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HomeMy WebLinkAboutTR-7685A i James F.King,President O��guFfO(�CO Town[-call,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �� Gy P.O. Box 1179 Dave Bergen h Southold,NY 11971 John Bredemeyer 4 h• Telephone(631)765-1892 Michael J.Domino y�0� � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: � Jill M.Doherty, President �*0f SOUJyO Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 James F. King Southold,New York 11971-0959 Dave Bergen John Bredemeyer �Q Telephone(631) 765-1892 couffN 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 1 st day of construction % constructed Project complete, compliance inspection Jill M.Doherty,President \\OF SO(/Ty0 Town Hall Annex Bob Ghosio,Jr.,Vice-President �� lQ 54375 Main Road ,New Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G John Bredemeyer �O a� Telephone(631) 7654892 ly`,oU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7685A Date of Receipt of Application: October 11, 2011 Applicant: Joseph & Julia Vergari SCTM#: 115-5-18 Project Location: 5855 New Suffolk Ave., Mattituck Date of Resolution/Issuance: November 16, 2011 Date of Expiration: November 16, 201. 3 Reviewed by: Board of Trustees Project Description: To replace the existing deck in-kind using untreated lumber on the decking and railings and remove existing 6'X 20.7' section. 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 indicated on the site plan prepared by Ira Haspel Architect, P.C. dated October 5, 1011 and stamped approved on November 16, 2011. '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 isnot a determination from any other agency. VA Jill M Doherty,ebeeside Boa of Trustees J Jill M.Doherty,President �*0f SUUryO Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 James F. King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer �� �� Telephone(631) 765-1892 I�COU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: � Please be advised that your application dated l 0/ 11 11/ has been reviewed by this Board at the regular meeting of J 11 11 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 st Day of Construction ($50.00) '/ Constructed ($50.00) V Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set.forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ E0 "()o BY: Jill M. Doherty, President Board of Trustees OSUFFQ(,�. Jill M Doherty,President Off' CQ P.O.Box 1179 Bob Ghosio,Ji,Vice-President Gy Southold,NY 11971 James F King Telephone(631765-1892 coo Dave Bergen ,y Fax(631)765-6641 John Bredemeyer Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: — 1 JULIA & JOSEPH VERGARI request an Administrative Permit to replace the existing deck in-kind using untreated lumber on the decking and railings and remove existing 6'X 20.7' section. Located: 5855 New Suffolk Ave., Mattituck..SCTM#115-5-18 Type area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: _L&hapt.275 Chapt. 111 other Type of Application: Wetland _Coastal Erosion _Amendment Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: Doherty B. Ghosio J. King D. Bergen, J. Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: 10-,o-tro �— �-- 1106n(c sc"'ws'" ,02 � EMacMu GREENPL3n, �1 11636 o' 6 62 t9A(cl.x a •',3? 14$ 1 l^ 11 $B i2$ O O' '1 111 1T0-0x i 02 Al Uie O a 0 A 5 ? g Ig 132 1$ Nsta63 I, 21 mT 2 3 .$a 6 ,e1 3 b 16 4A(l) ) 11 s63 x� W. �I xMxrsi tl& t5 19P11- em wm n 'wB w 'n ) 1 pm5.2S008B mG 13-$14 $ ga-Wmo ,8*--H_ ,1Alc) ] m o9-e}w O y R - �,. __ .,�•°• ., t 3AIc7 �S 9 E n� zz a b 9 SR 25 NNgpf � mj9 ag w5 Eg �y 5 r hm OS12 t0 , 9 s 6,1 OBa $ B � Y p m _ 2]9AIq O e6-x618 � • 5 g �B a N m TA A b <°M $3. q ¢z p $a oE'pv LE owEovmplo � a t 4 .r.B ¢ 12 � 22 r• a 9 A 23 T aMb ,pvMt Of 68utWta 9 m 14 -5'm$ 3211 -n 24 9A1EA- 131 E7 0 ee H IS 9 N 1 \lgfRipnox- 'g 311 $ 13 �I MARWTOOKA 1�¢) c y3 4 $ - tri 3BAlc) SUFFOLK '12 Sc¢ wl tT26 pa tin °\� LAKE t0] i mn u ¢ t ,1 g $ 30 m 11A(c) 3 n. 104 9th of ion g,bNc) '3g 31¢ s ,0"" " u BP n NEW 26 R1 5�¢ a, tt, m111 o I Yl]A(c7, 19 I.m m n m•9,7D`l1 � 2¢ ePA• T OF60CTHOm