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HomeMy WebLinkAboutTR-8817A John M.Bredemeyer III,President OF SOUlyO Town Hall Annex Michael J.Domino,Vice-President �O l0 54375 Route 25 P.O.Box 11 Glenn Goldsmith J�4 Southold,New York 11971 A.Nicholas Krupski Q Telephone(631) 765-1892 Charles J.Sanders O a Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1271C Date: September 16, 2016 THIS CERTIFIES that a Ten(10)Year Maintenance Permit to hand-cut Common Reed(Phraunites australis)to not less than 12"in height by hand on an as needed'basis. At 1600 North Oakwood Road, Laurel 9 Suffolk County Tax Map#1000-127-6-10 r" Conforms to the application for a Trustees Permit heretofore filed in this office Dated May 6, 2016 pursuant to which Trustees Administrative Permit#8817A Dated June 22, 2016, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a Ten(10)Year Maintenance Permit to hand-cut Common Reed(Phragmites australis) to not less than 12"in height by hand, on an as needed basis. The certificate is issued to JACOB KUBETZ owner of the aforesaid property. Authorized Signature John M. Bredemeyer III, President "opo oo�; Town Hall Annex Michael J. Domino, Vice-President ;S y1:?, 54375 Route 25 cm Glenn Goldsmith z `i P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders L''01 , ���= Telephone (63 i) 765-1392 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: q11 5-116 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/ constructed complete,lete liance ins ection. 1 p compliance P INSPECTED BY: G , G�Io�Sr►► t COMMENTS: P—�� b,or�a Cu�' �n �C�©t'�o��Cc° �✓�-�� pe?Cs'�1� . oK CERTIFICATE OF COMPLIANCE: John M_ Bredemeyer III, President tomo com`.. Town Hall Annex Michael J. Domino, Vice-President :.`' t ��' 54375 Route 25 CD Glenn Goldsmith ,+ P.O. Box 1179 A. Nicholas Krupski o�_y Southold, NY 11971 Charles J. Sanders " �o� ��;;f Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction '/ constructed complete,lete liance inspection J p com P p SOUry John M.Bredemeyer III,President ®f Town Hall Annex O`� ®l® Michael J. Domino,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® �� Telephone(631) 765-1892 Charles J. Sanders olif'C®U Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8817A Date of Receipt of Application: May 6, 2016 Applicant: Jacob Kubetz SCTM#: 1000-127-6-10 Project Location: 1600 North Oakwood Road, Laurel Date of Resolution/Issuance: June 22, 2016 Date of Expiration: June 22, 2018 Reviewed by: Trustee Glenn Goldsmith Project Description: Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. 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 allows for the operations as indicated on the project plan submitted by Jacob Kubetz , received May 6, 2016, and stamped approved on June 22, 2016. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites austral/s) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar(Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder(Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 2 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. John M. Bredemeyer III, President Board of Trustees 01 SURVEY OF PROPERTY SITUATE S 6,9. / LAUREL L(`uZAAS ALLISON 6� a\8jz e TOWN OF SOUTHOLD Te 0SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-127-06-10 LDT SCALE 1"=20' OCTOBER 15, 2014 M 60.'06 �/ \\ tJO• E• ,o• / p \ ,^ �� AREA = 36,761 cq I1 (To TE UNE) 0 844 a 69* TJII NOTE 1 LOT NUMBERS SHOWN THUS LOT 50 REFER TO c oas' / b /! �' MAP OF LAUREL PARK FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON OCTOBER 5, 1925 AS FILE No 212 CERTIFIED TO JACOB T KUBETZ �\ I ^� r ° co✓" JILL P KUBETZ 1p, J LOANDEPOT LLC STEWART TITLE INSURANCE COMPANY, Inc n Q \ LOT 49 \\ Q \ SITE-PLAN: Phragmites are in the area labeled Reeds/Brush. The will be trimmed b hand to no lower than 12", and native Y Y 1 LOT 4B plants will be encouraged to grow. •jJ1JPyy� ��Q` 1- �(}•�( M,J_ . �.