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HomeMy WebLinkAboutTR-8728 SprruL4, "'Z4 Michael J. Domino, President ZO,:" Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Charles J. Sanders P.O. Box 1179 Glenn Goldsmith 4V Southold, NY 11971 4�� A. Nicholas Krupski Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1302C Date:Janua1y 24,2017 THIS CERTIFIES that the construction of a 12'x 12' screened porch addition onto the existing 11/2 story dwelling, and the as-built two sets of steps to gade for each e /e t om screened-in--Dorch-, nIDL xi fr install a 6'x7' outdoor shower onto landward side of proposed porch, and for the as-built 6'x 12' addition 6fit6 the lafidW�rd sid&,of dwiblling,and the installation.ofugutters to leaders to dn�Eells to contain roof runoff, At 910 Oak A:-�ehue,�Sdiith6ld �7 Suffolk County Tax Ma #1000-77-1-5 P Conforms to the application for a Trustees Permit heretofore filed in this office Dated December 21,2015,pursuant to which Trustees Wetland Permit#8728 Dated JanuM 20, 2016,was issued and Amended on JanuaKy 18, 2017, 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 construction of a 12'x 12' screened porch addition onto the existing 1 V2stoKy dwelling, and the as-built two sets of stgps to grade for each gpLry/exit from screened-in�porch. install a 6'x7' outdoor shower onto landward side of proposed porch, and for the as-built 6'xl2' addition onto the landward side of dwelling,and the installation of g—utters to leaders to drsoyells to contain roof runoff. The,certificate is issued to CIMSTINE&PHILIP MASCIA owner of the aforesaid property. Authorized Signature Michael J. Domino, President ���OSuTruL/(0oGy Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Charles J. Sanders y = P.O. Box 1179 Glenn Goldsmith • Southold, NY 11971 A. Nicholas Krupski y'hOd , �ao� Telephone (631) 765-1892 Fax (631) 765-6641 January 18, 2017 Christine & Philip Mascia 2 Livery Lane North Salem, NY 10560 RE: 910 OAK AVENUE, SOUTHOLD SCTM#: 1000-77-1-5 Dear Mr: and Mrs. Mascia: The following action was taken by the Southold Town Board of Trustees at their_Regular Meeting held on Wednesday, January 18, 2017:1 RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit#8728 for the as-built two sets of steps to grade for each entry/exit from new screened-in porch; and the outdoor shower to be 6'x7' in lieu of 4'x4'; and as depicted on survey prepared by Kenneth M. Woychuk Land Surveying, PLLC, last dated December 6, 2016, and stamped approved on January 18, 2017. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Michael J. Domino, President, Board of Trustees tp1x� S.C.T.M. NO. DISTRICT: 1000 SECTION: 77 BLOCK: 1 LOT(S):5 RIO-14-0037 rco in of N _ STON m o v I y FIRM ZONE X �� ,' j+ �1 _, RUBBLE 3 m FIRM ZONE _ % I� 'L tl; I` 6 +; 0 �0 15.8' 1 s4 0003 r20"E AE EL 7 u PROPOSED — — ►� �` i 3 �t °D 1 Z 24" FLOWELLp, (1 47.79 CF , P/0 LOT 293 DEC ' ® l=� X 140.00 2016 w m �_ EL 5.2 W I _ __/0_ _LOT 293 `p Southold Town CONC. ._ .f - P �y co POINT"S"WATER SERVICE eo `..�_Boan!�f Trustegs T j W 1 �0 "26.•4'=: . - : EL 9_8 J W z STONE DRIVEWAY O Y COASTAL BARRIER RESOURCE SYSTEM � I :.._ MAP & DEED LINE - I ESTABLISHED 11-16-1990 3 1 CELLAR o x ENT _ Y _ _= _ __ = 0 EL 8.6 EXISTING 2090 MAXIMUM LOT COVERAGE O W000 STEPS FLAG j� = _ _ I SANITARY Un 0 1.7 -1.0 • POLE 1 C14EL4.7 "�-= 1 1/1 STY,. = - LOT 294 SYSTEM �s Q 12,296.04 x 209 = 2,459 SF ALLOWABLE COVERAGE --.FRM DWi:LLINC_': C11 m M 4' WIDE CATWALK I o """ _ Z to z woo D __ #91.a 45.2 — o ~¢ o STEPS ;FFL LP 5 --- BF 1:4 �j EXISTING COVERAGE: W o Ix ci o ---- - - 1.500 GAL. OPEN GRATE N w z :::: : := -- LP#4 DECKING I x U a " __ . - _ R OF DWELLING W/COVERED PORCH: 1,195 S.F. or 9.7% o in PROPOSED ■ " S.T. 1 5 SCREENED PORCH 12'x 12 - -"-" '-- POINT A- 41 Y O a _:.26.4':;. .,-:. - LP 3 0 :' z= --. _ U. m OUTDOOR SHOWER 6 x6' -`"- -=- \ Lor 295 a1 PROPOSED COVERAGE: O i o,� EL 4 ,,,,; ;;;; EL 6.3 SCREENED PORCH & OUTDOOR SHOWER: 160 S.F. Z) z ......� LPII LP#2 z °D 1 v� SILT FENCE/HAYBALES "� •" 1 0 .....:.. � 8'DIAx2'DE 3 TOTAL PROPOSED COVERAGE: 1,355 S.F. or 11.0 co TIDAL WETLANDS BOUNDARY EQUAL TO 3 3 84.0' 56.6' ^ ITHE SEAWARD FACE OF BULKHEAD, AS d �� ;jj t-� LOT 296 _ D� DETERMINED BY EN-C NSULTANTS. 1 4 of " 3 �Ott 100 EL 7.2 00 M 4.6'N P/0 LOT 297 "�' o ZONED R-40 50.00' 7.7' WD ONC. DRAINAGE GUTTER M NON-CONFORMING LOT FRONT SETBACK - 35'MIN O , SIDE SETBACK - 10-MIN (25-TOTAL) CONC/STONE 1 0 ' 'r 140.00 144S.F.x.166=23.9 C.F. N44 35 20 iV P/O LOT 297 a REAR SETBACK - 35' MIN (SUBJECT TO TIDAL WETLANDS FLOWELL DRYWELL < DELINEATION & SETBACK) RUBBLE 9 No.33-49-23, 24"DIA _ _ 2 = I rri NOTE: NO RECORDED DRAINAGE 47.79 CF. PROVIDED I THE WATER SUPPLY, WI=LLS, DRYWELLS AND CESSPOOL 50' WIDE UNNAMED STREET x EASEMENT INFORMATION FOUND. AS SHOWN ON TAX MAP 1 LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS & FILED MAP. m AND OR DATA OBTAINED FROM OTHERS o - FIRM PANEL A 66H NAVD 1988 . . SEPTIC LOCATION 3 POINT "A" POINT "B" AREA: 12, 96.04 SQ.FT. or 0.28 ACRES ELEVATION DATUM: -------------------- ---- S.T. 20 41.5 UNAUTHORIZED ALTERA77ON OR ADDITION TO THIS SURVEY IS A WOLA7ION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY LP #1 34' 57,5' MAP NOT BEARING THE LAND SURVEYORS Y.EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPGUARANTEES INDICATED HEREON SHALL RUN - ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TIRE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS7I7U770N LP #2 40' 61' LISTED HEREC"J, AND TO THE ASSIGNEES OF THE LENDING INS777UTI0N, GUARANTEES ARE NOT TRANSFERABLE. APPROVED BY THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 7HE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE LP #3 35� 53. NOT INTENDED' TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, AD0177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS SOARD OF TRUSTEES LP #4 37 49 AND/OR SUB.5JRFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY LP #5 3844.5' SURVEY OF: 'l LOTS 297 & 293, LOTS 294-296 I CERTIFIED TO: PHILIP MASCIA; Td" OF SOUTIOLQ = LP #6 