a 311 m T29 O 301 311 i 2 m$ala p 23 .n 25 �O W�(t5 .p TOWN OF 13A SUFFOLK O u ,i4c) �] M3AIc1 FOR FARLELNO OR tSAIN _`f Ex 5H E9 t: •� ' , �',8° a 11 t�15 18 m �3$T ' ,m,'01 n`,t,6 �@ 6 1x}01-0022 4 z' xx 13 $ � '15"9 � , 12 ♦o y, g n� B � m ¢ 0.1 5 x1 20 � x 15 14 g9 '° $ ° `� s2 �� • x P a w n,10 13A514 P 11 Oeeo xon Beet .'L�l m FOR RARLELNO _ FOR PCL NO 6 SEE SEC CVNO a 26 FOR PCL NO �� OR �9 8 13x b m W r 3 a 6EE 6EL NO e - 122 OS004 � 2TA(cJ SEE 6E0 NO i k r ��' 123p}O2a xrot¢ezs¢ESEt NOt — ---'�'---- ----- ----- —�.. ,+n nwrcn a a �" `y am �' x ,m a ;A 1g e v e u''R LINE ' MATCH 6EESEC N0123 i1 'p OFFo ,5c - _ t,t - m'1 ¢ 12 - �1Nle Sid „MOLE n OW Np tzagsme b COUNTY OF SUFFOLK © K �° SOu1HOLn SECTION NO NOTICE E uO¢or R,) .. 2 °'°'"' --°--_ p,-- GIN Rea.....ProyTalc Servicegency�0'' O °' P tu¢t xa 1006 PROPERTY MAP o°.mp n nw Jill M.Doherty,President q Town Hall,53095 Main Rd. James F.King,Vice-President cog P.O.Box 1179 Dave Bergen �,},, �► Southold,NY 11971 Bob Ghosio,Jr. Telephone(631)765-1892 John Bredemeyer Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application —A Administrative Permit U _Amendment/Transf r tension u Received Application: Received Fee:$ e_ _;' OCT 1 1 2011 Completed Application 111 1 11 _Incomplete _SEQRA Classification:. c Southhold Town,I Type II Unlisted Board of Trustees _Coordination:(date sent) v*rWRP Consistency Assessment Form CAC Referral Sent: 6ate of Inspection: _Receipt of CAC Report: Lead Agency Determination: Technical Review: 1�u—blic Hearing Held: (Q Resolution: Dame of Applicant—J u j 1 a- P 5, r ri c Addres� 5955- N ea 15L't-40 (C A G7 61-ff,-fvac- N� D9 P 0 e*)C 1-7 &C-0"« Phone Number:(q6 S I®- N tLJ Vo-11- 1 1 i q55 _ Suffolk County Tax Map Number: 1000 - i 1 t) - 5 " f 8 Property Location: 5 OV5S- �JE w &Lt F17-70 Z,4 #U ff /h 14-M wcx � PuL/ (provide LILCO Pole#, distance to cross streets, and location) i AGENT: (If applicable) I Address: , i f� Phone: I i Board of Trustees Application- GENERAL DATA Land Area(in square feet): ' . & 130 A G 09 Area Zoning: `R, L'®` Iii Previous use of property:_ r%yaJe Intended use of property: r-y o m"e Covenants and Restrictions: Yes No If"Yes",please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes No If"Yes",please provide copy of decision. Prior permits/approvals for site improvements: Agency Date N'Dpjg No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or susper ed by a governmental agency? ,�' No Yes If yes, provide explanation: Project Description use attachments if necessary): 1 u�► ����, � Lw m bee-. i Board of Trustees Application r - WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 1o114-ce -ex ' Jec k In knC . 9ZeM014a o QP15 +1KC (off` K ZV.'71 Cor+SFruc ►anr-,. Area of wetlands on lot: , 01 L square feet Percent coverage of lot: '9 0 . 611 % Closest distance between nearest existing structure and upland edge of wetlands: 2 y L4 feet Closest distance between nearest proposed structure and upland edge of wetlands: 2--4 ,q feet 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): - � t PROJECT ID NUMBER 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL.ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME Uc.fA 40%pal vow,( Re5t0EA( c6- 3.PROJECT LOCATION S$S S NEV✓ SN FFOGK 4v Municipality 44 A—M—/ T7/C•r— County ,`j tit Pr—o L� 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 5 8 u P—F-o&le ,4 t1c- IiA.4- r'r/ ill c-x � Z- 5.IS PROPOSED ACTION ❑ New ❑Expansion I V1 Modification/alteration 6.DESCRIBE PROJECT BRIEFLY- I �j C4 o Qze f Ietc e CCuslst��5 ec (� Iv, 1)O,Vn Q,3x c3, a 0%c, c-+ et r +1 •� m v Ir�e � re #-wt �2wtov...,1 7.AMOUNT OF LAND AFFECTED. N Initially acres Ultimately acres &WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? MYes ❑ No If no,describe briefly. t 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) Residential ❑Industrial ❑Commerc al ❑Agriculture []Park/Forest/Open Space ❑Other (describe) 10 •DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑ Yes ❑No If yes, list laTl agency name and permit //approval: :5 