon Capacity Varies 114 9ee4y Palm Ad. Middle IO e, New Ya , 11953 iwww P89e 831-92h7400 Fn.: 631-924-2243 wwwo reoaeLcom Copyright 95 20040Wwtr«..... • 0 John M. Bredemeyer 111, President ~gUfFD(r Town Hall, 53095 Main Rd. Michael J. Domino, Vice-President ~tO ~G P.O. Box 1179 James F. King Southold, NY 11971 Charles J. Sanders ~A Telephone (631) 765-1892 Dave Bergen 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 1st day of construction % constructed Project complete, compliance inspection John M. Bredemeyer III, President QF S0!/l~o • Town Hall Annex Michael J. Domino, Vice-President `p 54375 Main Road P.O. Box 1179 James F. King, Trustee Southold, New York 11971-0959 Dave Bergen, Trustee Q Charles J. Sanders, Trustee O • Telephone (631) 765-1892 ~yCOUr~ty Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8375A Date of Receipt of Application: February 25, 2014 Applicant: Moeller Family Trust C/O Margaret Jespersen SCTM#: 21-2-15 Project Location: 1155 Aquaview Avenue, East Marion Date of Resolution/Issuance: March 19, 2014 Date of Expiration: March 19, 2016 Reviewed by: Board of Trustees Project Description: For the as-built ±21' wide by ±16.7' long reconstructed deck with ±6' wide steps attached to dwelling; the installation of gutters to leaders to drywells onto the dwelling; with the condition to establish and subsequently maintain an 8' wide non-turf buffer along top of bank. 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 John Cunniffe, Architect, last dated February 20, 2014, and stamped approved on March 19, 2014. Special Conditions: The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 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. lo^ 6L404WAO ,IV4.W John M. Bredemeyer III, President Board of Trustees i a John Bredemeyer, President %UFFO(,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 Field Inspection/Work Session Report Datelfime: ? , Albert Jespersen on behalf of MOELLER FAMILY TRUST, c/o MARGARET JESPERSEN requests an Administrative Permit for the as-built ±21' wide by ±16.7' long reconstructed deck with ±6' wide steps attached to dwelling; the installation of gutters to leaders to drywells onto the dwelling; and install a non-turf buffer varying in width along the top of the bluff. Located: 1155 Aquaview Avenue, East Marion. SCTM# 21-2-15 Typ~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 Info needed: Modifications: r L 6~~s -{d? c>j~'~ 6 '~~f i AQJ V n /y Conditions: . f U Nor v F b ~-F{'2 Y f rte. GrC? ~ K" - / ~ ~ Present Were: J. Bredemeyer /M. Domino -"J. King / C. Sanders Bay Constable Other Form filled out in the field by -j ~V C Mailed/Faxed to: Date: -AA ~ I - c"U Ci /Y1 ~ Y 1 F I ~ ' ? • ? ? o • • j???•?••••• •j i ••••i 40 ~`41~1~i1'~'~~~ ? i i ? ? ? t t 111'`1 1~t11~ ~i ? ? ? 4p v * 40 • Oh r i \ z IN , 04 ~ t • • ? - Asa y .v r .7'L n 11,.N I JILA ter`, V) • f -x' a , • • • - fib y.: V ie • • • y • ' Mar ANEW 8\1 t + F k t c' ~ l r~ 4 OF IL, ?qr" ,1. • 1' ~ ,~xk ~ y'a X11 `1;' _ a A 00, 16 &OIL sp- TTT'ITTT ' • • y • • • • .41 41 . . ~'t. . ~4 .1v r "to f f ` 1 _~*,,•7~ . ~ gyp') 3`a J W ldp 8 O . S Ma,Y l Q arwmxe.ernm I' ..oaxeaverxc~ / v? v S 6 P f II O q 1 qx ~'1 a ~ 9Y q Apr F f 9~q II I q S I / } a 8 ?a is qq r ~ a _ _ GOUMYOF SUFFOLK © v axcroxxo pF SO~ryO OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 T Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) n Q Southold, NY 11971 Telephone: 631 765-1938 C,oU'~ Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 20To: John Bredemeyer, President MAA 1 3 ' 14 Town of Southold Board of Trustees $UUUIUitl Vr,i From: Mark Terry, Principal Planner LWRP Coordinator Date: March 13, 2014 Re: Proposed Wetland Permit for MOELLER FAMILY TRUST, c/o MARGARET JESPERSEN SCTM# 1000-21-2-15 Albert Jespersen on behalf of MOELLER FAMILY TRUST, c/o MARGARET JESPERSEN requests an Administrative Permit for the as-built ±21' wide by ±16.7' long reconstructed deck with ±6' wide steps attached to dwelling; the installation of gutters to leaders to drywells onto the dwelling; and install a non-turf buffer varying in width along the top of the bluff. Located: 1155 Aquaview Avenue, East Marion. SCTM# 21-2-15 It is my recommendation that the proposed actions 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. The structure described was not constructed pursuant to Southold Board Trustees permit and not permissible under Chapter 275 Wetlands and Shorelines regulations. In the even the action is approved it is recommended that the Board verify the width of the proposed landscaped buffer. 