43' PO 49' i, r MAP OF: GOOSE BAY ESTATES � CHRIS MASCIA; Q � ,� i� FILED: NOVEMjER 13, 1934 No.1176 'r0 REVISED 12-06-16 i REVISED 12-15-15 SITUATED AT: SOUTHOLD UPDATED 12-05-15 TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC REVISED 11-10-15 SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design REVISED 08-04-14 � }t-� P.O. Box 153 Aquebogue, New York 11931 REVISED 06-27-14 PHONE (831)298-1588 FAX (631) 298-1588 REVISED .06-09-14 FILE # 13-205 SCALE: 1"=20' DATE: JAN. 8, 2014 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Moychuk John M. Bredemeyer III, Presi �Qg�FFO(,��o Town Hall Annex Michael J. Domino, Vice-Presiaen't ,�� Gy 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders y �ap�� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Gl Completed in field by: '714 j CHRISTINE & PHILIP MASCIA request an Administrative Amendment to Wetland Permit#8728 for the as-built-two sets of steps to grade for each entry/exit from new screened-in porch; and the outdoor shower to be 6'x7' in lieu of 4'x4'. Located: 910.Oak Avenue, Southold. SCTM# 1000-77-1-5 CH. 275-3 - SETBACKS , WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: - Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: Present were: J. Bredemeyer M. Domino G. Goldsmith ' N. Krupski C. Sanders Other Page 1 of 2 _ got - John M. Bredemeyer III, Presic! r¢pS k� Town Hall Annex Michael J. Domino, Vice-Presiaen-d54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski A, Southold, NY 11971 Charles J. Sanders y� oo�An� Telephone (631)765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: CHRISTINE & PHILIP MASCIA request an Administrative'Amendment to Wetland Permit#8728 for the as-built two sets of steps to,grade for each entry/exit from new screened-in porch; and the outdoor shower to be 6'x7' in lieu of 4'x4'. Located: 910 Oak Avenue, Southold. SCTM# 1000-77-1-5 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect,navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change,the course of any channel or the natural movement or flow of any waters: H. Weaken'or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of theTown: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch: 111-9 = ISSUANCE OF PERMIT, MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the.proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective.features and their functions and protective values, existing erosion protection structures, and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: ' Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 QF (/j John M.Bredemeyer III,President �®��� soTown Hall Annex /y0lo Michael J.Domino,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G �► ® a0 Telephone(631) 765-1892 Charles J.Sanders ���C®U Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: COMM 7;,,t � � o CERTIFICATE OF COMPLIANCE: 1 John M.Bredemeyer III,President ���(t*soUPifOl Town Hall Annex Michael J.Domino,Vice-President 54376 Route 25 Glenn GoldsmithP.O.Box 1179 Southold,New York 11971 A.Nicholas Krupski ® ,gyp Telephone(631)765-1892 axles).S Fax(631)765-6641 it DEC 10 2016 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD outhold Town { t BwO,of Trustees APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT DATE i� b OWNER(A Y\S31c\�&k N-\\�,a @AOt(;(,;aPHONE (a1 Ly)po� MAILING ADDRESS �t 0 \ (� AGENT PHONE ADDRESS PROPERTY LOCATION RkQ O1 , Spy. np 11�1 TAX MAP NO. UWeChY �(lt��Q���` request an Amendment to Permit# 25laa to_ Wu� 0�_ ! �2QS On U�tc Si'Ale, 01f Qva,h Am Qlioyl� Kik-Q�qh-bmo each �x�e L. xLv Signed By: i John M. Bredemeyer 111, President O�OSVEfD(,Yco Town Hall, 53095 Main Rd G Michael J DomP.O. Box 1179ino, Vice-President �� �� o _t �.,.r.� *ry James F. King N x SoiitltVld, t 1 1071 y Charles J.Sanders �► �� Telephone(631)765-1892 O - 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, sift fence 1St day of construction constructed Project complete, compliance inspection r --win —z"low M.. BOARD OF SOUTHOLD TOWN TRUSTEES - W, X! SOUTHOLD, NEW YORK QN 44. z PERMIT NO. 8728 DATE: JANUARY 20, 2016 ISSUED TO: CHRISTINE &THILIP MASCIA PROPERTY ADDRESS: 910`OAK AVENUE, SOUTHOLD M ! a SCTM# 1000-77-1-5 PH AUTHORIZATION Town of Southold and in' Pursuant to the provisions of Chapter 275 of the Town Code of the T o g V accordance with the Resolution of the Board ofTrustees adopted at the meeting held on January 20,2016,and in consideration of application fee in the sum of$250.00 Daid by Christine&Philii Maicia afidsubject to the' Terms and Conditions as stated in the uth6rizOsnd permits a 5 I Resolution,the Southold Town Board of Trustees a' the following: Wetlind.Peiinit to constku"c'i-a screened porch-addition onto the eiisting' 1% de,o proposed`A-piorch; sto`r"y­dweiling; install a4'X4?:outdoot ihov�er onto landw','Air'ds,i' f opose W side-ddi�elmg, and' the`for the as-built 61x12' addition the land 'Ard installation of gutters; ojeaders to drywells to,contain roof runoff; and as depicted on the survey prepared by Kenneth M. Woychuk,Land Surveying, PLLC,,revised. December 15, 2015, and stamped approved on January 20,2016. NO IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, 1 and these presents to'-be subscribed by amajority,of the said Board as of This date. .......... ,ez CIO V; TERMS AND CONDITIONS The Permittee Christine&Philip Mascia residing at 910 Oak Avenue, Southold,New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation`as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required,upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. 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. �QF SOUjy John M. Bredemeyer III,President Town Hall Annex 11 � OHO Michael J.Domino,Vice-President 54375 Route 25 1�[ ILL P.O.Box 1179 1 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® COQ Telephone(631) 765-1892 Charles J.Sanders lif'enum Fax(631) 765-6641 I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 20, 2016 Robert E. Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: CHRISTINE & PHILIP MASCIA 910 OAK AVENUE, SOUTHOLD SCTM# 1000-77-1-5 Dear Mr. Hermann: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 20, 2016 regarding the above matter: WHEREAS, En-Consultants on behalf of CHRISTINE & PHILIP MASCIA 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 December 21, 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, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on January 20, 2016, 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 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 approve the application of CHRISTINE & PHILIP MASCIA to construct a 12'x12' screened porch addition onto the existing 1 Y2 story dwelling; install a 4'x4' outdoor shower onto landward side of proposed porch; and for the as-built 6'x12' addition onto the landward side of dwelling, and the installation of gutters to leaders to drywells to contain roof runoff; and as depicted on the survey prepared by Kenneth M. Woychuk, Land Surveying, PLLC, revised December 15, 2015, and stamped approved on January 20, 2016. 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/dd S.C.T.M. NO. DISTRICT: 1000 SECTION: 77 BLOCK: 1 LOT(S):5 �� O >. \N R10-14-0037 OI 2 cQ�` STONE 3 � m I FIRM ZONE `•y FlRM ZONE X ^ Cl� E 11 E RUBBLE � 15.8'U I S40003-920"E AE EL 7 _ PD, I u PROPOSED — ►� 24" FLOWELL f" 47.79 CF 140.00 P/0 LOT 293 JAN 2 0 2016 1 0 w � � EL 5.2 m I d-- �-- ' ►la CONC. .'�.._ ._.._.._.._.P/0 LOT 293 Soutl old Taw it) f POINT"B"WATER SERVICE ; Board of Trustees I - :_-26.4' - :. EL 9_8 ►p w z I STONE DRIVEWAY - COASTAL BARRIER RESOURCE SYSTEM I MAP & DEED LINE R ESTABUSHED 11-16-1990 = I CELLAR --. I; O EL 8.6 EXISTING � WOOD STEPS FLAG j� -- -_. =-::=.-:- :-.' -'- _ I SANITARY U1 207. MAXIMUM LOT COVERAGE 0 1.7 _1 p • POLE I N EL 4.7 _ 1 %=sTr �, Lor 294 SYSTEM 'P O 12,296.04 x 207 = 2,459 SF ALLOWABLE COVERAGE �- FRM DWELLING I- Gl RAMP 4WIDE CATWALK M o p z ' I cO z WOOD #910 45.2 — a o STEPS ' =_ FFL :.7.5 LP 5 iV LU w - = BF ;1.4 _ 1,500 GAL 0 � EXISTING COVERAGE: oOPEN GRATE R OLP DWELLING W/COV ERED PORCH: 1,195 S.F. or 9.79 DECKING N o g PROPOSED U a ---- _ ___ __-_ POINT'A'' S.T. I 5 SCREENED PORCH 12'x12° ____ w V� = __ ® X in OUTDOOR SHOWER 4 x4 - EL 6.3\. Lor 295 � PROPOSED COVERAGE. T z EL 4. ,;;;;,,, :: , LPI 1 LP#2 z SCREENED PORCH & OUTDOOR SHOWER: 160 S.F. V m I v¢i SILT FENCE/HAYBALES iiiiiiii o ........ � 8 DIAx2 DEE 3 TOTAL PROPOSED COVERAGE: 1,355 S.F. or 11.090 TIDAL WETLANDS BOUNDARY EQUAL TO g 84.0' 56.6' THE SEAWARD FACE OF BULKHEAD, AS ^ in?-N LOT 296 Q D� DETERMINED BY EN-C NSULTANTS. N r7 _ Z L M 100' EL 7.2 0 4,0 o ZONED R-40 50.00 d (n 4.6'N i 7' yylp DNC. DRAINAGE GUTTER P/O LOT 297 m NON-CONFORMING LOT MON. FRONT SETBACK - 35'MIN , SIDE SETBACK - 10'MIN (2570TAL) CONC/STONE I N44�35 X20�� 1 4.0.00 144S.F.x.166=23.9 C.F. P/0 LOT 297 a REAR SETBACK - 35' MIN (SUBJECT r0 TIDAL WETLANDS FLOWELL DRYWELL < RUBBLE 0 I No.33-49-23, 24"DIA _ _ DELINEATION & SETBACK) NOTE: NO RECORDED DRAINAGE 47.79 CF. PROVIDED I THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL 50' WIDE UNNAMED STREET Y i I EASEMENT INFORMATION FOUND. LOCATIONS SHOWN ARE FROM FIELD OBSERVAAONS AS SHOWN ON TAX MAP & FILED MAP. m AND OR DATA OBTAINED FROM OTHERS _ SEPTIC LOCATION FIRM PANEL f 166H NAVD 1988 a. 3� POINT "A" POINT "B" AREA: 12,42196.04 SQ.FT. or 0.28 ACRES ELEVATION DATUM. _________________________ S.T 20 41.5 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE £DUCA77ON LAW. COPIES OF THIS SURVEY 34' 57,5' MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN I APPROVED LP 2 4O 61 ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE Tr TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. LP #3 35' 53' THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE BOARD OF TRUSTEES .d LP 4 37' 4s' NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS # AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY OF SOOT LP 15 38' 44.5' `-`� LP #6 43' 49' SURVEY OF: P/0 LOTS 297 & 293, LOTS 294-296 CERTIFIED TO: PHILIP MASCIA; 2-0 MAP OF GOOSE BAY ESTATES CHRIS MASCIA; FILED: NOVEMBER 13, 1934 No.1176 REVISED 12-15-15 aOUTHOLD - - SITUATED AT: r i UPDATED 12-05-15 TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC REVISED 11-10-15 SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design REVISED 08-04-14 y f P.O. Box 153 Aquebogue, New York 11931 ' »> REVISED 06-27-14 t _ PHONE (891)298-1588 FAX (831) 298-1588 REVISED 06-09-14 FILE N 13-205 SCALE: 1"=20' DATE: ,JAN. 8, 2014 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Noychuk 1 I' y John M. Bredemeyer 111, President Ht4- Town Hall Annex Michael J. Domino, Vice-President ,`�� �Gy 54375 Route 25, P.O. Box 1179 o James F. King V2 Southold, NY 11971 Charles J. Sanders w -tilt Telephone(631)765-1892 g Dave Bergen y�o1 ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES Vddl TOWN OF SOUTHOLD J.?'94 L�lfR1S'f'l!1!� pmloP M4--Se4A el® OV— GvWSUVIA-W7J TO: Please be advised that your application dated ' 2 hof t' has been reviewed by this Board at the regular meeting of -TA)VV 20, 20�� and your application has been approved pending the completion of the following 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: (�g3 TOTAL FEES DUE: $ -5d1 OV BY: John M. Bredemeyer III, President Board of Trustees 1 John Bredemeyer, President �oSOFFot,tTown Hall Annex Michael J. Domino, Vice-President 54375 Route 25 Glenn Goldsmith y s P.O. Box 1179 A. Nicholas Krupski �y • �� Southold, NY 11971 Charles J. Sanders �O1 ,� �a° Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: ���, �,J 4� /0./K En-Consultants on behalf of CHRISTINE & PHILIP MASCIA request a Wetland Permit to construct a 12'x12' screened porch addition onto the existing 1'/z story dwelling; install a 4'x4' outdoor shower onto landward side of proposed porch; and for the as-built 6'x12' addition onto the landward side of dwelling. Located: 910 Oak Avenue, Southold. SCTM# 1000-77-1-5 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: Conditions: S ' Present Were: /J. Bre emeyer �M. Domino G. Goldsmith N. Krupski C. Sanders Bay Constable Other Form filled out