• ' No � �p }�/�l• �4J Y V/ ' ` PRFPePCD IN/l.'CORGNCE MM MC YWYUN 6 •1- 1 A �yl �D A m[—L two o D-,D MB© ° M' TEES N �`"" l 1 ! l l I ► „ MINE NL,roRK nuE R QPD DACE OIS� y0�� NYS U No 50e67 CwYINOP21D K1W19N OR 1. � 0t I ,=uaE �D nAF Nathan Taft Corwin III Land Surveyor 1�, S Q -D sumR 1 paao sEu oR _ } 111 TO� Y�wo 1RSWiL�N,OC BE COMiOERCD +•,� - -+ g� f E9Daunor5 i Sacs —To St=J 1e01°en J,LS I �(O _ ` L N iW Y�iOY InC 5� JosepN A Ing .LS I MAY 6 2016 s` � DaRNDC�FroTNL 5—,—,- sre P-1- co,uNcnwn Lywl _ n0 P�6'IDYIIDN 161FD n[RCD0.IND iurm—i i u,nr�iz°�RE'Nao,�ixwaWsu. PHONE(631)727-2090 Fax(6]1)727-1]27 `�' -� - - •� THE EXISTENCE OF RIGHT OF WAIS OFFICES LOCATED AT LAILING ADDRESS t - AND/OR EASENENIs aF RECORD,D' 1506 M—Road PO Doe 16 ANY,NOT SNDWN AAE NOT DUAftWTEEO JOmesparl New Yo.11947 JOmespoN,New Y.M1 1191] 35-047 Bea y of Tr s e John M Bredemeyer III, President ��c,11FF01!{��`� Town Hall Annex Michael J. Domino, Vice-President _ {��� Gym 54375 Route 25 Glenn Goldsmith o ` P.O. Box 1179 A. Nicholas Krupski w *c Southold, NY 11971 Charles J. Sanders �y� �ooTelephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ;�Zr3�lb x`30 Completed in field by: JACOB KUBETZ requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand- cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an,as needed basis. Located: 1600 North Oakwood Road, Laurel. SCTM# 1000-127-6-10 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 a/ 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: ��SGLq�r�l �O��n/o.�ni 1n/o�r1�S �o hadld F-INJ Tis' Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 SURVEY OF PROPERTY SITUATE s se'ss.I LAUREL fAU MAs Ai sol; �g'I 6� v/ 3sej? £ TOWN OF SOUTHOLD T$ w SUFFOLK COUNTY, NEW YORK /'ND yBT 51 ? % S.C. TAX No. 1000-127-06-10 SCALE I"=20' \ OCTOBER 15, 2014 x• 'Q f^ AREA = 36,761 sq fl (TO TE LINE) 0 B44 Oc 1 N 69. NOTES 0E 1 LOT NUMBERS SHOWN THUS LOT 50 REFER TO MAP OF LAUREL PARK aya. FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY 1 1 st'Gose s� ON OCTOBER 5, 1925 AS FILE No 212 CERTIFIED TO JACOB T KUBETZ JILL P KUBETZ LOANDEPOT LLC l \ TELLUS ABSRACT, Inc 1.7 E1\ 3"// \ 11 / i STEWART TITLE INSURANCE COMPANY, Inc 1 I ✓vP \ / oT O \ q$ I k\ LOT b9 \\ TO Ods yBT O/ X rn N/513A o. 69 oa 20 ITY eP°1 ion m n As ml TED O Oa \ f !+'P{���.4 NYS UG No 50467 ToWPHaGA GA—m AbNDRADDa� Nathan Taft Corwin III ph�N —TTN FATE NEW)OR s TATE BF/ RMO Land Surveyor pI� � �� 1�E W Lw4 Su1NM NAP ro]T rY NF LVID R�RYON'S Ib20¢IL OR gz� ? MAY - 6 A MEQ L DE CON90 RO _(p 20 16 t mcR[wnw5 INquT[0 12x[aN auu RUN S..—Ta St H;J Iso4sen,Jr LS YN- � e PYR TO E PSR N FOR BEwNiETHE iTo M JasePN A In9egno L 5 �E cOMPun�GcrnvwYFNTAE AGENLY AND NOW 5-1"-Sa6dmswas-S9e R—- C.Gl—lnan La l L EES�ME IiimNc�lµsn- PHONE(631)727-7090 Fm(631)727-1727 NTMI CENT', WS ARE NOT TRN9LU&F. '�--- OFFICES LOCJITED AT kULIND ADDRESS /� THE EIOSTENcE EASEMENTS TOF RICHT EC WAYS 1566 Main RPG 16 �7iEI11V141 IQIs� ANY.GR NOTSHOWN ARENOTGUARANTEED IF JameeadvGd,Ne.Y-1baa 1947 Jmnewt,Ne.York 11947 35-047 John M. Bredemeyer III, President ` ��gu40i.'r o Town Hall Annex Michael J. Domino, Vice-President �� Gy� 54375 Route 25 Glenn Goldsmith o '`� P.O Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders y?j�l �ap� Telephone (631) 765-1892 erly Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Timec Completed in Work Session by: JACOB KUBETZ requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand- cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. Located: 1600 North Oakwood Road, Laurel. SCTM#,1000-127-6-10 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: , D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 SURVEY OF PROPERTY SITUATE s 3•ss.I LAUREL pL LI5 $I�N ON �g"I 6� �yi TOWN OF SOUTHOLD p", SUFFOLK COUNTY, NEW YORK pN 51 4� SC TAX No 1000-127-06-10 LOT O SCALE 1"=20' y• von /// �� \ m OCTOBER 15, 2014 chNNWpOf `R'Mx x• / '� •yr \ (^ AREA = 36,761 sq ff (Ta TIE LINE) 0 844 ac OTE 1 LOT NUMBERS SHOWN THUS LOT 50 REFER TO s En'D' If - /' (� MAP OF LAUREL PARK FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON OCTOBER 5, 1925 AS FILE No, 212 Ti `? CERTIFIED TO, \ '� JACOB T KUBETZ JILL P KUBETZ LOANDEPOT LLC TELLUS ABSRACT, Inc STEWART TITLE INSURANCE COMPANY, Inc DAA'° t � \ Epi 30• IF 2: ! M AY — 6 2016 s I Board of Trustee O 5 69.0$20 "' IN DODID NCE—i aMc,eusm \ N E l iAES AD A•ID AmPrm w To� noN.IPRig2 RC NEW mFx STATE Uwp ` og L a \ oNi O O� f YAI� g O NYS trc No 50467 e^ gp A aTE°—N°R Nathan Taft Corwin III PMm ry w p 0) CO..s° I v-NEW MCRA STATE Land Surveyor p p, ��o TNS_� E OR E TO BE w TIIE m MERE GD mm CERR S.