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 ~r4F so~ly Town Hall Annex Bob Ghosio, Jr., Vice-President ~O~ O~ 64376 Main Bead P.O. Box 1179 Dave Bergen Southold, New York 11971-0969 John Bredemeyer C49 Michael J. Domino i~ Telephone (631) 766-1892 Fax(631)76b-6641 COUNPi BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only -Coastal Erosion Permit Applicatio -Wetland Permit Application Administrative Permit _Amend menvTransf dEx pion ceived Application: D E Q F R,~ r5 eceived Fee S QS ompleted Application -Incomplete FE B 2 5 2014 _SEQRA Classification: Type I Type IT Unlisted WRP Consistency Assessment Form CAC Referral Sent: ::?Date of Inspection: Z -Receipt of CAC Report: -Lead Agency Determination: ,Technical Review: I ublic Hearing Held: ~5/ Resolution: oti a Name of Applicant ~j /eigr "/~5 CSC Mailing Address C e`64aA~ ET Z NV ~4Z ] 3 3 Phone Number:( Suffolk County Tax Map Number: 1000 - .21 Property Location: ~~~~~~(r1(~ UrF/!s isillX/ (provide O Pole distances to~cross streets, and location) AGENT: /~F~J- ~/~oSt7FiP~~/t/ (If applicable) Address: Phone: ~o e~ - > d of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: R - 410 Previous use of property: o~A/Z F Intended use of property:_ _a V D 741y6- Covenants and Restrictions on property? Yes ?No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? _k!`~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 ?No Does the structure (s) on property have a valid Certificate of Occupancy? ?Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? v' No Yes If yes, provide explanation: Project Description (use attachments if necessary): .~I f r 6 moo'". 'v a F o oo ! o Ae 14.r, BoV of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ]?F. Area of wetlands on lot: A14 square feet Percent coverage of lot: N A Closest distance between nest existing structure and upland edge of wetlands: IVIA feet Closest distance betweene9arest 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? ,4 cubic yards How much material will be filled? /f cubic yards Depth of which material will be removed or deposited: *X feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: /~/,l~ 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): k V NE 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 Action or Project: Project Location (describe, and attach a location map): G%/y'o- /Gb0 Zr =--15 / S3~ >flc 4.4111 w 71W.1;Vyr Brief Description of Proposed Action: q /7E flNG ~acvySj~Bt, J s /N%6 Jam, UlE/~S TALfI-T('dN DF~oF/F~i2 Zanr~~,~/oFl~ Name of Applicant or Sponsor: Telephone: E-Mail: JeSr 4:2 A;I~n Address: tom/ •~E/~Q~~-?~~Kt<'T7~ //~3 City/PO: State: Zip Code: 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 may be affected in the municipality and proceed to Part 2. If no, continue to question 2. E4- -0 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: 5? U 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 residential (suburban) []Forest []Agriculture []Aquatic ?Other(specify): []Parkland Page 1 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? ? 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: 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? ? 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: El P_ 10. Will the proposed action connect to an existing publiclprivate water supply? NO YES If No, describe method for providing potable water: ? 11. Will the proposed action connect to existing wastewater utilities? NO YES If No, describe method for providing wastewater treatment tC/f y tvE/$ 136 ~jd ? 