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HomeMy WebLinkAboutTR-8489 s i BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK ' PERMIT NO. 8489, DATE: AUGUST 20,2014 ISSUED TO: CHERYL L. HANSEN REVOCABLE TRUST i PROPERTY ADDRESS: 405 WILLIAMSBERG DRIVE, SOUTHOLD � i - SCTM# 78-5-17 AUTHORIZATION �1(� Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in j accordance with the Resolution of the Board of Trustees adopted at the meeting held on August 20,2014, and f in consideration of application fee in the sum of$250.00 paid by Cheryl L.&Erik P. Hansen and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits I "' the following: Wetland Permit to construct a+/-2,400sq.ft. two-story, single-family dwelling; new sanitary system; and pervious driveway; and as depicted on the survey prepared I by John T. Metzger,Land Surveyor, last dated March 3,2006 and stamped approved t r on August 20,2014. i 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. I ( vaFFNIr �4 CD i CD COW i p4 • o�� f i I I t Cheryl Hansen 305 S Windsor Drive Arlington Heights, IL 60004 847-421-5581 June 19, 2017 Board of Town Trustees Town of Southold P. O. Box 1179 Southold, NY 11971 To Whom It May Concern: I am writing that my request for a one year extension on my Permit No. 8489 be added to the**meeting. This permit is for construction of a single-family dwelling at 405 Williamsburg Drive, Southold, New York. I have enclosed a copy of the original permit that was approved August 20, 2014. Sincerely, Cheryl ansen F ECE VE JUN 1 2 2017 Southold kwn of Tr Michael J.Domino,Preside J ��O `Y 0 Town Hall Annex John M. Bredemeyer III,Vice-President G�j, 54375 Route 25 Charles J. Sanders z P.O.Box 1179 Cn Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski '!' p! Telephone(631)765-1892 � ff., Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: CHERYL L. HANSEN REVOCABLE TRUST requests the Last One-Year Extension to Wetland Permit#8489, as issued on August 20, 2014. Located: 405 Williamsberg Road, Southold. SCTM# 1000-78-5-17 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch: 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: .Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino,Presidf �OSUFF��'f 0Town Hall Annex John M. Bredemeyer I11,Vice-President ��� Gyj, 54375 Route 25 Charles J. SandersN z P.O.Box 1179 Glenn Goldsmith l Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 I I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: CHERYL L. HANSEN REVOCABLE TRUST requests the Last One-Year Extension to Wetland Permit#8489, as issued on August 20, 2014. Located: 405 Williamsbergl Road, Southold. SCTM# 1000-78-5-17 I Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT ; MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: I LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith' N. Krupski C. Sanders E. Cantrell D. Di Salvo Other I Page 2 of 2 �o��pF SOUjyol Michael J.Domino,President Town Hall Annex John M.Bredemeyer III,Vice-President O 54375 Route 25 Charles J. Sanders P.O.Box 1179 Glenn GoldsmithG Southold,New York 11971 Telephone(631) 765-1892 A.Nicholas Krupski li�cou Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 19, 2017 Cheryl Hansen 305 S. Windsor Drive Arlington Heights, IL 60004 RE: CHERYL L. HANSEN REVOCABLE TRUST 405 WILLIAMSBERG ROAD, SOUTHOLD SCTM# 1000-78-5-17 Dear Ms. Hansen: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 19, 2017: RESOLVED that the Southold Town Board of Trustees grants the Last One-Year Extension to Wetland Permit#8489, as issued on August 20, 2014. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Michael J. Domino President, Board of Trustees MJD:dd Cheryl Hanl-11-1 305 S Windsor Drive Arlington Heights, IL 60004 EDD 847-421-5581 I JUN 1 0 2016 Southold Town Board if Truste g June 4, 2016 Board of Town Trustees Town of Southold P. O. Box 1179 Southold, NY 11971 To Whom It May Concern: I am writing that my request for a one year extension on my Permit No. 8489 be added to the August meeting. This permit is for construction of a single-family dwelling at 405 Williamsburg Drive, Southold, New York. I have enclosed a copy of the original permit that was approved August 20, 2014. Sincerely, i . Cheryl ansen John M.Bredeineyer III, President ®�®F S® sy®. Town Hall Annex Michael J.Domino,Vice-President 0 54375 Route 25 'g P.O.Box 1179 Glenn Goldsmith im Southold,New York 11971 A.Nicholas Krupski ® �@ Telephone(631) 765-1892 Charles J. Sanders l�`,®U '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 20, 2016 Cheryl Hansen 305 S. Windsor Drive Arlington Heights, IL 60004 RE: CHERYL L. HANSEN REVOCABLE TRUST 405 WILLIAMSBERG ROAD, SOUTHOLD SCTM# 1000-78-5-17 Dear Ms. Hansen: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 20, 2016: RESOLVED that the Southold Town Board of Trustees grants the One-Year Extension to Wetland Permit#8489, as issued on August 20, 2014. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, John M. Bredemeyer III President, Board of Trustees JMB:dd John M. Bredemeyer III, President i , �SO 14 04 Town Hall Annex Michael J Domino, Vice-President 54375 Route 25 Glenn Goldsmith o `� P.O. Box 1179 A Nicholas Krupski o Southold, NY 11971 Charles J. Sanders 'y, �p� Telephone (631) 765-1892 ` .. � Y Fax (631) 765-6641 BOARD OF TOWN TRUSTEES /[ TOWN OF SOUTHOLD Date/Time: l Yds Completed in field by: J rc CHERYL L. HANSEN REVOCABLE TRUST requests a One-Year Extension to Wetland Permit #8489, as issued on August 20, 2014. Located: 405 Williamsberg Drive, Southold. SCTM# 1000-78- 5-17 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: l Present were: J. Bredemeyer /M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 John M Bredemeyer 111, President �pS4 � Town Hall Annex Michael J. Domino, Vice-President �p Gym} 54375 Route 25 Glenn Goldsmithy z P.O. Box 1179 A Nicholas Krupski o Southold, NY 11971 Charles J. Sanders '�,�j o�ti Telephone (631) 765-1892 Fax 631 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: CHERYL L. HANSEN REVOCABLE TRUST requests a One-Year Extension to Wetland Permit #8489, as issued on August 20, 2014. Located: 405 Williamsberg Drive, Southold. SCTM# 1000-78- 5-17 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J: Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G:Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 0 John M. Bredemeyer Ill, President g�FFQ(,f- Town Hall,53095 Main Rd. O Michael J. Domino, Vice-President a�o� coG�� P.O. Box 1179 James F. King y x Southold,NY 11971 ( Tele 631 Charles J.Sanders � � �� Telephone )765-1892 Dave Bergen mal X00 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 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 8489 DATE: AUGUST 20,2014 ISSUED TO: CHERYL L. HANSEN REVOCABLE TRUST i i PROPERTY ADDRESS: 405 WILLIAMSBERG DRIVE,SOUTHOLD SCTM# 78-5-17 i AUTHORIZATION j Pursuant to the provisions of Chapter 275 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 August 20,2014,and in consideration of application fee in the sum of$250.00 paid by Cheryl L.& Erik P. Hansen and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits I the following: I Wetland Permit to construct a +/-2,400sq.ft. two-story, single-family dwelling; new sanitary system; and pervious driveway; and as depicted on the survey prepared by John T. Metzger, Land Surveyor, last dated March 3,2006 and stamped approved on August 20, 2014. 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. i f i i 4guFFO�,� C3 oA I I i 0 • TERMS AND CONDITIONS The Permittee, Cheryl L. Hansen Revocable Trust, residing;at 405 Williamsber Dg_rive, Southold,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages,or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents,and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title,or interest in real or personal property held or vested in a person not a party to the permit. John M. Bredemeyer III, President ��Qf SU!/ry0 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 I7COU +� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 20, 2014 Ms. Cheryl Hansen PO Box 1903 Southold, NY 11971 RE: CHERYL L. HANSEN REVOCABLE TRUST 405 WILLIAMSBERG DRIVE, SOUTHOLD SCTM# 78-5-17 Dear Mr. Hansen: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 20, 2014 regarding the above matter: WHEREAS, CHERYL L. HANSEN REVOCABLE TRUST applied to the Southold Town Trustees for a permit under the provisions-of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated July 21, 2014, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 20, 2014, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 0 9 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of CHERYL L. HANSEN REVOCABLE TRUST to construct a +/-2,400sq.ft. two-story, single-family dwelling; new sanitary system; and pervious driveway; and as depicted on the survey prepared by John T. Metzger, Land Surveyor, last dated March 3, 2006 and stamped approved on August 20, 2014. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $0.00 Very truly yours, John M. Bredemeyer III f! President, Board of Trustees JMB/amn John Bredemeyer, President �SUFFDIt Town Hall Annex Michael J. Domino, Vice-President °° ° 54375 Route 25 James F. King = P.O. Box 1179 Charles J. Sanders Southold, NY 11971 Dave Bergen ��'�� ,F �a°� Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: CHERYL L. HANSEN REVOCABLE TRUST requests a Wetland Permit to construct a +/-2,400sq.ft. two-story, single-family dwelling; new sanitary system; and pervious driveway. Located: 405 Williamsburgh Drive, Southold. SCTM# 78-5-17 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 _VINO Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredemeyer vXM. Domino King Sanders �-D. Bergen Bay Constable Other Form filled out in the field by c-� Mailed/Faxed to: Date: New York State Depart of Environmental Conserjeon Division of Environmental Permits, Region 1 — SUNY @ Stony Brook 50 Circle Road, Stony Brook, NY 11790-3409 Phone: (631)444-0403 • Fax: (631)444-0360 Website: www,dec.ny,aov Joe Martens Commissioner PERMIT MODIFICATION EEJC L April 4, 2011 2 1 2014Cheryl Hansen305 South Windsor Drive Arlington Heights, IL 60004 Re: DEC# 1-4738-03528/00001 408 Williamsburg Rd. Southold, NY 11971 Dear Permittee: The Department of Environmental Conservation (DEC) is in receipt of your request to renew or extend the referenced permit, and the request has been reviewed pursuant to the Uniform Procedures Regulations (6NYCRR Part 621). In order to continue to conduct authorized activities the permit is hereby extended to April 9, 2016. This letter is a modification to the original permit and must be available at the permitted site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. > Very truly yours, George W. Hammarth Permit Administrator sla cc: BOH —TW file NEW YO TATE DEPARTMENT OF ENVIRONMENTAL ERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-03528/00001 Aril 10,2006 FACILITY/PROGRAM NUMBERS) PERMIT EXPIRATION DATE(S) Under the Environmental Conservation Law Aril 10,2011 TYPE OF PERMIT■New ❑Renewal ❑Modification❑Permit to Construct ❑Permit to Operate ❑Article 15,Title 5: Protection of Waters ❑ Article 17,Titles 7,8:SPDES ❑ Article 27,Title 9; 6NYCRR 373: Hazardous Waste Management ❑ Article 15,Title 15:Water Supply ❑ Article 19:Air Pollution Control ❑ Article 34: Coastal Erosion ❑ Article 15,Title 15:Water Transpdrt ❑ Article 23,Title 27: Mined Land Management Reclamation ❑ Article 15,Title 15: Long Island Wells ❑ Article 36: Floodplain Management ❑ Article 24: Freshwater Wetlands ❑ Article 15,Title 27: Wild,Scenic and ❑ Articles 1,3, 17, 19, 27,37;6NYCRR Recreational Rivers ■Article 25:Tidal Wetlands 380: Radiation Control ❑6NYCRR 608:Water Quality Certifica- ❑ Article 27,Title 7; 6NYCRR 360: tion Solid Waste Management PERMIT ISSUED TO TELEPHONE NUMBER Cheryl Hansen 847-421-5581 ADDRESS OF PERMITTEE 305 S. Windsor Drive, Arlington Heights, IL 60004 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Hansen property, 405 Williamsburg Road, Southold, NY 11971 COUNTYiso:owu N WATERCOURSE NYTM COORDINATES Suffolk thold Core Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construct single family dwelling and pervious driveway. Install sanitary system. All work must be done in accordance with the attached plans prepared by John T.-Metzger last revised March 3, 2006 and stamped approved by NYSDEC on April 10, 2006. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3)and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS /'A Region 1 Headquarters George W. Hammarth �` `' SUNY Bld . #40, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE �, April 10, 2006 Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION • SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers,or other devices enter tidal wetlands and or protected buffer areas. 2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland)and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. stabilization of the entire disturbed area with appropriate vegetation (grasses, etc.) c. temporarily stabilized with straw or hay mulch or jute matting or other similar natural fiber matting within 1 week of final grading. Temporary stabilization shall be maintained until a mature vegetative cover is established. 5. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 75 linear feet from the tidal wetland boundary. 6. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 7. If seeding is impracticable due to the time of year, a temporary mulch must be applied and final seeding performed at the earliest opportunity when weather conditions favor germination and growth, but not more than six months after project completion. 8. All fill shall consist of"clean"sand, gravel, or soil (not asphalt, flyash, broken concrete or demolition debris). 9. Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. 10.A row of staked hay bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 50 linear feet from the tidal wetland boundary,or as per NYSDEC approved plan,at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 11. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for immediate on-site recharge. 12. Driveways and parking areas shall be constructed of pervious material. 13. Sanitary system (bottom of tank and leaching pools) shall be located a minimum of 2' above seasonal high groundwater. 14. The permittee shall incorporate the attached Covenant(or similar language)to the deed for the property where the project will be conducted and file it with the Clerk of Suffolk County within 30 days of the effective date of this permit. This depd covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record,along with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to: NYSDEC, Marine Habitat Protection Unit, SUNY Bldg.#40, Stony Brook, NY 11790-2356. 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M '� 1 'Wox P � F � •P mq` iM(U 9 >s� �x ea o n ,e2 �• i a( • s a n � qr n F RD. ,V M F/ —�__uN •Pt . RNs wrcN see sec.No.W L �� n tz,l W —O—' --�'-- ��— -- -- Nonce COUNTY OF SUFFOLK © e ,a a SOUrHDID SECTION NO Reao-1 P•roprty Tax Service Agency v �l Mu _—_— _—,-- i� � aw Nwi,wtl.NY,tM, N w� ® ]ate IS A V tw 1000 PROPERTY MAP - n� .m.� ...., 1 .n,...+rnt..f..mz*m+• .'*�Y+*iTn+tnmV+n.±mr ..,�w+.r.n.....m......m�,x.—.mriys.9. OFFICE LOCATION: o�*rjF SyOl MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) G Telephone: 631 765-1938 Southold, NY 11971 Q Fax: 631765-3136 �y�4UNT1,�� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM �C F t;r r EE C ->� AUG 1 9 2014 To: John Bredemeyer, President 3 I Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 19, 2014 Re: Proposed Wetland Permit for CHERYL L. HANSEN REVOCABLE TRUST SCTM# 1000-78-5-17 This action was originally reviewed in 2010 and recommended as Consistent with the LWRP. CHERYL L. HANSEN REVOCABLE TRUST requests a Wetland Permit to construct a +/- 2,400sq.ft. two-story, single-family dwelling; new sanitary system; and pervious driveway. Located: 405 Williamsburgh Drive, Southold. SCTM#78-5-17 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 LWRP policies and therefore CONSISTENT with the LWRP. Policy 4.1. Minimize losses of human life and structures from flooding and erosion hazards includes the following sub-policy. 3. Move existing development and structures as far away from flooding and erosion hazards as practical. Maintaining existing development and structures in hazard areas may be warranted for: C. sites where relocation of an existing structure is not practical. The majority of the subject parcel is located within and 0.2 percent annual flood area and remaining area in the FEMA flood zone AE el 8 (see Figure 1. below). The recommendation was made considering the following: 1. Due to the size of the lot (0.33 acres) there is no ability to relocate the structure with adequate on- site sanitary systems outside of the flood zones. 2. The first floor elevation of the dwelling will be raised to 12.0' N. A. V. D. to mitigate storm surge/flooding impacts. • - pp Figure 1. Subject parcel A non-turf buffer already exists on-site. 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 gpFFOt�- • Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O. Box 1179 Southold,NY 11971 Telephone(631)765-1892 1 J* Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., August 13, 2014 the following recommendation was made: Moved by John Stein, seconded by Keith McCamy, it was RESOLVED to SUPPORT the application of CHERYL HANSEN to construct a single- family, two-story dwelling, new sanitary system and pervious driveway. Located: 405 Williamsburg Dr., Southold. SCTM#78-5-17 Inspected by: John Stein, Keith McCamy, Doug Hardy The CAC Supports the application with the Condition of an updated survey to include a 15' non-turf buffer. Vote of Council: Ayes: All Motion Carried r - � 1 ' I ifa Ay F,i 1. AUG 1 4 2014 l John M. Bredemeyer III, President �*0� S�UTjyO Town Hall Annex Michael J.Domino,Vice-President ,`O l0 54375 Main Road P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee . �pQ Telephone(631) 765-1892 Charles J.Sanders,Trustee O��COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES l�E D rC E W E TOWN OF SOUTHOLD l5 I� l� To: Southold.Town Building Department JUL 2 8 2014 Re: Verification of Building Department Permit Requirements BLDG.DEPT. I TOWN OF SOUTHOLD SCTM#: .1�(l✓� Property Owner Name: C-he-yq - eEev . u_,S Date Sent to Bldg. Dept.: 2- 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 the Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: BIJ3 ` �! Rev;&,� us�n y/IVC)7 51,k c,Je re, nen�o v� {,--ori• b,A l LiA enol- 9 Signature ofsewer Date Gso °Cte'e bH� Purpose: Maintain existing bulkheading 2) V afAlm:/`l-W s pp 9,L 0W r aW �.09 3) New sheathing to 6e vinyl;timber to 6e CCA-treated _ � 4 GREAT ` H 4) ApproximatAq 21 cubic yards sand to I% LAFx 4 3 incidentalIq dredged from 10' x+82' area G S a OP J p Q� seaward of new bulkhead(to max.depth ofw� �Q�r•'`.'