o6l� hl'-' 1--o /I% "' ' 4' lmrAe4,- and iy HAVE A CURRENTLY ,VALID PERMIT OR APPROVAL? ®Yes No If yes, list agency name and permit / approval ---�- -- -� -C-✓ ail G e a - e - -- -C r g-�F� c 4c E° --- - C er / 121 AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? es ❑No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor-Name , J4 til,4 16el Date- Signature a I If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment r { OCT-05-2011 12:08 FROM:WICKAM PPP�9LER 631 298 8565 T:^-•7551991' P.00i/001 � il�l<'HPaL� �11i+1 �M S�M tc�* LS MOMN.Y. cS1MFICATIC`6F O IJIP �d �t k1{I ,fir 4/ �Jy'�� pyo 6 1 I,Q •^/r f■ ... r.,1,!!! 7.10 ""--,,.e.............ftt­14....... x......., !9-0 THts RT1Pim tw owo bu,ldrnQ icwad'it - INVO.-. ft)k AMg-•.... . Woof 4 Map No .. .,...,.....! black Nm4 ...j:C=.......... Lot Na .. .......l,J#4 1: 1�u�I�S.«., ,d�.aG+........ conforphs idbstonuaity to tfis Appl,catich fo dOldiry Pifrmre hrPtrofore filed in Haig +s4Fic+e dated y ;- ..... .,..,.,�, jt r purfypnt to*?$Ich kSIJ,{dSnQ Permit NIM ........ ............,.l.,. , •���$ �. dated..,...... ,.,.,,�„.......” �,,.... ...� ,. 19.,i. If 5, was issued,and cortfra�t 19k all of this tRqurrBrnants of the applic4lbFe pmos,vnf of 1!•►e Sow aiempancy for vmlg H thra wettfrCate is 1114.m1pa ie ........ t�1d cartffatlate m Istund to al.l.w4wa��i -I+wKT ...... ........ or ..,.", ............ .r.... 1. ��(ownrrr, liea't or fiieuanqy.• t of iha ahtfolmij bU111146140. �r 34t �'.9i�i3ii/ V 'Ar.V192EL 1....,.,..lr:...:...:1,....�.„1...... ....,!",".1.................. i'3urhd1rQ9 Inep r . B�5� xE9 ;�S,ixQltr�� S11tThl ` wa SS fib. �'Q X34 St1FFQ Town of Southold bO ,f J g Erosion, Sedimentation'& Storm-Water Run-off ASSESSMENT FORM ; PROPERTY LOCATION: S.C.T.M.M. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN 6ishici c�'cnonBlock— Tot — CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. I SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? (Include Total Area of all Parcels/opted within I Will this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Construction) 3 ' &re 5 Generated by a Two(2")Inch Rainfall on Site? 1 his item will include all,run-off created b site (S.F./Acres) y b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all F4 and/or Ground Disturbance for the proposed N',((. Site Improvements and the permanent creation of construction activity? impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT' DESCRIP'T'ION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and — R tLto I C,C e GX S 15+r n c, 4.e C,l� Slopes Controlling Surface Water Flow. l r+ 3 Does the Site Plan and/or Survey describe the erosion ac,vh -5+r UliE V rX Uri S+-x 6 le yinci and sediment control practices that will be used to control site erosion and storm water discharges. This 6L I 4�_a no, d.pyl t ati d-tf ^� item must be maintained throughout the Entire Construction Period. !f i Cq wt re p�t:ryto Ila O 4 Will this Project Require any Land Filling,Grading or /�w r, Excavation where there is a change to the Natural M lJ )G Z� •' G c Y>S 4'r�Lfi r, Existing Grade Involving more than 200 Cubic Yardsj� of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand ED( (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the r--- � Site? Is this Project within the Trustees jurisdiction I�L�3 General DEC SWPPP Requirements: or within One Hundred(100')feet of a Weiland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; Including disturbances of less than one acre that7 Will there be Site preparation on Existing Grade Slopes j are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to F L[ including Construction activities involving soil disturbances of less than one(1)acre where the DEC has determined that a SPDES permit is required for stone water discharges One Hundred Fifteen Of Horizontal Distance? (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious Elfor Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the NOT.The Not shall be into and/or in the direction of a Town right-of-way? j submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any ❑ — constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the tea?