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ? b. Is the proposed action located in an archeological sensitive area? 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. Idepify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: Shoreline ?Forest ?A cultural/grasslands ?Earlymid-successional E] Wetland ?Urban uburban 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? ry ? 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? VO DYES F\ -.;r b. Will storm water discharges be directed to established conveyance systems (runoff and stotyi drains)? If Yes, briefly describe: ? NO S 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: ? 1 AFFIRM THAT THE INFORMATION PROVIDE ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE a p Applicant/sponsor Date 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 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 occur occur I . 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? Q 3. Will the proposed action impair the character or quality of the existing community? a 4. Will the proposed action have an impact on the environmental characteristics that caused the ? 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 actioncause 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? 8. Will the proposed action impair the character or quality of important historic, archaeological, ? architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, ? 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? g;~I 1:1 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-tern, 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. Town of Southold - Board of Trustees 3-10-1 NameQ-{r,tead~~4ency Date ,J (7' V1 " I IN a y wr , President Pri r Type Name o esponsible Off r in Lead Agency Title of Responsible Officer gnature of nsible Officer in Lead Agency Signature of Preparer (if different from Responsible Officer) PRINT Page 4 of 4 yTown of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. a: THE FOLLOWINO ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WA ORADI DRAINAGE AND EROSION CONTR PLAN Muw- "Maur n -gE"'Ec - - CE F D BY A N PROFESSIONAL N THE STATE OF N YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION r1EM # / WORKASSFSSMENT Yes No a. What Is the Total Area of the Project Parcels? Will (Include Total Area of all Parcels krea In 1 Gethisnerated Probed Retain Ap Storm-Water the Scope of Work for Propoaed~Canstnxibn) Generated by a Two iro ( In - created r on ? (S.F. r Aose) (This Item will include all p run-off site b. What Is the Total Area of Land bring clewing and/or Construction activities as I as air and/or gwmQbiswrbance for the proposed Site Improvements and the pen arrant ti lion of -gonarthict(on acWky7 Impervious surfaces.) (S.F. l) 2 Does the She Pl/nd /or Survey S All Proposed PROMEB DESCRIP14 (Pmu. rWdlCOnrl PSlwnNSrrm Drainage Structuicating Si &Location?TMs Item shall includroposed Changes and - 'T /stT iv b ~6wK e3',~O ~S Slopes Controllinface We r Flan. $ Does the She Pl/or S describe the erosion Tv its and sediment coracd that will be used to control site erosand water discharges. This VU ~N. S T.4 L.4 i !N O F ~vFfce 21NF item must be maed roughout the Entire Construction Per4 Will this Project any Land Filling, Grading or Excavation whe(s a change to the Nadal e IC4 iSIJ ~li%~ a CC K 6 fisting Grad g more than 200 Cublo Yards of Matedal within aroe11 5 Will this Applicadquire Land Disturbing Activities N Encompassing a in Excess of Five Thousand ? ~y (5,000 S.F.) Sq re Feet of Ground Surface? (j Is there a Nalu I Water Course Running through the ? Site? Is Miff robed within the Trustees jurisdiction General DEC SWPPP Requirements: or within On Hundred (100') teat of a Wetland or Submission of a SWPPP Is required for all Construction activities imioNing sal Bead1? disturbances of one (1) or more acres; Including disturbances of less than one acre that 7 Will there Site preparation on Existing Grade Slopes am part of a larger common pan that wig uMmatey