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HomeMy WebLinkAboutTR-8488 John M.Bredemeyer III,President SO Hall Annex Michael J.Domino,Vice-President �� 01 0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G ® Q Telephone(631)765-1892 Charles J.Sanders O Fax(631) 765-6641 I�COUNT`1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1308 C Date: November 16, 2016 THIS CERTIFIES that the demolition of existing dwelling_porch and foundation; construct new+/- 1,213 sq. ft. elevated two-story dwelling and an attached+/-340 sq. ft. deck with steps to grade; remove existing sanitM system and install new sanitary system;raise the grade over new sanitary and ..under dwelling using+/- 150 cubic yards of clean fill; and construct new storm water mane eg ment system,with the condition to establish and subsequently maintain a 15' wide non-turf buffer landward of the bulkhead; ' At 20 Third Street,New Suffolk Suffolk County Tax Map#1000-117-10-19 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 5,2014 pursuant to which Trustees Wetland Permit#8488 Dated August 20,2014,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the demolition of existing dwelling,porch and foundation; construct new+/- 1,213 sq. ft. elevated two-story dwelling,and an attached+/-340 sq. ft. deck with steps to grade; remove existing sanitary system and install new sanitary system,• raise therg ade over new sanitary and under dwelling using+/- 150 cubic yards of clean fill; and construct new storm water management system; with the condition to establish and subsequently maintain a 15' wide non-turf buffer landward of the bulkhead. The certificate is issued to NICOLAS DE CROISSET owner of the aforesaid property. Authorized Signaturi L 4 ' o CC# : C17-4720 COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 02/02/2017 under Liber D00012899 and Page 185 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 02/02/2017 SUFFOLK COUNTY CLERK JUDITH A.PASCALE SEAL I IIIIIII IIII VIII VIII VIII VIII VIII VIII VIII IIII IIII I IIIIII VIII VIII IIII IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 02/02/2017 Number of Pages : 6 At: 02 :47 :02 PM Receipt Number : 17-0020578 LIBER: D00012899 PAGE : 185 District: Section: Block: Lot: 1000 117 .00 10 . 00 019.000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $30 .00 NO Handling $20 . 00 NO COE $5 . 00 NO NYS SRCHG $15. 00 NO TP-584 $0 . 00 NO Notation $0 .00 NO Cert.Copies $15 . 00 NO RPT $200 . 00 NO Fees Paid $285 . 00 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County F—il F21 Number of pdges =E1r_--RDED 12017 Feb 02 AX.:47.02 PM JUDITH A. FASCALE s:LEVE•: OF This document will be g ubflc SUFF011:; r:O iHTY record. Please remove all L D0�01289 Social Security Numbers P 185 prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps :3]� FEES Page/Filing Fee Mortgage Amt. 1. Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-52 17 (County) Sub Total Spec./Add. EA-5217 (State) TOT.MTG.TAX �C R.P.T.S.A. Dual Town Dual County � Held for Appointment Comm. of Ed. 5. 00 P� • ` Transfer Tax g ° Mansion Tax rertified it � The property covered by this mortgage is Coor will be improved by a one or two urcharge 15. 00 family dwelling only. Sub Total YES or NO Other �,.�. Grand Total If NO, see appropriate tax clause on page# of thi :L i e 41 1 Dist. 3326685 1000 11700 1000 019000 5 [Community Psese action Fund Real Property R DZIA Consideration Amount $ Tax ServiceU2_F� Agency CPF Tax Due $ Verification Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: Vacant Land / A TD 11P7-1 TD TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Comipawy Information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffiolkcountyny.gov/clerk Title# 8 Suffolk C_,ountj RecordingEndorsement Page This page-forms part of the attached Dr-C4444,774V W 16?- made by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of v 40 -"('C MVM 6 429 AP NO 6/'L� V0' fn the VILLAGE or HAMLET of �1�,Pc BOXES 6 THRU g MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12-0104..10/08kk (over) DECLARATION OF COVENANTS THIS DECLARATION made this Z , day of January, 2017, by NICHOLAS DE CROISSET, residing at 135 West Third Street, New York, N.Y. 10012, hereinafter referred to as "DECLARANT" : W I T N E S S E T H WHEREAS, DECLARANT is the owner of certain real property located on 20 Third Street, New Suffolk, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 117, Block 10, Lot 19 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a 15 foot "non-turf buffer" adjacent to and landward of bulkhead be established and subsequently maintained. NOW, THEREFORE, the DECLARANT does hereby covenant and agree as follows : 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and perpetually maintained a 15 v Non-turf buffer" as defined by Chapter 275 of the Town Code: to wit: " A vegetated area, as designated by the Board of Trustees, immediately landward of the wetland boundary, shoreline structure, or other line designated- by the Trustees where no operations, maintenance, placement of signs or other activities may take place, except that man-made debris may be removed from such area by hand without the permission of the Board of Trustees". An application for a wetland permit may be submitted for the removal of harmful, "invasive" or non-native vegetation; and as depicted on the Survey prepared by Nathan Taft Corwin 111, dated June 2, 2014 and approved by the Board of Trustees, Town of Southold on August 20, 2014, see Exhibit A attached; and 2) These covenants shall run with the land and shall be binding on the DECLARANT, his heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the Trustees . IN WITNESS WHEREOF, the owner has duly executed this instrument this day of �c�, ,,L ZIP 2017. NICHOLAS DE ROISSET 2 STATE OF NEW YORK ) COUNTY OF �&J�Okss . : On the L� day of January, in the year 2017, before me the undersigned, a Notary Public in and for said State, personally appeared NICHOLAS DE CROISSET , personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual or the persons on behalf of which the individual acted, executed the instrument. kkCaluA�'�' oak _�_C4_-'M' /lam Notary Public MARY KAITLjf LYNCH NOTARY pUBLIC,smote of New Yo* No.09LY03825M - Qualftd in Wn0s Coun4y Commission Expires 12=2020 3 0 0 . SCHEDUI-E A Stadderd N.Y.B.T.U.Form 8005—Executors Deed—Uniform Acknowledgment -r CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT WIOULD BE USED BY LAWYERS ONLY THIS INDENTURE,made the 2-*-A day of January,2008 BETWEEN I JOAN B. ROfBBINS,as Executrix of the Estate of Alfl?ed Newton Robbins, aRtla Agflred M. I Robbins, alkla A Fred N. Robbins,Jv.,alkla Alfred Robbins alWa Newton Robbins,who died a resident of Suffolk County on June 17, 2007 and whose will was admitted to probate by the Suffolk County Surrogate's Court under file 9156BP2007 residing at 16995 Main Street, New Suffolk, New York 11956, party of the first part, and NICOLAS DE CROISEET, residing at 1 Lexington Avenue, New York, New York 10010, party of the second part. I WITHESS[ETHI, that the party of the first part, in consideration of NINE HUNDRED TEN THOUSAND AND 4" 001100-(5910,000.00)-Dollars, and other good and valuable consideration paid by the party of the second part, �4 does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, i ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected, situate, lying and being in the Town of Southold, County of Suffolk