in the field by r Mailed/Faxed to: Date: S.C.LM. NO. DISTRICT: 1000 SECTION: 77 BLOCK: 1 LOT(S):5 -- R10-14-0037 Y of m 4p co o lipI I 1 STONE 3 m I FIRM ZONERUBBLE0 15.8,c�1 54003'2®"�,, AE EL 7 -t FIRM ZONE X _ _ 140.00 r P/0 LOT 293 It i i l �+ x 1 w DEC 2 1 2015 w o I EL 5.2 `n _ W o CONC. T —.WATER SERVICE _ P/p LOT 293 t` I �Ny z Southold Town 2s;4' POINT B EL 9.8 � g€Tr�s�Qs. STONE DRIVEWAY COASTAL BARRIER RESOURCE SYSTEM I MAP & DEED LINE R ESTABLISHED 11-16-1990 = CELLAR 3 ; R U W STP - _ _ EL 8.6 EXISTING 20% MAXIMUM LOT COVERAGE WOOD STEPS FLAG I ^ -- --=--- -- __ SANITARY U1 0 1.7 -1.0 s POLE 1 tV EL 4.7 '�"" T 1/2 STY. - LOT 294 SYSTEM ►P O 12,296.04 x 207 = 2,459 SF ALLOWABLE COVERAGE FRM DWELLING-. � CJl Z RAMP 4 WIDE CATWALK I z WOOD = /(970 = :`' 45.2' — .,:C o STEPS 17.5 ;�-- =__-_:-_ �j EXISTING COVERAGE: o _-- ,-- - " 1,500 GAL W OPEN GRATE N w z _ ' LP#4 DECKING m R OF• ® DWELLING W/COVERED PORCH: 1,195 S.F. or 9.77 = g v a = ::_- :_ S.T. Q I v► PROPOSED -. : ----- =:_ "': ' 1 g SCREENED PORCH 12 x 12 -== POINT'A. 41 0 Cn OUTDOOR SHOWER 4'x4' = . -"= :: 1 LOT 295 � 3 o U. . Y _ 9 PROPOSED COVERAGE: o EL 4. .... EL 6.3 '. — LP#1 LP#2 Z SCREENED PORCH & OUTDOOR SHOWER: 160 S.F. V to 1 SILT FENCE/HAYBALES ,;;;;;;; 3 TOTAL PROPOSED COVERAGE: 1,355 S.F. or 11.07 Lot o ::::::: - �� 8'DIAx2'DE TIDAL WETLANDS BOUNDARY EQUAL TO 3 84.0' _ 56.6' THE SEAWARD FACE OF BULKHEAD, AS d n i[j t^� LOT 296 ¢ �C DETERMINED BY EN—C NSULTANTS. 1 d °� U_ " 3 :v t;^ ) 100' EL 7.2 o o ZONED R-40 50.00' N 4.6'N i.7' yWID ONC. DRAINAGE'GUTTER P/0 LOT 297 0 NON—CONFORMING LOT o �o� �-' o FRONT SETBACK — 35'MIN o� 140.00, SIDE SETBACK - 10'MIN (25'TOTA►_) CONC/STONE 1 I N44035'20"W 144S.F x.166=23.9 C.F.C.F FLOWELL DRYWELL P/O LOT 297 a REAR SETBACK - 35' MIN (SUBJECT TO TIDAL WETLANDS < RUBBLE o No.33-49-23, 24"DIA DELINEATION & SETBACK) NOTE: NO RECORDED DRAI,VAGE 47.79 CF PROVIDED I z _ EASEMENT INFORMATION FOUND. THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL 50 WIDE UNNAMED STREET Y AS SHOWN ON TAX MAP 1 LOCA77ONS SHOWN ARE FROM RELD OBSERVATIONS & FILED MAP. to I AND OR DATA OBTAINED FROM OTHERS. g I SEPTIC LOCATION FIRM PANEL 166H NAVD 1988 3 POINT "A" POINT "B" AREA: 12,296.04 SQ.FT. or 0.28 ACRES ELEVA77ON DATUM.• ------------------------- S.T. 2041.5 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A V70LA77ON OF SEC71ON 7209 OF THE NEW YORK STATE EDUCATION LAW, COPIES OF THIS SURVEY LP #1 34' 57.5' MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS7777JI70N LP #2 40' 61' LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TUTION, GUARANTEES ARE NOT TRANSFERABLE. LP #3 35' 53' THE OFFSETS]OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, AD0I77ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS LP #4 37 49 AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY LP #5 38' 44.5' LP #6 43' 49' SURVEY OF: p/0 LOTS 297 & 293, LOTS 294-296 CERTIFIED TO: PHILIP MASCIA; MAP OF: GOC SE BAY ESTATES 4 CHRIS MASCIA; FILED: NOVEMBER 13, 1934 No.1176 REVISED 12-15-15 SITUATED AT: SOUTHOLD r L UPDATED 12-05-15 rowri OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLIC REVISED 11-10-15 SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design REVISED 08-04-14 P.O. Box 153 Aquebogue, New York 11931 REVISED 06-27-144_A_y_1S1,1SC. PHONE (831)298-1588 PAX (831) 298-1588 REVISED 06-09-14 FILE N 13-2'05 SCALE: I"=20' DATE: JAN. S, 2014 NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk w ► —se�� Christine&Philip Mascia _ e 910 Oak Ave.,Southold r t _ SCTM#1000-77-1-5 nt .. 1/14/16 r „� Ar it Ise*w fxlM' .� �a a - i • a •Ni ��-\\����♦ as a��4���� • i i ` i P / A A ft�.�,w . i i � '` 1. . � . , '� .�'^ fr _- P• l F , _ �. � ., AA '� i., s� .may-`` '•-P��r T'�` � � /•• �l� ED Im �I jay -r PHILIP AND CI NINE MASCIA,910 OAK AVENUE,. �UTHOLD f -00 t � •� 3 wsa, F �;5� ay, Figure 3. Looking northwest from Oak Avenue at existing dwelling and location of recently constructed addition to southeast roadside corner of dwelling(righthand side of photo). Figure 4. Looking southeast from Goose Creek over recently reconstructed bulkhead and toward existing dwelling. s - N �� `�• X13 r -]---�e if /� .!�`� ;•ii• ``�'.day. .�,`.,`. ------ - 21 14 •�°• ,a_ .w,r O _.__3e" ___-,mo i--___ ------ 1 ., A_ `mac) •°'4• far _______ � _�-- _____ ______ 13.1--- ----- +. fD 12.1 b - r wcxowr ----- -----�- AVE. ° e - scu W SECTION N Nor cE 9 COUNTY OF SUFFOLK © e OWMO` 1NOLD ...rru�u. -----�• or�� b• ..,.. -----' wr."��..ww. ----ar---- "'ted�aW----�" -- rww." ">v• Hnwo.wrt .p.y..*�iaW..rgn.UK'.wenurn,�ow.fsc.."u6.*nrE �, •, � Real Property Tax lwService Agency rY � 77 w OFFICE LOCATION: OF SO(/��®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) cis �c Southold, NY 11971 ® �� Telephone: 631 765-1938 ®�yc®UN�`I,� 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: January 14, 2016 Re: Local Waterfront Coastal Consistency Review CHRISTINE & PHILIP MASCIA SCTM# 1000-77-1-5 En-Consultants on behalf of CHRISTINE & PHILIP MASCIA request a Wetland Permit to construct a 12'x12' screened porch addition onto the existing 1'h story dwelling; install a 4'x4' outdoor shower onto landward side of proposed porch; and for the as-built 6'x12' addition onto the landward side of dwelling. Located: 910 Oak Avenue, Southold. SCTM# 1000-77-1-5 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 action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "BB" which states: BB. Additions to an existing dwelling constituting less than 25% of the existing structure where the addition is greater than 75 feet from a natural protective feature, except where the parcel is located in a coastal erosion hazard area; Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. C FI Peter Young,Chairman H Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 �► ` Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., January 13, 2016 the following recommendation was made: Moved by Doug Hardy, seconded by Keith McCamy, it was RESOLVED to SUPPORT the application of CHRISTINE & PHILIP MASCIA for the construction of a 12'X 12' screened porch addition to existing dwelling; 4'X 4' outdoor shower on landward side of proposed porch; and a 6'X 12' addition located on the roadside of the dwelling. Located: 910 Oak Ave., Southold. SCTM#77-1-5 Inspected by: Doug Hardy, Keith McCamy Vote of Council: Ayes: All Motion Carried _1 John M. Bredemeyer III, President ^ ��®F SO!