—D—D..vwi NUN S.—,To St. I.S.J IaoFs Jr LS 1 D2 pFoxx FOR——SL— Jpx,pD A bgNTp R—A4Ep/D ONR.—To- ETw co Om CE tmm x ARD-A'D rill,Sunup-Subdvurom- 91e Pl.,- C—I.fi-La .t TO 9N Ts—rs 1.o,'.u2 por—&— PHONE(631)727-2090 Fox(631)727-1727 TSTENCE Df RIGHT pf WRYS DOLT LOGiEO AT NW IE EXIUNC ADDRESS AND/GR EASEMENT^OF RECORD IF 1506 Morn Rood Po EDN 16 ANY.NDT Sit—ARE NOT GUARANTEE. Jamesporl.N, Yoh 11947 Janespori,NeW Yoh 11917 35-047 • _ M w �5 t � lF�.,"•. 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' -- rt..x Sav'7�� ar AP PROPERTY MAP N OFFICE LOCATION: S®Ury®l MAILING ADDRESS: Town Hall Annex ® P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) CA Southold, NY 11971 ® �p� Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: June 20, 2016 Re: Local Waterfront Revitalization Program Coastal Consistency Review for JACOB KUBETZ SCTM# 1000-127-6-10 JACOB KUBETZ requests an Administrative Permit for a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, on an as needed basis. Located: 1600 North Oakwood Road, Laurel. SCTM# 1000-127-6-10 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 written determination regarding the consistency of the proposed action. Town Hall Annex John M.Bredemeyer III,President Michael J.Domino,Vice-President 54375 Main RoadP.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee 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 7Administrative Permit Amendment/Trans e nsion X _:,.Received,Application: V Received Fee:$ MAY 6 2016 Completed Application:- Incomplete: - SEORA Class'ificat' ion: Type I_Type 11 Unlisted pgard of Trustees oordination:(date sent): -VICL RP Consistency Assessment Form: 41-L ,CAC Referral Sent: -Zbate of Inspection: Receipt of CAC Repo& Lead Agency Determination-: 7�echnical Review: . _,4Public Hearing Held:- Resolution- Name of Applicant: 4ftto Mailing Address; om deo:k4' 0'#-W0 Av R.EL --------- Phone Number: (931 Suffolk County Tax Map Number: 1000.- Ob Property Location:_ ] D'D IVO-f�4­ Lek"A (provide LILCO Pol-e­#-,-distance 16 cross itreets-, andlocation) AGENT: (If applicable) Address: Phone: -\ 7 Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: U3 Previous use of property: Intended use of property: 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 L 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 requireany demolition-as per.Town Code or as determined by the Building Dept.? _ Yes No F Does the structure(s)on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: s i Agency Date f�51-cam �y•Ib'�S , D e L �Pr'► r;, ��b t No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes,provide explanation: Project Description(use attachments if necessary): \ - l Hoard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: 44 V� '(kC �w�, L✓�W�fF.)L PVA�1r� ��aw + Area of wetlands on lot: g.Qeje 3 W. square feet Percent coverage of lot:_ �V� % r Closest distance between nearest existing structure and upland edge of wetlands: �' feet Closest distance between nearest proposed structure and upland edge of wetlands: t feet ry►,—"- 10 Does the project involve excavation or filling? ✓ ' No Yes If yes,how much material will be excavated? cubic yards How much material will be filled?, _ cubic yards Depth of which material will be removed or deposited:, ___ _ - - _____ feet Proposed slope throughout:the area of operations: - Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town-that may result by reason of such proposed operations(use attachments if appropriate): 617.24 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. s Part 1 -Project and Sponsor Information Name of Action or Project: 1 rte Q"����; �� ------- - ---- •---- -- Project Location(describe,and attach a location map): I D 1v A f. ��' �_ 0 lL"o Je/I I Brief Description of Proposed Action: I Lh Name of Applicant or Sponsor: Telephone: Int v�i E-Mail:' { u�I�C T�(s 6M'" f,•t;�q Address: LAtLwOm� City/PO: State'.