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HomeMy WebLinkAboutTR-8587John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King Charles J. Sanders Dave Bergen BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 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, silt fence 1 st day of construction % constructed �/ Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8587 DATE: APRIL 22, 2015 ISSUED TO: JACOBY FAMILY LTD. PARTNERSHIP C/O WINIFRED BREINES PROPERTY ADDRESS: 3055 KIRKUP LANE, MATTITUCK SCTM# 125-1-5.3 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 April 22, 2015, and in consideration of application fee in the sum of $250.00 paid by New England Barns & Finb Homes and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and pen -nits the following: Wetland Permit to replace existing 26'x14' dock and 3' wide steps attached to side with a proposed 4'x10' steps and landing at lake edge; and as depicted on the site plan prepared by Joan Chambers, last dated March 26, 2015, and stamped approved on April 22, 2015; and as also depicted on the site plan prepared by Joan Chambers, last dated March 25, 2015 and stamp approved on April 22, 2015. . . 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. co y o TERMS AND CONDITIONS The Permittee, Jacoby Family Ltd. Partnership c/o Winifred Breines, residing at 3055 Kirkup Lane, Mattituck, 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. 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. 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. 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 Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee April 22, 2015 Mr. Bill Gorman PO Box 1447 ` - Mattituck, NY 11952 pF SO(/j�o COUNT`1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 RE: JACOBY FAMILY LTD. PARTNERSHIP C/O WINIFRED BREINES 3055 KIRKUP LANE, MATTITUCK SCTM# 125-1-5.3 Dear Mr. Gorman: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 22, 2015 regarding the above matter: WHEREAS, Bill Gorman on behalf of JACOBY FAMILY LTD. PARTNERSHIP C/O WINIFRED BREINES 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 February 23, 2015, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policies of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit; and the use of untreated materials on structures; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 18, 2015 and again on April 22, 2015, 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, 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of JACOBY FAMILY LTD. PARTNERSHIP C/O WINIFRED BREINES to replace existing 26'x14' dock and 3' wide steps attached to side with a proposed 4'x10' steps and landing at lake edge; and as depicted on the site plan prepared by Joan Chambers, last dated March 26, 2015, and stamped approved on April 22, 2015; and as also depicted on the site plan prepared by Joan Chambers, last dated March 25, 2015 and stamp approved on April 22, 2015. 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 John M. Bredemeyer III, President Michael J. Domino, Vice -President TO: James F. King Charles J. Sanders Dave Bergen BOARD- OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax(631)765-6641 Please be advised that your application dated Y "1�5 CSI has been reviewed by this of Board at the regular meeting and your application has been approved pending the completion of the 161lowing items checked off below. .Revised Plans for proposed project Pre -Construction Silt Fence 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: I%in6A -- s -b ooD Doc �4, x Ip3, TOTAL FEES DUE: $ BY: John M. Bredemeyer III, President Board of Trustees f� John Bredemeyer, President soFFot Michael J. Domino, Vice -President James F. King y Charles J. Sanders • Dave Bergen Date/Time: x Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Bill Gorman on behalf of JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES requests a Wetland Permit to replace existing 26'x14' dock and 3' wide steps attached to side with a proposed 4'x10' steps and landing at lake edge; a 4'6"x3' hinged ramp; and 4'x4' float. Located: 3055 Kirkup Lane, Mattituck. SCTM# 125-1-5.3 Type of area to :be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre -Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: /t'7 -�? J��4) P AT Conditions: OKG1Y� Present Were Bay Constable J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Form filled out in the field by Mailed/Faxed to: Date: Other o Winifred B reines low. q 19-1 7W IN 41MOOk R map low N IS 777 Wilt 0_ � � � a it +�' YO 7* w , , • / e �'i f- � j.).f `,r� k ydllti iYR ,'')i� fW "1 tied , P ..s1�M k1• '�•'�' It Alk,\ finerjr;;�''.v I fti. ol I OW q 19-1 7W IN 41MOOk R map low N IS 777 Wilt 0_ � � � a it +�' YO 7* w , , • / e �'i f- � j.).f `,r� k ydllti iYR ,'')i� fW "1 tied , P ..s1�M k1• '�•'�' It John Bredemeyer, President gUFFOI,tTown Hall Annex Michael J. Domino, Vice -President tea° °may 54375 Route 25 James F. King y P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�'or ,� �a°! Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionMlork Session Report Date/Time: ly� R P, I I Bill Gorman on behalf of JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES requests a Wetland Permit to replace existing 26'x14' dock and 3' wide steps attached to side with a proposed 4'x10' steps and landing at lake edge; a 4'6"x3' hinged ramp; and 4'x4' float. Located: 3055 Kirkup Lane, Mattituck. SCTM# 125-1-5.3 Type of area to be impacted:��� Ad rzf ,- Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: L/Chapt.275 Type of Application: Wetland - Administrative Emergency Notice of Hearing card posted on property Storm Water Management Review: Info needed: Modifications: Conditions: '44 Coastal Erosion Pre--Subrni'ssion cYes No Chapt.111 other Amendment Violation Not Applicable Yes No /Not Applicable Present Were: rJ. Bredemeyer 'I'M. Domino 1-J. King !C. Sanders D. Bergen Bay Constable Form filled out in the field by Mailed/Faxed to: Date: Other A , V) n/G Per"��sIf '18.. 