disturb ores or more saes of lend: which Ex Fifteen (15) feet of Vertical Rise to ? includirg Construction activities involving sar disturbances, of less than one (1) acre where One Hun (100') Of Horizontal Distance? the DEC has determined that a SPDES pennit Is required for storm water discharges. (SWPPP's Shall western Wnhnum ReWhements *few SPDES General Permit 8 Will D , Parking Areas or other Impervious / for Storm Water Discharges from Construction activity -Prml No. GPA10-001.) Surfs be Sloped to Direct Storm-Water Run-Off ? V 1. The SWPPP shell be prepared prior to the, submittal of the Not. The Ns, airs/ be Into an or In the direction of a Town right-Of-way? submitted to the DepeMent prior to tine wnsnsrpement of construction activity. 2. The SWPPP shd desabe the erosion and sediment control practices and where 9 Will Project Require the Placement of Material, ? required, poorconsbuahn skim water management practices set will be used and/or Rem at of vegetation and/or the Construction of any constructed to reduce the polutenls In sterns wear dischagas and to ashes Item In the Town Right-of-Way or Road Shoulder compliance with the lanes and conditions of this permit M addition, se SWPPP shall Are ? mes mum rear Tar Imm raw patrenen atAlves yApma) Identify potential sc urow of partition which may reasonably be expected to affect the qualityofsions waterdbcharres. NOTE' #Any Anwar to Questions One through Mae Is Answered with a Check Mark 3. AN SWPPPs that require the postcrosNwtbn storm water management puctk:e in a Soand the apnstrucson site diourWrua Is beteson 3,000 S.F. a 1 Am In res, component shell be prepared by a qualified Design Professional Dowsed in New York a Stoma-Waur, Grading, Drainage a Erosion Control Plan Is Required by the Town M that Is knoMe fteable in the pikcdpies and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to isesree of Any Building Ps mR (N07E~ AChx*Mark (q1)widbr Anwar a eadi OiesGan Is RewMad bra Caspian Appluibq SPATE OF NEW YORK, r( COUNTY OF LL+. 1b.1 j = SS That I, j LEnt gn St~(2 being duly sworn, deposes and says that he/she iAcan r P o nd that he/she is the ( :...........(O ..m.....ar,..Co...n. ..oa .a....or......Agent......C...a ...po..u .te ..O....fti..cr, A Z o eb.) w 2 Owner and/or representative of the Owner or Owners, and is duly authorized [o perform or have perwork an $ E make and file this application; that all statements contained in this application are true to the best of hid belief; , that the work will be performed in the manner set forth in the application filed herewith. 3 Sworn to before me this; Cc ,ff W ~a w day f 7L , 20.1` x' .............2.`.7.:....'........ 9 ~ Notary Public:..... ~Y . . Z r' (slow'; a Of FORM - 06/10 B01# of Trustees Application • County of Suffolk State of New York ~21+~6i15P / /~~~f ~ ~~~E H t/ES9E/PS~N 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. Sign xeofPro a y wner Siq CF Pyr)f SWORN TO BEFORE ME THIS _DAY OF ( 20 14 nn~~~~ u, c Votary P lic JENNIFER L COHEN Notary Public - State of New York NO.OIC06247209 Qualified in Suffolk County My Commission Expires Sa, 711 I B#Wd of Truateea Application AUTHORIZATION (where the applicant is not the owner) I, -S esiding at OZ 1~/f/~fck-4c~ (print owner of property) (mailing address) os~i4~~~/~/ t • //733 do hereby authorize A (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner' ignature APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE,. FORM The Town of c Folds Code of Ethics prohibits conflicts of interest on the part of town officers and emp ovees The pill a of this form is to provide information which can alert die town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name, first name, piddle initial, unless you are pplying 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 Variance {rT Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of,Southold? "Relationship" includes by blood, marriagc, 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 50 of the ares. YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): _A) the