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HomeMy WebLinkAboutTR-8418A *pf SO(/l John M. Bredemeyer III, President O� �Q� Town Hall Annex Michael J. Domino,Vice-President ® 54375 Main Road P.O. Box 1179 James F. King,Trustee C** Southold, New York 11971-0959 Dave Bergen,Trustee p@ Charles J. Sanders,Trusteea Telephone (631) 765-1892 &UNTY, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1161C Date: August 26, 2015 THIS CERTIFIES that the existing 26'x20' concrete patio; the addition of 30" on the east and west sides of the patio; add 2' onto the length of the southern back of the patio; install pavers or stones on top of the patio; install new steps off of the back of the patio; and to install a new 8'x12' shed 10' landward of the non-turf/no- mow boundary area At 1940 Mason Drive, Cutchog_ue Suffolk County Tax Map#104-7-16.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated May 19, 2014 pursuant to which Trustees Administrative Permit#8418A Dated May 21, 2014,was issued and Amended on November 19, 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 existing 26'x20' concrete patio; the addition of 30"on the east and west sides of the patio; add 2' onto the length of the southern back of the patio, install pavers or stones on top of the patio; install new steps off of the back of the patio• and to install a new 8'x12' shed 10' landward of the non-turf/no-mow boundary The certificate is issued to SCOTT AMB'ROSIO owner of the aforesaid property. Authorized Signature f John M.Bredemeyer 111,President ��gUFF�[,f-`, Town Hall,53095 Main Rd. P.O.Box 1179 Michael J.Domino,Vice-President C2 Southold,NY 11971 James F.King w ae i Dave Bergen �► �� Telephone(631)765-1892 Charles J.Sanders Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: X Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, silt fence 1 st day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: J �� COMMENTS: - r / IT l ' CERTIFICATE OF COMPLIANCE: O 0 • John M. Bredemeyer III, President ti0��o� S�UjyOl Town Hall Annex Michael J. Domino,Vice-President 54375 Main Road P.O. Box 1179 James F. King,TrusteeCA Southold, New York 11971-0959 Dave Bergen, Trustee Q � Telephone (631) 765-1892 Charles J. Sanders,Trustee Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 19, 2014 Mr. Scott Ambrosio 25 Brian Lane East Northport, NY 11731 RE: SCOTT AMBROSIO 1940 MASON DRIVE, CUTCHOGUE SCTM# 104-7-16.1 Dear Mr. Ambrosio: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, November 19, 2014: RESOLVED, that the Southold Town Board of Trustees APPROVES the Administrative Amendment to Wetland Permit#8418A to modify the dimensions of the concrete patio addition to 30" on the east and west sides; add 2' onto the length of the southern back of the patio; install new steps off of the back of the patio; and to install a new 8'x12' shed 10' landward of the non-turf/no-mow boundary area; and as depicted on the revised project plan prepared by Scott Ambrosio, received on October 20, 2014 and stamped approved on November 19, 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, Qw- V.% ,�jw: John M. Bredemeyer III President, Board of Trustees JMB:amn APPROVED BY u, 2A/1 V BOARD OF 1 RUSTEES TOWN OF SOUTHOLD ' r } l- r*40L are t • ;� L, coo p '� �.r�ago t,.�►a�2 D Ar4� 9� ,�r,b,W�A+�t�i � � � . If; is4syl P a d µrws� 91 S7 � t 75 4k' PA}�a Sao ML (*� & S+� v4bd%4 4( IQ q fo 014pka swo 0 aL a�k �lnshc S�n c{Z, @ 4 2 1533 Q /744 Q/o fG ;?�/ 5,41&/% �oV2vAg .,. ev IY OCT 2 0 2014 'P or CAW to tc�o fAoww John Bredemeyer, President �o$nFFo4�, Town Hall Annex Michael J. Domino, Vice-President ��° ° 54375 Route 25 James F. King 2 P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen ol ,� �a°� Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: A l 6 ?, / ) � SCOTT AMBROSIO requests an Administrative Amendment to modify the dimensions of the concrete patio addition to 30" on the east and west sides; add 2' onto the length of the southern back of the patio; install new steps off of the back of the patio; and to install a new 8'x12' shed 10' landward of the non-turf/no-mow boundary area. Located: 1940 Mason Drive, Cutchogue. SCTM# 104-7-16.1 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: i15hapt.