/Tyo Town Hall Annex Michael J.Domino,Vice-President ,`O l0 54375 Main Road P.O. Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G ® �O Charles J. Sanders,Trustee O! A� Telephone(631)765-1892 - �v yC®UI�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD — --- To: Southold Town Building Department Re: Verification of Building Department Permit Requirements SCTM#: '77-1-AI Property Owner Name: ' A-SE4A- Date Sent to Bldg. Dept.: 12` The Office of the Board of trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO ill the proposed project require a Building Permit? Will the proposed project require a variance determination from e Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: 1 Signature of R iewer Date John M. Bredemeyer III,President �� Town Hall Annex Michael J.Domino,Vice-President54375 Main Road y P.O.Box 1179 James F.King, Trustee d Southold,New York 11971-0959 Dave Bergen,Trustee Telephone Telephone(631)765-1892 Charles J. Sanders, Trustee Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit _Amendment/Transfer/Extension /Received Application: l_Received Fee: ;"� 71 Completed Application 12•ZI�15 Fri; �� i Incomplete 1. _SEQRA Classificat' n: ';s a � TypeI. Type IIDEC 1 2015�Unlisted � { Coordination- (date sent) 6—/"—'LWRP Consistency Assessment Form ----- - 12�23Soutl�cld'fa:an CAC Referral Sent: �s f?oLr�i_f Tr este,s TDate of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Technical Review: 1/ Public Hearing Held: ZDI/(p Resolution: Name of Applicant Christine&Philip Mascia 2 Livery Lane Address North Salem,NY 10560 Phone Number: 914 523-7508 Suffolk County Tax Map Number: 1000 - 77-1-5 Property Location: 910 Oak Avenue,Southold Property is located on north side of Oak Avenue,+/-317'west of Cedar Avenue (provide LILCO Pole #, distance to cross streets, and location) AGENT: En-Consultants (If applicable) Address: 1319 North Sea Road,Southampton,NY 11968 Phone:631-283-6360 ,til 3a-rd of Trustees Applicati4 GENERAL DATA Land Area(in square feet): 12,296 sf Area Zoning: R-40 Previous use of property: Residential,one-famiy dwelling Intended use of property: Same with proposed additions Covenants and Restrictions: Yes X No If"Yes", please provide 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 Yes X No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by Building Dept. Yes X No Does the structure(s)on property have a valid Certificate of Occupancy X Yes No Prior permits/approvals for site improvements: Agency Date Southold Trustees#6065 01/19/05 Southold Trustees#8430 05/21/104 NYSDEC#1-4738-03430/00001 02/18/05 NYSDEC#1-4738-03430/00002 07/02/14, 10/14/14,04/10/15,08/07/15 NYSDEC#1-4738-03430/00003 07/02/14, 10/14/14,04/10/15 NYSDEC#1-4738-03430/00004 05/06/14, 10/14/14 Southold Building Pesnd.t No. 39524 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): Wetlands Permit requested for the construction of a proposed 12'x 12'screened porch addition to a legally existing dwelling (Certificate of Occupancy No.Z7270);a proposed 4'x 4'outdoor shower on landward side of proposed porch;and a recent,legally constructed(Building Permit No.39524)6'x 12'addition located on the roadside of the dwelling at the approximate limit of Chapter 275 jurisdiction,all as depicted on the site plan prepared by Kenneth M.Woychuk Land Surveying,PLLC,last dated December 15, 2015. BC d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Addition of screened porch and outdoor shower to existing dwelling. Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 o% Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 84 feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A 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): The project proposes a 12'x 12'screened porch addition on the south side of the existing dwelling(and a 4'x 4'outdoor shower on the landward side of it),which will be located at least 84 feet from the surface waters of Goose Creek and associated tidal wetlands,which are separated from the property by a bulkhead recently reconstructed pursuant to Town Wetlands Permit No.6065. As a recent,legally constructed addition(Building Permit No.39524)appears to have been located at the approximate limit of Chapter 275 jurisdiction,the application seeks approval for this addition as well. As project mitigation,a drainage system consisting of two drywells is proposed to capture and recharge runoff associated with both additions;and a project limiting fence and staked haybales will be set in place to contain site disturbance during the proposed construction. The minimally scoped project will have no adverse impacts on the adjacent wetlands or tidal waters of the Town. 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 Name of Action or Project: Mascia Additions Project Location(describe,and attach a location map): 910 Oak Avenue,Town of Southold, Suffolk County,SCTM#1000-77-1-5;property is located on north side of Oak Avenue,+/-317'west of Cedar Avenue,refer to provided maps. Brief Description of Proposed Action: Wetlands Permit requested for the construction of a proposed 12'x 12'screened porch addition to a legally existing dwelling (Certificate of Occupancy No.Z7270);a proposed 4'x 4'outdoor shower on landward side of proposed porch;and a recent,legally constructed(Building Permit No.39524)6'x 12'addition located on the roadside of the dwelling at the approximate limit of Chapter 275 jurisdiction,all as depicted on the site plan prepared by Kenneth M.Woychuk Land Surveying,PLLC,last dated December 15, 2015. Name of Applicant or Sponsor: Telephone: 914-523-7508 Christine&Philip Mascia E-Mail: mascial73@aol.com Address: 2 Livery Lane City/PO: State: Zip Code: North Salem NY 0560 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 X 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: X 3.a.Total acreage of the site of the proposed action? 