+ �= � r ` �ti^. l<'"O SIII,<AGa55 VIA 9FQr -30''&W)to recover lost backfill and maintain depths for boat dockage;spoil to 6e used together wtth approx.16 cy clean sand to 6e trucked in from an upland source to backfill new AD3 Cf. o pe B A Y�� bulkhead and boat launching ramp G ?'0 5) A silt curtain will be set in place to contain 131J localized y — -- '- localized tur6ldtw LIA Suffolk Canty H&* Map 29 'a.,�`� o - 6) A 10-foot non-turf buffer will 6e e5ta6h5hedIL I" +3000' adjacent to die new bulkhead upon Its completion / 00' 1) Property location:x}09 Williamsburg goad, / $3 Southold; 5CtM #1000-78-5-17 / l / „ 1 " = 30' Z / o � o o / c9 (---E—X. DETERIORATING BOATo�o / LAUNCHING RAMP TO BE / BACKFILLED AND CLOSED ,�0 2sv 2� EX. ±14' TIMBER RETU TO BE CUT TO GRADE AND REPLA D IMMEDIATELY LANDWARD THEREOF TH VINYL BULKHEADQ05 �,� TOP OF eAN — —LIMIT OF�BACKFILL K' — I+ . AHW: AHW �, : : : ': y•16. .�' IM A A _ 6—9 +21' R RN 0 BE OVED 1 _ ALW j ±10' ±82' — — —-- 0— --- _ ±10 x ±82' AREA OF INCIDENTAL DREDGING TO -30"ALW PROPOSED ±98' VINYL BULKHEAD TO BE CONSTRUCTED IN PLACE OF EX. TIMBER BULKHEAD CANAL (COREY CREEK) pt?Op05�n 6UI.KH�An �pI.AC�N1�N1" EN-CONSULTANTS INC. ( IN-PLAM FOP MVOCAPL1 181.151' 1319 NORTH SEA RD. OF CHM HAN5F-N ON COMY CMft, SOUTHAMPTON, N.Y. 11968 U11HOI.n, 5UFFOLK COUNTY, NY 631-283-6360 51f ff 1 OF 2 4119101 -7 6W • • John M.Bredemeyer III,President 6*QF SUFI 0� y�l Town Hall Annex Michael J.Domino,Vice-President O 54375 Main Road James F.King,Trustee P.O. Box 1179 Southold,New York 11971-0959 Dave Bergen,Trustee G Q Charles J.Sanders,Trustee O • �� Telephone(631) 765-1892 �yCOUFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit _A mendment/Transf r/Ex nsion Received Application: ceived Fee:$ ompleted Application c h � _Incomplete D n _SEQRA Classification: _ ! l Type I Type II Unlisted " t __,,,Coordination:(date sent) Ic UL 2 1 2014 f V,GAC Consistency Asse sme Form s/1 /14 �AC Referral Sent: _. ate of Inspection: _Receipt of CAC Report: Lead Agency Determination: Pechnical Review: ublic Hearing Held: Resolution: Name of Applicant Mailing AddressrlS- 9 47 (n o?rpc9 q Phone Number:(24'7 - �,1 �/ ��"�-w �T 6.SS- 908'3 Suffolk County Tax Map Number: 1000 -_ Property Location: X40' W/LL l q-mS ,g ag& ,bx 1 V6" O!_ A7d F 07 FZ/JU V/, [_o (provide LILCO Pole #, distance to cr s streets, and location) AGENT: 0.i �i 0�OX 9y3 oil dUri S nne (If applicable) Address: Phone: �ard of Trustees ApplicatV GENERAL DATA Land Area(in square feet): 6S1-1 q 1,4 - ze AE 6-67F Area Zoning: C_ Previous use of property: 1/,4 e AX)7- L-H A) l� Intended use of property: i A ,- L E /if 1* /1-x1 bwr F- L w rU G-- Covenants and Restrictions on property? Yes ,/ No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes �No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date 1?1)Fr��K No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes,provide explanation: Project Description (use attachments if necessary): �e p�-� T LI © sv w0 S e2 S }{� s s os� ,e✓�o f �LT6 u BWd of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: (�4 NS 7/Z. k—.-'r od SIA2Ct 4,6. L //)w6L)vJ& Area of wetlands on lot: /U 0 NE square feet Percent coverage of lot: AJ Q % Closest distance between nearest existing structure and upland edge of wetlands: Q26 feet Closest distance between nearest proposed structure and upland edge of wetlands: &a feet Does the project involve excavation or filling? No t/ 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: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Brd of Trustees Applicatiob COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No E/ Yes If Yes,how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completine Part I -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 l -Project and Sponsor Information S Name of Action or Project: bitt-t-ows Project Location(describe,and attach a location map): Brief Description of Proposed Action: ,�1 c�� a�� � 7cvo .s�,e y oz y�o s� 17-A y MOM F N�� sAN, ��� sys 7E)� Name of Applicant or Sponsor: Telephone: _qa-1 _S-S ( � L- � E-Mail: h 6 Address: S v)/,4/4SCV 4_� v6 City/PO: State: Zip Code: Y.