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NO SEE sEc NO. x 'Bet la 2>motx 4 - p _—_-----_LIKE ♦ 3xi __________ __—_ c I.MTLH LINE MATCH - --------IINEy �. N" m AU—Y---- SEE SEC, NO 127 TCX r♦ SEE SEC NO to--- L,NE v E - r •~ .. -- e�w —_—_�_ _SECTION NO NOTICE f,�"`•'� COUNTY OF SUFFOLK O x o eouT„an E "�+ ------ ».--. „"2222 --.-- .,-- Real Property Tax Seryice Agency r' N w —_— w _—,_— —_ <r� em,Nr r,tfo,L.«n 125 D '�"� a r a ]21x1 r. �__ w - --"-- e_�---r_—x�%i,i.'J� ,•' p rmcr xo , PROPERTY MN Cantrell, Elizabeth From: Terry, Mark Sent: Tuesday, April 14, 2015 11:27 AM To: Cantrell, Elizabeth Subject: JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES Elizabeth, I have looked over the new project and will not make another recommendation regarding consistency on the action. The changes further the policies of the LWRP, however, the original structure does not have a permit. Therefore, the proposed action is still recommended as Inconsistent. Mark Terry Principal Planner LWRP Coordinator Town of Southold 54375 State Route 25 P.O. Box 1179 Southold, New York, 11971 (631) 765-1938 1 JOAN CHAMBERS__.�..._.�_._..�.____�_ PO BOX 49 SOUTHOLD NY 11971 joanchambers10@gmaii.com 631-294-4241 MAR 2 6 2015 Southold Trustees Jacoby Dock and Steps 1000-125-01-p/o 05 3055 Kirkup Lane, Mattituck March 26, 2015 Concerning the above-named project: Please find attached a revised LWRP forms with some minor revisions that include: 1. The project name has been changed to "Jacoby Family Dock" ( Brienes) for clarity. 2. Under "Developed Coast Policy" #1 1 have added the note that-the_dock Will contain no treated materials and eliminated the phrase "in kind" after the word replaced. - 3. On the same page as "Developed Coast Policy #1 1 have noted that the project will require review by the NYSDEC. The revision to the project description is to eliminate the hinged .ramp -and' (float -from the -North -East -end of -the dock -and -to relocate thet _2,attached.steps from the north side of the dock to the -south side of the -dock. The size and location of the dock and the size and location of the steps and platform on land have not been altered. I have added notes on the plans that state that no treated materials can be used in any part of the dock, including the pilings. Thank -you, Joan Chambers 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 evafluated. as to its siu�t ficant 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 exnlaincd in detail, listing both sumortina 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: rhe H the Town of^Sa_utholil website (southoldtown.northfork.net), the Board of Truste4 the Planning Dep ent, all local libraries and the Town Clerk's office. 3 MAR 2 6 2015 s B. - DESCRIPTION OF SITE AND. PROPOSED ACTION ' SCTM# 10 01D (1- Q I PROJECT NAME �_jA,Cok3Y F -AM( .` e'«N The Application has been submitted to (check appropriate response): , "Town Board ❑ Planning Board 0 Building Dept.. Board of Trustees 1. Category of Town of Southold agency action (check appropriate'response): (a) Action undertaken directly by Town agency (e.g. capital -construction, planning activity, agency regulation, land transaction) (b). Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: .S A, D, AC: i g Via' x A-0 � ition of action: 3o 55 N ?4–' O f LAN 6, N &T—TI TLK–Le - CE J acreage:. %38's tee. Present land use: ' �S t A Ct-O FPQNX �` j Present zoning classification: Ke. 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: U NQ Ct�AM,16t✓ R.S A&60—k F-09 MOLFfLED 139a ME S' (b) Mailing address: (c) Telephone number: Area Code () (031 --2'-6L4 --A '2–`-( • (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? "--- Yes `R = No . D If yes, which state or federal agency?� C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy, Incomplete answers will require that the form be returned for completion, DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, :makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III – Policies; Page 2 for evaluation Criteria. ❑ Yes ❑ No 0 Not Applicable e -OK sS i DOCK-- �'�S � -.RE � � LA,Cie5C-> 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 RNot Applicable i' Attach additional sheets if necessary" Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III — Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ZNot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LUMP Section III - Policies Pages 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 iouthold. See LWRP Section III -- Policies Pages 16 through 21 for evaluation criteria 11 Yes ❑ No RNot 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.. o r-1 -e No Not Appucaule 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 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. 1-1 Yes ❑ NoWNot 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. ❑ Yet❑ No Not Applicable Attach additional sheets if necessary 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 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 LVVRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No tallot Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands. in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. 0 Yes Q No 19 Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVWRP Section III — Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No K Not Applicable PREPARED BY CttkME5ERS TITLE N &eN a DATE Q, 2'l - OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971;kn 9Z pF SO(/r�,o� � O COUNT i MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: March 16, 2015 1' MAR 1 6 2015 s .._1 Re: Proposed Wetland Permit for JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES SCTM# 1000-125-1-5.3 Note that Laurel Lake is a Special Groundwater Protection Area and NYSDEC Critical Environmental Area. The water body is also included in the Town of Southold Laurel Lake Preserve. Bill Gorman on behalf of JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES requests a Wetland Permit to replace existing 26'x14' dock and 3' wide steps attached to side with a proposed 4'x10' steps and landing at lake edge; a 4'6"x3' hinged ramp; and 4'x4'. float. Located: 3055 Kirkup Lane, Mattituck. SCTM# 125-1-5.3 The proposed actions have 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 INCONSISTENT with the Policy Standards and therefore are INCONSISTENT with the LWRP due to the following: 1. A Wetland'Permit for the existing dock structure was not found. 