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TR-8788A
Glenn Goldsmith, President \31 so Town Hall Annex �® A. Nicholas Krupski,Vice President �® �® 54375 Route 25 P.O. Box 1179 Eric Sepenoski qr Southold,New York 11971 Liz Gilloolillooly Elizabeth Peeples ® Telephone(631) 765-1892 Fax(631) 765-6641 C®UNTV,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1924 C Date: June 22, 2022 THIS CERTIFIES that the conduct of construction activity within 100' from the landward edge of wetlands for the construction of a+/-41 3'x50' two-story, single family dwelling with attached 15'x50' seaward deck; install a sanitary system landward of dwelling; install a driveway; install a system of gutters leaders and drywells to dwelling to contain storm-water runoff in accordance with Chapter 236 of the Town Code; and install silt fencing prior to and during construction; At _150 Budds Pond Road, Southold Suffolk County Tax Map #56-5-20 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 27, 2016 pursuant to which Trustees Administrative Permit #8788A Dated May 18, 2016, was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the conduct of construction activity.within 100' from the landward edge of wetlands for the construction of a+/-41 3'x50' two-story single family dwelling with attached 15'x50' seaward deck; install a sanitarysystem landward of dwelling; install a driveway; install a system of gutters leaders and drywells to dwelling to contain storm-water runoff in accordance with Chapter 236 of the Town Code; and install silt fencing prior to and during construction The certificate is issued to John Weber owner of the aforesaid property. 1 Q Authorized Signature Glenn Goldsmith, President a� t°# so& Town Hall Annex A. Nicholas Krupski,Vice President �� �' 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Telephone (631) 765-1892 Elizabeth Peeples ,� ® � Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: �0 22 22 INSPECTED BY: L l 00� X Ch. 275 Ch. 111' INSPECTION SCHEDULE Pre-construction, haybale line/silt boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection COMMENTS: Oe- �eTA ck-cf(0� 1V? 11,1 cl'ic� OsSo (cia)c:io . CERTIFICATE OF COMPLIANCE: 5 +D �S�- rrrr - i suFFocx John M. Bredemeyer Ill, President ro�� oo Town Hall Annex ti4�� `ids• ' Gym, ,: Michael J. Domino, Vice-President �•_ , s : ; � 54375 Route 25 Glenn Goldsmith , ` P.O. Box 1179 A. Nicholas Krupski }''' Southold, NY 11971 Charles J. Sanders Telephone (631) 765-1892 Y1 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 / SiL.-r /cEb46— V Pre-construction, herltrale-liie— 1 St day of construction - '/2 constructed / V Project complete, compliance inspection John M.Bredemeyer III,President f'� ��® ���4,q,#; Town Hall Annex �� '� : 54375 Route 25 Michael J.Domino,Vice-President � � � �. � % E ., F°, , P.O.Box 1179 Glenn Goldsmith ,y Southold,New York 11971 co A. Nicholas Krupski L G � ` �z it 1 �® �-�4� y®��� Telephone(631) 765-1892 Charles J. Sanders : ��/IMP(% �� Fax(631) 765 6641 + ,D BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8788A Date of Receipt of Application: April 27, 2016 Applicant: John Weber SCTM#: 1000-56-5-20 Project Location: 150 Budds Pond Road, Southold Date of Resolution/Issuance: May 18, 20'96 Date of Expiration: May 18, 2018 Reviewed by: Board of Trustees Project Description: Conduct construction activity within 100' from the landward edge of wetlands for the construction of a +/-41.3'x50' two-story, single family dwelling with attached 15'x50' seaward deck; install a sanitary system landward of dwelling; install a driveway; install a system of gutters, leaders and drywells to dwelling to contain storm-water runoff in accordance with Chapter 236 of the Town Code; and install silt fencing prior to and during construction. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allowslfor the operations as indicated on the survey prepared by Nathan Taft Corwin, Ill,'Land Surveyor, last dated April 26, 2016, and stamped approved on May 18, 2016. Special Conditions: None. Inspections: Pre-Construction, Silt Fencing and Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. 6984.- , . John M. Bredemeyer III, President Board of Trustees RECEIVE 111 " "I , L ' x tPAGE 1 O ,, 7 F 2 . . `' o �� � eAvA iON INS ECTIOi`I i+<r'JIRED TEST HOLE DATA- HEALTHVICES `,URVEY OF G`' P�� a QOJ?C' O•�R�,�Al�ll Aa�R`_SYST TEST HO; DUG BY McDONALD GEOSCIENCE ON MAY 76, 2014 12 70PM Or OF WASTEWATER 31 D fl��.1l��+ Q. Oy� 'J\•C'� /� °D °Qp.0. 'f OO° \0 5 7 v EM Y F1GA�LlEPAR�I•�Vl,t�l�T ( EL 5 5' 0. ) 11' "FICE Nyfi3 d la1fi Y`1 13 6@8'1�i. LOT 18 Q ,� L O - //// DARK BROWN LOAM OL MAP A n OF 5 �tl - ' �O lir °� 1 `�° °� WILLOW POINT x ° �� / A, °��+�. ,,'s„ ��O^h EL 2 2' BROWN CLAYEY SAND SC ♦• / II s' Q•`p\i FILE No. 4652 FILED JULY 16, 1966 9S�a P Q d' A,P�� \ O.y Q�OQ WATER IN BROWN CLAYEY SAND Sc SITUATE , a 4C:ok.4,`�� r ��� o • d< F. � ��4 �o� I 5' ARSHAMOMAQUE 0\`°a O� �� �`,, �'���� s`"s°�F TOWN OF SOUTHOLD .Q / v ,Q'1', 1), 0SUFFOLK COUNTY, NEW YORK q0�4 � \ pTOWATERIRBROWNFlNE- 5' a 4.