�y Zi�Cod 1.Does"the proposed action only involve the legislative adoption°of a"plan,-local`law,ordinance;'' NO administrative rile,or regulation? J If Yes,attach a narrative description ofthe intent of the proposed action and,the envfronmental resources that may be affected in the municipality and proceed to Part 2..If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO, YES If Yes;list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? _•�g� _ acres b.Total acreage to be physically disturbed? �ti�°l' D L acres i c.Total'acreage(project site,and any contiguous properties)owned �.{ or controlled by the applicant or project sponsor? a 0 .� acres ------------ 4. 4. 'Check all land uses that occur on,adjoining and near the proposed'action. - - - -- ❑Urban ❑Rural(non-agriculture) [:]Industrial ❑Commercial E Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify):,"_ ❑Parkland' Page 1 of 4 5. Is the proposed action, - - ; `NO YES /A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ! ❑ ` ❑ i 6. Is-the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? Fit 7. -Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify:- -8. dentify:-8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO V YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? .71 -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: EJ 10. Will the proposed action connect to an existing public/private water supply? NO r'YE If No,describe method for providing potable water:11.Will the proposed action connect to existing wastewater utilities? ;j,'NO- If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13.'a.Does any portion of the site of the proposed action,or lands adjoining the proposed action;contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? EJ ;( b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? u If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that oceur-on,or are likely to be found on the project site. Check all that apply: [❑ horeline El Forest ❑Agri cultural/grasslands E]Early mid-successional Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associafed-habitats,listed' T -NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 1'00 year flood plain?' NO qVE 17.-Will the proposed action create storm water discharge,either from point or non-point sources? i NO _ YES ' If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES b.Will storm water discharges be directed to established conveyance systemsrunoff and'storm drains)? If Yes,briefly describe: �NO DYES '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:,_ iF i 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 I-AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: ��� [ `� _t _ Date:___ S M _"U i66 Signature: � Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" - - - No,or Moderate ,small to large impact impact may may ` ;occur_ occur_ 1 Will the'proposed action create a materiafconflict with an adopted land use plan or zoning-- regulations? oning-regulations? -- — - -- -- ,❑`,- i 2. Will the proposed action result-in a change in the use or intensity of use of land? ;a c1 3. Will the proposed action'impair the character or quality of the existing community? n i U, 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 15. 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? o 6: Will-the proposed action-cause an increase in the use of energy and it fails to incorporate a - _reasonably available energy conservation- reasonably renewable energy o portunities? 