and State of New York, bounded and described as I �`S-c follows: j' BEGINNING at a point in the easterty line of Third Street,distant 233.28 feet southerly from the comer fbiTned `IQb by the intersection of the easterly line of Third Street with southerly line of Jackson Street; RUNNING THENCE North 87 degrees 21 minutes 00 seconds East along land now or formerly of Martin 90 feet 6e to a point; oTHENCE South 5 degrees 00 minutes West along land now or formerly of Cartwright 127.00 feet to the apparent high water mark of Great Peconic Bay; THENCE westerly along said high water mark to the easterly line of Third Street;the tae line of the last course (SI'v— being North 89 degrees 28 minutes 30 seconds West 89.47 feet; THENCE North 5 degrees 00 minutes East along the easterly line of Third Street 122.00 feet to the paint or place of BEGINNING. BEING AND INTENDED TO BE the same premises conveyed to grantor by deed made lby and recorded in n d Liber 5734 page 256. TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party" shall be construed as if it read "parties" when ever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. INP E611 E C►F: , Veedexrobbins 016i6—B- Robbins, Executrix SURVEY OF PROPERTY SITUATE R v� E NEW SUFFOLK, n Q IF ` '-� TOWN OF SOUTHOLD f> .10D SUFFOLK COUNTY, NEW YORK JACKSON JUL 2 5 2014 SC. TAX No. 1000-117-10-19 STREET JANUARYSCALE12. 008 ,n V/./P JANUARY 20,20DS VERIFIED HIGH WATER MARK TTTOYAS 1X(HARTIN MAY 9 2009 STAKE PROPERTY LINES w$ d JAYNE P YARTW ` _ NOVEMBER 19 2009 UPDATE SURVEY y mS DAELLING JN'6.2013 ADDED lal UPDATE EL R FLOOD ZONE 47 usEs PUBUD MIER 90 00' � ��„ FEBRUARY 3,20f 4 UPDATE SURVEY N 87 21'00" F MARCH UNE 24,2014 400 PROPOSED HOUSE JUNE 2,2014 REVISE SEPTIC SYSTEM Do AREA ew,mo) D.250 . It. 5 c CERTZEWD TO [n NICOLAS DE CROISSET i NN , 5' p A• APPROVE® BY FIRST AMERICAN TITLE INSURANCE COMPANY Of NEW YORK I ` BOARD\OIL AUSTEES �L''�•. �iH-F-L p 1.ELEVATIONS ARE REFERENCED TO N,A.V.D.1988 DATUM T,NC ,Art, I" 5 F R.t TO"OF SO EXISTING ELEVATIONS ARE SHOWN WN THUS:- I, HU �� ,k�iq•N b� g, ��`\ S ,�x �'7 EXISTING CONTOUR LINES ARE SHOWN THUS:————s———— A���B IfII — Y OD DAT, x �1 D 2•TFLOOD HIS RINSURANCE OPERTY IS IRATE.MAP No.36 0ZONE VE 3005EL 01 AS SHOWN ON �iTG (l L ZONE VE COASTAL FLOOD WITH VELOCITY HAZARD(WAVE ACTION), i i ,t' A� BASE FLOOD ELEVATIONS DETERMINED V]l sa - © P so 3 MINIMUM SEPTIC TANK CAPACITIES FOR 3 BEDROOM HOUSE IS 1,250 GALLONS- 7 "r2`+o_ �Q TANK, 10'DIA.,3'DEEP 4.MINIMUM LEACHING SYSTEM FOR 3 BEDROOM HOUSE IS 300 cq 11 51DEWALL AREA J g , ti PR0p o - 5 POOLS.2'DEEP,B'di. M �LL SCK PROPOSED FUTURE SOX EXPANSION POOL O k o FJ(ISTIN6 SEPTIC SYSTEM TO BE REMOVED �y y 0 _ K SEE NOTE Ho 6 O PROPOSE.B'DLL X 2'DEEP LEACHING POOL m AIS' 13R •' `'-- --�yu j x. �'' TEST HOLE DATA + INs/ xy (TEST HIXE WO BF-gin2S9J QIE=v ON MNa1 1,2014) PROPOSED 1,250 GALLON SEPTIC TANK - *K SAUAN IDw.1 5.THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS Pvms >I \ RaIAI tuRY sum x 6 EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND N anve N M` / Kg .) 4)n ' R AB• REMOVED IN ACCORDANCE WITH S C.D H S.STANDARDS a � p VVV p xVm WATER Ix BKMM CUYLY SAND 50 _ PREPARED IN ACCOIjjRDANCE WITH THE MINIMUM N 89.28'30" W 89.47' r BY TTHHEE LIALS AND APPROVED�AN OPTED FOR SUCH USE BY THE NEW YORK STATE LAND GREAT PECONIC BAY TTLEA�OGATID�� qE of roE6,} IwATm w eRa.H DxE sNro sP Ab ZAFT . p � � PROPOSED SEPTIC SYSTEM DETAIL NOVSE (NOT TO SCALE) $a ELLV'LLD NMSN aRAOE' FINISHED GRADE ELEV eA' NY S L,.. No 50467 ON PIISA des .cm,Ws m TOP EL BT �I'Yul i0P---I tet'YIN 70 THIS SURV ALTERATION TI ADDITION YIN FOIA e' TO THIS SURVEY'IS A VIOLATION OF [iNZathsn ���� ®���� ��� SEPTIC LEACIONG u 3'CLEAN SECTION 7209 OF THE NEW YORK STATE A._11MPROYED PIPE TMK mAPPR O PWL IFACHOM i SMO EDUCATION LAW I 63 PITCH t/4- a ,N n PRCN I/8�/1' THY-El Lb' �L o COLIAR CUSS 2400 PIPE�P EL 56' INV EL COPIES OF THIS SURVEY MAP NOT BONING La��_p �y'p�u���®� THE LAND SURVEYORS INKED SEAL OR f{llm W2'Oy[7 Surveyor ROT EL 3O' (•�-9'-+{ EMBOSSED SEAL SHALL NOT BE CONSIDERED Tom A VALID TRUE COPY aSTRIBUTiON POOL OF .T EL 2.q• CRWND WATER CERTIFICATIONS INDICTED HEREON SHALL RUN 5 POOL SmT M HEV p,B ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED,AND ON HIS BEHALF TO THE SEPTIC TANK (1) TITLE COMPANY,GovERNMENTAL AGENCY ND Tfe Surveys-Su6d,.SlonS - Sde PICS - CostrU'"'Layout LENDING INSTITUTION LISTED HEREON,NO 1 MINIMUM SEPTIC TMK CAPACITIES FOR 3 BEDROOM ROUSE a 1230 GALLONS LEACHING POOLS (5) TO THE ASSIGNEES OF THE LENDING INSTI- j TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE(631)727-2090 Fox(631)727-1727 1 TANK.iD .lil,S'DEEP , WKARIY(D.LNNG MRM FOR A t TD 3 BEDIppY X0150 5 250 N SIDEWNI IAEA 3 CACRNC SNNL IIAYE A MINWOY�LOLdREw A SIRFNGIN Oi JWO AN T]B N.YS 5 POOLS 1 DEEP.a PU 3.WNL R4CKXESS 5HALL BE A YNIRAI OF 3'A iaP IHIDIOrt55 OF e-MD A BOTTOM T ANESS Of{' 2 IFA-a LAOIS ARE TO BE INSIRDGTED DF PREfAST 1INFOR=CONLRETE(OR EDW.) MAILING JUtORE55 ALL RJAIS,eOROY AND TOP SWLL ROW—ND.F.II Ne TO RES6i M APPDED FORCE OF 3(10 PM RZA-0 STRUC10REs Seal—m 4x0/-was OFFfCES LOCATED Ai s ALL JONTS SNAIL RE SEALED SO THAT THE TANK s INATERKANI. S ALL 001'CNS" 0E eE WIECASF RD,IMM CpNCAG1E TOR IT1Wl} THE EXISTENCE OF RIGHTS OF WAY 1586 Mon Road P 0 Boz 16 5 INC sEPIK TANK SHNL BE N5IAYJD AT LEYSA a ALL MREa1016 DrM A A1Ax IOLEAANCE Oi 21/4-) A TD n•m.DBTAN S OflWCEN LOLNINC PDOIS AYD M1ER TINE SNAIL YNMTNNCD ON A YFAMW 3-MEK BFO U Ca1PAC1ED SAM OR PFA vPAVLI i M e'mw D6TAvc[9EiWMp1 Au vACX2K:was MD SFP1K TAMIL sNAu BE M4HTN2 AND/OR EASEMENTS OF RECORD,IF Jomesport.New York 11947 Jamesport,New York 1194 A,A 10'.1 DWAPAX eETwEEx SM.rMK AAD xolcE S-K YlwIAAWa ANY, NOT SHOWN ARE N01`GUARANTEED I p I EXHIBIT A r z i F John M.Bredemeyer III, President SU(/a�ol Town Hall Annex Michael J.Domino,Vice-President O 54375 Route 25 Glenn GoldsmithP.O.Box 1179 Southold,New York 11971 A. Nicholas Krupski G Telephone(631) 765-1892 Charles J. SandersCOU Fax(631) 765-6641 , BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 11 '►9/'y Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed j° Project complete, compliance;inspec'tion. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: John M. Bredemeyer 111, President O�OguFFQ( -co Town Hall,53095 Main Rd. Michael J. Domino, Vice-President 4� Gym P.O. Box 1179 James F. King ti x Southold,NY 11971 Charles J.Sanders 4,- �� Telephone(63 1)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 I BOARD OF SOUTHOLD TOWN TRUSTEES I SOUTHOLD, NEW YORK rr PERMIT NO. 8488 DATE: AUGUST 20,2014 i ISSUED TO: NICOLAS DE CROISSET i PROPERTY ADDRESS: 20 THIRD STREET,NEW SUFFOLK =. SCTM# 117-10-19 i AUTHORIZATION 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 Nicolas De Croisset and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the j following: Wetland Permit for the demolition of existing dwelling,porch and foundation; construct new+/-1,213sq.ft. elevated two-story dwelling,and an attached +/-340sq.ft. deck with steps to grade; remove existing sanitary system and install new sanitary system; raise the grade over new sanitary and under dwelling using+/-150 cubic yards of clean fill; and construct new storm water management system; with the condition to establish and subsequently maintain a 15' wide non-turf buffer landward of the bulkhead; and as depicted on the survey prepared by Nathan Taft Corwin III,Land j Surveyor, last dated June 2,2014 and stamped approved on August 20,2014. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, I and these presents to be subscribed by a majority of the said Board s of this date. � I ��g11EF91�.co CIO A i i I 0 • TERMS AND CONDITIONS The Permittee Nicolas De Croisset residing at 20 Third Street,New Suffolk,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. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. 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. H. 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 �*OF SO!/T�o Town Hall Annex Michael J. Domino,Vice-President �� lQ 54375 Main Road P.O.Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q • �O Telephone(631) 765-1892 Charles J.Sanders,Trustee �OIyCOU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 20, 2014 Mr. Michael Kimack 321 Riverside Drive Riverhead, NY 11901 RE: NICOLAS DE CROISSET 20 THIRD STREET, NEW SUFFOLK SCTM# 117-10-19 Dear Mr. Kimack: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 20, 2014 regarding the above matter: WHEREAS, Michael Kimack on behalf of NICOLAS DE CROISSET 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 25, 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 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 NICOLAS DE CROISSET for the demolition of existing dwelling, porch and foundation; construct new +/-1,213sq.ft. elevated two-story dwelling, and an attached +/-340sq.ft. deck with steps to grade; remove existing sanitary system and install new sanitary system; raise the grade over new sanitary and under dwelling using +/-150 cubic yards of clean fill; and construct new storm water management system; with the condition to establish and subsequently maintain a 15' wide non-turf buffer landward of the bulkhead; and as depicted on the survey prepared by Nathan Taft Corwin III, Land Surveyor, last dated June 2, 2014 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: $50.00 Very truly yours, John M. Bredemeyer III President, Board of Trustees JMB/amn 0 John M. Bredemeyer 111, President �c0 gQEFO( Town Hall Annex Michael J. Domino,Vice-President 54375 Route 25, P.O.Box 1179 James F. King y Southold,NY 11971 Charles J. SandersG r► Telephone(631)765-1892 Dave Bergen ' '� Fax(63 l)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Wcbaej Lwotk -Qi� A hto lis De-, C � Please be advised that your application dated 2,FS has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of Ahe tollowing items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) '/ Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50. 00 BY: John M. Bredemeyer 111, President Board of Trustees Nicolas De Croisset 20 Third Street, New Suffolk SCTM#117-10-19 8/13/14 i - s; +.r _ i w "s c'ST,� ..k , •� , ',.�'r` � '16. � . 1.. J a , 4 k y 4.- i i �r s , k _ ' � w =M ?r , ,. ,- ♦ <. ..:. *eye r , I m-t Tny,�s < , a•. i �y�� h�,,,.{, jai � � Y�- m. ,z1 � f�:4• • r S . as r f n • c � 1 x "" �' #� { •4d � E ; 1..7 ,p x#33 �� �" � � '�`� a • r i r r P �d 6 a John Bredemeyer, President �OfF014r 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 ��'�� ,p �a°' Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: l Michael Kimack on behalf of NICOLAS De CROISSET requests a Wetland Permit for the demolition of existing dwelling, porch and foundation; construct new +/-1,213sq.ft. elevated two-story dwelling, and an attached +/-340sq.ft. deck with steps to grade; remove existing sanitary system and install new sanitary system; raise the grade over new sanitary and under dwelling using +/-150 cubic yards of clean fill; and construct new storm water management system. Located: 20 Third Street, New Suffolk. SCTM# 117-10-19 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: ---64hapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredemeyer --I Domino King 'C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: 2• '•i 5j (1)Nicholas De Croisset May 13,20141 Looking SE i 3y� (2)Nichlas De Croisset May 13,20141 Looking South , f - E T _ No . s i -tom ate• "�'-�i(v ..`" (3)Nichloas De Croisset ..' -. May13,2014!Looking Werst Aa win o ry s (/ Y L 'j .-.. A S '_ F FrAT ) .vr'v✓�pp,�.ew" .--so +'-n ,u i .. �yylr•t.re.r�rt...«.:.v......,..,�nrt.'"e'�e�n'f^'.,wrenr'nAw.P'^' ays i� (4)nichlas De Croisset May 13,2014 I Looking West A } c 6� 4 I . r, r � r � (7)Nicholas De Croisset May 13,20141 Looking NE yf A it (8)Nichlas De Croisset May 13,20141 Looking NW I J a, (9)Nichloas De Croisset May13,20141 Looking NE w,. (10)nichlas De Croisset May 13,2014 1 Looking NW r f , 1f"a .o — , •l. (11)Nichlas De Croisset May 13,20141 Looking NE 4 (12) Nichlas De Croisset May 13,20141 Looking NW fJ # t � Y�q Will E, (13)Nicholas De Croisset May 13.20141 Looking West i ' fiK g r May J3,201411 Looking South - __ /;•.� �, _ B fdl k4 .yea iLm�., 'mob' � � N y�� 4i:• �` a t , ami # r• ► earth feet 400 meters 100 OE CA:olSSe7 R4l,0,6A CA Sr Rgn6�,6 0907-00 9 t0 A 022 01 SNE 0i 09 o ey g 12,0. 09OLO— SEED SEC— ,.,N,)•' z iWcgI HILL RD. rsal £ ,B z.iNc1 FOR 2 �. R .NG R b g +Nq t�tNcl eA(U `• BEE gECfG.NG. 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SAY a PECONIC xoN +it GREAT t .aw r+. •" ,. - -- �-�- -- -- �-'- --"-- a,,, NOTICE GO a" COUNTYOF SUFFOLK © x os SOUTHOLD bECTN1NN0 G �-d- _-�— - le,l �u —Qz — Real Property Te9(Service Agency v WxYCr,wRImMM.xvnWt A 117 P ,000 %10PERTY MAP aom OFFICE LOCATION: ���rjf SD(/�yQl MAILING ADDRESS: Town Hall Annex ti O P.O. Box 1179 54375 State Route 25 J Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) G Telephone:hone• 631 765-1938 Southold, NY 11971 '�► • �� Fax: 631 765-3136 olyCOU ,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM p E C Ff a; y To: John Bredemeyer, President , Town of Southold Board of Trustees AUG 1 9 2014 i E From: Mark Terry, Principal Planner i LWRP Coordinator Date: August 19, 2014 Re: Proposed Administrative Permit for NICOLAS De CROISSET SCTM# 1000-117-10-19 Michael Kimack on behalf of NICOLAS De CROISSET requests a Wetland Permit for the demolition of existing dwelling, porch and foundation; construct new +/-1,213sq.ft. elevated two- story dwelling, and an attached +/-340sq.ft. deck with steps to grade; remove existing sanitary system and install new sanitary system; raise the grade over new sanitary and under dwelling using +/-150 cubic yards of clean fill; and construct new storm water management system. Located: 20 Third Street, New Suffolk. SCTM# 117-10-19 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 the FEMA flood zone VE and the remainder is located within the AE flood zone (see Figure 1. below). The recommendation was made considering the following: 1. Due to the size of the lot (0.225 acres) there is no ability to relocate the structure with adequate on- site sanitary systems outside of the VE (velocity hazard) flood zone. 2. The first floor elevation of the dwelling will be raised to 14.0' N. A. V. D. to mitigate storm surge/flooding impacts. q 50 0 or wr s t r ..�. .+ `r r' ,+' �'"�F',v"`� '✓"fir il[ Figure 1. Subject parcel. 