°c ' po.�.ONE AE (E� yp�.p, _ TO COURSE SAND SW S.C. TAX No. 1000-56-05-20 fi• 4 Z �� _ $� �� 62;441.141 ��II ' �► s X •," • • �0, p'�.5`% — — SCALE 1"=30' ° o� •■ ► ".Mi ; —\' F of — — MAY 20, 2014 ,<IS o �' ..::• �• ° a i❖i' xx, OA; JULY 1, 2015 REVISE PER S.C.D H.S. NOTICE 06 25 2015 pJ�fi• ■., `V HOLE G ./ Zith ,• F •' .i► u► 53� a d/ �i.���,4 O 1 c,' 7 0 ::::'� .:"' ;.;:,,�\'', c� 12' AREA = 18,936 sq. ft. s �� •� ` i ` °0 j NC)• < ��:��'�� o (TO BULKHEAD) 0.435 ac. • ti:�`� • Ri '�'�'�' ' CERTIFIED TO: 5��y \ �Q �� _ e; e JOHN WEBER e• /1i 0o OJ - p JEAN WEBER of Q - - I / FIRST AMERICAN TITLE INSURANCE COMPANY o� �c, �' qt,�` 0� �► �, \ O SPANO ABSTRACT SERVICES Corp. p `9 j dp - 6) V' - -- � ` '00� D • <•;C O S.�o ,sr 1°170 �+. c �o boa op 4\43. 00'�yY u yO'' Di cd0 ' \• oo 4, NOTES. . - •°� •\ \ NZ' S �� 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM 4111101P- - <i� t ��6.9, 4 j 64°Q Sa EXISTING ELEVATIONS ARE SHOWN THUS: a ��) Inspected S}The ��J I 43 40'-' PROPOSED CONTOUR LINES ARE SHOWN THUS: Q ^, k County Dept. Of Health Services. y�\, ,s ,''\- 4.6/ • ' F 2. FLOOD ZONE INFORMATION TAKEN FROM: 852-5700, /�� ^lx— e�y M FLOOD INSURANCE RATE MAP No. 36103C0158H 48 Hours IP!Advance °�� \1 �7 1 X25• ZONE AE: BASE FLOOD ELEVATIONS DETERMINED "'OT To ed�>�i ). � I /� `� m ZONE X: AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN c\�'i sFs o�� `X4 I �Q� e �0 4 1 5 3. MINIMUM SEPTIC TANK CAPACITIES FOR 5-6 BEDROOM HOUSE IS 1,500 GALLONS. s__; <<, r 1 �� P M• p w00D 1 TANK; 8' DIA. 5' LIQUID DEPTH ' DOCK 4. MINIMUM LEACHING SYSTEM FOR 5-6 BEDROOM HOUSE IS 400 sq ft SIDEWALL AREA. o a 8 GALLEYS 2' DEEP ' 0 , '<2-Os U CD of 3 u 3�o j/� PROPOSED 4.75' WIDE X 8.5' LONG LEACHING GALLEY SUFFOLK COUNTY DEPARTMENTOF HEALTH SERVICE' Q 4.2 .,$. •a- i i \ a,. p j O J PERMIT FOR APPROVAL OF CO�t 'z : L'TI°`� '�° / ; 24" HARDWOOD 3 m 4.4, PROPOSED FUTURE EXPANSION GALLEY �� FAMILY . ,�o SINGLE FAMILY RESIDENCE,ONLY �� ,o Q3 C3 PROPOSED 1,500 GALLON SEPTIC TANK �� 0, 56 \ 24" HARDWOOD a 5'2 A c�.z �, FOUND zQ 5. THE LOCATION OF WELLS 'AND CESSPOOLS SHOWN HEREON ARE FROM FIELD Y, n '�� CONC MON , ^ �� DATES .i } ' EF' NO. �.lU,-/S�C��® N 82°5� ,� ; x5 35 m OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. r `, e gy''qq��q,g,�� t�Zf Ta y.,,,,i4A,, 20 ` I WOOD TIES 15 ^N Lb R ti�-i.'AEEOF - TH MINIMUM APPROVE -- FOUND • 9 GRAVEL ^ ST94tD lAb ,f ABDSHEDr��jr �wqaan�c PTED CONC. MON ` i 1 O 3 7' mu FLOATING DOCK0 .c'\�Y) .A,L5 FOR MAXIMUM® (�, L7Ev MS ♦O L vsJ✓�/\\ " G (7 . C US1w. ' 4y TA O LAND s+ 1 2 iiui4tt�+► yy n nlAno, - i" O% Tn ..gel t�PLREs THREE YEARS rR03+h HATE®F Ali . t^�.:�, �� = �` '`1'� -11 DWELLING • — �` aUSESPUBLfc ✓ 'r ..WATER J � _ .(rLOT ` )DRAINAGE SYSTEM CALCULATIONS: 2OOpt1oN `y��Nos av I<ZPI ^ j ct" LOGE 3 ROOF AREA: 2,090 sq. ft. � j `"V1T7 1 JO N Y.S. Lic No. 50467 2,090 sq. ft. X 0.17 = 355 Cu. ft. _ UNAUTHORIZED ALTERATION OR ADDITION 355 cu. ft. / 42.2 = 8.4 vertical ft. of 8' dia. leaching pool required TO THIS SURVEY IS A VIOLATION OF O SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. Nathan Taft Corwin HI PROVIDE (3) 8' dia. X 3' high STORM DRAIN POOLS COPIES OF THIS SURVEY MAP NOT BEARING DRIVEWAY AREA: 1,890 sq. ft. THE LAND SURVEYOR'SEALSHALL INKED SEALO OR SI Land Surveyor 1,890 sq. ft. X 0.17 = 321 Cu. ft. EMBOSSED SEAL SHALL NOT BE CONSIDERED ( TO BE A VALID TRUE COPY 321 Cu. ft. / 42.2 = 7.6 vertical ft. of 8' dia. leaching pool required CERTIFICATIONS INDICATED HEREON SHALL RUN PROVIDE (4) 8' dia. X 2' high STORM DRAIN POOLS ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED.AND ON HIS BEHALF TO THE \ TITLE COMPANY. GOVERNMENTAL AGENCY AND Title y —SurveysSubdivisions — Site Plans — Construction Layout PROPOSED 8' DIA. X 3' DEEP DRYWELLS FOR ROOF RUN-OFF ARE SHOWN THUS: �1–„ LENDING INS11TUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727 PROPOSED 8' DIA. X 2' DEEP DRYWELLS FOR DRIVEWAY RUN–OFF ARE SHOWN THUS: i��:..., THE EOF RIGHT C WAYS OFFICES LOCATED AT MAILING ADDRESS AND/OREXI EASEMENTS OF RECORD, IF" ANY, NOT SHOWN ARE NOT GUARANTEED. 1586 Main Road P 0 Box 16 I Jamesport, New York 11947 Jamesport, New York 11947 34–BA£1A yx °• PAGE 1 OF 2 TEST y�°G�p'F`� -� o e ����'� Q`n O ���° °� \, (TEST HOLE DUG BY_McDONALD IGEOS I NCEEAONAMAY 16, 2014 12 10PM) S L 0 T 1 8 F 4" of p1 5 7 S \11'". EL 5 5' 0 Oy QJ of Q 0, a \ /// :N:::N: C ++.+ .� ej/° ���� ,<, *.t.. G s� Q V��\ 33' FILE No. 4652 FILED JULY 16, 1966 ySEy4, Dp �` j0\,POS '\\, O Q�OQ WATER IN BROWN CLAYEY SAND SC SITUATE .� : 'c /' `��`�� °< F °�� �0 = 5' ARSHAMOMAQUE �O \ r 0,,°op�� D ��� �1\ 43— GSFSA4� a TOWN OF SOUTHOLD i� e° ° c�° p 4�IID► ��1Q1 ��,•, � °��;��� O SUFFOLK COUNTY, NEW YORK 9 `� J xi ' <06 Dc� ' 4 O a ° ° ° i �( C' WATER IN BROWN FINE _ / D O ► �' ► - �..� 5• FQ ,:°° ONE AE ( . 6) �iyT� TO COURSE SAND SW S.C. TAX No. 1000-56-05-20 I ..