7. Will thaproposed 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? _ Ej ID 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 s - No,or Moderate small j to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? j 11. Will the proposed action create a hazard to environmental'resources or human health? ET 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 wil I 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. a e k Y i k " ........6 I 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. ElCheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees - ,Name of Lead Agency Date _ President Print or Type'Name of Responsible Officer in Lead Agency Title of Responsible Off icer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) ; PRINT' - Page 4 of 4 Board of Trustees Application I AFFIDAVIT 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 WORD 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) OP.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. Signature of Property Owner s SWORN TO BEFORE ME THIS , 3 DAY OF M A Michael G. MCCOY Notary Public,state of Now YQ* No,0IIM06074487 Oudliflod 16 Suffolk County 06thmigeloh Rpm of M61io 1 ' Notary Public APPIIICANUAGENUREPRESENTATIVIE; TRANSACTIONAL DISCLOSURE FORM The'town of$9-uthold's Codc of EthlIts.probihits conflibt,'dff interest on liri'gart'of toivn`61 ficers and employees the purpose of this fnii pis to provide ifififmati6n'whict,can-alerf(li6toNvnWjossihlq conflicts of interest�and allow it to takewhatever'action'i necessary to avoid same. YOUR NAME: (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 t person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building ' Variance Trustee Change of Zone Coastal Erosion Approval of plat - Mooring Exemption from plat or official map: Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a.rcladonship with any officenor employee of the Town of Southold? "Relationship"includes by blood,marriage,or businessihte"rest `%ifu iness interest'means a business, including a partnership,in which the town officer or employee has even a partial;dw„be'rsitip of.(or employment by)a corporation i in which the town-officer or employee owns more than 5%of the shares. 3 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 j 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): r A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 3 loaf I `' 200 11U Signature V'h� Print Name Form TS l Town of Southold LWRP CONSISTENCY ASSESSMENT FORM t 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;•oaeh.nnsiveir-must b&,eXplaiitAedig detail;,••li'tine•,botN-supportii iz and,now, supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. { • C 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 4 SCTM# I 1 PROJECT NAME ell—f``"" The Application has been submitted to(check appropriate response): Town Board ❑ Planning]Board❑ Building Dept. ❑ Board of Trustees ,I-1 1. Category of Town of Southold agency action(check appropriate'response): t. (a). Action undertaken directly by Town agency(e.g. capital �❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: n ��� T�•�e�g°�^.}rte - 0 L.-.r t1 I n Location of action:_. 1600 Site acreage: Present land use: 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: (b) Mailing address: (c) Telephone number: Area Code( (d) Application number,if any: . Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes E` No"E.!`; If yes,which state or federahgeucy?= 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. 0, Yes EJI 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—Poli ies Pages 3 through 6 for evaluation criteria ,13 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—ZApplicable Pages 6 through 7 for evaluation criteria Yes 10;No 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 S through 16 for evaluation criteria o ,Q o' 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 ` I Yes..E] 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. El D 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 3,4 for evaluation criteria. 