2. The piling materials have not been identified. Lumber pre-treated with any preservative is prohibited. In the event that the action is approved, it is recommendr.d that the Board require the following: The prohibition of the wood treated with fur'gicide and insecticide in construction of dock structure in this important lacustrine wetla'id. The use of ACQ materials does not comply with Chapter 275-11 of the Southold Tov:n Code which states: "In order to prevent the release of metals and other contamina,-'ts into the wetlands and waters of Southold, the use of lumber pre-treated with any preservative, including but not limited to chromated copper arsenate (also known as "CCA'), commercial copper quat (CCQ), penta products, Alkaline Copper Quat (ACQ), or homemade wood preservatives is prohibited for use in sheathing and decking on structures in the wetlands as well as on any part of a structure in low tidal flow wetland areas as determined by the Trustees" 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 Peter Young, Chairman Q Lauren Standish, Secretary COO r Conservation Advisory Council Town of Southold Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1889 Fax(631)765-1823 At the meeting of the Southold Town Conservation Advisory Council held Wed., March 11, 2015 the.following recommendation was made: Moved by Peter Young, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the application of WINIFRED BREINES to replace existing 26'X 14' dock and steps attached to side, 4'X10' steps and landing at lake edge, 4'6" X 3' hinged ramp and 4'X 4' float. Located: 3055 Kirkup Lane, Mattituck. SCTM#125-1-p/o5 Inspected by: Peter Young The CAC Supports the application but questions whether the dimensions of the dock conform to the standards set forth in Chapter 275. Vote of Council: Ayes: All Motion Carried MAR 1 3 2015 John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee pF SOUTgO y�OUIVTV,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ,Coastal Erosion Permit Application V Wetland Permit Application Administrative Permit ARWeceived _A mendmentlTransfer/Ex nsion eceived Application3S Fee:$ S ,D ompleted Application _Incomplete _SEQRA Classification: Type I Type II Unlisted ._, Coordination:(date sent) IWRP ConsistencA e t Form 25 AC ReferralSent Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: �LTechnical Review: Public Hearing Held: _Resolution: I_ Name of Applicant W I W I F FIJE�p k� k,E (N E S Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 - _--_.___ � 3 3 FEB 2 20I�15 ' ' i Mailing Address 30 55 til R4K_L9 P L At�,kE r A kTTcT U C� i Phone Number:( ) 13 2� Suffolk County Tax Map Number: 1000 - 125 — L,0 D 5 - Property Location: 3 oss- Wtco FOLZ -4+'20( i.1) l i n. - - - . (provide LILCO Pole #, distance to cross streets, and location) AGENT: I I—L (If applicable) ►'� TiTuC� N l R52 S� fARKvP u41-�E FRO ryk O0M0 AUE , Address: " fix 44-7 YYI fkT'(-[1 UC[4 r3� � SOLS' Phone: L4 _ I. 1Dard of Trustees Applicat GENERAL DATA Land Area (in square feet): + C) Area Zoning: A C Previous use of property: PARI_C�N�srRV Pti cdc�1 eA;SeMervT A-REA• (`M SUFF'dt_. C'ourJ i YJ E V J/ (215S L Q E NCF_ — F -,)C k S T Intended use of property: N 0 QCT k S -CD F -151M L f21 p_e?LACE �Xvs %. 'QCT CV f Covenants and Restrictions on property? Yes !1 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 V 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.? V/ Yes No Does the structure (s) on property have a valid Certificate of Occupancy? V Yes No Prior permits/approvals for site improvements: Agency Date t+ ohL 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 c-ifn-ecessary): TO F,15PLACS E>XkSTo 120, 0 ?< 14,D ( V o Ck * \ Ci \ -S1 ATS Ct 1 _---Q -rD -S toe 2� Mrd of Trustees Applicati4 y" WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: l D C<Z—,? LAC 6 eXVs . 1 'L(o.oi x l �o T)o els A s�'cs 4 -ra F-eeu&-'C�E EX15'V- 10,0' x 4 m 0' L r,) Q I r. C— c* ifs 0 LAKt--'E E;D G G, Area of wetlands on lot:—B ( square feet Loi' l s - 4013) -1 `t (0 it Percent coverage of lot: 'V (Le SS -V-t �N i Closest distance between nearest existing structure and upland edge of wetlands: L(05,5 ` feet — D PeStDeWCe* Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? W Ar cubic yards How much material will be filled? N PV- cubic yards Depth of which material will be removed or deposited: N A • feet Proposed slope throughout the area of operations: Ex UST S L D P e Manner in which material will be removed or deposited: Wk - 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): 1`R k W ' (A Pel, (PA PACT —(-o FKV,=SKVUAXT---F-, w r5TLAN OS eB eCAjs ErD D CK s � p �— R 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 I - Project and Sponsor Information I N i FKe €5FZe( NES C-er-�e"L �Fo R_ TVi-e 'J&Cozy- Name of Action or Project: t -�M (L: -f ' j,4 rVX ITE.D F ->A R_ TM eP s i*( P) . Project Location (describe, and attach a location map): '3055 e EZ>✓r✓ t-�i 1<< Lfi�o , M P -'T TL-FJC�- Brief Description of Proposed Action: TO F, P SCE / JP i�I N t� ► � K � S� • 2E, d o t x l4 0 � �(� Ci! STopS eKlbT :, _ Telephone: Name of Applicant or SponsorAIV(&C—e� i) E Q—d R& M_ AI l .! -Mail: Ci PLjJ Q n I [Ctn ( b cL� 7 1 Address: 4 CP C( 'C5 Lam% City/PO: State: Zip Code: Yn -A-71-1TL) C Le--- N [ R5__7_ 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, NO YES administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? NO YES R ❑ If Yes, list agency(s) name and permit or approval: 3.a. Total acreage of the site of the proposed action? • 38 5 acres b. Total acreage to be physically disturbed? ew3s 'Az) —(90 6c? ° FT- Tc. c.Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor?Sacres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑Urban ®Rural (non -agriculture) ❑ Industrial ❑Commercial .residential (suburban) ❑Forest ❑Agriculture ❑Aquatic []Other (specify): �IyS�K�PcTI�� ❑Parkland �lSEMN T Page 1 of 4 5. Is the proposed action, a. A permitted use under the zoning regulations? Consistent with the adopted comprehensive plan? NO YES N/A ❑ jam( LL 1 1:1b. ❑ ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: NO YES RKI ❑ 8. a. Will the proposed action result in a substantial increase in traffic above present levels? 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? NO YES ® ❑ © ❑ 9 ❑ 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: N NO YES ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? If No, describe method for providing potable water: NO YES ❑ ❑ 11. Will the proposed action connect to existing wastewater utilities? A r If No, describe method for providing wastewater treatment: ,v NO YES ❑ ❑ 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES © ❑ 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain 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? Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: 2h, o x\ 4.y' o C� ' �-�€�� 1 ty E to l i�� NO ❑ YES ElIf 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ,Shoreline ❑ Forest ❑ Agricultural/grasslands El Early mid-successional Wetland El Urban ❑ Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO YES 1K ❑ 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? 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 storm drains)? If Yes, briefly describe: ❑ NO ❑YES NO YES ❑ Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: NO YES 91 ❑ to large impact impact may 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: NO YES occur ❑ raj u 1:1regulations? 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? 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES EY ❑ of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: &0 Date: `Lb 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 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?" Page 3 of 4 No, or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning raj u 1:1regulations? 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? 4. Will the proposed action have an impact on the environmental characteristics that caused the EY 1:1establishment of a Critical Environmental Area (CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit, biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a. public / private water supplies? b. public / private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, ❑ waterbodies, groundwater, air quality, flora and fauna)? Page 3 of 4 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. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that e proposed action may result in one or more potentially large or significant adverse impacts and an ironmental 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 pacts. Town of Southold - Board of Trustees 2," —/S Name of L d Agen y Date President Print or y Na of Rtspo�Officerad Agency Title of Responsible Officer gnah re of—ResR94ATe OITIcer in Le Agency Signature of Preparer (if different from Responsible Officer) PRINT I Page 4 of 4 No, or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage r-7(� ❑ u problems? 11. Will the proposed action create a hazard to environmental resources or human health? E 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. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that e proposed action may result in one or more potentially large or significant adverse impacts and an ironmental 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 pacts. Town of Southold - Board of Trustees 2," —/S Name of L d Agen y Date President Print or y Na of Rtspo�Officerad Agency Title of Responsible Officer gnah re of—ResR94ATe OITIcer in Le Agency Signature of Preparer (if different from Responsible Officer) PRINT I Page 4 of 4 SXIFRZA:'q� O o Town of Southold Erosion, Sedimentation std Storm -Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A (00 L9,5- () F/0 OS STORM -WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN isl�trl'ct ectron oc Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION I ITEM # / WORK ASSESSMENT I Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels located within C(. 3857 the Scope of Work for Proposed Construction) b. What is the Total Area of Land Clearing (S.F. /Acres) and/or Ground Disturbance for the proposed D construction activity? PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additional Pages as Needed) TD K1�,--PLACk,;-. IN K(►Js), EKUS7. ���Pr cC�T r✓?�Ls�dd lD,o x 4.01 L NOlNG / t & K -e EEDGrE - Submission of a SWPPP is required for all Construction activities involving soil disturbances of one (1) or more acres; including disturbances of less than one acre that are part of a larger common plan that will ultimately disturb one or more acres of land; including Construction activities involving soil disturbances of less than one (1) acre where the DEC has determined that a SPDES permit is required for storm water discharges. ( SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit for Storm Water Discharges from Construction activity - Permit No. GP -0-10-001.) 1. The SWPPP shall be prepared prior to the submittal of the Not. The NOI shall be submitted to the Department prior to the commencement of construction activity. 2. The SWPPP shall describe the erosion and sediment control practices and where required, post -construction storm water management practices that will be used and/or constructed to reduce the pollutants in storm water discharges and to assure compliance with the terms and conditions of this permit. In addition, the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. 