-1-'4:7,r/ � °< �� ° , ZON SCALE 1"=30' ° $N �j ..�I��,n,'�I ► x , 2O' °•i''s' 2°F E — — MAY 20, 201 4 � a ° °� '���� ,rl ►HOLE ^ °d e°M/�/ +i����� �:_• EF''SF' — – JULY 1, 2015 REVISE PER S C D H S NOTICE O6\25\2015 Vi APRIL 26, 2016 ADD PROPOSED DECK o a °, ••w AREA = 18,936 sq. ft. ° ;' '���� < •• c 12' (TO BULKHEAD) 0.435 ac. 7 0 Sna vu• O •+•••..o c<` ■.. ' ° I N0 , �•.�.j: \ °,� ��,�5 \ 3 \\ s■G:■� O. ••• ,. `q4. \ ..5 %, o 1 4' .+,�,' ti CERTIFIED TO 0�5t�y JOHN WEBER - ���J� ° p ° \ JEAN WEBER of O%02 O `. FIRST AMERICAN TITLE INSURANCE COMPANY X04 L3 ?, QQ 00r Q SPANO ABSTRACT SERVICES Corp. ,aiw �pO �s poA A 'L � �� c-0� O� ° °� <0 l<D* OO-e,i Ay 'O �, ' �O 0 �0� •O\� \\ o�o °� a NOTES c'',3\-\c' �� Q Q Foo`' S fr) 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM G ` <i�\ 20(9 Ti \--'(1 9'//64' 64._ 5E 3a EXISTING ELEVATIONS ARE SHOWN THUS 5D 0 `: .40''' o> PROPOSED CONTOUR LINES ARE SHOWN THUS: Q �i QAt Q \." 1 43 6), F 2. FLOOD ZONE INFORMATION TAKEN FROM. O 1 i x48/ I eLyD FLOOD INSURANCE RATE MAP No. 36103C0158H 01 -5,0l\-1, ' V. I Al OZS in ZONE AE BASE FLOOD ELEVATIONS DETERMINED G j 3 7 ` m ZONE X AREAS DETERMINED TO BE OUTSIDE THE 0 2% ANNUAL CHANCE FLOODPLAIN N M sFs O ' ' I '�<i� I ° �m��"� j5 3. MINIMUM SEPTIC TANK CAPACITIES FOR 5-6 BEDROOM HOUSE IS 1,500 GALLONS. II II e0 A��� \ 1 �� �M• �,• WOOp 1 TANK; 8' DIA. 5' LIQUID DEPTH °°2� ,-; (,°y° \ 1 ,Q� <,, ?osr ° ��y Dock• 4. MINIMUM LEACHING SYSTEM FOR 5-6 BEDROOM HOUSE IS 400 sq ft SIDEWALL AREA. o�) \ ; 5 5 'i 0 x 5 D ' F'0 8 GALLEYS 2' DEEP oq °� cy,,, •1 /,ii ,q- O ; W Y'3� //� PROPOSED 4.75' WIDE X 8.5' LONG LEACHING GALLEY / Q 42 °�0-: o \ ' o .j ....4:4 PROPOSED FUTURE EXPANSION GALLEY � 24' ,� m r J ` HARDWOOD e� o //� .} �� \��' % !:4) , ,C 3e3 PROPOSED 1,500 GALLON SEPTIC TANK "�� 4rn i,,l. V .,;r' 16-. �\ •Q - 5 6 24" HARDWOOD ••4, Y2 ___`_ ' `! 0, FOUND CO i 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD - 1� CONC MON - ° „� ` OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. I� (1' I N c ; x5 3 5 m \` Q7 s. 0 2 7 2016 VV 1 5 PREPARED IN FYs ;s .- I_ 20 WOOD TIES N a gpi¢I �I s f„ APR R O O STANDARDS F! Tl R 5 AS" °�.Li�' `� FOUND GRAVEL BY THE L S AN PIZL VLZ3- ID:ADO • Y1 . FLOATING DOCK 0 ���JJI FOR SUCH SE BY ea O 1 Cp �'� Y6RK fSTAYEiEAl3 CONC MON (.- \ �`� N" oy //,.-Y,�yry��j�\ \\ cO TITLE Ass�clAno Y) SOtlihvlU Town , o%IA r:„..n_�� .� 0 ,,g,1, ',� y' USES4'' ' L....... _..'2','iltico:.s.to,P..........__ ....i DWELLING )� v*–J r - r ws PUBLIC WATER J `� � `/IPPR® ! BY LOT �' '<-'` 217 5 re_# ,'' IB.' INACE SYSTEM CALCULATIONS zron�w�1pND41( a �� °° ':iiD OF T w EDGE°F / 44V�SIJ N Y Llc No 50467 f ,,- ::•OOF AREA: 2,090 sq. ft. _ �r1(7' . 'cf�y4#14 n 2,090 sq. ft. X 0.17 = 355 cu. ft. ,Y TOUNATHIS SURVEY IS A VOLATION OF {.� —� `w, 355 cu. ft. 42.2 = 8.4 vertical ft. of 8' dia. leaching pool required �l O SECTION 7209 OF THE NEW YORK STATE Nathan Taft Corwin in III EDUCATION LAW A t. „,L{ st -, - „ ,,-;,:,,,:c.-.--,,,;-' , PROVIDE (3) 8' dia. X 3' high STORM DRAIN POOLS 7 r t Hk' ►$ -20( THE COPILAND ES FSURIVEYORSS �INKED SEAL NOT BEARING Land Surveyor i. ,y �r.. , .�R ` 1RIVEWAY AREA: 1,890 Sq. ft. EMBOSSED SEAL SHALL NOT BE CONSIDERED 1,890 sq. ft. X 0.17 = 321 Cu. ft. TO BE A VALID TRUE COPY y 3 :,`. 321 Cu. ft. / 42.2 = 7.6 vertical ft. of 8' dia. leaching pool required CERTIFICATIONS INDICATED HEREON SHALL RUN I / X.-"'' PROVIDE (4) 8 dia. X 2 high STORM DRAIN POOLS ONLY TO THE PERSON FOR WHOM THE SURVEY ,- l "-"` ���/�""" _ ”',�>L'��°; IS PREPARED,AND ON HIS BEHALF TO THE r r _ \ TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys – Subdivisions – Site Plans – Construction Layout -� `` PROPOSED 8' DIA. X 3' DEEP DRYWELLS FOR ROOF RUN—OFF ARE SHOWN THUS: \�\1j_'- LENDING INSTITUTION LISTED HEREON, AND y Y "a:Y j„a',;�, TO THE ASSIGNEES OF THE LENDING INSTI– TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727 - ,' PROPOSED 8' DIA. X 2' DEEP DRYWELLS FOR DRIVEWAY RUN–OFF ARE SHOWN THUS: ••••••••• THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS a•. AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. 1586 Main Road P 0 Box 16 Jamesport, New York 11947 Jamesport, New York 11947 :-t4–f9H11 STORMWATER MANAGEMENT NOTES PAGE 2 OF 2 I 1. ANY WORK OR DISTURBANCE, AND STORAGE OF CONSTRUCTION DETAILS MATERIALS SHALL BE CONFINED TO THE LIMIT OF CLEARING ' AND/OR GROUND DISTURBANCE SHOWN ON THE APPROVED PLANS. SURVEY OF - 2. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, STEEL OR WOOD " _ LOT I C? A CONTINUOUS LINE OF SILT SCREEN (MAXIMUM OPENING OF POST (TYP.) 4. L 1 U -f U.S. SIEVE #20) SHALL BE STAKED AT THE LIMIT OF CLEARING EXTRA STRENGTH FILTER FABRIC r' _ 1! L� REWD WITHOUT WIRE MESH SUPPORT Ir —"--��^�T �i MAP OF AND GROUND DISTURBANCE SHOWN ON THE APPROVED PLANS. nrur u'" I 11. THE SCREEN SHALL BE MAINTAINED, REPAIRED AND REPLACED AS 10' MAX O C SPACING ipA.iAliilllipliuri' ' OFTEN AS NECESSARY TO ENSURE PROPER FUNCTION, UNTIL ALL W/ WIRE SUPPORT FENCE I% Oirrr.Airrrpr'prrri0 v"I11' E, - WILLOW Yd P OI_V T TRAPPED BY AREAS SCREENS SHALLBE VEGETATED. SEDIMENTSFROMTHE W/0 WIRE SUPPORT FENCE 'r�pA���Oiripiii�� 011ll011101011 li'jO�rl "IIIU 666iii DISTURBED ARE l p®R 7 2016 I FILE No. 4652 FILED JULY 16, 1966 v '' p1 II APR SITUATE "'��lI"�'ll"�pllll�11l 1pp11�'Ir'� r'''III II , SCREEN TO AN APPROVED UPLAND LOCATION BEFORE THE pool. 11��1111��OiOro'Ar"ir�r'nii'A�O''i10 III 1. :, • " •_ I SCREEN IS REMOVED. 