(This Item will NOT Include the Installation of Driveway Aprons.) If quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre In area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Stone Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark(.►)and/or Answer for each Question is Required for a Complete Application) i SPATE OF NEW YORK, COUNTY OF S LA o...................�L `Mom�f .....being duly sworn,deposes and says that he/she is the applicant for Permit, That I................�.. .................................... (Naual signing Document) Andthat he/she is the .........Q�VA-k�.r.................................................................................................................................... (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth'in the application filed herewith. Sworn to before me this; I ..................JI.............. .......day of...l?(.., ..................,201.1 I NotaryPublic: ....... ............... ................................. .......... ......:.........••....... (Signature of Applica t) FORM - 06/10 Notary Public,State of New York No.01 BE6099317 Qualified in Suffolk County I lrnlssion Expires Sept.29, 1 t `,:oard of- Trustees Applicat-'_.I County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFM),141HAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S)JO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION Signature SWORN TO BEFORE ME THIS 1 DAY OF D CA- ,20 J Notary Public PENNY BEDELL Notary Public,State of New York No.01 BE6099317 Qualified in Suffolk County Commission Expires Sept.29, oZy I S APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to Rrovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: VC R-&A Rt j u i,1,4 (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee ✓ Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other,name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest_"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%' of the the shares. YES NO "' If you answered"YES"',complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thisay of C)C jD 6C 2041 Signature i&A4?,0 ,- Print Name W t t ,- Form TS I Town of Southold 1 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# 100 Q - - IS PROJECT NAME G0-&A P- 5 idenc e The Application has been submitted to (check appropriate response): RVI Town Board ❑ Planning Board❑ Building Dept. And Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval, license,certification: LEN Nature and extent of action: k► +�=e.rvly'V�ca'L \ 0-� .(D � � ZO .7 A C4 r,S•��oo,-�a-o%.• P � J S N EW Slot*- AC:5c M+ ' Location of action: r-/nJcle-- Site acreage: 3,. (a6 A L n 5`; Present land use: 12 — q® te 5 t d 4- f 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 ❑ No 4M 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 L' Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of in makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria Yes 11 No NW Not Applicable I Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout .the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria F-1Yes ❑ No � Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No X Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ONot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not App: ble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substanees and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No Not Applicable i i Attach additional sheets if necessary 1 ' I I WORKING COAST POLICIE1 Policy 10. Protect Southold's water-dependent uses.and promote siting of new water-dependent uses m suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria: ❑ Yes ❑ No 21 Not,Applicable Attach additional sheets if necessary 'Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ NoNot 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 It Not Applicable - I • f I PREPARED BY A t I/ ATITLE DATE i I A l f� Julie &Joseph Vergari E C 15��y� 3 Wilder Lane Huntington, NY 11743 1�, ! 