3. All SWPPPs that require the post -construction storm water management practice component shall be prepared by a qualified Design Professional Licensed in New York that is knowledgeable in the principles and practices of Storm Water Management. I Will this Project Retain All Storm -Water Run -Off Generated by a Two (2") Inch Rainfall on Site? / F (This item will include all run-off created by site v clearing and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed rpm Drainage Structures Indicating Size & Location? This ❑ Item shall include all Proposed Grade Changes and — Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion / and sediment control practices that will be used to ❑ 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 Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ❑ (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction ® or within One Hundred (100') feet of a Wetland or. — Beach? 7 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to ❑ / V One Hundred (100') of Horizontal Distance? 8 Will Driveways, Parking Areas or other Impervious / Surfaces be Sloped to Direct Storm -Water Run -Off ❑ ✓ into and/or in the direction of a Town right-of-way? 9 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right -of -Way or Road Shoulder — Area? (This Item will NOT Include the Installation of Driveway Aprons.) NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in a Box and the construction site disturbance is between 5,000 S.F. & 1 Acre in area, a Storm -Water, Grading, Drainage & Erosion Control Plan is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check Mark (4) and/or Answer for each Question is Required for a Complete Application) SPATE OF NEW YORK, -5.. U �I 0 LtL COUNTY OF ......................................... SS �cwt. tzW__-.1-10.1-1/being That I, = ... duly sworn, deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) Andthat he/she is the ................................ .`....`".....`............................................................................................................ (Owner, Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to die best of his knowledge and belief; and that the work will be performed in the manner set forth in die application filedXhheremituh.Sworn to before me this;II ^^............................23...�.... day f...Ec.1;1IC.11lM:.--•--•---.. , 20�5J.Notary Public:.F 1� ....._gnature of Applicant) FORM - 06/10 . ....... ___. _ NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2N_? O Ln PROOF OF MAILING 0'r-9 ATTACH CERTIFIED MAI o O ' O O D Name: Addre& a FA�n k ` —`[ L -TD • P&fZ1V etc P 3 U.S. Po ervicer. CERTIFIED MAIL,. RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) For delivery, information visit our website at wwwxsps.come Return Re'CVP' Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) 'go \jorzl= -r&�K&CS MA- b?,44c�, '2_ ' DJ . `P(ZDI?. ®luNegS , 12s _i 1Z5-_ISES C L STATE OF NEW YORK COUNTY OF SUFFOLK -JO?V"3 C tkt-y'&B°�S , residing at 5-0(a?� P_-(�. Z �SouTlt-OL-C) Y , being duly sworn, deposes and says that on the da of , 20 (S, 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 50 U k k-y_o - that said Notices were mailed to each of said persons by CERTIFIED MAEURETURN RECEIPT. Sworn to before me thisF Day of MktzC -- 120 (:57 Notary Pu c TRACEY L. DWYER NOTARY PUBLIC, STATE OF NEW YORK NO. 01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30, 2PS John Bredemeyer, President Michael J. Domino, Vice -President James F. King Dave Bergen Charles J. Sanders BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ------------------------------------------ In the Matter of the Application of Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR EIGHT DAYS iding at /dba `Z �� V/� uk VK) U 6c�'� L_:�-?Ur_� being duly sworn, depose'and say: / That on the 10 day of � �`� , 2015,71—personally posted the property known as by placing the Board of Trustees /official poster where it can eas`Ty—Gelseen, 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 Dated: , rraa Sworn to before me this ,2t)�1 day oq jpr)12015' & _L 9 n^P64 Notary Public CONNIE D. BUNCH Notary Public, state of Now Yo* No. 01 BU6185050 Qualified in Suffolk County Commission Expires April 14,2__((D NUTILt UF Ht:AKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: JACOBY FAMILY LTD. PARTNERSHIP, c/o WINIFRED BREINES SUBJECT OF PUBLIC HEARING: To replace existing 26'x14' dock and 3' wide steps attached to side with a proposed 4'x10' steps and landing at lake edge; a 4'6"x3' hinged ramp; and 4'x4' float. TIME & DATE OF PUBLIC HEARING: Wednesday, March 18, 2015.— at or about 5:30P.M. If you have an interest 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 days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Feb.23.2015 01:28 PM nifred Breines 617 "'-7S 1426 PAGE. 1/ 1 Board of T}}uot®ea APP11catiML County of Suffolk State of New York �N IN t r J:7 -, z- V:l11 �a BEING DULY SWORN DEPOSES AND AFFIRMS THAT HFUSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS. APPLICATION AND AS MAY BE APPROVED By THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN'TRUSTEES HARMLESS .AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. 'IN COMPLETING THIS APPLICATION, ! HERESY 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, WS Signature of Property Owner SWORN TO BEFORE ME THIS gg ,3 DAY OF / ZIO Ed 0-LS.7 NotaryPub"c Rco'sm f cbrom ysS�►�.o� Feb:22.2015 10:27 AM L*:,ifred Breines 617 'zQ 1426 PAGE. 2/ 3 APP sFORK i,rM M v w uvo,� via. • ,'. .. . YOUR NAME: (Last name, first nada jAiddle iakial, or, a you areapplying in the name of someone also or other entity, su* as a cc mpany. If so, Indicate the other person's. or company's name,) NAME OF APPLICATION: (Check all that apply.) Tax grievance Su' Variance Tru ing geY, Change of zona C 81 Erosion Appmvai of plat . M ring Exemption fkM plot or official map Other (If"Other" name the activity.) Do you personally (or through your company, spouse, sibling, pa_ rent or Child) have a relationship with any officer or employes ' of the Town of 5nuthold7 -Rol ationship" includes by blood, mat dogai or buslocas interest. "13usineas lntetcstn means a business,, including a partnership,, In which the town officer or employee.has oven a partial ownership of (or employment by) a corporation In which the town officer or employee owns more than 3% offt shares. YES