00000000010001001,010101$010 I , i0' '" j''IID — ., 1 "' ' "' ''' • ARSHAMOMAQUE 3. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, 111�10A1�0.0011ri100� I ' • .• FLOW i I- ------CSfl """"" I A CONTINUOUS ROW OF STAKED STRAW OR HAY BALES SHALL 0101'" 1:);'!-t" n +F^„ fry BE STAKED END TO END AT THE BASE OF THE REQUIRED SILT 111j1 "I'l' 1111 tGX< TOWN OF NEW LD 010000101101011j00011j14111111111 SCREEN AT THE BASE OF THE REQUIRED SILT SCREEN. THE BALES - 1001 lllllj1111111111�'ll.1f ��- .�� .�►A:� •� ' � '�' •• -• - �"""'��"---� `LLL`Y,����-�_-•��__-_• . SUFFOLK COUNTY, NEW YORK SHALL BE MAINTAINED, REPAIRED AND REPLACED AS OFTEN AS IS �'1IIII-.1IIIIII• ATTACH FILTER FABRIC SECURELY NECESSARY TO ENSURE PROPER FUNCTION, UNTIL_ALL_DISTURBED I�IIIII, TO UPSTREAM SIDE OF POST S.C. TAX No. 1000-56-05-20 AREAS ARE PERMANENTLY VEGETATED. THE AVERAGE USEFUL LIFE //// /\/\j 1111\/\/\//�� NOT TO SCALE OF A BALE IS 3-4 MONTHS. SEDIMENTS TRAPPED BY THE BALES /�\//�\//�\//\ /.\//�/A SHALL BE REMOVED AWAY FROM THE BALES TO AN APPROVED \iV SILT FENCE DETAILS MAY 20, 2014 UPLAND LOCATION BEFORE THE BALES THEMSELVES ARE REMOVED. NOT TO SCALE JULY 1, 2015 REVISE PER S C D H S NOTICE 06\25\2015 4. STRAW BALES SHALL BE RECESSED TWO TO FOUR INCHES INTO THE GROUND. APRIL 26, 2016 ADD PROPOSED DECK 5. SILT SCREEN SHALL BE RECESSED BY TRENCHING SIX INCHES INTO THE GROUND. NOTES SILT FENCE SHALL BE PLACED PARALLEL TO SLOPE CONTOURS TO 6. LEADERS AND GUTTERS THAT EMPTY INTO DRYWELLS SHALL BE INSTALLED MAXIMIZE PONDING EFFICIENCY INSPECT AND REPAIR SILT FENCE AFTER ON THE PROPOSED RESIDENCE. EACH STORM EVENT AND REMOVE SEDIMENT WHEN NECESSARY. REMOVED 7. ALL PROPOSED SWIMMING POOL DISCHARGES SHALL BE DIRECTED TO DRYWELLS. SEDIMENT SHALL BE DEPOSITED TO AN AREA THAT WILL NOT ALLOW 8 PROPOSED DRIVEWAYS MUST BE CONSTRUCTED OF PERMEABLE MATERIALS OFF-SITE TRANSPORT. OR IF PAVED, BE EQUIPPED WITH DRAINAGE SUFFICIENT TO PREVENT RUNOFF FROM BEING DISCHARGED ONTO THE ROAD OR OFF-SITE. 36" HIGH POLE (MAX.) 9. ALL AREAS OF SOIL DISTURBANCE RESULTING FROM THIS PROJECT SHALL BE STEEL OR WOOD POST SEEDED WITH AN APPROPRIATE PERENNIAL GRASS, AND MULCHED WITH STRAW PROPOSED SEPTIC SYSTEM DETAIL IMMEDIATELY UPON COMPLETION OF THE PROJECT, WITHIN TWO (2) DAYS OF _41 FLOW ELHOUSE (NOT TO SCALE) FINAL GRADING, OR BY THE EXPIRATION DATE OF THE BUILDING PERMIT, FINISH GRADE WHICHEVER IS FIRST. MULCH SHALL BE MAINTAINED UNTIL A SUITABLE /FINISHED GRADE ELEV 8 5' ELEV 7 7' VEGETATIVE COVER IS ESTABLISHED IF SEEDING IS IMPRACTICAL DUE TO TIME OF YEAR, TEMPORARY MULCH SHALL BE APPLIED AND FINAL SEEDING TOP EL 75'� 1' MIN TOP EL 6 7' �7' MIN PERFORMED AS SOON AS WEATHER CONDITIONS FAVOR GERMINATION 4/\\� \ j\\v\\\� r MIN 4" DIA I �` _ _�-6 AND GROWTH. ///// /////// f SEPTIC-- — T 3' CLEAN \\ \ ''% \\ \\ INV EL APPROVED PIPE TANK APPROVED PIPE n? SAND 10 SUITABLE VEGETATIVE COVER IS DEFINED AS A MINIMUM OF 85% AREA /\/\ • • ///\/ 67 min PITCH 1/4"/1' I ci' min PITCH 1/8"/1' INV EL°59'' ° �1 COLLAR VEGETATIVE COVER WITH CONTIGUOUS UNVEGETATED AREAS NO LARGER / \ �/\�\ INV LEACHING LEACHING o THAN 1 SQUARE FOOT IN SIZE. \// \/ EL 6 5•v INV 6ELL e C I I FY GALLEY _ 11. ALL CONSTRUCTION ACCESS WAYS SHALL BE RAISED SUFFICIENTLY AT THEIR w �\ /\\/ 1--.-0'--•-1 E a s'�-do 1--a sb -J ZN SITE ACCESS LOCATIONS WITH THE EXISTING ROADS, TO PREVENT RUNOFF <\./\/ OF WATER, SILTS AND SEDIMENTS FROM BEING DIRECTED OR DISCHARGED ONTO THE ROAD. A NON-LOAM BASE MATERIAL, SUCH AS CRUSHED STONE, GRAVEL, DISTRIBUTION GALLEY OF BOT EL 42 GROUND WATER OR RECYCLED CONCRETE BASE, SHALL BE PLACED ACROSS THE DRIVEWAY OR 6 GALLEY SYSTEM ELEV 22' CONSTRUCTION ACCESS WAY AT THE ACCESS POINT ALONG THE ROAD. TRENCH DETAIL SEPTIC TANK (1) (NOT TO SCALE) 1 MINIMUM SEPTIC TANK CAPACITIES FOR 5-6 BEDROOM HOUSE IS 1,500 GALLONS LEACHING GALLEYS (6) 1 TANK, 8' DIA 5' LIQUID DEPTH 1 MINIMUM LEACHING SYSTEM FOR 5-6 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA NOTES• 2 CONCRETE SHALL HAVE A MINIMUM COMPRESSIVE STRENGTH OF 3,000 psi AT 28 DAYS 6 GALLEYS, 2' DEEP, TO BE USED WHERE TOPSOIL IS NECESSARY FOR 1. AREA CHOSEN FOR STOCKPILING OPERATIONS 3 WALL THICKNESS SHALL BE A MINIMUM OF 3", A TOP THICKNESS OF 6"AND A BOTTOM THICKNESS OF 4" 2 LEACHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REINFORCED CONCRETE (OR EQUAL) REGRADING & VEGETATING DISTURBED AREAS. ALL WALLS, BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 300 psf LEACHING STRUCTURES, SOLID DOMES AND/OR SLABS SHALL BE DRY AND STABLE. 