1516-510-5214 ;' OCT 1 1 2011 Squthhold Tom October 11, 2011 Board o£Trustees Re: Residence-5855 New Suffolk Avenue Mattituck, NY Dear Trustees; Thank you for accepting my application for the above residence in Mattituck to replace the existing deck.,We have searched for over a year to find the right place to move our family and finally we did! In making the decision the right amount of privacy, natural beauty and a well built home were all on the list. The location is perfect and the house of course needs some updating, being built in the 1960's. It seems the previous owners just summered there so a lot of things were not maintained properly. After hurricane Irene hit some trees came down, and the deck,which had a lot of rot, partially came away from the house. Not realizing we would need to file any type of permits we removed the deck in fear someone might get hurt. We also removed some down trees due to Irene's wrath (it was a war zone). We a,re,not looking to expand the house just update its charm and make it safe for our family. We are excited to be a part of this beautiful town and raise our family. We have started our youngest in Mattituck Jr High School and we both work locally and are looking forward to being settled here soon. Thank you again,we are available tomorrow, October 12, if you would like to meet us sooner than next month... Julie &Joseo Vergari I t I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I SURVEY OF PROPERTY 51TUATIE: MATTITUCK TOM: 5OUTHOLD 5UFFOLK COUNTY, NY SURVEYED JUNE 15, 2011 CERT. REVISED JUNE 21, 2011 1L 1 L SUFFOLK COUNTY TAX # LOT 4 Ref Suffolk r 1000 - 115 - 5 18 Rer-reotlon Ou D--pt. of I Ond"ponser,otto, CERT MD TO: JOSEPH VEGARI B82053'.501 JUUEVEGARI 3 AQUEBOGUEABSTRACF Cmp. FMST AhMRICAN T= flr ................................. INSURANCE COMPANY LOT 42 X' t'f' � i/ /n0 0 0 ® i I\ IT) to j LOT 45 z CL 0 0 E v 3— V open meter N56>006>I00IIU) --------- ------- 0152 Of < easement� drainage m 0 La c � Ditch06 - m 165. 0 -N82 053 2.009 T\ OZ-v EE 73 U S ig 0 "Y I� 9 n LOT 44 x ' cin _ '�9� �\4 � � ��\ �I 1 11 � � O o ro� � \� � �� rnr \� d� Lril LL + LOT 45 n) \lk 0 Ire MON. N820,53 1-939 DRAINS p:R 92 50 R -ke 1�61� I s 1 1-4 "s WATER N05019'3(0' L"I"j" , ME-TER 0 'LLAFR 550.Go, N88008 /,F 737.62' 69-21 A-Al, Avena(e, Cut r I s(3)111 OF NEw C. E 'ul utholl-d Itt"It-or Idditlo,to a survay 71— ,I. wr e,CO I _eat le 61 1��,lb-di-ldl me York 5-1 E—atbn L—' '0,1y,Oplthe 11 wrvey "'I'd wlth V——1-1 of the land st—p.d-Il shall he--lde-d.be—1.tree NOTES: 1-11,�II—I'lle hereon -Vt=�111, dl�g Cd-If pZtl-for L-d�—qs adopted FLOOD ZONES REFERENGE FIRM MAP NUMBER 36103G4e)2H by the�,Y,,k State A_1d,_of F"f_111-1 L-d — r. -1. shall,, l� to Ne person for _,eq 1Ped LAST REVISED SEPTEMBER 25, 2001 —d-lls behalf to'7e title—.p— NU .1"1-, ll�te9d,hereon and t,the I-—If the leldill Ge,tlf— 'Id"are _t transferable to adddld,.l InstlWtlons ■ MONUMENT FOUND GRAPHIC,Area = 15cf0sq. FtGRAPHIC, 5GALE 1 50' JOHN C. EHLERS LAND SURVEYOR Area = 3.6650 Acres F-1 6 EAST MAIN STREET N.Y.S.UC.NO.50202 w7m, W.73 r MIF= RrVERREAD,N.Y. 11901 369-8288 Fax 369-8287 0 50 100 150 REF.-CAUsers\John\Dropbox\l l\11-134.M 11 44�- I`/2 ± - - 4 4�- I1�2 + L T- —- -- - - - - rI ii a eF o Ii I I v I _, 126/�GRCEME/JT AEc�i t� -k- Co x �, I {I 1416 DECK/NG I - 3- 2�g - - -- - - - - - - II , I ii OF Taj�'rra TOWN OF _ 4"C6 POST ovf-� i — . Z cov. DEVOW CTY P.) DATE 4 4s - EX tST. r4A-f R00 M r � ;O ��... EX15T. t�ESIeEnGE - � 1 , i I I t 10 q Ln ` O tV III _ 2�a AOa - - I( I @ 1G%' 010. A-1 A-1 j � "4xq- �STEEL COI„ w�4 'i2 ><a A.13. i I I( , r't' - Ex 1ST. dTII•ITY _ I - v I i X.A. Ta G O,D E - c- I- - ----` 2� 1 01CT 1 1 L011 1! 4U --9- 6 • 4'/2 (TYP,� „ R�I'Ib✓� exis7- �R – _ .--- - wooer Col., ?tel'' 24�� CON C, F TG sHE,4THIN G .. t 8 � X 4.2x4 LrrP) I .�L� Ex.sT. /OvF33 - I I �/NDo w5 - - - - J 5/4 I REMOVE E�c i s r 6'x 20,7 1 I ' GpNST/2UCTlO/1' — I 3/47 6 LET-IN RAII E15. { QYJ I ,I // �' � I 11 �LA_1J ...<-. 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