NO `P ifyoU answered"M", oomplete the balance orthfs tbrm and:dwo and sign whsro indicated, Name of person employed by the Town of Southold Title or position of thatperson Describe the relationship between yourself (the applicant7egent/re resentative) and the town oMcer or employes. Either aback the apprvpdate.Une.A): through k�)ancVor•tksenbc rn the gpace p video. The town officer or omployee or his or her spoux, sibling, parmnt, or child Is (chock allthat apply): A) the owner of greater than 5% of the shaves of the corpo c stock of the appllefutt (when the applicant is a corporation); _B) the legal or benoilcial owner of any interest in A noel -corporate entity (when the applicant is not a corporation); . C) as offeer, dirotor, pantie`; oremp{oyee of the applicant' or D) the actual applicant. DESCRIPTION OF RELAnoNswip Submitted is Z_3; dtty tels ?V I'� Signature L -dl A Print Name n - V--, Form -TS I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The 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 necessn to avoid same. YOURNAME: e q1 c,*ii�4.0 17e ��tco�s v4W� t e initial unless ou areapplying in the name of r -t t (Last name, First nam ,.��ddl y 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 V Ifyou 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 2 day of r'G� 204!!r Signature 'e07 A - Print Name Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form. should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated. as to its significant beneficial and adverse effects 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 supporting and non- supportin'g 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# I ® o0 - [25 - D I FEB 2 3.2015 r PROJECT NAME W N I ME D 5 RSI NES The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board ❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action (check appropriate'response): (a) Action undertaken directly by Town agency (e.g. capital ❑ construction, planning activity, agency regulation, land transaction) ❑ (b). .Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: X Nature and extent of action: Kel?LP�cCE i It\J tit N Q exl�� 2��0x'. I T�OC� sTEt�S DJ ACK i' Location of action: I SS LAN 6.1 01 KEL-G, Site acreage: R, 39S ac'cg- Present land use: S l rJ CYt-O� FNNX(L-�y Re;S WER Ice Present zoning classification: f C. 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: U N'J C 4& -Mb a(ZS QCs rel { a K W t N l F-F�E9 �$ i (b) Mailing address: SZ) X- 4c '�Sb L)—(A-VO L10 �q - (c) Telephone number: Area Code ( (d) Application number, if any; Will the action be directly undertaken, require Rmding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency?. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III — Policies; Page 2 for evaluation criteria. ❑ Yes ❑ No R1 Not Applicable EX�-s-T- D® Qr - d S-Fff Rs Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LVW Section III = Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ 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 ❑ Yes ❑ No gNot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No Z Not Applicable r--xy� SS S —rD '54� 1F e -R- ACED l6� Kc ry a Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III — Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No RNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III — Policies; Pages. 22 through 32 for evaluation criteria. Yes No (=NotApl-_--,------ble 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. R Yes ❑ No DS Not 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 ❑ No12"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. ❑ YeF-1 No ba Not Applicable Attach additional sheets if necessary WORIING COAST POLICIEL 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 FNot 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 •NNot Applicable ` L--A<y KE5-- L-A Attach additional sheets if necessary Policy 12. Protect agricultural lands. in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No R Not Applicable (tel tet- &&G -, t C L --,-(U f -A L - 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 KNot Applicable PREPARED BY J - CttAM eeKS TITLE Cei T DATE 2 � 22 - S .•-Sau.-dcrn F�'� dY.t:rsl+2s - - yeti,. Mea�.c fcw�sar ay. ii L �J �}`'J' ®, __ • \ �--•� l:air. C:• Is �. .09 le ' ",-`' ' MAR 2 6 2015 3US'iltirkupLn LaueflirlsarArrF��r'reeP or 3•. CD?,Wt Sur 4. 1_ncral trl;r'hnrrnrds _ A � , S�"\ ��• G�``�• � j 1 � ` _ "� � �• �i�S •E'E'R /�f Pt'TM:''�`� 1 pt�� N, '� • `,� t�+�• Int ® �. N. BOARD OF TRUSTEES 22 SOUTHOLD - \ �s- \ \ cs_ t� g DATE 2�-• -- \\ i `` �� �,� �8 V4C ccXtiP�: 5 LAGC- r7777 26 28 let SIN mtfA tisr-e�. \ \\-' FLAN :. b e� 3055 \ I� 1 � �. �• � fi A= ... � u I E 20.�tUtd 1(�`�`� E� , +, ` ` ® \ S !d @ f `/. % I \ r. .r.• Q> C,O t" -TO U, P& F "su p-\lE . 4 � � \ `�► \1 1 f �>� .� fir: {/ \ '�— -:...... .- —{ General Notes Scope of Work PRESCRIPTIVE OR ENGINEERED. REPLACE, IN-KIND, EXIST. 26X 14 FIXED DOCK AND 10'X4' 1. All work shall be performed in strict accordance with the PLATFORM AND STAIRS. rules and regulations of the Southold or Riverhead Building BASEMENT: NA Code and the New York State codes having jurisdiction over F any portion of the work. Additional Construction Notes 2. The general contractor and all subcontractors shall visit 1. All portions of the proposed structure shall comply with the site and verify all dimensions and the existing conditions the building Code of the State of New York and the covering or affecting the work prior to construction. Any Re.;idential Code of the State of New York. discrepancies or omissions which would interfere with the ROOF - DEAD LOAD 20 Pei SNOW LOAD 45psf satisfactory completion of the work d3scribed herein shall be 2. All portions of the proposed structure are designed to reported to the architect or property owner. comply with local geographic and climactic criteria as WIND ZONE stated in the adjoining table. 