4 ALL JOINTS SHALL BE SEALED SO THAT THE TANK IS WATERTIGHT / TEMPORARY STOCKPILE STABILIZATION MEASURES INCLUDE 2. MAXIMUM SLOPE OF STOCKPILE SHALL BE 2:1. 5 THE SEPTIC TANK SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS (WITH A MAX TOLERANCE OF ±1/4") 3 ALL COVERS SHALL BE OF PRECAST NREINFORCED CONCRETEWATER(OR EQUAL) VEGETATIVE COVER, MULCH, NONVEGETATIVE COVER, AND ON A MINIMUM 3"THICK BED OF COMPACTED SAND OR PEA GRAVEL / ) 4 A 18' min DISTANCE BETWEEN LEACHINGL GALLEYSAANDAND LINE SHALL BE MAINTAINEDMAINTAINED UPON COMPLETION OF SOIL STOCKPILING, EACH 5 AN 8' min DISTANCE BETWEEN ALL LEACHING GALLEYS SEPTIC TANK SHALL BE MAINTAINED PERIPHERAL SEDIMENT TRAPPING BARRIERS. THE PILE SHALL BE SURROUNDED WITH EITHER SILT 6 A 10' min DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED STABILIZATION MEASURE(S) SELECTED SHOULD BE FENCING OR STRAW BALES, THEN STABILIZED WITH APPROPRIATE FOR THE TIME OF YEAR, SITE CONDITIONS, VEGETATION OR COVERED. ti AND REQUIRED PERIOD OF USE. 2 i SLOPE OR LESS C �vL ._ 177-''..--.---- * e fjbP•1' r !' STABILIZE ENTIRE PILE 1 u'� 9 }i WITH VEGETATION OR COVER TYPICAL STORMWATER UNIT 4 • ' - ‘ (TOPS TO BE TRAFFIC BEARING) $ iVP �i� t•' (NOT TO SCALE) - 1CAST IRON INLET FRAME & COVER (FLOCKHART #63518 TYPE 6840) d _ y',."1/ FINISHED GRADE OR 6' THICK REINFORCED CONC COVER ( ��^- ' y•p;�/ v 4oppr. , , \i/ , \v \V \V \V \V ` 8" TRAFFIC BEARING SLAB } (max `x '"_C�, :- 1 max `•, ,. ,/ .i. ., 1 — PIPE FROM ROOF GUTTERS \-T ' "UI , ' 9 Na 50467 • . �I. Nathan T �+ er Quin III ,P••,NL .L 'V , CRUSHED 3/4" — 1-1/2" STONE Illik n ALL AROUND Land Surveyor c 'V_ ' 'V ., ,, ' _����—_ LEACHING RINGS REINFORCED PRECAST CONC 4000 PSI O 28 DAYS Successor To Stanley J Isaksen, Jr L S (min) 4'L.f(min) Joseph A Ingegno L S STRAW BALES OR SILT FENCE Title Surveys - Subdivisions - Site Plans - Construction Layout —J — PHONE (631)727-2090 Fax (631)727-1727 SOIL STOCKPILE E OFFICES LOCATED AT MAILING ADDRESS (NOT TO SCALE) "1/" 1586 Main Road P O. Box 16 GROUND WATER Jamesport, New York 11947 Jamesport, New York 11947 :I4-(19HH };; 0S�}fFQ(�co ;` John M Bredemeyer Ill, President Town Hall Annex o� :�-. o Michael J. Domino, Vice-President '� } .` ` ` 54375 Route 25 Glenn Goldsmith r � ' z ; P.O. Box 1179 A. Nicholas Krupski ":;y � �:;Y Southold, NY 11971 Charles J. Sanders -3,...„70i , - r- Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TD TO: A-51- END CON6TROCTCO1J SFA\liCE3 Please be advised that your application dated ! lL 27( 20/4, has been reviewed by this Board at the regular meeting of MN I g, 20/e,0 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project s .r F WcintG- / Pre-Construction HayBalee 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.) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 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: 0-0 TOTAL FEES DUE: $ 5o BY- John M. Bredemeyer III, President Board of Trustees ram rte' , John M. Bredemeyer Ill, President .( ,G I�gpFFO(kc , _ 1 , Town Hall Annex Michael J. Domino, Vice-President °�.,. -, *••• t r 54375 Route 25 Glenn Goldsmith ,§,..?y � , , r, P.O. Box 1179 A Nicholas Krupski o <° Southold, NY 11971 Charles J. Sanders x#44 ,W o�.r� Telephone (631) 765-1892 �. * 1 %11' Fax (631) 765-6641 ate:. " BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time:"2k 1 •vt',t C D;`'4, Completed in field by: /6 ' East End Construction Services, Inc. on behalf of JOHN WEBER requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a +/-41.3'x50' two-story, single family dwelling with attached 15'x50'`seaward deck; install a sanitary system landward of dwelling; install a driveway; install a system of gutters, leaders and,drywells to dwelling to contain storm-water runoff in accordance with Chapter 236 of the Town Code; and install silt fencing prior to and during construction. Located: 150 Budds Pond Road, Southold. SCTM# 1000-56-5-20 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=- Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet ' 4. Septic Tank: 75 feet ' 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: , 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 / Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 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: A4-e--.}A-eL4i,e, liA144-e- 4fr ,e/t/te.41441,- , Are,,iii r-el, 6-6-14.~ q- 'KJ'faC4111 ' Ct., ki ClAre+iii 1'kr NW ke 7.