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 ❑ F] may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and ppermit or approval: 3.a.Total acreage of the site of the proposed action? ��I,� aeres sf( b.Total acreage to be physically disturbed? �av�! acres 9 ' c.Total acreage(project site and any contiguous properties)owned d or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. DUrban El Rural(non-agriculture) ❑Industrial ❑Commercial E]Residential(suburban) ❑Forest ❑Agriculture []Aquatic ❑Other(specify): ❑Parkland Page I of 4 5. fs the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 0 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ Er 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? ❑ PJ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water 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 treatmentx).60 sAEr' El � r 1Z)7� &V91—A T 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. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑Agri cultural/grasslands F-1 Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ET ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? [ NO ❑YES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and sto rains)? If Yes,briefly describe: ❑NO ES 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 I YES completed)for hazardous waste? If Yes,describe: ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spon r n 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? ❑ 3. Will the proposed action impair the character or quality of the existing community? Zr 1:1 4. Will the proposed action have an impact on the environmental characteristics that caused the F-1establishment of a Critical Environmental Area(CEA)? El 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, (moi' ❑ architectural or aesthetic resources? �J 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, F-1waterbodies,groundwater,air quality,flora and fauna)? �I Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. EICheck 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 r/ Lo / rr-- Name of Lead Agency Date L tt f e_ T J-)6—i rte., President 4P, Print or Type Name of Responsible Officer in Lead Agency Titl9 of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 4o� N 1106-0 AJq 71- e,6 STATE OF NEW YORK j, (j& k) 0F, ) �(�Nf (p0 (J COUNTY OF SUFFOLK 4AL5,-"V _, residing at.90T 5. L� JAI bSap- ��. �O(J E op being duly sworn,deposes and says that on the 1/04 day of/4U j v ST , 20L, deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. Sworn to before me this Day of 20j ROBERT A MAZZAFERRO j NOt 1C NOTARY PUBLIC-STATE OF NEW YORK NO.01 MA6207376 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 15,20 f Lot Number Name Address 78-5-10 Wamsley Family Trust 490 Williamsburg Drive Southold,NY 11971 860 A Avenue Coronado, CA 92118 78-5-9 Cheryl Hansen 305 S Windsor Drive Arlington Heights, IL 60004 78-5-16 Peter &Aletra Tagios 26 Amherst Road Port Washington, NY 11050 78-5-14 Brian Parker 305 Williamsburg Drive Southold, NY 11971 1599 New Scotland Road Singerlands, NY 12159 Postal Postal t'S. " RECEIPT O1Omestic Mail • ..- .-. M1 I. • . Covera. Provided) zi- m 0 0 ' rr "ICIAL USE � 5 , 171- Pcstage $ 10.49097 NY 11 Postage $ $0.49 111,9 1 19 Certified Fee $3r-q . ,� Certified Fee $3. O Return Recei t Fes Postmar k Pq rk p _ � O Retum Receipt Fee O (Endorsement Required) $2.70 H Her p (Endorsement Required) $2.70 re i Restricted Delivery Fee ````�j Restricted Delivery Fee S^ O (Endorsement Required) 30.00 �� wv C M (Endorsement Required) $0.00 O wv n� rUTotal Postage&Fees $ $6.49 08/1 apQ"` M Total Postage&Fees $ 36.49 Sent To Sent o Street,Apt No.; treet,Apt.No.; - --------------------------- _ O or PO Box No. / �r- �y((� N or PO Box No. $i7 V �i � --- 1V V6 [ _flNI !j_!�!u r11 M1 / Q q,r City ate,ZIP+; , Q �� City,,Slater�/CYC f�L'J N N j PS Form :ri AugN rr. �• everseforInstructions IV:00 August 2006 See Reverse f or Instructions Postal Service,,, Postal Service-r. -n 1. I . Insurance Coverage • .., 1T (Domestic Mail I . Insurance CoverageProvided) IT' W M For delivery information visit our website at www.usps.coms rn For delivery information visit our website at www.uspsxom..