'R Yes ❑No E Not Applicable s 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 ElNo Not Applicable S 1 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. nn 'Ej 40 No U Not Applicable Attach additional sheets if necessary t ( F WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations;Not WRP Section III•—Policies; Pages 47 through 56 for evaluation criteria. M Yes ❑ No 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 shee is 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 2Not Applicable - a Attach additional sheets if necessary4 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 E Not Applicable PREPARED BY 0'3 j 'i/��S E�C� TITLE 9 "' DATE /'? 7014 To: Town of Southold May 5, 2016 Board of Town Trustees - 54375 Main Road, PO Box 1179 Southold, New York, 11971-0959 En From: Jacob &Jill Kubetz DI 1600 North Oakwood Rd, Laurel Re: Administrative Permit Permit to Trim Phragmites Dear Board Members, Attached is our administrative wetland permit application. Also included are copies of the survey, site plan and photographs. The property is currently under construction pursuant to Trustee permit 8717 issued December 16, 2015. The new residence will be 1,940 square feet and the existing barn is 617.12 square feet and neither will be affected by this phragmites permit. We are requesting this permit to trim the invasive phragmites. Currently the phragmites grow from the edge of the high tide line and spread landward in varying depths, and are approximately 6 to 12 feet in height, and grow along the 172.45 feet of creek frontage. Our proposal is to trim by hand the phragmites to no lower than 12 inches. Attached are four photographs and a survey labeled "Photo Key" showing the direction and location of the photographs. Photographs 1-3 were taken in late April, 2016, and number 4 was taken in the summer of 2015 for reference as to the phragmites in full bloom. Our hope is that trimming will encourage the growth of native, non-invasive species, and also improve the view and character of our residential property. Also, in the limited time that we have been on the property,while the house has been under construction, numerous birds can be seen nesting, eating and frolicking in the areas across the creek free, an area free from phragmites. We hope that an additional benefit will be that wildlife will return to our side of the creek. We are seeking a ten year permit to trim the phragmites. Please contact me with any questions, or should you require additional documentation. Jacob T. Kubetz SURVEY OF PROPERTY SITUATE S s8°ss LAUREL �O ,10 50 .6� FpP�2�N 3S_8),? TOWN OF SOUTHOLD t1 g,A A S LA A i SUFFOLK COUNTY, NEW YORK FE�2 N S. C. TAX No. 1000- 127-06- 10 SCALE 199 .�yP // 'pL y�,F 2_➢c / / Sym � � OCTOBER 15, 2014 cE I SjoGKPo� N v N➢cam a '�j FRPME \ , AREA = 36 761 sq. ft. oN G / ���� �� \ (TO TIE LINE) 0.844 ac. F AGN �P GONG GPZ STEPS \ 6 of GSE \ NOTES: 2a 129 �a ReRG�16Rg 1 . LOT NUMBERS SHOWN THUS: LOT 50 REFER TO o cos / MAP OF LAUREL PARK M N'02 i GONG' FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ��o�o�SE sjE95 / 2\ ON OCTOBER 5, 1925 AS FILE No. 212 FRP v\ CER TIFIED TO: JACOB T. KUBETZ Z I I� / 0 GE�VPNGE 9 JILL P. KUBETZ LOANDEPOT LLC L9 TELLUS ABSRACT, Inc. STEWART TITLE INSURANCE COMPANY, Inc O J \ N3 0 0_1 s a0 i "a-v, � JO ?a\ oT �9 \ MAY - 6 2016 Al FEgN• e J� ,i {C ii� \ y 1 Board f Trustces O1,0TA �0 OF o IA Ns PREPARED IN ACCORDANCE WITH THE MINIMUM STANDS 6g BY THE L.S TITLE Vf-&YS A�SNDSADOPTEDD FOR SUCH USE 7�IEV¢ R TATE LAND TITLE ASSOCI N_ !; A � � 0 o L o AS.P A I DRIVEWAY �� �• �� � , a o O � � N.Y.S. Lic. No. 50467 moo, t M UNAUTHORIZED ALTERATION ADDITION Nathan Taft Corwin iii p to' �/ � TO THIS SURVEY IS A VIOLATION OF A"7 fin/ 00 SECTION 7209 OF THE NEW YORK STATE � A7 _ q EDUCATION LAW. vCOPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor 0 THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S. ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S. IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys — Subdivisions — Site Plans — Construction Layout LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI— PHONE (631)727-2090 Fax (631)727-1727 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. OFFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHT OF WAYS 1586 Main Road P.O. Box 16 AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 35-047