-.S AA t.1 .9---v atvii f/yriu A-- vtilr cCli v C 0%4 t J�Ae . /AO 1%/1 UOzf d.1 CovP i i./ , Present were: J. 1edemeyer M. Domino G. Goldsmith N. Krupski . Sanders Other Page 1of2 . �ytrx,crxtt s` John M. Bredemeyer Ill, President , �SOFFOL,�c Town Hall Annex Michael J. Domino, Vice-President ,���s� , �Gy54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski 0 Southold, NY 11971 Charles J. Sanders y . off,,," Telephone (631) 765-1892 Dor Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: East End Construction Services, Inc. on behalf of JOHN WEBER requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a +/-41.3'x50' two-story, single family dwelling with attached 15'x50' seaward deck; install a sanitary system landward of dwelling; install a driveway; install a system of gutters, leaders and drywells to dwelling to contain storm-water runoff in accordance with Chapter 236 of the Town Code; and install silt fencing prior to and during construction. Located: 150 Budds Pond Road, Southold. SCTM# 1000-56-5-20 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife &.vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents,'if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. <_25% 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 vicj " s ?, • ss t; .►— E T /Sv /S.1L.1 S ('�p I2 four+(c z y/271 I co (11 Lu.-.) la:x 2- -1-11 „T — JJ,,5J,,t (Jit„s(atile_if w f 4 evi t, . � ` Y 0' .11" a .. '�•" 440 * '17,V':•c .4- 4.- , , .4,,,,,, .-":„..,1 $ ! -;y. J YC a •mac•�J '` Y-. . 111 -1-1S (i r✓O (Z __. ....c.;.477-4-1,,5(,4._ i q(2-) //4 V mill -11 ` r , 't":4,'4",,, t. . 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FOR PCL NO x333202 '4011:11:01.10,, SEE SEC NO W , —� UNE xsu w tiA x p MATCH ' SEE SEC NO W6 rOR PoC• MATCH U! (^�+ - T A pes02aW - ' SOUTIOLO SECTION NO __ _ __ _ _o, x, NOTICE y� COUNTY OF SUFFOLK © E TOWN 02 t N�> dA.a e» — x 0.0- - x ^°b' _ 005,000,0 o"aVAND ENANCEN-TENATIoN 5/11,:01+ a Real Property Tax Service Agency Y M AGEGF 56 E e.e.�..s.ow --- ,A.,,m, (z1) amw O � -- -- ooxN°FAxr P"''''''''3 08 2.1.5 50 , County ceN,er waemeae,nr nsm M ' msrwm NO C'ceam...in,.. 133 mi°�""' __ 01,00_ --,-- n...�eva.w--A-- O Ourouxn TAx WON moKerrEo ENl em A t°OO --- 01121101MENPERNISNON Or THE -.%:..,,,,,P''+ m_—, P PROPERTY MAP E. N µn m...s :,Awl>,2,A ”. ----- :.'e!*^„- I ""°"'� .NA,rv.,G. PROPEm.TAX SERACEAGENCY I mNr.A9oNTx.�F.Ev 2013 �..,.� 121 No - a1 ' s SOUl�- OFFICE LOCATION: ���I ® � MAILING ADDRESS: Town Hall Annex ��/ � �® P.O. Box 1179 • 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 � �O 1� Telephone: 631 765-1938 c4UNri - ... s_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: May 17, 2016 Re: Local Waterfront Revitalization Program Coastal Consistency Review for JOHN WEBER SCTM# 1000-56-5-20 East End Construction Services, Inc. on behalf of JOHN WEBER requests an Administrative Permit to conduct construction activity within 100' from the landward edge of wetlands for the construction of a +/-41.3'x50' two-story, single family dwelling with attached 15'x50' seaward deck; install a sanitary system landward of dwelling; install a driveway; install a system of gutters, leaders and drywells to dwelling to contain storm-water runoff in accordance with Chapter 236 of the Town Code; and install silt fencing prior to and during construction. Located: 150 Budds Pond Road, Southold. SCTM# 1000-56-5-20 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 CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its writtendetermination regarding the consistency of the proposed action. Cc: Stephen Kiely, Assistant Town Attorney „ John M. Bredemeyer III,President •'' oUryO Town Hall Annex Michael J. Domino Vice-President of �o =,t x to ; 54375 Route 25 ' , 4 ., P.O.Box 1179 Glenn Goldsmith * # , Southold, New York 11971 G ,1 A. Nicholas Krupski -O / Telephone(631) 765-1892 Charles J. Sanders Fax.0 Fax(631) 765-6641 rii.... o's BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio _Wetland Permit Application V Administrative Permit / Amendment/Tranfer/Extension V/ Received Application: 'tali/(a V Received Fee:$ 160400 Completed Application 'f.,a7,1(0. Incomplete rp' SEQRA Classification: �.� Type I Type II Unlisted ;? { Coordination:(date sent) 5.6e/‘ ' s LWRP Consistency Asses” nt Form APR 2 7 2016 CAC Referral Sent: ! • Date of Inspection: .5 1 t I� +, -"" 1 Sn.tlt . ,r,:r} _Receipt of CAC Report: L.._ r; Yr r,iix,% __ .1 _Lead Agency Determination: Technical Review: d Public Hearing Held: 5.1 1 8'4[1� Resolution: Name of Property Owner(s) Address BCA o os Pon)oS o 1 So i--&o'-►o Phone Number:( ) (0.5----1 Suffolk County Tax Map Number: 1000- SGo -- o -- Property Location: /S 0 /Sn noS Ph,sc ''1-'° , S LA\TN-ta�—�a 200 " 10 12)(.o o S Pol.no (My g-0 - VA c o (provide LILCO Pole#, distance to cross streets, and location) AGENT: S1Ck-,* 1%lyOp (L,os C--":"NO C.\\OS i;Lu c;cle v) S uic (J c__ (If applicable) Address: j�U W PTS rzV1 ) (,,- S .t-n-c o� Phone: at ac-l(3 4a and of Trustees Applicati GENERAL DATA Land Area(in square feet): S' q S.6 Area Zoning: Previous use of property: 1/Acra,,TeW4PL� Intended use of property: S etkn.i�.� Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require y demolition as per Town Code or as determined by the Building Dept.? Yes ,/ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes Nom N`r 4A Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? A No Yes If yes, provide explanation: Project Description (use attachments if necessary): C. t e tt 0P j).9,-7( S (i c A\,,n4,,.,) vrrr— (AF ITld P S T i 20 (•l etc r yard of Trustees Applicata WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 3 cJ�S c��J, v° SviJe.