3. Before starting work, the contractor shall make a 1/2" PRECUT PLYWD. PANELS FOR PROTECTION AGAINST WIND BORNE DEBRIS, APPROPRIATE thorough examination of those portions of the structure in which 3. All structural elements are designed to be adequate for the work is to be performed, checking all the a ground snow load of 45 psi, and wind speed of 120 adjoining or underlying locations. Report to the archite.t or mph. property owner any and all conditions which may interfere with FLOOR - 1 LAYER 314"CDX PLYWO. & 1 LAYER 1/2" PTS FIN. SURFACE or otherwise affect or prevent the proper execution and 4. Footings shall be at a minimum of 36" below finished completion of the work. Do not start the work until such grade. conditions have been examined and a course of action mutually ROOF - 1 LAYER 3/4" CDX APA RATED NAILED WITH ID @ 4" O C. @ EDGES, G" O.C. INTERIORS. IF agreed upon. 5. Poured concrete shall have a compressive strength of 2500 psi at 28 days. 4. Failure to notify the architect or the owner of unsatisactory conditions will be construed as an acceptance of the conditions 6 Sill plates shall be preservative treated wood and be to properly perform therequired work. installed above 16 oz copper termite shield. 5. The execution of the work constitutes acceptance of the 7. Shingle siding shall conform to ASTM D 3679 conditions. Later claims will not constitute relief from the requirements and be installed in accordance with the requirements of the work, nor will extra compensation be paid requirements of the Building Code of the State of New by the owner. York and manufacturers specifications. 6. All work is to conform with drawings and specifications of the I Pilings shall be Installed by a licensed contractor to a architect and engineer consultants. depth and bearing agreeed upon by an engineer and I-II certificates shall be issued stating same. 7. The general contractor is to maintain a complete and up FASTENED W/ 3/4" GALV. FENDER to date set of drawings on the job site at all times, LO Including contract documents and specifications. Energy Conservation Notes 8. The contract documents and drawings are not to be BOLTS, NUT, WASHERS scaled under any circumstances. Field approvals by the 1. All building envelope components shall comply with architect or owner are required are required for final locations of Chapter 6 of the Energy Conservation Code of the State exterior and interior partition walls, wall openings, electrical of New York. outlets and devices including light fixtures, mechanical devices and equipment, plumbing fixtures, and decorative 2. All glazing shall have a max. U Factor of .40. surfaces and materials. 3. Ceilings shall be provided with a min. R-19 fiberglass 9. Furnish and supply all materials, labor, and equipment as batt insulation. required to perform and complete the work indicated in the contract documents and drawings. 4. Exterior walls shall be provided with min. R-13 fiberglass batt insulation. 10. It shall be the contractor's responsibility to ascertain all prevailing procedures including: storage and toilet 5. Floors shall be provided with min. R-19 fiberglass batt facilities, protection of existing work to remain, access to work insulation area, hours of permitted work, availability of water and electric power, and all other conditions and restrictions, 6. Basement walls shall be provided with min. R-9 for this particular location. Polystyren ri id lnsulatiOACVIDEMSTA30OREQUAL 11. The general contractor shall take every precaution to METAL STRAPS OVER RIDGE TO ROOF RAFTERS Q 1C OC TVP NOT APPLICABLE IF protect the existing work to remain. If work to remain becomes COLLAR TIES ARE PRESENT damaged during the course of operations, it will be repaired to the owner's Satisfaction, at no additional cost. 12. The general contractor shall obtain any and alt permits required for the performance of the work, and also file the necessary documents with the Department of Buildings in preparation for permitting. PROVIDE I-100 COMMON NAILS EACH END OF COLLAR TIES TYR 13. The general contractor shall make the necessary PROVIDE SIMPSON H2 / H10 OR EQSECURE UIVALENT HURRICANE TIES R TO arrangements to utilities and services temporarily disconnected PLATE AND WALLLFFRAME while performing the work as required, and maintained for temporary use PROVIDE SIMPSON LPT4 OR EQUIVALENT TO TIE RIM BOARD 14. The general contractor shall do all cutting and TO DOUBLE PLATE TVP chopping for all subcontractors and trades. 15. The general contractor shall provide proper shoring 9 P P P 9 ED PROVIDEOR PROVIDE SIMPSONOTIE HB LL TO TIE WALL STUDS and bracingfor all remaining structure prior to removal of 9 P OF BOTH FLOORS TO PLATE L BAND JOIST o 16- OC TYP existing structure. F ROM DE SIMPSON HG OR 16. The general contractor shall be responsible for necessary EQUIVALENT TO TIE WALL STUDS TOPLATE i BAND JOIST Q 16. OC TYR patching and refinishing of the adjacent properties as required PRO V DE SIMPSON LPT40R due to contract work within the project site. EQUIVALENT TO TIE RIM BOARD TO SILL PLATE 17. The general contractor will be responsible for scheduling all inspections as required, including. foundation PLATE WASHER PROVIDE APPR9�P (a) (b) rough framingMASON BOLT TO TIE SIL -FOR c roughelectrical O FOR I S B'STORI FOR 1 STORY 3' -D RN R - co Ess (d) rough plumbing OR NINES NDSOILM 1r 1111 AND BOLTS TO BE MIN (e) final electrical TYP NAILING SCHEDULE finish 18. Surplus material of eve rychoracler resulting from the work, which may be left over during the work and after the work is completed, shall be hauled away and the site left entirely clean and unobstructed on a regular basis. 19. Execute the work in a Careful and orderly manner with the least possible disturbance to the public. 20. The general contractor is solely responsible for construction safety and shall hold the owner, architect, and assigns harmless from litigation arising out of the contractors failure to provide necessary construction safety means and methods. 