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: II j2- A 4•�J Modifications: Conditions: Present Were: J. Bredemeyer �M. Domino King C. Sanders -"D. Bergen Bay Constable Other Form filled out in the field by ���' 5 e ✓1 Mailed/Faxed to: Date: Board of Trustees 9/11/14 Town Hall Annex 54375 Main Rd P.O. Box 1179 Southold, NY 11971-0959 Re: Ambrosio permit 8418A 1940 Mason Drive Cutchogue Attached is a approved revised plan by the NYS DEC for the patio addition approved by the Trustees on 5/21/2014. Please note the following changes were required/approved by the DEC. 1) Side addition of the patio was reduced from 54"to 30"on the east and west sides 2) Add 2 ft of concrete to the length of the southern back of the patio 3) Install new step in the back of patio 4) New shed to be placed 10 ft north of 10ft non disturbance boundary. I request that my permit be amended with the above modifications. Scott Ambrosio 11 Mailing Address 25 Brian Lane East Northport NY 11731 i ss zai W87)-9a New York State Department of EnVironmentai Conservation oboe `r w NOTICIE . The Department of Environmental Conservation (DEC) has .issued permit(s) . pursuant to the Environmental Conservation Law for work being conducted at this site. For* further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below.. Please .refer to the permit number . shown when contacting the DEC. Regional Permit Administrator Permit Number 10 q 138"0.3 72 ROGER EVANS Expiration Date W. NOTE: This notice is NOT a permit SURVEY OF PROPERTY Sl rUA T*R U T C H 0 G UE TOWN OF SOUTHOLO SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-104--07- 16.1 SCALE 1 "=40' AUGU2ST 19t#k,, �20 JU�Y 31. 010 DATX09 SURVrY AREA a 52,613 vq, ". (10 YV uw.) 1,437 SCOTT AWAROSIO 1. EU Apt AU lttPt*tWt* TO MtO W* WON CU V. 0,0 tmt*4 cuVAT100% CSW STOUR UNtl AIK NOW TWA - WARD OF TRUSTEES TOWN OF SOUTHOLD' Ac DATE Ak� AL P MAY 1 9 2014 � F SURVEY OF PROPERTY SITUA TE Mps "'"� 137 e"► 1 `� CUTCHOGUE N7r51.5o" E a TOWN OF SOUTHOLD z a+ NEW YORK SUFFOLK COUNTY, N S.C. TAX No. 1000-104-07-16.1 SCALE 1"=40' a1"Tu Z ' AUGUST 19, 2009 . 1. JULY 31, 2010 UPDATE SURVEY 1F # . b, • r�raF"�" AREA = 6ft. (To TIETIELINE) 1.437.437 ac. 3 n- tet•tt ' � CERTIFIED TO: 7 >tl s p, ioL SCOTT AMBROSIO WN THUS-is {�9a'l �, 1 ROTES: /J! /• "'R °pta�� � yFS��.� wt 1. ELEVATIONS ARE REFERENCED TO MEAN LOW WATER ELEV. 0.0 "e , Jlh. a/s. r-- `�K� EXISTING CEXISTING ELEVATIONS UR LIN SE ARE SHOWN THUS: -----------• ZAL ' Z � a A �•O ,y '�� bC I '�� AL AL t <'z F AL AL" AL 1•� ny s AL AL AL 4 AL 0 N / 1 & + zas i ALr i 3 5 0 64 ?' AL aio /fir�9s �� �`" J*L ` Ax.l .lq// 4j. ` !ME o� `�44SQe r 'na 1 / t = asAn 0 • John M. Bredemeyer 111, President �y,BEFQ(,�,co Town Hall,53095 Main Rd. O� Michael J. Domino,Vice-President �� Gym P.O. Box 1179 James F. King y Southold,NY 11971 Charles J. Sanders �y,O� � 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 rjv John M. Bredemeyer III,President �Ok S�UryOlO Town Hall Annex Michael J.Domino,Vice-President 54375 Main Road P.O. Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G.�c` Q Charles J.Sanders,Trustee • Telephone(631) 765-1892 �lij'COU � Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8418A Date of Receipt of Application: May 9, 2014 Applicant: Scott & Susan Ambrosio SCTM#: 104-7-16.1 Project Location: 1940 Mason Drive, Cutchogue Date of Resolution/Issuance: May 21, 2014 Date of Expiration: May 21, 2016 Reviewed by: Board of Trustees Project Description: For the existing 26'x20' concrete patio; install a.54" wide by 20' long concrete addition to each side of patio; install pavers or stone on top of patio; and to install an 8'x12' shed. 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 Scott Ambrosio, received on May 19, 2014, and stamped approved on May 21, 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 III, President Board of Trustees 0 0 John Bredemeyer, President �OFFo4C' Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanderso • Southold, NY 11971 Dave Bergen y�o! ,�, �a°' Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: y kt SCOTT & SUSAN AMBROSIO request an Administrative Permit for the existing 26'x20'concrete patio; install a 54" wide by 20' long concrete addition to each side of patio; install pavers or stone on top of patio; and to install a 8'x12' shed. Located: 1940 Mason Drive, Cutchogue. SCTM# 104-7-16.1 Tyne 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 Info needed: Modifications: Conditions: Present Were: J. Bredemeyer 1<1M. Domino—J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: James F.King,President *of so�ryo Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O �p 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer N • �O Telephone(631)765-1892 Michael J.Domino O�yCO Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 20, 2012 Mr. Scott Ambrosio 1940 Mason Dr. Cutchogue, NY 11935 RE: ADMINISTRATIVE PERMIT#7705A 1940 MASON DR., CUTCHOGUE SCTM#104-7-16.1 Dear Mr. Ambrosio: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., June 20, 2012: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Administrative Permit#7705A to include the installation of a gravel driveway/storage area, as depicted on the plan stamped approved on June 20, 2012. This is not a determination from any other agency. Sincerely, o Jame . King, Presid or Board of Trustees JFK:Ims 00 �• w� g jup� 2012 j S. TWB i a 1 AIIL AL 6JlkL AL ALL x ty AIL ALc y EX. TRODDEN PATH y ALL AIk 1,i TO BE ABANDONED AIS AL AVL NEW 4' PATH TO DOCK 'y_ 50' TO BE MAINTAINED !