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 gUFFOt,,� Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish, Secretary , P.O.Box 1179 �► ` Southold,NY 11971 Telephone(631)765-1892 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 Peter Young, seconded by John Stein, it was RESOLVED to SUPPORT the application of NICOLAS DE CROISSET for the demolition of the existing dwelling, porch and foundation; construction new elevated dwelling with mezzanine storage and deck; remove existing septic system and install new system; raise grade over new distribution pools; and construct new storm water management system. Located: 20 Third St., New Suffolk. SCTM#117-10-19 Inspected by: Peter Young The CAC Supports the application with the Condition of a 15' non-turf buffer landward of the bulkhead. Vote of Council: Ayes: All Motion Carried AUG 1 4 2014 ` " 0 BOARD MEMBERS *t� so Southold Town Hall Leslie Kanes Weisman,Chairperson 53095�053095 Main Road-P.O.Box 1179 Southold,NY 11971-0959 Eric Dantes Office Location Gerard P.Goehringer y G • � Town Annex/First Floor,Capital One Bank George Horning %2` y Old � 54375 Main Road(at Youngs Avenue) Kenneth Schneider CQuSouthold,NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 •Fax (631)765-9064 July 25, 2014 , ._ r� Michael A. Kimack AUG ` 1 2014 f 321 Riverside Drive Riverhead,NY 11901 " +a RE: ZBA Application#6762 -DeCroisett r fTr} Dear Mr, Kimack: Transmitted for your records is a copy of the Board's July 24, 2014 Findings, Deliberations and Determination, the original of which was filed with the Town Clerk regarding the above variance application. Before commencing any construction activities, a building permit is necessary. Please be sure to submit an application along with a copy of this determination to the Building Department. If you have any questions, please call the office. Sincerely, Vicki Toth Encl, Cc: Building Dept. BOARD MEMBERSso • Southold Town Hall Leslie Kanes Weisman,Chairperson �O��oE l/jy0lo 53095 Main Road•P.O.Box 1179 Southold,NY 11971-0959 Eric Dantes Office Location: Gerard P.Goehringer G Q Town Annex/First Floor,Capital One Bank George Horning �p �� 54375 Main Road(at Youngs Avenue) Kenneth Schneider �yCOUNV, Southold,NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel.(631)765-1809•Fax (631)765-9064 FINDINGS,DELIBERATIONS AND DETERMINATION MEETING OF JULY 24,2014 ZBA FILE: 6762 NAME OF APPLICANT: Nicolas DeCroisset SCTM# 1000-117-10-19 PROPERTY LOCATION: 20 Third Street(adj. to Great Peconic Bay),New Suffolk,NY SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated June 19, 2014 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. The LWRP Coordinator issued a recommendation dated July 1, 2014. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to us, it is our recommendation that the proposed action is CONSISTENT with LWRP policy standards and therefore is CONSISTENT with the LWRP because the small 0.225 acre lot does not allow relocation of structures with an adequate on site sanitary system outside of the VE floor zone. PROPERTY FACTS/DESCRIPTION: Subject property is located in the R40 zone district and is non-conforming with 11,105 sq. ft. of buildable area. It is improved with a one story framed dwelling and an accessory shed and outdoor shower. It has 122.00 feet of frontage on Third Street, 90.00 feet on the north property line, 127.00 feet on the east property line and 89.47 feet on the Great Peconic Bay as shown on the survey dated January 2, 2008, last updated June 26,2014 prepared by Nathan Taft Corwin, III,LS. BASIS OF APPLICATION: Request for Variances from Article XXIII Section 280-124 and Article XXII Section 280-116 and the Building Inspector's January 13, 2014, amended/renewed April 22, 2014 Notice of Disapproval based on an application for building permit for demolition of an existing single family dwelling and construction of a new single family dwelling, at; 1) less than the code required front yard setback of 35 feet, 2) less than the code required bulkhead setback of 75 feet RELIEF REQUESTED: The applicant requests variances to construct a new dwelling having; 1) a 9.3 foot front yard setback where the code requires a minimum of 35 feet and, 2) a 13.1 foot bulkhead setback where the code requires a minimum of 75 feet. Page 2 of 3—July 24,2014 • ZBA#6762—DeCroisset SCTM#1000-117-10-19 ADDITIONAL INFORMATION: The applicant proposes to demolish the existing nonconforming dwelling which was damaged by Super Storm Sandy and construct a larger new dwelling in its place, meeting FEMA requirements. The existing dwelling's first floor elevation is almost at grade. In order to meet FEMA requirements, the proposed new dwelling's first floor will be elevated from grade onto a piling foundation. The total height from grade to the proposed roof ridge will be conforming at 30 +/- feet. This property was the subject of a prior ZBA decision in 2010, under file#6354, in which the applicant was granted the non-conforming accessory shed location. At the public hearing the adjacent neighbor spoke in favor of the proposed new dwelling. FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on July, 10, 2014, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law 4267-b(3)(b)(1). Grant of the variances will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The proposed new elevated dwelling will be approximately 300 square feet larger than the existing dwelling and have decking of approximately 400 square feet, all of which is in character of this neighborhood. 2. Town Law §267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than area variances. The subject parcel, like others in this neighborhood, is small and does not permit other feasible options for the proposed new dwelling's location given the location of the driveway/parking, frame shed,proposed new septic system and storm water drywell system. 3. Town Law 4267-b(3)(b)(3). The variance granted herein for a front yard setback is mathematically substantial, representing 73% relief from the code. However, the proposed new dwelling will maintain the existing dwelling's front yard setback. The variance granted herein for a bulkhead setback is mathematically substantial, representing 83% relief from the code. However, the proposed bulkhead setback to the proposed deck will be greater than the existing bulkhead setback to the existing deck(to be demolished). 4. Town Law 4267-b(3)(b)(4) No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code. The proposed first floor elevation will be raised to 14 feet N.A.V.D. to mitigate storm surge and flooding impacts. 5. Town Law 4267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 6. Town Law 4267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of demolishing an existing dwelling and constructing a new FEMA compliant dwelling in its place, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Schneider, seconded by Member Horning, and duly carried, to GRANT, the variances as applied for, and shown on the Survey/Site Plan prepared by Nathan Taft Corwin I1I, L.S., dated January 2, 2008, last revised June 26, 2104 (add drywells), and the architectural drawings prepared by Page 3 of 3—July 24,2014 ZBA#6762—DeCroisset SCI'M#l 000-117-10-19 Toshiko Mori Architect PLLC, dated March 7, 2014 and Jan. 31, 2014, floor plan, cross section, elevations and 2 color renditions showing the proposed dwelling. Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variance(s) granted herein as shown on the architectural drawings, site plan and/or survey cited above, such as alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Vote of the Board.