-N1 Oewtoc7-LS L="7w&(o,-) C2)Oc= �`JQ'L.O A Cha c N To ( /LL''v t2�a Jc-A two Area of wetlands on lot: square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? - No 9( Yes loZ =SL-w c- If yes,how much material will be excavated? 80- cubic yards Cl Z How much material will be filled? g 3� cubic yards O,_,,,a,,A,1 Depth of which material will be removed or deposited: 9 feet a d = NPn`-h""'��" Proposed slope throughout the area of operations: /o dl Manner in which material will be removed or deposited: OCcA/X-en UI-'i 1 Ovate l Z LXcAvAD 0,3 Ccvu ^ GA-A oc-Y> cAodJ nno4-nor\ 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): gu° CPP-c--c eco rn, f'<-Aec rc+l -- Ij..cAIl`A/J W r"N (14-lC.,lL(4(74e7�PeLc-C�c(Srn,JG) 2 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: CA..) Project Location(describe,and attach a location map): 5-0 SCA✓J oS E31\ .A.TV.0'—•' Brief Description of Proposed Action: CO Ns VYL&A C no /`Rz,J nn-00 U4-0,0-- (4 J M c= LS l AltAft._ �Jc=t rG• CAL 1(wr (3') erf-0 SC::"Ic. t (LC A,Z (1.(:=714 irrvp ©Czl`. lJ2VlWf s i,•) PA2 i, c:IVCOAct Name of Applicant or Sponsor: Telephone: 19 3 90s_se 3 6, S-gccl (?,‘,31-lop . .C's�0 � 1—'. .c 0,� Secs (0c— E Mail:lrl ud v� l�j c.•-( .i @ Cf o l,c44- Address: V /SS W City/PO: State: A Zip Code: k -�OL�z74v�o "l (197/ I.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that F n 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:�e ,..Yratn tcxt s. sexA rt-&o v10 / Q( Pcvrur i -1D IA eery rv`r (iSScu=�, 3.a.Total acreage of the site of the proposed action? 3 acres b.Total acreage to be physically disturbed? 2_5i acres 10 oX 11ef c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? • a 4-/35'- acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial 1Residential(suburban) El Forest CI Agriculture El 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? j"� b. Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: .r51 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO, YES El 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? g ❑ 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: ea )sgo CONS-AAc & wcu— t,1 C.-TOL-1%42k( s ue( urjTf /� 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: V0ULL(c i )ATk ..- ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: CJyJU-NtlajAc_ S PT)c.- 12. .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? ❑ El 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? �f�❑ 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 0 Agricultural/grasslands ❑Early mid-successional ❑ Wetland 0 Urban -Suburban ildae� r� La'1,u G►ek,c►r.id v cm oh) in Ask)SCA L 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? ~f ❑ 16.Is the project site located in the 100 year flood plain? /aL` Psc.oeo. 1 c J, J ,c.,Ac,taJ NO YES mNaJust-i 7^ S or.A 2-Or.k,' /mac= IS Qt -l-1 10 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? VNO nYES b.Will storm water discharges be directed to established conveyance systems(runoff and stmdrains)? If Yes,briefly describe: n NO S trJ;Q..�tdez_c..S' 114e...-7Y C)--►lsv pp- carr tf+r3 TKST-r-r - Jug-IS' M-77 OA.; // �- �l Od�JtJ�zLJ �N c7Vly� (Lufv,O{-a- ("J._ OvciJ Page 2 of 4 •I8. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: g'�c (3i S'Mee Date: Si 2-2—/ !(.0 Signature: t✓ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? rZY 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? I� f 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, WA 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 / _r 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 problems? ►�_, 11. Will the proposed action create a hazard to environmental resources or human health? cti— 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. -10-- Pwe r2 CitIOS-riu,t c-110Z I S aPt 3 cmc I ST)Ag. VA c-Ao.Jr ��,P M _ 1,0 --Ivz�z:s f3c�t-r c�,cx-w, (,� C��AS•S — i to (.� C-1CtSTS (1\) 1Siln9t., n4rtti.✓N I'M 0 f S/NGc.v: ,Os...1._y /4,,,,,,,.-s , 't1.1 S' COM rt tJrv-r ti C LS A it_c_vt-4 A i4, m ram fel A tOc_= ��L t�L P.0n..Pcr1c-:.r A.&(lT`1 ,06 `11115 C ANAL-I (tVC&, V -j1AU 1L(7 w` O ft.LcuiLz_LS S�tv�►�arra (Lvn) - '�/' ca,x_g_o ra,_,t t. Ir JVD I j-u$ . .)1L-\S 0 r c,t�u1,1. Tam l'ar J rug rJ 4 I\n( -c_1-4' GP is (u -ca^ (fru (ni -.-0vv� ) - ac-tT.Pt i'— 0P cl2AJit - 300-ts01cala„u, 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 action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees2 c5�' //� Name of Lead Agency Date 37D n ii President Print or Type Name of R onsible Offic r in Lead Agency Title of Responsible Officer •- z' h� carJ 2744.,3-1.a) Jam' fr., - Sig re of Res nstble Officer in Lead Agency Signature o ijrer(if different from Responsible Officer) PRINT Page 4 of 4 Apr 21 2016 4:02PM HP Fax page 2 • AFFIDAVIT U�0, 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 BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Ilk 9 .6sLca_. 