� AL AkL 2.M AIL AL / AL AFL / 119 IM , 12' INCLINED RAMP x ALW x= / s" / `\ \ / x1A0 \ \ \ / n ,. m 1 i / \ \ ` // /o kw AN/ A P mv PPR BOARD OF-TRUSTEES'`, \ 1 �►�- /; ` °" qa' CATWALK f TOWN OF SOOTHOID - �'� bLoh 3- Am- AM4 rJa c! 000 Jill M.Doherty,President O��DF so#' Town Hall Annex Bob Ghosio,Jr.,Vice-President h 54875 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen N � John Bredemeyer � � � Telephone{681}765-1892 Fax(831)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7705A Date of Receipt of Application: October 26, 2011 Applicant: Scott Ambrosio SCTM#: 104-7-16.1 Project Location: 1940 Mason Dr., Cutchogue Date of Resolution/issuance: December 14, 2011 Date of Expiration: December 14, 2013 Reviewed by: Board of Trustees Project Description: To trim and cut trees along the west side of the driveway and conduct light grading and seeding. 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 indicated on the survey stamped approved on January 13, 2012. Conditions: A non-disturbance buffer area within 20'from the established wetland line on the west side and a 10'wide non-turf buffer from the established wetland line on the east side of the property. 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. P Jill Doherty, Preside Boa of Trustees SURVEY OF PROPERTY MfaS�� ,,..• _ ,3,.9A'. ;�--"` slTvnrE• CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK ..�•,II I /` S.C. TAX No. 1000-104-07-16.1 SCALE 1••=40• k�a AUGUST 19, J-31.I01V VOOAiE SUR SUxOEv \/ AREA_11 4613 1 11. 110 IE uxEl f..13]a. O SOOU AMMOSIO 1'1 , MD76S. ��0i 00 APPROVED BY BOARD OF TRUSMS MVM OF SOM HOLD '41 9/ddllo l �� BROMYVATF;K,S MVG Nathan Taft Corwin III Land Surveyor —-FL A. ��1 rxoxE ls3rvn-xmo r.,lw�pa-�,r I ...w.�...,.,..,•4,4,44,,." _�.-. I ."4_444 4444 _...—J 00 Jill M.Doherty,President O` 1X V soyo Town Hall Annex Bob Ghosio,Jr.,Vice-President ti 54375 Main Road P.O.Box 1179 James F.King 4 Southold,New York 11971-0959 Dave Bergen � • Telephone(631)765-1892 John Bredemeyer 0� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0639C Date ApW 27,2011 THIS CERTIFIES that the fixed timber dock consisting of a 4'X 12' inclined ramp,4'X 118' fixed elevated catwalk with open-grate decking,3'X 14' hinged ramp and 6'X 20' float secured by(2)8"dia pilings,a single light located at the most seaward end of the fixed catwalk,water and electric,and a 4' wide path to dock At 1940 Mason Dr.,Cutchogue Suffolk County Tax Map#104-7-16.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 11/18/09 pursuant to which Trustees Wetland Permit#7221 dated 12/16/09 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 Fixed timber dock consisting,of a 4'X 12' inclined ramp,4'X 118' fixed elevated catwalk with open-g[ate decking,3'X 14' hin eg d ramp and 6'X 20' float secured by(2) 8"dia.pilings, single light located at the most seaward end of the fixed catwalk,water and electric.and a 4' wide path to the dock. The certificate is issued to SCOTT AMBROSIO owner of the aforesaid property. . 6 ethorized Signatur Jill M.Doherty,President '*0 so�jy Town Hall Annex James F.King,Vice-President ,`O0�0 54 Main Road P.O64375..Box 1179 Dave Bergen Southold,New York 11971-0959 Bob Ghosio,Jr. er � � Telephone(631)76&1892 John Bredeme Y � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 22, 2010 Mr. Robert E. Herrmann En-Consultants, Inc. 1319 North Sea Rd. Southampton, NY 11968 RE: SCOTT&SUSAN AMBROSIO 1940 MASON DR., CUTCHOGUE. SCTM#104-7-16.1 Dear Mr. Herrmann: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., September 22, 2010: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit#7221 to authorize the relocation and downsizing of the previously approved dock, specifically the construction of a 4'X 12' inclined ramp; 4'X 84'fixed timber catwalk; TX 14' hinged ramp; and 6'X 20'float supported by(2)8"dia. pilings, and as depicted on the plan prepared by En-Consultants, Inc. last dated August 1, 2010. This is not a determination from any other agency. Sincerely, (fit. Jill . Doherty, reside Boa of Trustees JMD:Ims .off �g ,�, ``Q �• top ytt 4 �� `f�1.� ❑11 `�Ce e 'rayroate r w+ Cotte s 5n(KCl;55 via i1E SUDCt pR01'�RfY)' LITTLE M HOG •• W �� NECK Ax J ° A A6 r Q M ��N ELM m000[N r V? r^`(�_ POINT 80'e► roMwoorrr �\}: ,r, VIEW r`o MW a�m AL 5uFd�A IN.apY'w"h1.�'29 AL it e► .rr .' 7 #NUI Mei ` .. ww 1s Am �` y� � `y� ■qk•GMK ��..