�, = m 1 m 1 Postage $ 34.49 O NY T9` Postage $ 30.49 O p N Y Certified Fee �� Certified Fee $3. C3 Return Receipt Fee Poe e` p Return Receipt Fee PostmarkM OG (Endorsement Required) 32.70 = H p0 (Endorsement Required) $2.70 0 �@y{v� Restricted Delivery Fee O � Restricted Delivery Fee U Q (Endorsement Required) $0.00 n G (Endorsement Required) $4.00 • rU Total Postage&Fees $ $6.49 � J �J` RJ Total Postage&Fees $ $6.49 08 r1 ✓ rq Sent 'AVi;t.j��l d 1 R- _�41 — � Sent Tony`` nC - A lT W l3 Street,Apt. oo.;l•`__f__U Cq�/� / / /� f�'/^ -" 0 Sfr`eYeYt;p No. Gc7 �1/�}� /�- m��}— (� or PO Box No.-_-____-____ko. _J_S.C_---^4V�L.lc� --- CL or PO Box N--- 51 _/_I_ !�`�1__---__-- !.1-_---- City, te,ZIP+4 k C' State,Z/Pt4 � PS Form 3800,August 2006 Spe Reverse for Instructions PS Form 3800,AijqL]st r John Bredemeyer, President SUfFDI* Town Hall Annex Michael J. Domino, Vice-President °°�° C°Gy 54375 Route 25 James F. King P.O. Box 1179 Dave Bergen a Southold, NY 11971 Charles J. Sanders y�'oi , �a°! Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of CHERYL L. HANSEN REVOCABLE TRUST COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS I, CI-16 /U , residing at/dba rad 6' c�, 1�✓bSc��' /�� 6r%/ 6,roA) 1746-7`S -Z::C (0 OCOIC being duly sworn, dep se and say: That on theme day of �� , 20 IV, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, August 20,2014. Dated: (signature Sworn to before me this aoday ofNj54.-120 I" N ry Pu c Jeanne Sweet Bartos NOTARY PUBLIC,State of New York No.O1BA6210083 Qualified in Suffolk County Commission Expires August 10,20�� NOTICE OF HEARI ,NG NOTICE IS HEREBY GIVEN that a public hearing will '',be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. � OWNER(S) OF RECORD: Chewyl Le. Afxnsen �R�e�oco�bt e' T usf` SUBJECT OF PUBLIC HEARING: Construct a +/-2,400sq.ft. two-story, single-family dwelling; new sanitary system; and Pervious driveway. TIME & DATE OF PUBLIC HEARING: 9 If you have an in'Ferest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business dam between the hours of 8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (6311) 765- 1892 Brd of Trustees Applicatiob County of Suffolk State of New York /-//9-/V S C—/) BEING DULY SWORN DEPOSES AN AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)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. 4Signat$feof Property wner SWORN TO BEFORE ME THIS 2- 1 DAY OF ,20J' DANIELLE GRATHWOHL Notary Public, State of New York No. 01 GR6208717 Qualified in SOo k unty -1 Commission Expires 20 i Notary Publ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of intemg on the nart of town officers and emnlovees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necc&M to avoid same. YOURNAME: (Last name,first naine,diddle initial, less 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 of Southold? "Relationship"includes by blood, marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the 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 da of _ 'U 20d`L Signature Print Name (f 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 TownZ 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 Offic ad J , local libraries and the Town Clerk's office. _. _ ... B. DESCRIPTION OF SITE AND PROPOSED ACTION J U L 2 1 2014 SCTM# _ PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees CJ 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: Natureext- of action Ir CJJTi c-�tJ ��fc�-d Location of action: W/4 L / IM6a U,,O 6- ,d 1 ✓Gr Site acreage: Present land use: &A) Present zoning classification: ee:SS /A,5/U 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: O/h � (b) Mailing address: ( cS, 1!)/N D S G& 4kwaa-'161( C��S L two 3 (c) Telephone number: Area CodeVy)r a 2-3 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes EfNo❑ If yes, which state or federal agency? U�-�P�-U✓1� L (qC 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 ❑ o ❑ of Applicab ' Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No l-7 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 Q 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 Page 8 through 16 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III -Policies Pages 16 through 21 for evaluation criteria 1:1Yes ❑ No U❑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. Pf ❑ ❑ Yes No Not Apple 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 DNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No l� 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. ❑ Ye -1l— �-- No f PP Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 0 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 12/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 forZNot on criteria. ❑ Yes F] NoApplicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ NotNot Applicable PREPARED BY Iry TITLE 0 (.1)/U c5k DATE HOUSE /NG Bl 7-4- PRcwOSEO 6rrADE %y, 4 A VW PPE /O,:� �iQj� ��GFti -9T J lE Ad"M PW 4 JE L I2oo GAL. 4, cF�sPooL '- SEPTIC rAMK �E r�V I�FS•i J F �� �CPrE spT S 11 3L° c'uOF. faN Q .4�Os01A 0�LNrr A 4QJO� ANGLE Mch� yr•we- s,- e i-7 PORsVaE °, � �cLu StP ,6p F aD PROPOSED SEWAGE Dk%'OSAL s'rsTEM 6 POOLS S t� SeCI 19' M7TH u EAN SMD 3'COLLAR 1200 GAL PRE - Es Std , ►'' \fie s, r� �v Lias POOLSTOP TICr a BOTTOM wATER e30p, 0 h0 �VE A�BELOW LP., TO SAW sP s FX.L CROSSEC TION- SEPTIC SYSTEM PPE Q0- NO TE: .o 02 am ' _ E DISPOSAL O SUBStr:- 'Cc SFWAGE G BY: JO^ ..