• Ayes: Members Weisman (Chairperson), Schneider, Horning, Goehringer, Dantes. This Resolution was duly adopted(5-0). Leslie Kanes Weisman, Chairperson Approved for filing f71 /2014 out John M.Bredemeyer III,President ',` Town Hall Annex Michael J.Domino,Vice-President 64376 Main 1 oad�? P.O.Box 117979 James F.King,Trustee Southold,New York 11971-0969 Dave Bergen,Trustee 1; Telephone(631) -6b-1892 Charles J.Sanders,Trustee � „ '� ,� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD w................._ Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit E Ca Amendment/Transfer/Exkension 4eceived Application: 1FILeceived Fee:$ Q 5t p Application_Com leted A lication JUL 2 5 2014 sM _Incomplete SEQRA Classification: – i Type t Type 11 Unlisted oordination:(date sent) WRP Consistency Ass t Form �✓C C Referral Sent:­..jk� te of Inspection: PI1 ^Receipt of CAC Report: L ad Agency Determination echnical Review:_ _Public Hearing Held ,-z..' ` 1 Resolution; Name of Applicant Mailing Address _ .3 ,_.._.�/L/ r �''o r_��j'' ;�/�/ M/ V—aEk.A&k--/G 41 Z Phone Number:( ) fly, Suffolk County Tax Map Number: 1000----/– 7 – /O / Property Location: .dao ir,troves oC�7 !G/'e'l s---rte a'.g P'� Pccvv� ,B•a y (provide LILCO Pole#, distance to cross streets, and location) (If applicable) Address: -Phone: Lard of Trustees Application GENERAL DATA Land Area(in square feet): /A /0 Area Zoning: Previous use of property: L Intended use of property: ,Q f'l��iV, [-,. Covenants and Restrictions on property? Yes ___X No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? X 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? X 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.? X Yes No Does the structure(s)on property have a valid Certificate of Occupancy?_ Yes No Prior permits/approvals for site improvements: Agency Date Z&j&ZES Pte' Z: ,707/A AUG. L 9, Z x'11401✓G 0,501• e or D ,ovG 24, l 9?G Z A ot.e Z o/O No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: _____ Project Description(use attachments if necessary);2E"w[r1 Df X/17:/lOU P�O� �NpT'v' CON1'J�'U�T NBlU�L,�1�,gPt.lJ .VG-�/,p17"FC. td"6'X 92'7�'= /?/3 53.x+ •�T Gv/J7� M�ZL�W/N�1TA6E%!q���'ar29�t"xiI '6�ftt�'.�"SO?. �r�tr wig 0.Cok- " X39•S'�J4fI• N,�6u D117�t,8Lrra.✓ pOoGS �-Z FT- con�/�.tUcr"IY6+W 17"0 Mew ���,D UrV.r�,✓Z �'rl �t,e•rr u con ���varix , n6�uJ D GUL�tLd91/ls Lard of Trustees Applicatioe WETLAND/TRUSTEE LANDS APPLICATION DATA To � ' 0AW. &4>P Purpose of the proposed operations: wG�`�{il✓eGz oV. e ,¢ vp ca lrlxu or lmw owr � WZZ�y ,� rs Area of wetlands on , squar feet S �2W.t�.t'O Percent coverage of lot: O. /fT % Closest distance between nearest existing structure and upland edge of wetlands: /,?, q feet Closest distance between nearest proposed structure and upland edge of wetlands /3 1 — feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated?<,' __-cubic yards Q6/roV14 'ex1j " oot-A/ar�V 25 How much material will be filled? cubic yards Fa W aY�NS G ' UVA�NEwdG��t' Depth of which material will be removed or deposited; .7—4 feet��v_ __ Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: /z VAD b UMlP 7 O40-3 � y L aV G lU /f� 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): ��'Ory �'E/� PQNJ�",�UG�70i►/ OF ��' p���os�1� `'�'OJ�CT 617.20 Appendix B Short Environmental Assessment Form Instructions_for Completing 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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Projects Project Location(describe,and attacJha location map): 104 Brief Description of Pro sed Action: o0.,OZ//1&V 4,-oXl..�r til <!/it J'��`Z2�N/N,LC/J�'"OE'.�1G�: /9 'C'7`�C•24'2�'1C //�L X17•d°'.507. ��'Q�f�'." 1�1 �'7�' ,DLC/ : �?. 9d?5���f/•�'fl u.�GEV. t4 /4��E�T. ,gd/'/Ov� eX/.13r �PP7C ,1�/`/ D Aoff) a N6&) 1"YJ'l rHU4.G�'.� O✓ N,�/rY,D/1?�'/.8(�)T dA1 PC W5 .,W,& z ui R, Arab N" P"o;0zU1VG Name of Applicant or Sponsor: Telephone: Address: z 1! City/PO: State: Zip Coder 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 r may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval:zg� /(IYS.0,e NON-7URi.TD/C�dDiv�' PvF XlG c7Y. V%AVW ©•4I°T., 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? ( Q acres c.'total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? _�� acres ................. d Check all land uses that occur on,adjoining and near the proposed action. []Urban ❑Rural (non-agriculture) [—]Industrial ❑Commercial gResidential(suburban) ❑Forest ❑Agriculture [:1 Aquatic ❑Other(specify): ❑Parkland Page l of 4 thprod pose action, NO YES N/A a. A permitted use under the zoning regulations? 9 El M b.Consistent with the adopted comprehensive plan? u 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? XJ m� 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Fnvironmental Area? NO YES If Yes, identify: _� 4L,1 ' LJ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action'? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceedthe state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: Co/►/JUCJTN 10. Will the proposed action connect to an existing public/private water supply? _ NO YES If No,describe method for providing potable water. 1111..e _.� _. ................___...._-_ _u...._.__.._..____ 11.Will the proposed action connect to existing wastewater utilities'? NO YES If No,describe method for providing wastewater treatment:0A1 P1A5 fZMC ,r/,f 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? II b. Is the proposed action located in an archeological sensitive area? t-1 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: _............ .........1. 1111 1 1.1_..._..._ ............................._.......... _1111.. - ... - -- 14. ntify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Id Shoreline ❑Forest ❑Agricultural/grasslands ❑Early rnid-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? y 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 T—ES — If Yes, a.Will storm water discharges flow to adjacent properties? —of YES 14%J1 El b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes briefly describe: NO WYES h- Y/ _... .. _. _....... .. �.. Page 2 of 4 0 ! .. ..._..m____ ............ 18.Does the proposed action include construction or other activities that result in the impoundment of NO Y's water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size 19.t las 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: (�( n 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: rvf 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: f ,� �� _. Dates ,� j t Signature: .............................. % ,,�9...... _.. Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" _..._._........____ No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations -1111-11111 :. ...:: .......................__ __ Will the proposed action result in a change in the use or intensity of use of land? C 3. Will the proposed action impair the character or quality of the existing community? Cl R 4. Will the proposed action have an impact on the environmental characteristics that caused the C...I (] establishment of a Critical Environmental Area(CFA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ("`1 affect existing infrastructure for mass transit,biking or walkway? U 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate I (� reasonabl y available ener conservation or renewable ener a ortunities? 5 7. Will the proposed action impact existing: E-D a. public/private water supplies? b.public/private wastewater treatment utilities? R' El 8. Will the proposed action impair the character or quality of important historic,archaeological, n architectural or aesthetic resources? ............._�_ — _ __ _ __._...................._.... _....... 