�•-�-_�-- ^��_ �'� ~_- ---- �� �rPose:f'nvate,rpncaranerc�i bast dadcage -------------- '' ----------- __-- 3. PbW ad OWPatt&bm to be CCA-treated: ----------- ;,- ,y` --�,;,- „�~ �,e deam arrr vegetated marsh to be f bff4aw ' reinforced,oparA ate(Thrf 60m or radar"Auct ' P vAdrq 607.. operrstme):deckmq mer aper water 2 OF 3 FOR LARGER SCALE� to be acre"Unbrr a canmU mat�rai� 4, hock to be equipped with a 1*.water ad AWLM service N C ETIL OF PROPOSED DOCK 5i. Water depth(referenced to Al W)t vocribed from 9-19-09 hyctnq ol:sirvq prepared by r.' Nara►faft Corwin 111,1.,5. L � a 6, t'ralect Ixatlax 1940 Macon DrMe,OAciIac++e: ►-- = 5CTM#1000-104-1-16.1 ��a r 0 cX. DOCK EX. DOCK A E;� O aa. ue CoI'RO S UANTS iNC OW VOCK FOR 5CO f AW 9 H SEA RD. 56AN AMI3fz0510 ON MOAMASP5 SOUTHAMPTON, NY 11968 COW, CUTHOaf, 5VOLK Co,, W 631-283-6360 5f9r+ of 5 11/9109, 1/11/10, 811/10 ' pg E t37.gI► 00 N 0 5[ .� TWO 6 a�x JUL AL AL AIL AIL AL AL EX. TRODDEN PATH AL BE ABANDONED AIL AL ��• AL AL NEW 4' PATH TO DOCK 1~= TO BE MAINTAINED 50' AL r H`N AL AIL AL r i' 12' INCLINED RAMP � \ IM � ALW IN `�� % `x1w \ /:fro IN \\ `� 911c 4'�x CATWALK \\\ \\ xr1.4\ \ x_3l1 X a'4' ` 6 x 2(P F V-ALE \ \ s MV E N - CONSULTANTS IKV _0AI�W-4-TL�'IR_ '� � n POCK � �� 1319 NORTH SEA RD."°----- C'fj -J 5U5AN AM(3�0510 ON PROAMATER5 GOA, c SOUTHAMPTON, NY 11 968 � - ^ u�'cHoc�,�, 50=CO., NY Sit 2 OF 3 II/9/09, 1/11/10, 8/1 10 631-283.6360 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.22_2_1 DATE: DECEMBER 16.2009 ISSUED TO: SCOTT& SUSAN AMBROSIO PROPERTY ADDRESS: 1940 MASON DRIVE.CUTCHOGUE SCTM# 1047-16.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted-at the meeting held on December 16,2009,and in consideration of application fee in the sum of$2",M paid by Scott&Susan and*object to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a fixed timber dock consisting of a 4'xW inclined ramp,a 4'x118' fixed elevated catwalk,3'x14' hinged ramp and a 6'120'float secured by(2)8"diameter pilings,catwalk to be equipped with a single light,water and electric service,,a portion of the existing 4' wide,path to be abandoned with,&new 4'wide .portion to be created Into existing path to dock and maintained,with the conditions of the use of open grate decking on the fixed catwalk,the light is to be located at the most seaward end of the fixed catwalk and it must'conform to Chapter 275-IIC(2)(11)[12)of the Town`Code=Wetlands and Shoreline-Construction and Operation Stundards- I#Zht1u&and as depicted on the site plan prepared by En-Consultants,Inc.,last dated January 11,2610,and received on January 13,2010. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. �y Peggy Dickers — Absent �37.9�, MASol EN-CONSULTANTS, INC. 93, 1319 NORTH SEA ROAD SOUTHAMPTON, NY 11968 631-263-6360 1"= 50' s I!r 1 -e x J xo� nc .® TWO °, xK >K � �gx AL 0 AL d � ALAL AIL AL AL AL EX. TRODDEN PATH t.l., .• PORTION OF EX. PATH y AL �: i+: TO BE ABANDONED AIL ally ,lye it ,iL NEW 4' PATH TO DOCK �y A. TO BE MAINTAINED � is \ AHW ".,Ak INCUNED RAMP I I i.•' �s2 y.. I I: Jllc IM - - 12' AL AL AL I/ALW ILI AL i`l r�'F ROV�,D B1(- 4' ! ,t$' CATWALK : :�� RD OF TRUSTEES _ - 14' RA#�P�`� _ , � , _ _.. 1 ION OF SOUTHOID 6 �o FLOAT (TYP.) s ' WA-�'ER► ' PPOP05N9 POCK rOR 5COrf ANP 5U5AN AMIR0510 ON ROAMAM5 .- Ej ifs' COVE, CUTCHOaf, 51fraK CO., W 5Wef 2 OF 3 1119109, 1111110 d �br �I .d L .a I 6 i N i H t 41p Is�Ji9 j I 631-2U' LJ"6 3 V +/N PROPO5EP POCK FOR 5COff ANP SUSAN AMR0510 ON ROAMAM5 COV., CUrCH06T, 5TFOLK CO,, NY %fvf3OF 3 11/9/09, 1/11/10 _ - 00 0 Jill M.Doherty,President �QF SDUly Town Hall Annex James F.King,Vice-President ,`O� 0� 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 Bob Ghosio,Jr. John Bredemeyer Telephone 765-1892 Fax(83I)1)76 766-8641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7394A Date of Receipt of Application: August 30, 2010 Applicant: Scott&Susan Ambrosio SCTM#: 1047-16.1 Project Location: 1940 Mason Dr., Cutchogue Date of Resolution/issuance: September 22, 2010 Date of Expiration: September 22, 2012 Reviewed by: Trustee Dave Bergen Project Description: Construct an 8'X 12' shed. 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 survey prepared by Nathan Taft Corwin III last dated July 31, 2010. Conditions: 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. er Jill M ohe ty, sidenBoa of Truste --- --- DRt :;_ SURVEY OF PROPERTY (I ''i ( jl c�ON ga SITUATE AUG 10 2010 �= CUTCHOCUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-104-07-16.1 SCALE I"=40' AUGUST 19, 2009 ss�]0 JULY 31,2010 UPDATE SURVEY m q, We -y aAA (TO BE I IMF) B 4373 .. ff. n \ NC C6R%'IN'/E'U TU SCOTT AMBROSIO `weN... NUT6,4: Y-� '"�'Mw�1ry""�•�, M£p I.ELEVATIONS ARE REEERENECO TO MGN LOW WATER CILV.0.0 AW AL –^Zo E%ISTINO ELEVATION6 ARE SHOWN iNU9 Ja _ �N�— E%IS11NG CONTOUR LINES ARE SHOWN THUS:-----"--- l', S �'- OCL. �' zkw 0` \ AV, �a IL d 96 e 'IL Alk & , C AL WEIU`N°S A `, IAL Aa AIL �L AIL „ AAL ] 4 ' �� ,JL j:LGD Oi Tl,ii:,1 S_ s'WW, n n° 41 .S, Inn T'OV:N OF SOUTHOLD- N I LATE g aa1 o AIM 3HOADWATERS COVE ' �-1 JNA�HaNg oM°x A°DnDH �� I Nathan Taft Corwin III THE m°s°E °N OF NEW� THEE=°°LWR SUW Mw Mm.E R,D rtE MWKI M E Land Surveyor w�wRawR'z ecONsioaED ,� � iORrsA wiio i�uE tan. OA,P SNFT Cq aRrnun°Ns NmcATED IE7aaM sr°u RUN O4LY TO T!E RR—FOR MHDII 1 SMRT' 5 P-1T.AMO DH HIS INNAF TO ,X ~ .'