12,296 sf -- - b.Total acreage to be physically disturbed? <1,000 sf - c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 12,296 sf 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ®Residential(suburban) ❑Forest ❑Agriculture ®Aquatic ❑ Other(specify): ❑Parkland Page 1 of 4 5.Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? X b.Consistent with the adopted comprehensive plan? X 6.Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? X 7.Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes, identify: Goose Creek,Peconc Bay&Environs;Significant coastal fish&wildlife habitat,protect public health,water,vegetation&scenic beauty;Town of Southold,Suffolk County;3-9-90,7-12-88 X 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES X b.Are public transportation service(s)available at or near the site of the proposed action? X c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: N/A 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: N/A 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: N/A 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? X X 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? X b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? X If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply. ❑ Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑ Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? X 16.Is the protect site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will storm water discharges flow to adjacent properties? ❑NO❑YES X b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO❑YES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: X 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: X 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: X I AFFIRM THATtTHE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor e: Robert E.Herrmann,Coastal Mgmt. Specialist Date: December 15,2015 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?" 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 regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a. public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic, archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? 11.Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance.The Lead Agency is responsible for the completion of Part 3.For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part I 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 the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed actio will not result in any significant adverse environmental impacts. VW' /—/'--,4 Name of Lead Agency Date Print or Type e of Resp o ible Officer in Lead Agency Title of Responsible Officer Sig ure of RespdA<Ie Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) Page 4 of 4 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM l PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Q� 1000 77 1 5 STORM-WATER,GRADING,DRAINAGE AMP EROSION CONTROL PLAN iI3-s ict Section Block Lot 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? 1 Will this Project Retain All Storm-Water Run-Off (include Total Area of all Parcels located within 12,296 SF Generated by a Two(2")Inch Rainfall on Site?( . ./Acres)) X ❑ the Scope of work for Proposed Construction) (S.F./ (This item will include all run-off created by site b,What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site improvements and the permanent creation of construction activity? (S F/Acres) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed ❑ PROVIDE BRIEF PROJECT DESCRIPTION(Provide Additional Pages as Needed)) Drainage structures Indicating Size&Location This item shall include all proposed Grade Changes and Wetlands Permit requested for the construction of a proposed 12' Slopes Controlling Surface Water Flow, x 12'screened porch addition to a legally existing dwelling 3 Does the Site Plan and/or Survey describe the erosionXF (Certificate of Occupancy No.Z7270);a proposed 4'x 4' and sediment control practices that will be used to outdoor shower on landward side of proposed porch;and a control site erosion and storm water discharger.This recent, legally constructed(Building Permit No.39524)6'x 12' Item must be maintained throughout the Entire addition located on the roadside of the dwelling at the Construction Period. approximate limit of Chapter 275 jurisdiction,all as depicted on 4 Will this Project Require any Land Filling,Gradin or F X the site plan prepared by Kenneth M. Woychuk Land Surveying, Excavation where ere is a change 2 the bic Ya Existing Grade involving more than 200 Cubic Yards PLLC,last dated December 15,2015. of Material within any Parcel? 5 Will this Application Require Land DisturbingActivities ❑ Encompassing an Area in Excess of Five Tousand (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 General DEC SWPPP Requirements or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes Elare part of a larger cvnmionplan that will ultimately disturb one or more acres of lands; which Exceed Fifteen(15)feet of Vertical Rise to IncludmgConstruchonactivities involving soil disturbances ofless than one(1)amewhere One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges, p (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit O Will Driveways,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 ❑ X 1.The SWPPP shall be prepared prior to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-way? 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, 1:1required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the Area?