21. Perform the work in accordance with the highest standards and established practices of the trade, and conform to all village GEOGRAPHIC AND CLIMATE DESIGN CRITERIA state, and federal authorities having jurisdiction over this work. GROUND SNOW LOAD 45 PSI 22. Work specified shall be performed by subcontractors WIND SPEED 120 MPH SEIMIC DESIGN CATAGORY ■ regularly engaged in the supply and installation of work 9 yPP Y WEATHERING SEVERE FROST LINE DEPTH 36" required by these specifications. TERMITE MODERATE TO HEAVY DECAY SLIGHT TO MODERATE WINTER DESIGN TEMP 11-83 23. It is the intent that the contract documents and bid ICE SHIELD UNDERLAYMENT REQUIRED specifications include all labor and material to accomplish a FLOOD HAZARD AS NOTED complete installation. ..F APPROVED BY BOAR"F-TRUSTEES TOWN OF ' SOUTHOID DATE V. I MAR 2 6 2015 Building Department Information PRESCRIPTIVE OR ENGINEERED. PRESCRIPTIVE SQUARE FOOTAGE: EXISTING: PROPOSED I I BASEMENT: NA REPLACE, IN-KIND, EXIST. FIXED DOCK, 26X 14 AND PLATFORM AND STAIRS. F FIRSTFLOOR: NA 101_01� I I II I I I SECOND FLOOR NA REBUILD EXIST. PLATFORM i STAIRS LU ATTIC NA DESIGN LOADS: ROOF - DEAD LOAD 20 Pei SNOW LOAD 45psf SECOND FLOOR NON SLEEPING AREA - DEAD 20psf LIVE 40psf ATTICS WITHOUT STORAGE - DEAD 10psf LIVE 10 psi WITH STORAGE, DEAD 10 psf LIVE 20 psf STAIRS: DEAD 10 psf LIVE 40psf GUARDRAILS i HANDRAILS. DEAD 5psf LIVE 200psf WIND ZONE 120 mph, Zone III - WITHIN 1 MILE FROM COAST, MISSILE D TEST APPLICABLE PROTECTIVE GLAZING PANELS 1/2" PRECUT PLYWD. PANELS FOR PROTECTION AGAINST WIND BORNE DEBRIS, APPROPRIATE LL ATTACHMENT HARDWARE SHALL BE INCLUDED. PANELS SHALL COVER ENTIRE GLAZED OPENING. LUMBER SPECIES i GRADE DOUGLAS FIR -LARCH SELECT STRUCTURAL GRADE FY = 1450 psi Z ENGINEERED LUMBER LVL 1 9E FY 2600ps, i 11-7/I" TJI 560 SERIES MAX. VERTICAL SHEAR 20501Ys. NAILING FLOOR - 1 LAYER 314"CDX PLYWO. & 1 LAYER 1/2" PTS FIN. SURFACE < o w ? TREX DECKING WALLS - 1 LAYER 5/B" CDX APA RATED, NAILED WITH ID @4" O C. @ EDGES, G" 0 C. @ INTERIORS 3 X 12 PLASTIC JOISTS @ 24" OC.- FASTENED TO PLASTIC GIRDERS W/ OFF -SET STAINLES STEEL ANCHORS IF PNEUMATIC GUN IS USED NAILS SHALL 111 -.099 1-3/4" 3" O.C. EDGES 6" O.C. INTERIOR ROOF - 1 LAYER 3/4" CDX APA RATED NAILED WITH ID @ 4" O C. @ EDGES, G" O.C. INTERIORS. IF I lo�wtn I I I I PNEUMATIC GUNS ARE USED - NAILS SHALL 15E.097 -.099 NAIL, 1-7/9", 3" O.C. EDGES, 6" 0 C. INTERIOR. ..F APPROVED BY BOAR"F-TRUSTEES TOWN OF ' SOUTHOID DATE V. I MAR 2 6 2015 4X4 ACQ POSTS ANCHORED TO 8" D!A. CONC. FTGS TO A MIN. OF 3'-0" BELOW EXIST. GRADE - TREX DECKING ON 2X8 @ 16" OC ACQ JOISTS - � (V 2 TREADS MOLTED o TO DOCK FRAME 2X12 PLASTIC STRINGERS TREX OR EQUIV. TREADS REBUILD EXIST PLATFORM & STAIRS /- HANDRAIL AS REQ. I �. / I I F 101_01� I I II I I I I I REBUILD EXIST. PLATFORM i STAIRS LU t I I000z I I I I 1 I LL NLu LU - I I I I I 2X12 ACQ STRING @ o DN RISERS @ 8-1/4" MAX. Ui o LL PLATFORM v I I U 3 X 12 JOISTS @ 24" OC.-IFAStENED TO GIRDERS W/ OFF -SET STAINLLS STEL ANCHORS Y I I Z ( < o w ? TREX DECKING MASONRY FTG. SUPPCRT 3 X 12 PLASTIC JOISTS @ 24" OC.- FASTENED TO PLASTIC GIRDERS W/ OFF -SET STAINLES STEEL ANCHORS FOR STRINGER9 S I lo�wtn I I I I I I Z LL N m W PLAN I I I I I I I I 1/4" = 11-011 a_ 2-3X10 PLASTIC GIRDERS KNOTCHED REV. 3.18.15 REV. 3 25.15 INTO 10" DIA. LOCUST PILES. ( UNTREATED) I✓I I✓I I✓I I-II 4X4 ACQ POSTS ANCHORED TO 8" D!A. CONC. FTGS TO A MIN. OF 3'-0" BELOW EXIST. GRADE - TREX DECKING ON 2X8 @ 16" OC ACQ JOISTS - � (V 2 TREADS MOLTED o TO DOCK FRAME 2X12 PLASTIC STRINGERS TREX OR EQUIV. TREADS REBUILD EXIST PLATFORM & STAIRS /- HANDRAIL AS REQ. I �. / I I TREX DECKING I� 0 _. / 26'-0" t 1"�E �--� 2X12 ACQ STRING @ /C� `1.J LL Z 16" OC Z ( MASONRY FTG. SUPPCRT 3 X 12 PLASTIC JOISTS @ 24" OC.- FASTENED TO PLASTIC GIRDERS W/ OFF -SET STAINLES STEEL ANCHORS FOR STRINGER9 S r Z W / if 0 lJ a_ 2-3X10 PLASTIC GIRDERS KNOTCHED DC I INTO 10" DIA. LOCUST PILES. ( UNTREATED) PILES ,•w`, MHWL FASTENED W/ 3/4" GALV. FENDER X LO W O '^ V J BOLTS, NUT, WASHERS / MM0 O %i Z SECTION #1 / SIDE ELEVATION 1/411 = 11-01, REV. 3.18.15 REV. 3.25.15 NOTE ON MATERIALS NO TREATED PILES, LUMBER OR DECKING ARE TO BE USED ON ANY PARTS OF THE DOCK. THE PILES ARE TO BE UNTREATEDt�3SF WOOD, THE STRUCTURAL MEMBERS OF THE DOCK ARE TO BE COMMERCIAL GRADE PLASTIC LUMBER & THE DECKING AND TRIM WILL BE TREX OR AN EQUIVILANT NON -WOOD PRODUCT. SCALE AS NOTED 2.21.15 REV. 3.18.15 RAMP & FLOAT ELIMINATED. STEPS FROM DOCK TO WATER RELOCATED REV. 3.25.15 ALL WOOD SPECIES REV. TREX DECKING ADDED DRAWN BY JOAN CHAMBERS 631-294-4241 �. / Z 0 _. / t �--� Z /C� `1.J LL Z 06 Z ( Z U r Z W J 0 i,// a_ Z I ,•w`, Z X LO W O '^ V J 3: / MM0 O W Z i 0. ;'ii,SLOPED BOTTOM/... SCALE AS NOTED 2.21.15 REV. 3.18.15 RAMP & FLOAT ELIMINATED. STEPS FROM DOCK TO WATER RELOCATED REV. 3.25.15 ALL WOOD SPECIES REV. TREX DECKING ADDED DRAWN BY JOAN CHAMBERS 631-294-4241 PLAN SECTION ELEVATION 1 OF 1 lr-- IV') W Z 0 _. / �--� Z /C� `1.J LL Z 06 Z ( Z U LU Z W J 0 Q a_ Z I ,•w`, Z X LO W O '^ V J 3: m MM0 O W Z PLAN SECTION ELEVATION 1 OF 1 S 6S• 23, S6., H� 8p , f �wrr fir.. EDGE OF FRESHWATER WETUNp$ CON�LTI CY SE 'O EN"RONUEr 7A� RviCEs ON MARCH 27. 2007 O '°R pp ffo — — - 22 fXp�Nsof0 50� CFSSw004 �3� O ' N gu 3 400 v FEB 2 3 2015 SURVEY OF LOT 2 CLUSTERED CONSERVATION SUBDIVISION FOR THE PROPERTY OF THE JACOBY FAMILY LIMITED PARTNERSHIP SITUATED AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-125-01—P/0 05 SCALE 1"=60' MAY 2, 2007 DECEMBER 21. 2007 ADDED PROPOSED SEPTIC SYSTEM TOTAL AREA = 408,796 sq. ft. (TO TIE LINE) 9.385 OC. NO TES: 1. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM 2. REFER TO FILED MAP FOR TEST HOLE DATA. 3. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1,000 GALLONS. 1 TANK; 8' LONG, 4'-3" WIDE, 6'-7" DEEP 4. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA. 1 POOL; 12' DEEP, 8' dia. PP.OPOSEO E PAN :CV mOCL s 0 PROPOSED LEACHING POOL =1 PROPOSED SEPTIC TANK 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. 6. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND REMOVED IN ACCORDANCE WITH S.C.D.H.S. STANDARDS. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK 'STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE ORK STATE LAND TITLE ASSOCIF�* 4F t F y� J7 ,, "•�suv N.Y.S. Lic. No. 50467