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Modcratc 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? 2111 1:1 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. that the proposed if actio _ _, d Tomh r ti �.-_....e...,_nd any _ _ _.c _t Check this box if you have determined,based on the information and analysis above,and any supporting documentation, p p n 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, 4 that the proposed action will not result in any significant adverse environmental impacts. Town of Southold Board of Trustees �� .., .. __ �e ..�.�..___ . _.. _ Name of Lead Auncy, Date �j�� !pv�n President Print or'l ype Name of Responsible O ccr in Lead AgencyTitl If Responsible Officer iinLead A .nc) nSignature of Pre aver(if diferenfrom Responsible Officer)nna�o�Rsponsiftcer PRINT Gage 4 of 4 Town of Southold t ` Erosion, Sedimentation S Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.c.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 1-7 /(� STORM-WATER GRADING DRAINAGE AND EROSION CONTROL PLAN s c section o o 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? " /65 1 Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within 0.255- Generated by a Two(2")Inch Rainfall on Site? the Supe of Work for Proposed Construction) (S.F./Acres) (This Item will include all run-off created by site 7( , F-1.L� b. What is the Total Area of Land Clearing 2' �aQ Gearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? Q=- �— impervious surfaces.) (s.i='/Acres) Z Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Page.asNeeded) Drainage Structures Indicating Size&Location?This X P'00V O'U0AN Owalzmr, oe Item shall Include all Proposed Grade Changes and A74 40ONP11Pyt," p�uJ,e1XV 4»D 4p4"U,1A G Slopes Controlling Surface Water Flow. A/J?frfZ,.OIF6 W 42'-7 ;I1,'S0"3V 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to F-1 x/I'6 i,ez7'3y�3"a7. 3s -AZZ-w�aew control site erosion and storm water discharges. This • item must be maintained throughout the Entire _ Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural Al --Z Existing Grade Involving more than 200 Cubic Yards ovol Nib w (j^/ 6&Z AJ terial within any Parcel? ,41a� j Will this Application Require Land Disturbing Activities X co/vim vM-me 6V frne./I (jPArZjL Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? L= 6 is there a Natural Water Course Running through the F] X- Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Reathirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities Involving sol Beach? disturbances of one(1)or more acres; Including disturbances of less then 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 X Including Construction activities involving soil disturbances of less than one(i)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPOES permit Is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 WillDriveways,Parking Areas or other impervious for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The NO[shall be into and/or in the direction of a Town right-of-way? F] X. submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction 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 R_ 1V compliance with the terms and conditions of this permit.In addition,the SWPPP shell Area?(This Item will NOT Include um Installation of Driveway 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.All SWPPP-that require the post-consttuctlon storm water management practice In a Box and the construction site disturbance Is between 5,000 S.F.&1 Acre In area, component shall be prepared by a qualified Design Professional Licensed In New York a Storm-Water,Grading,Drainage&Erosion Control Plan In Required by the Town of that is knowledgeable In the principles and practices o1 Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check Marc(4)and/or Answer r r h a complete Appllcsllon) ary PUBIR5,S a e ew YoFR STATE OF NEW YORK, No.01 BU6185050 COUNTY OF...n1'1� , P � •• SS Qualified in Suffolk County Commission Expires April 14,2a1 That I, ............being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual signhV Document) And that he/skt:is the ........................A-6Zt6�, .... ..... .... .............................................................. ... .. . ............. ....... ........ (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 hue to die best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn tto/before me this; .., c ay of... ,.,,.,,., ,....,20.1. Notary Public: . � .... {Signature of Applicant) FORM - 06110 PROOF OF MAILING OF NOTICEAEG 1 8 2014 ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 9o. ,Bae 6 ti Y /,/ 9s-C nIAW �t�044, Z6,8 ,7? ,8/.S 04>'t/Z PRI v.6 yv�v>►��f�P'oN, N Y /1743 !/7 /� _�a, 9 �Ict1Ar! w c. r ?7 sTCAyryz �.R/v.L� ,�/CV,440 11VA0V-1iV&, -&vv/ Al v. /l-7 43 1�?- 10- z4- R LtlJLL/,tZi`! GUODDA.�R7 2 4/ Rwvow rC.aie>9 99/D �L UTeil/, STATE OF NEW YORK COUNTY OF SUFFOLK ,Gi/Ai4C� , residing aty .c�Jt'>LE O�Y� _ r14?5G 0&e Al —/J p0/ , being duly sworn,deposes and says that on the .day of AUGU.S'T , 2q/Gl, 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 a✓Flb x ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. -7 le�G'D Sworn to b Are me this Day of 20 Notary Public OT Notary Public Stattiof New York No. 1`9190696 Qualified in Suffolk County Commission Expires July 28 T1 (� PostalU.S. Postal CERTIFIED MAIL,,,, RECEIPT CERTIFIED MAIL,�, RECEIPT (Domestic Mail Only;No Insurance Covera e Provided) Ln (Domestic Mail Only;No Insurance Coverage Provided) M In m . 11 A L U Postage $ $0.70 0971 r%- Postage $ $0.70 0971 Certified Fee $3.30 0 ��j N Y Certified Fee $3.30 W 1 I O Return Receipt Fee Ostmark �� G Return Receipt Fee Q Posama j Q (Endorsement Required) $2.70 /� Here ,` O (Endorsement Required) $2.70 .Z Here`R Restricted Delivery Fee ��� Restricted Delivery Fee �� O (Endorsement Required) $0.00 0 ��,G 6 0 (Endorsement Required) $0.00 t C3 C3 r U Total Postage&Fees $ $6.70 06 14 M Total Postage&Fees $ $6.70 Q�!p Sent-To -r Uaa�,ra R /��� �O �,,/!� [+ ,�''�/ Sfreef.ApClub; T_ [4 ---!=:�/C!__� �1.( ------- Sent To �,'Ir,Cz Z.L—rp4.�._C------------------------ ------------ Street Apt No.; � or PO Box No. r- or PO Box No. �` ----------------- Z--,0,1.,f'AIW46._-,lll__IlE---------- `` ----------- 21_L1Q �1.r �1l�f'Q�Y ------------ - Ciry,State,ZlP+4 City,State,ZIP+4PS Form 3800,August 2006 See Reverse for Instructions PS Form 3800,August L G JY/ rr. See Reverse for Postal Postal CERTIFIED (Domestic / (Domestic m m ,,i For delivery information visit our website at www.usps.comb r� n visit our website at Ir M .., 1 L US m NE r- Postage $ $0.49 0971 Y '� C3 Postage $ $0.49 O LD Certified Fee V 9 Certified Fee $3.30 02 $3.30 rq tmark �` r� Return Receipt Fee J� Here A O Return Receipt Fee C3 (Endorsement Required) $2.70 = 6^�� p (Endorsement Required) $2.70 Restricted Delivery Fee 0 ���G Restricted Delivery Fee O (Endorsement Required) $0.00 (Endorsement Required) 50.00 C3 �/ tiTotal Postage&Fees $ $6.49 08/0b 14 Ur�Q O Total Postage&Fees $ 56.49 ( m Sent To Sent To srreet � t2 .� /ll.�__!�1 . ?