},H * r�lk SWv[y!—SUOdIN°ron°— sile NoM— Cm[bucMon Loywrt iwic wzrmiroM laim HERmx,.No ar a SME �Nsm- " � PHONE(831)717-2090 iaR(631)727-1]7] HE E%ry'tENUE u[9MWis OF WAY— u Of ES LOCATED AT IL4t ADORDSS ANO/OR EASEMENTS OF RECORD,IF I56E Lbm Roof PO fio°16 ANT,HOT SHOWN ARE NOT OUARANTEED. __ LAHID�Iic No_SO/fiT J°me[p°rt,New Yoh 11917 JRme[pal.Ns°YOM 11947 James F.King,President ���(/fy� Town Hall Annex Jill M.Doherty,Vice-President ti0 54375 Main Road P.O.Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen Bob Ghosio,Jr. Telephone(631) 765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # Q441 C Date June 22.2009 THIS CERTIFIES that the replacement of the siding,windows,doors,and installation of two(2)new windows on the existing dwelling,trimming of trees inland of wetlands.removal of a fallen tree. 10' non-turf/no-mow zone landward of wetland boundary.and trimming of phragmites by hand to 12" At 1940 Mason Dr.,Cutchhogue Suffolk County Tax Map#1047-16.1 Conforms to the application for a Trustees Permit heretofore fled in this office dated 11/3/08 pursuant to which Trustees Wetland Permit #7002A Dated 11/19/08 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 replacement of siding,windows door,and installation of two(2)new windows on the existing dwelling trimming of trees upland of wetlands,removal of a fallen tree 10' non- turf/non-mow zone landward of wetland boundary,and trimming of phrapnites by hand to 12" The certificate is issued to _SCOTT AMBROSIO owner of the aforesaid property. Authorized Signature James F.King,President �%f sorry Town Hall Jill M.Doherty,Vice-President ,`O� �� 53095 Route 25 Box Peggy A.Dickerson > Southold,New York 11971-0959 Dave Bergen Bob Ghosio,Jr. Telephone(631)785-1892 Fax(831)785-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7002A Date of Receipt of Application: November 3, 2008 Applicant: Scott Ambrosio SCTM#: 104-7-16.1 Project Location: 1940 Mason Dr., Cutchogue Date of Resolution/Issuance: November 19, 2008 Date of Expiration: November 19,2010 Reviewed by: Board of Trustees Project Description: To replace the existing siding, windows, doors and rotted wood on the existing dwelling; install two(2) new windows in back area left and right side of existing back wall; trim trees upland of wetlands and remove a fallen tree; and trim phragmites by hand to 12". 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 survey prepared by John T. Metzger last dated November 25, 2008. Conditions: This permit is issued with the condition of a 10' non-turf/no- mow zone landward of the wetland boundary line and no removal of trees on the east side of the property. 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. o'er Jame F. King, Preside Board of Trustees . so a N --- SURVEY OF PROPERTY �,PP�COVEE? ' AT EAST CUTCHOGUE COARD OF TRU51c,' TOWN OF SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. DATE AEC / O 8 1000-104-07-16.1 SCALIk 1=4(Y DECMEBER 14 2006 DECEMBER 24 2006(�(RENSIDN) INYOOPWWR NERANO FLAGS!CERM) NOV. 20, 2008 IPHRAGUTES TRIM AREA1 NOV. 24 2008(IO'BUFFER). DON �qp�1 3q.9 L 17*51'SO�' 7Z~j4 376-10' 2 y I'4 W FRS C IVAL NIRAWS AS ORMAIM - Y yy ...... 333444 Y cu Y �t Y Y y Y Y y ~ Y Y 1 NETIANOS Y' Y Y Y Y vY a/,RAG A4 1 r F-5 Y Y Y y Y T'RI Al Y Y Y Y.AC'CA y Y Y Y NERANaS D E t 11! Y Y Y Y � NOV 2 5 2Rt Y Y 5626 Y Y Y Y Y 13 Y � Y Bnrd� sru im Y ��! Y 0, NY �•� y Y � � Y. Y it CERnF/ED Ta. Y Y SCOTT AMBROSIO Y SUSAN AMBROSIO y Y Y AFEA-62,612 M Ff. ` TO M LIKESY..S UC, NO. 49618 AMY AL AMA IM OR ADO17M TO na SURVEY IS A NONWN OF SECIM 7MW THE NEW MW STA7E EDUCATION LAW.cwcjpr AS PW qX 611 yAW FOR M MAP IXW AM COPIES�£oF OOfay rWXA S A=�TLAND FLAG"A* O AMP OR OWES BEAR MHOSE SO"RW APPEARSIMWOM SSEO SEAL OF THE SURbEY01P *- ONUMENT PPISOUTHOLD, N.Y. 11 T OV-257 a q . T� g e �ii81�i�{lui���III��fili79' � IIP �� Mw�� �. -:'k�a k. .:a �3, .��. s-�,,`�`c�wa�,q��b• ""w� ��.,<�. �_: ,..amxa= a� �. �S:`s a. € t moi" ���"3► X p � € r r d !"» ! 'bx fa t�.• � F'� r q ��6 q{ a � ��� .x7F� a��'i�Ya viewattachment(JPEG Image,3264 x 2448-1--ds) aled(29%) https://webtop.welo.iw.net/http/viewattachment?clientld=13... 1 y 1 of 1 4/17/2014 1:28 PM oczaee �C"' �) � sTc xer ,♦ � ,., orae a +�Fzo. �` I D62>b • }, ,� P� e9� +))�M• CREO( $1qA B—��p,�e •�Lp.4 ,.� °ep` F -P� F;, 6 w ,' � ^ w•o'�,�.'v14 " .rt 3e--� .� ,,�cl )1�1. ,I, 91. ',�y I P,' ♦ w M+_m ,e Ma row '�.. ti olmaa YP{yE ° I ,'° t' '-Br.j,' �• "� bb_W �4 .