0,gnature of Property Owner SWORN TO BEFORE ME THIS a DAY OF PI *-J , 20 Notary Public,INDA State sNewYork No.01Pg613 145 Notary Public Te Qualified i"Q' Co Apr 21 2016 4:02PM HP Fax page 3 • AUTHORIZATION THORIZA.TION (where the applicant is not the owner) r, J© x., C1 WE 1�J (Z residing at Jq 0 B t?op S rc30 n�0 R b (print name of owner of property) (mailing address) ••,„,;(-1-10c._t (v 0171 do hereby authorize STgcc--t,i ( •t3 14610 (Agent) `t=n1•O ca^)S r tuit_c &vim 1, to apply for permit(s)from the Southold Board of Town Trustees on my behalf. r , C____ U(1_,?_______ (0- `s signature) UNQA K.PRASAD Notary Public,State of New York No.01 PR6131145 4DLI if i in het 5 tY Apr 21 2016 4:02PM HP Fax - page 1 • APPLICANT/AGENTIREPRESENTATTVE TRANSACTIONAL DISCLOSURItr FORM • The Town of Southold's Code of Ethics prohibits conflicts of interest on the nart of tt wni ff ers and emnlovees.The Ramose of this form is to provide information which can alert the town ofepssible conflicts°Ottawa and_albow it to take whatever action is necessary to avoid same. - 1 - YOUR NAME: VlJ €c C C-- CZ. o (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�t Variance Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lf"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 11/4/7- If 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 applicanthagent/representative)and the town officer or employee.Either check the appropriate line A)through I))andlor 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); • - 13)the legal or bent icial owner of any interest in a non-corporate entity(when the applicant isnot a corporation); C)an officer,director,partner,or employee of the applicant;or11111. D)the actual applicant. DESCRIPTION OF RELATIONSHIP L I 2-0140 Submitte�►�, I i d o .!1 1 �'.._ Signaturl V°, CV! Print Name Li. j ' , "4131) Form TS 1 LINDA K.PRASAD Notary PubIic,State of New York No.01 PR&131145 Qualified in • e Co ty Term Expires Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - - PROJECT NAMEThe 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 fl 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: AVDm /02711-44 vef�Qro,c_uciA� TC) PNS1rJLc O (c.�L��' C) S'`1Z12Aa� ct314 enln�c�z r;'` Pchtt-SuA. 11/4-)G,3 make--r1"- f�a,� Location of action: /..O (r .Ao oS ( 'z (L� / S Site acreage: 0 q Present land use: Vp,c.,oal— Present zoning classification: ' 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: S')ckcal (51Si-tc 0 --(EAS ��J� c�� ����,�s,� S'u cc � Pc (b) Mailing address: ISO G )A`hv r uJ p,- (c) Telephone number: Area Code( ) G 2( d (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes Ne 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 LWItP Section III—Policies; Page 2 for evaluation criteria. Yes No / Not Applicable l/JIS LI A lily, KA' LIT (4;i,i A MruviJ,7.1 (\.N a0 !GAJ—Ac4�i • 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 No Not Applicable C /S-7 1. VAcaLdt ld.S CA c_i2J-((a4D lel 6,hKi<mut T t /J iCtAG..e aztajoit, ®,ce AaScv9 Ce437 .4A(23-1O4 PALLS "JAW^12-41/ an OP 'f 144.,0 sz= AALISo/c7ns-) AAP-7 GM arc. i8 t t= tj nJ4. C A c.,c GP 744c...- 4.+4:46t46.-41^L1.10[1r), WitniC 14 e(to"ia'(//' ( 47A/A-2- 010 0lyan 4-¢.J1✓2 c- es - 442_ < bt/IA.L.,)7 5 , (' 9i Kt /4-fi ntal oal4c z-- Attch 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 (SA eat-, - W14-4_ /JAa:3 ,.1 Pe-,fcce 1o$i t4Ac P0.1 Gn..).Si"ct c,`CV J — .S''fi,24l,c OA rue—. (dad_ (x-' Co)0 !,J ce) o rn-►i J A©D,L.0 04.4./X11 22, 1y.Y.A �_ 't it-4 t6 V .JA 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 n Not Applicable tem Cad Ai- ,cJauc.,a (3z_ ry or, AALASu v / �� �[ �.S�- A/ e e V Ch t �c 0/.1- i C'1 + 7,f(�L�L�K7 n AS llJi/4 e/.5 - A)brufli OF PiLoJezrr c�c1�S is cr (CO ' 61- BF Mr1.0 I�,L•�(A)(z.L-f ii c— S'�.2.1vt./A i v iNIn1cIA-c-7UT- PALL_ 90-/w ` t4c2.;. CA t,c _. 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. n , Yes No Not ApNa:able - /14 Ars ivvao if vffl P/t� L r o ' dNi eit.6\ , ACc_ 1�rf f 616 CASlAi;C M i Af"rn 6(.4c.tci4cs pf / 00.n,01. I Aek1' + (36A7-3' Il?s plc CAW c� c� ,W CfUCK- c4-1 et rJ 1c .ry Sib at cA�JT tJ rLj')Cil _= (41 eartg ice(__ Pelt=c t d/J/S 1-r14-rml; I 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 NbUts (1- , 47.) Lfi.foc/ S%1Q` i'L-vJ /•LSIQCr1i1HL_- 1� tcff (.l LG O•AScT— ruc.C�fsil uzzL t'PAca— I\I 4_ 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. YesNo 1�� Not Applicable ees ASILAL - n0 k— rrvipeoc- -- 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. YeJ No iNot Applicable �L140 bd,G) 1Y1 fJA rbtACAO AL NtL U,ILr Olt /0c t f eUisc-/� ALA c-ia P � cz7 / ) ea ru_uN I9 Attach additional sheets if necessary WORKING COAST POLICIES• j 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. n Yes n No of 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 ❑ NoApplicable 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 cot 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 ,911 (SIS 143 f' TITLE A(o-‘TDATE VLSI(b