�7/' a Ti4 Y'e— .J)X ------------------_._.. pt.No.; O Street Ap"t.No.;' or PO Box No. or PO Box No. ------------ --j-- -------j------- City,Stat:;IP+4 � � City State,ZIP t ►ws t/• //��/ :ri August 2006 See Reverse for Instructions PS Form 3800,August 2006 See Reverse for Instru Postal Postal I RECEIPTCERTIFIED MAILT. CERTIFIED ■ • I r•• •• • • • r (Domestice Provided) • • • C3 • •• • E rn S 1 lu [`- Postage $ $0.49 o Postage $ $0.49 0971 Er Certified Fee tO7 D ABY Certified Fee $3.30ostmark ?' rq $3.30 SOLD NY O Return Receipt Fee toO Return Receipt Fee ark 7 p (Endorsement Required) 62.70He�req 00 (Endorsement Required) $2. Here C7 Restricted Delivery Fee / 2U14 Restricted Delivery Fee A�. ��L7 (Endorsement Required) .QO O (Endorsement Required) $0.00 M Total Postage&Fees $ $6.49s m Total Postage&Fees $ $6.49 08 7i♦ Sent To Sent To 112-Ald- �/v al.. lcl 2------------------ r-3 _ Ft .t r� ..... Street Apt.No.; ,J�- -�J��� /. �7/�/ O Street pt.No.; /� — I [` or POBox----- �. /l..0 L_.0 e� C.1___ if ___Y_ -- (� or PO Box No. _40---'89'X �,f �--------------------------- � City,State,ZIP+4 c.J �� �t A Cd}4 Stat, tPO ' � IPS Form 3800,August 2006 :rr August 2006 See Reverse for Insti PostalPostal ■ , . ■ T .0 CERTIFIEDRECEIPT•. Only, CO ru M For delivery information visit our website at www.usps.comr.For delivery information visit our website at www.usps.comoEr a m ti ""POVIAL rr- Postage $ $0•70 iY 9 Postage $ $0.49 0971 $3,30 ''� Certified Fee $3.30 QLD /VY Certified Fee r Postmark Postmark 1 O Return Receipt Fee 1." Return Receipt Fee J C3 (Endorsement Required) $2.70 Hemp � (Endorsement Required) $2.70 Q Here art Restricted Delivery Fee Q � Restricted Delivery Fee � AUG—/ LU1 (Endorsement Required) $0.00 �Gj IO (EndorsementRequired) $0.00 M Total Postage&Fees $ •?0 OB/O 14,, ��S/ m Total Postage&Fees $ $6.49 S $ i r-1 Sent To M Sent To li�1Y__GIJo ol. .P - �� �- -ei`1 '!r411�?_/Gh? '--------------- Sheet Apt.No.; �y,y/���j / /�! p Street, .No.; /�/(' v N or PO Box No.7�'J !CI£+ _ !_.1�fr............. r'- --PO Box No. 27_.V � 1 _� '--------------------•- City,State Zi� .f. v city,Stare, iP+a John Bredemeyer, President oSVFotx�o Town Hall Annex Michael J. Domino, Vice-President ,��° ay 54375 Route 25 James F. King y P.O. Box 1179 Dave Bergen s • Southold, NY 11971 Charles J. Sanders 'poi , , �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 __. F._ ._. NICOLAS De CROISSET AUG 1 8 2014 COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS 1, M/ CYrZF� .Q ,e1/y/Zesiding at/dba /zl VEX1'>125 D,t21 VF being duly sworn, depod and say: That on the f day of,4061 7- , 201¢I personally posted the property known as by placing the Board of Trustees 6ficial poster where it c�y 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) Q Sworn to,�efor��e this Y (f�t I.UGi-14 Notary Public VICKI TO'f H Notary NoOf'E1611 0696 of w York QuatiNd in Suffolk county Commission Expires July 2P ' t I NOTICE OF - HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, 40 Southold, New York, concerning s property. . per�' OWNER(S) OF RECORD*: A)icol e: CM133ef UBJE1CT OF PUBLIC HEARING: neo rtton o existing dwelling, porch and foundation; construct new +/-1,213sq.ft. elevated two-story dwelling, and an attached +t- 340sq.ft. deck with steps to grade; remove existirtg sanitary system install new sanitary system; raise the grade over new sanitary and under dwelling using +/-150 cubic yards of clean fill; and construct new storm water management system. TIME & DATE OF PUBLIC HEARING: 0 WedA V1 oo 14 a, ok or nkmocu+ If you have an interest in this project, you are invited to view the Town file(s) which are available for ins ection rior to the day of the hearing duringnormal business days between the ours o 8 a.m and ,4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 I • tees A Board of Trus pplicatioa• i " County of Suffolk State of New York i JtJ r c a c, s !9E C/� iSJ `r BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES !. HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS i 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. i u I Signature of Property Owner SWORN TO BEFORE ME THIS /d DAY OF AM ---520/4 Notary Public v0vm:!=9rmQrmWvms COM291 I " I Sward of Trustees A PPlicatio• i i AUTHORIZATION (where the applicant is not the owner) I, SC QI L2Erjesiding at1,.��� j�,3Rp PY (print owner of property) (mailing address) QAl. do hereby authorize �:- (Agent) HZ AL!/`M CLI to apply for permit(s)from the Southold Board of Town Trustees on my behalf. u (Owner's signature) APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i informationwhich w il IQ lWm whatever i rnecenary to mold same, YOUR NAME: —A&&E4 .a 1!7 O Cll (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee 1{ 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''own 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 _ _r 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 orthe corporate stock of the applicant (when the applicant is a corporation), B)the legal orbeneficial owner ofany interest in a non-corporate entity(when the applicant is not a corporatism); Q an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this da of 20VL4 Signature 1 Print Name 'yJ 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 gpon 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 guopyrting and nun- 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#,._ZZ. - _ .. PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. 0 Board of Trustees ZSJ 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) El (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval, license,certification: aelf DL/T/ONC c ex/jT,/dV,5 f'4oac14,G/VOT'��l. COWJ;rX uq1&1.�GU Nature and extent of ac`on:,,ff VA 4V,6C11/N6;/4r,�Q. 2?`6#'X4z'7 tf 4 213.53-W xx !0�0/k;r� /NPMI-e Location of action: 2D ZW" Site acreage: • Present land use:_ 7»iVv%/JL 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: AC DIES ,A55' Q/� � (b) Mailing address: /.3 iit/ /U'�1,J1 yD.Px� N`L• /DO/Z (c) Telephone number: Area Code (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? YesEl Nog 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 D No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes F-1 No ® 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 0 Yes No ❑ Not Applicable ME A&IPOZ9 &W MA19 W LG e d N 0 2 O c AMPi� OAtEeg-vo&ffnew 7-4 Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria 0 Yes F No El Not Applicable C f ,o D 9Z ilia 2&2wAaw- Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria S Yes ❑ No ❑Not Applicable W-&4e 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. ❑ F-1 9 Yes No Not Applicable 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 Q No❑ Not Applicable v S w 121!16 D924 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 2 No ❑ Not Applicable ki I NC 0 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. ❑ YX No❑ Not Applicable 0 L e Attach additional sheets if necessary 0 0 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. Q Yes R No N 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. F] Yes 1:1 No Z Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. Sec LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. Yes 1-1 No V1 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No ❑ Not Applicable W yr PREPARED BY _ Cr ,CG ,Q. JG/r1,1 C/G TITLE [ANT" DATE SURVEY OF PROPERTY SITUATE D FF 0 a Pa NEW SUFFOLK ' TOWN OF SOUTHOLD 1 SUFFOLK COUNTY, NEW YORK JUL 2 5 2014 s S.C. TAX No. 1000-117-10-19 JACKSON STREET j SCALE 1"=30' T" N/O/FF JANUARY 2, 2008 NN THOMAS M. MARTIN -`'_:�„� - JANUARY 20, 2008 VERIFIED HIGH WATER MARK TL"o & JAYNE P. MARTIN MAY 9, 2009 STAKE PROPERTY LINES } ro� DWELLING Board _ _ ••__ - NOVEMBER 19, 2009 UPDATE SURVEY mo USES PUBLIC WATER '` "\ _ JANUARY 6, 2013 ADDED 1st FLOOR EL. & FLOOD ZONE ° + + 90.00, SET