� ��.� \.4 F f Oma• w ^�� P ..� 6JA•) m^^1T •} ^p� P !♦ w� t �+• I , 61 �l G1 "�^�+9 ♦ 'B ® e .Iy 1" � ty+BNoca1 i�": ;,.*,�• s� .n� a yam\ �.� ) 91 � ♦°; \ may\ o I ° :+ ')�e +"' i�,�ey I�♦ +° ~ BROADWATERS COVE 1 1 •fie ° F�`° ^,) I S "+ +v •�\ \i �� 1 � �F 4 • }' F +) TN ,� y ) TOWN OF SOUTHOLD 11 s•' ,pia ^ O ye •�_�r_J� m.mv"1 li e \ ! I tN•) � � ^ '1 '� zP°9 �r __ K6 teWI a.I ^�♦ "',•�'4 ; .� HAYWATER COVE ® roB � i ) r i I e B •,p L (21)Is1I — — — --A " ^� rgnce COUNTY OF SUFFOLK © K ^ SOUnwin SECTION No E ______ N �___,^__ ""�^^•"'•"a Real Property Tax Service Agency v ^ N "' ,.._--. _ c.^x,c.•�.xN.�..•.x.nw, N 104 —__— e..... --.-- o..0--+v-- m 10 P ra+ro 00 PROPERTY IMP • • SU(/ryO OFFICE LOCATION: 0lO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) G Q Southold, NY 11971 Telephone: 631 765-1938 rnU ,�`t.` Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ---- p E C._ " �� To: John Bredemeyer, President MAY 1 22014 Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: May 19, 2014 Re: Proposed Wetland Permit for SCOTT & SUSAN AMBROSIO SCTM# 1000-104-7-16.1 SCOTT &SUSAN AMBROSIO request an Administrative Permit for the existing 26'x20'concrete patio; install a 54" wide by 20' long concrete addition to each side of patio; install pavers or stone on top of patio; and to install a 8'x12' shed. Located: 1940 Mason Drive, Cutchogue. SCTM# 104-7- 16.1 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 actions are CONSISTENT with the Policy Standards and therefore are CONSISTENT with the LWRP. Note that the Board established a 10'wide non-turf, no mow buffer from the wetlands in 2009 in Wetlands Permit 7002A and a 20'wide non-disturbance buffer from the wetlands in Wetlands Permit 7705A. 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 ��F SOTown Hall Annex Bob Ghosio,Jr.,Vice-President ��� y�lO 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer v: � Michael J.Domino i QQ Telephone(631) 765-1892 O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES D E C E Q TOWN OF SOUTHOLD To: Southold Town Building Department WAY 14 2014 Re: Verification of Building Department Permit Requirements BLDG.DEPT. / / TOWN Of SOUTHOLD SCTM#: IoLl—— 7— /6 , Property Owner Name: _, 5usz�xr1 Date Sent to Bldg. Dept.: S The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: Signature of FWvew—er Date John M.Bredemeyer III,President �*qf S�(/jiyo Town Hall Annex Michael J.Domino,Vice-President �� l0 54375 Main Road P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Charles J.Sanders,Trustee '�Q • �� Telephone(631) 765-1892 �yCOU�m,��' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application D , _Wetland Permit Application Application Permit _ 9Amendment/Transfer Extension Received Application: 1 y eceived Fee:$ 100 MAY - 9 2014 Completed Application _Incomplete _SEQRA Classification: 5ou`tiocs iti���.. Type I Type II Unlisted tCoordination:(date sent) LWRP Consistency Assessment Form dll ECAC Referral Sent: —/Date of Inspection: / '/ _Receipt of CAC Report: _Lead Agency Determination: echnical Review: Public Hearing Held:S 1 Resolution: Name of Applicant a4e10 Mailing Address 45_ 9A,.3 Pooq4pod�: �Aj U73/ Phone Number:(So &44 0 Suffolk County Tax Map Number: 1000 - /v -/ " 7— /6 ' Property Location: �Ctq O fj A6ar2 j S � l (provide LILCO Pole#, distance to cross streets, and loc on) AGENT: (If applicable) Address: Phone: 04pard of Trustees Appliqft GENERAL DATA Land Area(in square feet): (,L Ar-v-(r, Area Zoning: Previous use of property: Intended use of property: 42>% Oe&, � 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 G--�No If"Yes",please provide copy of decision. Will this project require pZ 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? I, Yes No Prior permits/approvals for site improvements: Agency Date �rvs tae -Dee ��O -Qe>it Ct�� No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? e� No Yes If yes, provide explanation: Project Description (use attachments if necessary): Wpo 6K a D d of Trustees Applica ow ve WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: a;lle lg�e ayk �P Area of wetlands on lot: 31 1029 Q-W/--11are feet Percent coverage of lot: :S y % Closest distance between nearest existing structure and upland edge of wetlands: 30 feet Closest distance between nearest proposed structure and upland edge of wetlands: A e" feet Does the project involve excavation or filling? No `� Yes If yes,how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: �:). feet Proposed slope throughout the area of operations: I)Ii4 Manner in which material will be removed or deposited: cvv-'Vo-4--vu-P-D ✓ o i r o�' p�-t a Dip oc 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): t-4oL)F 00 00 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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: +e'- " Project Location(describe,and attach a location map): / k Q Brief Description of Proposed Action: nn -TY4 0AD4S f, fg'S4- KWo 0 + 5 x o?O / ®,v s a 6, 12- S,ti�v� 41 _QlAq e, Name of Applicant or Sponsor:40-1615X6 Telephoner'l&,6 VV .5 -11',"D �c0-{/ °� c�rJ$,9r> E-Mail: Address: City/PO: State: Zip Code: �f .cJo► i, r .