-L; iSC'H`. T;1, P.E. 4FQ HOBART' RC,A:: 7 2954 0.1 'S P APPROVES BY SURVEY OF oAR� of RusrEE� PROPERTY G J ivwry of sourHoi,p A T BA YVIEW JUL 2 �,�,�� DATE N OF SOUTHOLD 204 2-b FOLK COUNTY, N. Y. 11 } SITE ADDRESS 1000-78-05-17 ��– � 405 WILLIAMSBURG ROAD SCALE 1 - 30 . BA MEW, N.Y. DEC. 29 2005 �8. .e. JAN.!�•. 'CF; _ ' `'_-'`r'�' Mar. s. 2!%C6 !odrfl/lo. ��`�KER TERMS `; AREA PROP. HSE, 1540 sq,tt. ND CONDITIONS of 76- LOT COVERAGE HOUSE 8 DRIVE = 15% PERMIT x = LA M DATE AREA - 14,547 SOFT. ' ej TEST HOLE 2 p,►, . (g VW06 9Y AkDON ALD GEOSCIENCE — – I DARKBROWN LOAM acBROWN CLAYEY SAW SCANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION Gj S.MEel 1175j• OF SECTION 7209 OF THE NEW YORK STATE EDUCATIOAi LAW. 00D ZONE AE (e'8,'MATER N BROWN CLAYEY SA ND RC EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. A" f$.ICA TIONS FIRk 3610300166 5/04/98 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR -B, WArER N BROWN CLAY CH YHOSE SIGNATURE APPEARS HEREON. WATER N BROWN CLAYEY SAND Sr 1 am lomiliar with the STANDARDS FOR APPROVAL / fO' AND CONSTRUCTION OF SUBSURFACE SEWAGE The locations of welts and cesspools DISPOSAL SYSTEMS FOR SINGLE FA MIL Y RESIDENCES shown hereon are from field observations PECONIC EYORS, ft WATER N PALE BROWN FINE.SAND SP and wilt abide by the conditions set forth therein and or, the and or from data obtained from others. (631) 765 - 5020 FAX AglpiWg permit to construct. P. O. BOX 909 ELE'JATIONS ARE REFERENCED TO N.G.V.D. 1230 TRAVELER STREET it SOUTHOLD, N.Y. 11971 85 - 246 AL O`y� HOUSE � ��.� <z/N � / S9 q q C G rode &1 7.4- � B � PROPOSED 4•G�ArAPDPrE z/0 4A a rp8m 1200 GAL. LE CESS POOLFN TF SEPTIC TAW ' .o /E SrL Ptt "� (��(//�/,I �O 3�COLLAR OF.' o- 2. /V 2 i�(C 21A 'QQ HWY a DLA. 0 O 5,6,//� �.a� 0�� ANGLE MOM gr w�,r�r e! i 7 CENTER c.P oEFTVE GRP 6Q Q J O, O /i� �N�J POOL CLUSTEW !t'- / ~ S PROPOSED SEWAGE DISPOSAL,SYST&W 6 POOLS_ J U L 2 1 2014 ` • ( y/�/ t, ��i, s' WITHCLEANcave -mSANDsEpncc FAW o�OF 7! v p� LEACHNG PPOOIXS TO BE P'ALCOVE GROfAVWATER - - 4O AE140VE AEA TENAL BELOW L..P.s TO SAM SP 6 FALL i `S� .Q np�• W TH CLEAN SAPD rria L 'a �j01 �'y �Fg3�o h� LLV CROS CTION- SEPTIC SYSTEM q. �' NO Tt h � Q' 7�� �.� 2 $ SUBSUF�oed .�ACE SF_WAGE DISPOSAL 5 C':-1E. r I P.E. d+ 32° �o e `�� �`sr a� h� \� n R� .. � T'-J \`•vG, c �8 �V S\js SO);T:-IO '�; N� 1'971 InsgecM \2 0 . / �x v:or Sa�ita�Y \\ 4�0� �► health DePa' SUR VEY OFof NEy, �� - �`�° 'P � PROPERTY P� �, S�y��09� o�P G A T BA YV1EW le- TOWN OF SOUTHOLD t° x\01 o�' �P SUFFOLK COUNTY, N. Y. "°�0520 e`'� 1000-78-05-17 ss �yoo SITE ADDRESS 405 BA W I LLl tefSBURG ROAD SCALE 11t= 30f DEC 29, 2005 JAN.IG. "006 AREA PROP. HSE, 1540 sq.tt. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES /a 6/O4 LOT COVERAGE HOUSE 8 DRIVE = 15% PERMIT FOR APPROVAL OF CONSTRUCTION FOR A `/6• x = LA TH SINGLE Fm LY RESIDENCE ONLY AREA = 14,547 SO.FT. ' et TEST HOLE 2 P'^ • MAY 3 0 2012 / ] g 1/W06 BYA*d)ONALO GEOSC ENCS DATE H . REF. RIG'. �!�' Ia"�Jt✓! DARK BROWN LOAM OL APPROVED .- 1 BROWN CLAYEY SANG SC ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION FOR MAX Ed 0 BEDROOMS e/!.7_ �• OF SECTION 7209 OF THE NEW YORK STATE EDUCA TION' LAW. �L 000 ZONE A E l e 8i WATER AV BROWN CLAYEY SAND ;C EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. HAliE OF ONLY IF FIRM 3610300166 G 5/04/98 EXPIRES TH YEARS FROM DATE Of APPROVAL — _ i. HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVF_YOH ——_ WATER IN BROWN CLAY CH JYHOSE SIGNATURE APPEARS HEREON. 10' WATER AV BROWN CLAYEY SAND SC I ant lomiliar with the STANDARDS FOR APPROVAL / N.Y.S L1C. NO. 49618 AND CONSTRUCTION OF SUBSURFACE SEWAGE The locations o/ wells and cesspools DISPOSAL SYSTEMS FOR SINGLE FA MIL Y RESIDENCES shown hereon are from field observations PECONIC .WileVEYORS, P.C. WATER AV PALE BROWN FINE'SAND SP a;rd Nil/ abide by /he conditions set forth therein and on the and or from data obtained from others. (631) 765 - 5020 FAX (631) 765 - 1797 permit to construct. P. 0. BOX 909 ELEVATIONS ARE REFERENCED TO N.G.V.D. 1230 TRAVELER STREET Lr SOUTHOLD, N.Y. 11971