(This item will NOT include the installation of Dnveway Aprons.) quality of storm water discharges. NOTE If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S F &1 Acre in area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable m theprinciples and rachces of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit g P g NOTE AQteck Mark and/or Answer for each Question is for a ClinililetedApplication) STATE OF NEW YORK, COUN'T'Y OF -SUFFOLK ----FF K------------------ SS That I, Robert E.Herrmann ----being duty sworn,deposes and says that he/she is the applicant for Perrrut, (LinzEcfird%i asaW1gDMn'rt) And that he/she is the Agent - ----------------------------- - - -- -- ------------------------------- -------------------------------------------- (Onrs;Ca9iact A02M Ccapi ateCffio3 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 thejbestfs knowledge and belief;and that the work will be performed.in the manners set forth in the application filed herewith. Sworn to before me this; --------------15th December ,2015 - -- - - da ' Notary Pu f --_ *4:---�-�-RHHI-- -------------------- -------- -------------- Apphcant) FORM - 06/10 STATE OF NEW YORK COMMISSION NO . 5015931 QUALIFIED IN SUFFOLK COUNTY EXPIRES AUGUST 2 . 20. 1 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD r' In the matter of applicant: Christine&Philip Mascia SCTM#1000-77-1-5 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Wetlands Permit requested for the construction of a proposed 12'x 12'screened porch addition to a legally existing dwelling(Certificate of Occupancy No.Z7270);a proposed 4'x 4'outdoor shower on landward side of proposed porch;and a recent,legally constructed(Building Permit No.39524)6'x 12'addition located on the roadside of the dwelling at the approximate limit of Chapter 275 jurisdiction,all as depicted on the site plan prepared by Kenneth M.Woychuk Land Surveying,PLLC,last dated December 15,2015. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 910 Oak Avenue, Southold 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: DATE: January 20,2016 @ 5:30 p.m. You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. Christine&Philip Mascia PROPERTY OWNERS NAME: 2 Livery Lane MAILING ADDRESS: North Salem,NY 10560 PHONE #: 914-523-7508 AGENT: En-Consultants MAILING ADDRESS: 1319 North Sea Road, Southampton,NY 11968 PHONE #: 631-283-6360 Enc: Copy of sketch or plan showing proposal for your convenience. PI. -IF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Daniel McGovern&Catherine Lucarelli 138 5th Avenue Kings Park,NY 11754 Richard Trownsell&Karen Ellis 28 Creekview Drive Irvington,VA 22480 Troy Baydala 1600 Parkway Southold,NY 11971 Robert Grattan 875 Oak Avenue P.O.Box 1710 Southold,NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK Robert E.Herrmann doing business at En-Consultants 1319 North Sea Road Southampton , being duly sworn, deposes and says that on the 29th day of T)prPmlxpr ,201_, deponerk xrailed a tme 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 their 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 Southampton , that said Notices were iled to each of said persons by (certified) ateved) mail. Sworn to before me this 29th day oliecenber ,20 15 KIM N . fi€€ NOTARY PUBLIC€N IC STATE OF NEW YORK COMMISSION N0 . 5015931 Nota blic QUALIFIED IN SUFFOLK COINTY EXPIRES AUGUST 2 , 20 v, John M. Bredemeyer III, Presidj4� ent 0 �FFot cow a, Mown Hall Annex Michael J. Domino, Vice-President ��4 54375 Route 25 Glenn Goldsmith N y P O. Box 1179 A. Nicholas Krupskiy� �o Southold, NY 11971 Charles J. Sanders 01 �� 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 CHRISTINE & PHILIP MASCIA COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR NOT LESS THAN SEVEN DAYS I, Robert E. Herrmann /dba En-Consultnats 1319 North Sea Road, Southampton, NY 11968 being duly sworn, depose and say: That on the 12thday of January , 2016, I personally posted the property known as 910 Oak. Avenue, Southold: SCIM #1000-77-1 5 by placing the Board of Trustees official posterwhere it easily be seen, and that I have checked to be sure the poster has remained in place for e g days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednksdav, January 20 2016. Dated: (signatNj Sworn to before me this 20th day of Jan 20 16 No -y Pu c 01 KIM H. HT€PH€NS NOTARY PUBLIC STATE OF NEW YORK COMMISSION NO ,-5015931 QUALIFIED IN SUFFOLK COUNTY EXPIRES AUGUST 2 , 20±7 v , ■ ® 1 Q ■ ■ ■ ® © m ■ ru ®. . m c. a N -r Certified Mall Fee = Certified Mall Fee ° t Extra Services&Fees(check box,add fee as app ropnatc�4 �/ 1:0Extra Services&Fees(checkbox,add fee as Opp ro date) 1 ❑Return Receipt(hardcopy) $ s `t T ❑Retum Receipt(hardcopy) $ t' _ 4R9 f7l ❑Retum Receipt(electronic) $ r��S ttatk 0 ❑Return Receipt(electronic) $�='t �y POStma G C3 ❑Certified Mail Restricted Delivery $ � �re r3 ❑Certified Mall Restricted Delivery $ t7 Js HOt�S, ❑Adult Signature Required $ 0 0 E]Adult Signature Required $ ❑Adult Signature Restricted Delivery$ t%A 1-1 I []Adult Signature Restricted Delivery$ O Postage /tG O Postage 'S• C1 Total Postag �� -��� I Total Poe $ Daniel Me v rtis f $ Richard Trownsell Ln Sent To Ln Catherine Lucarelli Sent To Karen Ellis StreefandAj th Stieeiani 28 Creekview Drive 13 8 5 Avenue r cry srate;z Kings Park,NY 11754 cry srarr Irvington,VA 22480 Da 0 C3 ®o • 7traF � C3 tm Mad Fee Certified Mad Fee cc ices&Fees(check box,add fee as appropriate) f � Extra Services&Fees(check box,add fee as ap neffi) []Return Receipt(hardcopy) $ [I Return Receipt(hardcopy) $ 0 Receipt(electronic) $ POStmark ❑Return Receipt(electronic) �y�tmark Ced Mail Restricted Delivery $ Here ❑Certified Mali Restricted Delivery $ 'a ere � Signature Required $ � ❑Adult Signature Required $Signature ResMcted Delivery$ ❑Adult Signature Restricted Delivery$ -ZO O Postage U C3Total Poe 0 Total Posta ---� r� Robert Grattan.._ Ln Sent To Troy Bay a� In IS To 875 Oak Avenue - C3 S7eetan 1600 Park /�`` o Si>ee[anrlA P.O. BOX 1710 Southold,NY h'19I' --------- ----- - Southold,NY 11971 '---- '� r a o ora•r NUTILt: Ulm HtAiiING 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: CHRISTINE & PHILIP MASCIA SUBJECT OF PUBLIC HEARING : For a Wetland Permit to construct a 12'x12' screened porch addition onto the existing 1 % story dwelling; install a 4'x4' outdoor shower onto landward side of proposed porch; and for the as-built 6'x12' addition onto the landward side of dwelling. Located: 910 Oak Avenue, Southold. SCTM## 1000-77-1 -5 TIME & DATE OF PUBLIC HEARING : Wednesday, January 20, 2016 — 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 B a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Christina M. Hill-Mascia residing at 2 Livery Lane (print owner of property) (mailing address) North Salem,NY 10560 do hereby authorize (Agent) En-Consultants to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's lgnature),Christina M.Hill-Mascia f Board of Trustees Application County of Suffolk State of New York Christina M Hill-Mascia BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ignature,Chris a M. Hill-Mascia SWORN TO BEFORE ME THIS_ DAY OF O A1)2g, ,20 1 j SHAUNI YASSIN NOTARY PUBLIC STATE OF NEW YORK WESTCHESTER COUNTY Notary Pub LIC.