�9.c� 1117,31 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 1:1may 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? acres b.Total acreage to be physically disturbed? s®©O acres ('2,6,0 , �r c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? // Y 3 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 El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 00 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: [J ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ff b.Are public transportation service(s)available at or near the site of the proposed action? Er F-1 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 FzT 10. Will the proposed action connect to an existing public/private 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: 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? FTIZI b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑A icultural/grasslands El mid-successional ❑ 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? ❑ 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 1f Yes, ET 1:1a.Will storm water discharges flow to adjacent properties? ❑NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO AYES Page 2 of 4 00 00 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: ❑ I AFFIRM THAT THE INFORMATION P OVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsoreffiiiij�k Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all ofthe.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? u 2. Will the proposed action result in a change in the use or intensity of use of land? L__! 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate (�' ❑ reasonably available energy conservation or renewable energy opportunities? LJ 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? Ef 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 00 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. ElCheck 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 environment impacts. Town of Southold-Board of Trustees J- 1 I _-FNameALead Agency Date b ed//II 0 President Print oryp Name of Bible O ficer in Lead Agency Title of Responsible Officer nature of Re le Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 *A Town of Southold Erosion, Sedimentation $t; Storm-Water Run-off ASSESSMENT FORM gPROPERTY LOCATION: s.c.T.M.N: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Q(� STORM WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN 'DTs lrt c� To-can— –91;EK- -' t� CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (include Total Area of all Parcels located within I Will this Protect Retain All Storm-Water Run Off the Scope of Work for Proposed Construction) /� T `3 7 Generated by a Two(2")Inch Rainfall on Site? (S.F./Acres) (This item will include all run-off created by site / b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all u and/or Ground Disturbance for the proposedSite Improvements and the permanent creation of construction activity? (S. .!Aaes) impervious surfaces.) PROVIDE BRIEF PROJECT DESCRIPTION (Provide AdMonal Pages as Needed) 2 Does the Site Plan and/or Survey Show All Proposed El Draiage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and ,#/-Do S�)C o'la � �?d��� Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion O 7 ILS and and sediment control practices that will be used to control site erosion and storm water discharges. This (,✓LS� S'lf2L O� � /� item must be maintained throughout the Entire �p n n Construction Period. CSG ' a4ho". �/44 4 Will this Project Require any Land Filling,Grading or ( Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards a of Material within any Parcel? rj Will this Application Require Land Disturbing Activities ❑ — Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the — Site? Is this Project within the Trustees jurisdiction El '1;1� General DEC SWPPP Requirements: or within One Hundred(109)feet of a Welland or Submission of a SWPPP Is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be.Site preparation on Existing Grade Slopes are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to ❑ Including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')Of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shag be prepared prior to the submittal of the NOI.The Not shall be into and/or in the direction of a Town right-of-way? F-1 to the Department prior to the commencement of construction activity. 