F�WON. FEBRUARY 3, 2014 UPDATE SURVEY o N 87-21'00" SEE, gAPPED RESET 1440MARCH 24, 2014 ADD PROPOSED HOUSE Q �S FOUND 350 JUNE 2, 2014 REVISE SEPTIC SYSTEM f x ''P� xss FENCE AREA = 1 1,105 sq. ft. X" 0 _ (TO BULKHEAD) 0.255 OC. z x I� o CERTIFIED TO: y �` x ~ � 5' APPROVED BY NICDLAS DE CROISSET ur p h oRNT FRAME sNE / 0 FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK `E o - x BOARD OF 'i RUSTEESNOTES: c �~ x PR p $T "OLE b� 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM KM1ATER I� 5 FRAME DUTSID TOWN of soUTH4W EXISTING ELEVATIONS ARE SHOWN THUS:.0 v c vALVE o TFPS sNowE xlrnNc tsJ c R N {p Pry q ' 4 B'DIA.r 2 DEEP y ✓>P 0E N K2g.b' LEAgNKAc Pools m s b EXISTING CONTOUR LINES ARE SHOWN THUS:- 'D - - -5- - - - a �_ ns � $ ^1H • • cm a 0 DA 2. THIS PROPERTY IS IN FLOOD ZONE VE (EL 8) AS SHOWN ON m .4 € m� FLOOD INSURANCE RATE MAP No. 3610300501 H D A Ul • $ nZ �y ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); _St.:Y En �fl m-�i O x• • ylug BASE FLOOD ELEVATIONS DETERMINED � � `� �0 3. MINIMUM SEPTIC TANK CAPACITIES FOR 3 BEDROOM HOUSE IS 1,250 GALLONS. ry?c Q �l� -_ E%6fINc io X 3'DEEP v ya 1 TANK; 10' DIA., 3' DEEP rL SEPTIC TANK R �"� J 4. MINIMUM LEACHING SYSTEM FOR 3 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA. QZ LL pEOI?OSED W000 y 5 POOLS; 2' DEEP, 8' dia. `MJ O O k x EXISTING SEPTIC SYSTEM PROPOSED FUTURE 50% EXPANSION POOL _7 Q 3' TO BE REMOVED 7 FLAG rn� a<Kw O' :-. POLE SEE NOTE No. 6 1.3 x PROPOSED 8' DIA. X 2' DEEP LEACHING POOL A 3 0 xyQ xst TEST' HOLE DATA gCo X-4-0x� GD (TEST HOLE DUG BY MJNALD GEOSCIENCE ON MARCH 1, 2014) PROPOSED 1,250 GALLON SEPTIC TANK Q Q g x <:> °Ol to 7& WOOD BULKHEAD EL. 5.5' D• BLKH. TB. TEL RR DARK BROWN LOAM OL 1.2'W. 0- V 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD STEPS �� �� OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. Iv �8 Iv BROWN CLAYEY SAND SC 6. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND tO O \�2 EL 0.6 ` 4.6' REMOVED IN ACCORDANCE WITH S.C.D.H.S. STANDARDS. oV// RV�H WATER MARK AS OF Dl 2D/DB x� WATER IN BROWN CLAYEY SAND SC TIE UNE PREPARED IN ACCORDANCE WITH THE MINIMUM N 8928'30" W 89,47' STANDARDS FOR TITLE SURVEYS AS ESTABLISHED 7' BAY Y BY THE L.I.A.L.S. AND APPROVED AND ADOPTED GREAT PECONI C BA 1 FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. WATER IN BROWN FINE SAND SP OF NEh,} *1 } PROPOSED SEPTIC SYSTEM DETAIL HOUSE (NOT TO SCALE) ELEV. 14.0 FINISHED GRADE FINISH GRADE ELEV. 7.7' ELEV.6.6' ON PILES 24'd'w. LOCKING•WATERTIGHT&INSECT PROOF N.Y.S. LIC. NO. 50467 CAST IRON COVER TO GRADE TOP EL. 6.7' 1' MIN. TOP EL. 5.6' rt' MIN. UNAUTHORIZED ALTERATION OR ADDITION MIN. 4" DLA. 6" TO THIS SURVEY IS A VIOLATION OF SEPTIC LEACHING r 3' CLEAN SECTION 72LA OF THE NEW YORK STATE Nathan Taft Corwin ��� APPROVED PIPE APPROVED PIPE LEACHING ,,1 INV. EL. TANK POOL m SAND EDUCATION LAW. min. PITCH 1/4"/1' w min. PITCH 1/B"/1' POOL 1 6.3' CLASS 2400 PIPE TYP Imo' INV. EL 4.8' o COLLi.R EL. 5.5' INV. EL. COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor D. THE LAND SURVEYOR'S INKED SEAL OR BOT. EL. 3.0' {_8'-�-} 50 ° 8 ,81 "k Z^ EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. DISTRIBUTION POOL EM gOT. EL. 2.8' GROUND WATER CERTIFICATIONS INDICATED HEREON SHALL RUN 5 POOL SYSTEM ELEV. 0.8' ONLY TO THE PERSON FOR WHOM THE SURVEY IS , AND ON HIS BEHALF TO SEPTIC TANK (1) TIT EREPAREDCOMPANY, GOVERNMENTAL AGENCCYTHE AND Title Surveys - Subdivisions - Site Plans - Construction Layout LEACHING POOLS (5) LENDING INSTITUTION LISTED HEREON, AND 1. MINIMUM SEPTIC TANK CAPACITIES FOR 3 BEDROOM HOUSE IS 1,250 GALLONS. TO THE ASSIGNEES OF THE LENDING INSTI- 1 TANK; 10' DIA., 3' DEEP 1. MINIMUM LEACHING SYSTEM FOR A 1 TO 3 BEDROOM HOUSE IS 250 sq ft SIDEWALL AREA. TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. PHONE (631)727-2090 Fox (631)727-1727 2. CONCRETE SHALL HAVE A MINIMUM COMPRESSIVE STRENGTH OF 3,000 psi AT 28 DAYS. 5 POOLS; 2' DEEP, 8' dia. 3. WALL THICKNESS SHALL BE A MINIMUM OF 3", A TOP THICKNESS OF B"AND A BOTTOM THICKNESS OF 4". 2. LEACHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REINFOR,;ED CONCRETE (OR EQUAL) ALL WALLS, BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 30D psf. LEACHING STRUCTURES, SOLID DOMES AND/OR SLABS. 5. THE SEPTIC TANK SBE WOFFICES LOCATED AT MAILING ADDRESS 4. ALL JOINTS SHALL HILL BE INSTALLED SEALED SO THAT THE TANK IS WATERTIGHT. 3. ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE (OR i:QUAL). THE EXISTENCE OF RIGHTS OF WAY 1586 Main Road P.O. Box 16 AT LEVEL IN ALL DIRECTIONS (WITH A MAX. TOLERANCE OF 1:1/4-) 4. A 10' min. DISTANCE BETWEEN LEACHING POOLS AND WATER LINE SHALL BE MAINTAINED. ON A MINIMUM 3"THICK BED OFF COMPACTED SAND OR PFA GRAVEL. S. AN 8' min. DISTANCE BETWEEN ALL LEACHING POOLS AND SEPTIC TANK SHALL BE MAINTAINED. AND/OR EASEMENTS OF RECORD, IF James Ort, New York 11947 James Ort, New York 11947 B. A 10' min. DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED. ANY, NOT SHOWN ARE NOT GUARANTEED. P P 27-479E 1 D - JUL 2520147 LO SECT MAL t rSECTION 2B-T 2B-T 2T-T in - SNOWE\ ❑ ❑ COLUMN BRACING H I BATNflOOAA z L— STORAGE AND co� BEDROOM, BEDROOM MECHANICAL LINE OF STRUCTURE 1 \ ABOVE —`�SKYLIGNT ABOVE ❑ ❑ ❑ b CLOSETREF b ' w/D CLC CLOSET I 7 sa m � BATHROOM y WCHEN ENTRY Era LADDER TO MEZZANNE f LADDER FIREPLACE) j\ ❑ ❑ ❑ OPEN TO BELOW GREAT ROOM / \ i PILE FOUNDATK7NS ❑ ❑ ! i § DECK LME OF DECK ABOVE tO �g 5N1K0 MO �' 2P'-5' Ground Floor First Floor Mezzanine sT9TFO0 42 F NE�yO� de CROISSET SCHEMATIC poPLANS SCALE: 1/OM= V-0" TOSHIKO MORI ARCHITECT PLLC MARCH 07,2014 NOTE: ALL ELEVATION MARKERS ARE MEASURED IN REFERENCE TO SEA LEVEL is-io• Rr-0• za-Ro• sem• s-0• is-r EL- +36•48' TOP OF ROOF F R � zv OPERABLE WW4DOW MECHANICAL MECHANICAL - LADDERTO MEZZANINE EL +22-6' , m BEDROOM CLOSET ® BA 1 I IL GREAT ROOM BATHR00M1 WTCHEN �I L EL +14•-6• :. A.F.F.° STAIR WYOND to MECH m MIN.UNDERSIDE STRUCTURE CHASE ----------- — ---- ----------- ----------- ELFEMA FLOOD UNE i EL: +5 lip GRADE r 11 I I I I 1 1 MEI I I I I I f F"F FOUNDATIONS I I II II II I>r 11 11 II II 11 II II II II 11 II II FOUNDAnONS 11 11 II 11 II II 11 it EL: 940_ LONGITUDINAL SECTION CROSS SECTION ED ARC h'i 5NiKO tij0 7� s�9TF Oa2 `N�O4, N de CROISSET SCHEMATIC PLANS SCALE: 1/8" = V-0" TOSHIKO MORI ARCHITECT PLLC MARCH 07,2014 EL: +36'48' EL +35-8' , TOP OF ROOF" TOP OF ROOF e f777NI ' CFiMEY I I I EL: +22-i' EL- +27-6' F.` A.F.F. m � m EL: +14'-6' EL: +14'-6' , AF.F. A.F.F. EL- 10'-0' EL 10' MIN.UNDERSIDE STRUCTURE MIN.UNDERSIDE STRUCTURE EL 6-V EL- 5-0' s. FEMA FLOOD UNE ° FEMA FLOOD LINE EL- +5'-6' v EL, +5I-W GRADE GRADE WEST ELEVATION SOUTH ELEVATION EL: +35-8' m EL +36 8' k TOP-OF TOP OF ROOF' Civ ' I oPEWLe vnrroow .D Aq� a l � EL: +27-6' +27 Ile 0142 .4 § �9TFpF NE`4 EL, +14'-17 ,. AF.F.` A.F.F.' EL: 10-0' j ELW-V \ MIN.UNDERSIDE STRUCTURE' \ MIN.UNDERSIDE STRUCTURE EL 5-0' ,, EL- 5-0' FEMA FLOOD LINE ' FEMA FLOOD UNE EL- +6-& / EL +6-6' GRADE" } g� s-p GRADE EAST ELEVATION NOM: NORTH ELEVATION ALL ELEVATION MARrERS AM IN REFERENCE TO SEA LEVEL MEASUREDde CROISSET SCHEMATIC PLANS SCALE: 1/8" = 1'-0" TOSHIKO MORI ARCHITECT PLLC MARCH 07,2014 . 014259 OQ' - N de CROISSET SCHEMATIC PLANS SCALE: 1/8m = 1'-0' TOSHIKO MORI ARCHITECT PLLC JAN 31,2014 iv' r 4--.-a_.. 1011 t i n u xs _ #S•, 'Yes.. p E t z . F. I .2 �ciED ARC Mp9��� 3� 0142`1S F OF NE'N de CROISSET SCHEMATIC PLANS SCALE: 1/8w= 1'4" TOSHIKO MORI ARCHITECT PLLC JAN 31,2014