owner of 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 a o 200/ Signature Print Name Form TS I Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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 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, 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: online website (southoldtown.northfork.net), the Board of Trustees O R th 'l#n b, Mrfie , local libraries and the Town Clerk's office. B . DESCRIPTION OF SITE AND PROPOSED ACTION [FEB 2 5 2014 SCTM# lej90 O PROJECT NAME iaeo t S7 /C< /i /'c d F The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? 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: le S Nature and extent of a ' n: li a Jo c Ec S-tl QF Oct,, a I • Location of action: l .S --67, C dA diEUJ U6 DN 51. Site acreage: `hF Present land use:FS~7~iv7~ffL- 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: (a) Name of applicant (b) Mailing address: 97-1 (c) Telephone number: Area Code ( ) G e' (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes El 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 of Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Polic' s Pages 3 through 6 for evaluation criteria ? Yes ? No LJa 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 ? 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 S through 16 for evaluation criteria a - ? Yes ? No u 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 ? 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 Apable 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 wastes..SSee LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. F] Yes El No a I t~'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. ? YeO No u Not Applicable Attach additional sheets if necessary WORKING COAST POLICIO 9 Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L RP 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 orate See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? No I~ Not 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 P Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pa s 65 through 68 for evaluation criteria. ? Yes ? No Not Applicable PREPARED BY &e je11 -w~ TITLE DATE 2 LONG ISLAND SOUND DRAINAGE SYSTEMS oRO. HIGH WATER nwuc SYSTEM #1 42'± ROOF AREA = 485 SQ. FT. 485 X 0.167 = - 80 CU. FT. USE (1) 6Y3 X 4' DEEP POOL = 89.36 CU. FT. 1 ~ 1 I SYSTEM #2 I I REA = 485 SQ. FT. 144 APPROVED Y UsE(1>tezaDEEPPOOL= 89.380 CU. FT. ' 6 CU. FT. BOARD OF TRUS~J ES O I MEANHI% WATER LINE TOWN OF SOUTHOLD I DATE lq 1 I ~FtED q/? 1 O. CU yNS~~ , t g O T~F~ I I 4" PVC FROM ROOF LEADERS 1 I PRECAST. REINFORCED SOLID DRAIN DOME. * oral 1 try~~~ fV 1 CAMPBELL FOUNDRY ~T _03GBg3 OQ~ j #1009 FRAME 8 COVER I EXIST. WOOD STEPS fir' N 1ST. W/~~O~D F NCE GRADE 1 1 LANDSCAPED BUFFER 1r _ I LAND APE ~AND APE BUFFER AS PER TOWN OF b+¢~Ff AS PER TOWN OF SOUTHOLD CODE SOUTHOLD CODE SECTION 268-3 SECTION 268-3 - M C.E.M.L.I No a`p N 1 1 1 p p 0 0 0 0 1 - woof) p o p o 0 0 DRAINAGE SYSTEM 1 I DECK p o 0 0 0 0 (PRE-CAST CONC. RING) o 0 0 a 0 0 Y~ I 1--LEADER FROM ROOF aM p o 0 0 0 0 I O Io onsr. i p o 0 0 0 0 00 STORY IN RAME MOOS p p p CI o 0 a ' LEADER FROM ROOF p p o 0 0 o O DRAINAGE SYSTEM 2 1 I p o 0 0 0 o Z (PRE-CAST CONC. RING) 10'-O O I p o 0 0 0 0 F- of *1 p o 0 0 0 0 U 11400, a' NI p p o 0 0 0 U R0L'kYp0RO 7.l ,o p o 0 0 0 0 uWi 1 to I®®®®®® o p o 000 A~UAV/F~ 'N 1 V-0" DIAMETER q z q VANUF GROUND WATER _ 1 SOIL BEARING CAPACITY IS SUFFICIENT TO ALLOW FOR IM 600 THE ELIMINATION OF FOOTING RINGS PROPOSED DRAINAGE & LANDSCAPE PLAN SCALE: P =30' DRAINAGE BASIN N.rs. BASED ON A SURVEY BY MICHAEL K. WICKS, INC DATED SEPTEMBER 28, 2009. D FEB 2 5 2014 MOELLER RESIDENCE JOHN CUNNIFFE - ARCHITECT JESPERSEN ¦ DESIGN CONSULTANTS ~ 07.20.14 11 Stony Brook Avenue 11 BLUE-TOP RD. SETAUKET, NY 11733 DRAM YAI cxno East Marion New York Stony Brook, New York 11790 PHONE 631834.8745 T 1.631.751.0590 PJESP1®OPTONUNE.NET REV. DATE SUBMISSION F1.631.751.0592 T 02.20.14 ISSUED FOR FILING john@jdCBrChlteCtS.Com LS