2.The SWPPP shag describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, i required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall Area?MAS item will NOT include the rrrstalWon of Drl w y Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.AN SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area, component shag be prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check Mark(,I)and/or Answer for each Question Is Required for a Complete Appgcatkm) STATE OF NEW YO COUNTYO ...........................................SS That I, © ........... 00 S .................being duly sworn,deposes and says that he/she is the applicant for Pernut, (Name of incl dual signing Documeent) And that he/she is the .......C .....-........." ......... .................................................................................................................... (Owner,Contractor,Agent,Corporate Officer,etc.) 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 die best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewi Sworn to before me this; ............n..�.......................day of....A.-I, .......................,20.l.Y Notary Public: ............ r. ,v..f...... 0—Ai. :...QRAMMAN ........... . ............................... ........................ °tafll f Ul)IIC, State of New York (Signature of Applicant FORM - 06/10 ° Qualified in Nassau County Cnmmicsion Expires Sept.21,20 '/ rd of Trustees Applica County of Suffolk State of New York cf�,'+� BEING DULY SWORN DEPOSES ANDA FIRMS 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. Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF ,20j NotaryFvubla DONNAJ. GRAMMAN 'vOtRary Public, State of New York No. 4906377 Oualifaed in Nassau County Sept. 21,212-7 rd of Trustees Applica AUTHORIZATION (where the applicant is not the owner) 1 ° r/5 G'7 residing at (print owner of roperty) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town T tees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The puMgse of this form is to nrovide infor ation which can alert the town of pgssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Laht name,first ngine,middle initfal,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate.the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building 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,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town o.fSouthold? "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%/ofthn shares. YES NO (Y 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 day of 200_ Signature f Print Name Form TS 1 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 at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - 0.1 -&rZ PROJECT NAME /�s�d q�� �� ✓, o r� The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. a Board of Trustees LJ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval, license,certification: Nature and extent of action: 1915 01'S�/N� < fi _��� �.�Oi�� .A- o /l�gal ��l Z (��►�� As � c���I/M�. Location of action. 44,205 Site acreage: A e13 -1 Present land use: S rg2eA 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: 1� (b) Mailing address: c 22 �- � 7 , LA 3 (c) Telephone number: Area Code (d) Application number, if any: Will the action be dire tly 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 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III es Pages 3 through 6 for evaluation criteria El Yes 1:1No 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 through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through for evaluation criteria Yes 1:1 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 N"able 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❑ was�Zot es See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.Yes 1:1No Applicable pp icable 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. 1:1Yes-1 No dNot Applicable Attach additional sheets if necessary WORKING COAST PO** 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 Q Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town�waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No U 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 forevaluation criteria. El Yes ❑ No U Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P es 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY %0 TITLE O"q_ DATE /W/V 0 SURVEY OF PROPERTY Sl TUA TE cu'rCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-104-07- 16.1 AUGUST 19, 2009 JLI LX Sl, 201PrATE �SVRVEY AREA = 62,613 aq- W (To 11" UK) 1,437 tot $-COTT AMBROSIO 41-4 f 'z" ektl i. CUWAMM AMC REME V WAN LOW WOO My. OO E)MTWC (UW06 A*E SN*wW WS;As '4V MTOG MOW* UNES AK 5NOWN TWn; ALN APPROVED BY �5 IGN BOARD OF TRUSTEES 70 tl�14 -4t TOWN OF SOUTHOLD DATE T4 All, AL AL 4A f ' ' '-4 17 nD C F- E[M MAY MAY 1 9 In 074 AL aft,