#01YA6209407 COMM.EXP 2 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 puWse 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 necessary to avoid same. YOURNAME: Hill-Mascia,Christina M. (Last name,first name,middle 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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent/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 noncorporate 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�d t,of {�c� 2001, Signature Print Name Chris i M.Hi I- fascia Form TS 1 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Philip R. Mascia residing at 2 Livery Lane (print owner of property) (mailing address) North Salem,NY 10560 do hereby authorize (Agent) En-Consultants to apply for permit(s)from the Southold Board Qf Town Trustees on my behalf. (Ow s signature), Philip R.Mascia Board of Trustees Application County of Suffolk State of New York Philip R. Mascia BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. l Signature, Philip R Mascia r SWORN TO BEFORE ME THIS DAY OF ,20L� Notary Public MARIA C. BAHIA NOTARY PUBLIC My Commission Expires 08/31/2016 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees The puWse 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 necessary to avoid same. YOURNAiv1E: Mascia, Philip R. (bast name,first name,middle 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 X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi day of c 206/5— Signature iv — Print Name ill R. Mascia Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1, All applicants for perm its' including Town of Southold agencies, shall com plete this CCAF for proposed actions that are subject to the Town of Southold W aterfront Consistency Review Law . This assessm ent is intended to supplem ent other inform ation used by a Town of Southold agency in m a k in g a d e to r m in a t i o n o f c o n s is to n c y. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 77 - 1 5 PROJECT NAME Christine&Philip Mascia The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 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: ❑ Nature and extent of action: Pursuant to Southold Town Code §268-5("Review of Actions")and the corresponding definitions of"action"and"minor action"by §286-3 ("Definitions"),the proposed 12'x 12'screened porch addition(144 sf);4'x 4'outdoor shower(16 sf);and recently constructed (Building Permit No.39524)6'x 12'addition(72 sf)to the roadside of the dwelling,which together constitute a 232 expansion of the legally existing dwelling(Certificate of Occupancy No.Z7270)located more than 75 feet from wetlands,meets the following definition of a minor action and should thus be determined to be exempt from waterfront consistency review pursuant to Chapter 268: "BB. Additions to an existing dwelling constituting less than 25%of the existing structure where the addition is greater than 75 feet from a natural protective feature,except where the parcel is located in a coastal erosion hazard area." Location of action: 910 Oak Avenue,Southold Site acreage: 12,296 sf Present land use: Residential,single family dwelling Present zoning classification: R-40 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: Christine&Philip Mascia (b)Mailing address: 2 Livery Lane North Salem,NY 10560 (c) Telephone number: Area Code 914-523-7508 (d) Application number, if any: Will the action be directly undertaken, require funding, 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 ® 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 ❑ 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 0 No ® Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III- Policies Pages 8 through 16 for evaluation criteria ❑Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ❑Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. ❑Yes ❑ No ® Not 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 ❑ 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. ❑Yes ❑ No ® 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. ❑ Yes ❑ No® Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ElYes ElNo ® 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 PREPARED BY TITLE coastal Mgmt. specialist DATE 12/15/2015 Robert E.T lerjohnn Amended on 811105 C- EN-CONSULTANTS December 15,2015 Town of Southold Board of Trustees 54375 Main Road Post Office Box 1179 Southold,New York 11971 Re: Christine&Philip Mascia 910 Oak Avenue, Southold SCTM#1000-77-1-5 Dear Board of Trustees: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: I. Three(3)Wetland Permit Applications including: a) Short Environmental Assessment Form; b) Authorization&Disclosure Forms; c) Survey prepared by Kenneth M. Woychuk Land Surveying,PLLC, last dated December 15, 2015,2015. 2. One(1)set of site photographs. 3• Application fee of$250.00. 4. Three(3)LWRP Consistency Assessment Forms including: a) Survey(as referenced above). I trust this information shall allow you to process our permit request. Should any additional information be required,please do not hesitate to contact our office. Sinc rely, Robe*- obe .Herrmann Coastal Management Specialist /khs Enc. 1319 North Sea Road I Southampton,New York 11968 1 p 631.283.6360 f 631.283.6136 www.enconsultants com environmental consulting 1