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TR-8948
Michael J. Domino,President r3F SO(/py Town Hall Annex John M.Bredemeyer III,Vice-Presidenth®� �lC:� 54375 Route 25 P.O.Box 1179 Charles J. Sanders Southold,New York 11971 Glenn Goldsmith G w ® � Telephone (631) 765-1892 A.Nicholas Krupski O a Fax(631) 765-6641 U Til BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1379C Date: August 15, 2017 THIS CERTIFIES that the removal of 102 linear feet of existing bulkhead and 6' return and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 6"above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell• and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead,• At 2100 Ole Jule Lane,Mattituck Suffolk County Tax Map#1000-122-4-8 Conforms to the application for a Trustees Permit heretofore filed in this office Dated December 2,2016 pursuant to which Trustees Wetland Permit#8948 Dated January 18, 2017,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 removal of 102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 6"above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell• and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead. The certificate is issued to RYAN &CHRISTINE HARPER owners of the aforesaid property. Authorized Signature r- a �QF SOuj'z° Michael J.Domino,President Town Hall Annex O� Ol0 John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders y Southold,New York 11971 Glenn Goldsmith ® yon Telephone(631) 765-1892 A.Nicholas Krupski o?e' 0' 0 I1 Ty�� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 0/1g/I Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: y B u, d'� ►n o,ccv�o�ccs.Cz ,.�:�6-, �e�r�: � . CERTIFICATE OF COMPLIANCE: March 24 2017 � D MAR 2 8 2017 Town of Southold Trustees Town Hall Annex Building BUILDING DEPT. 54375 Rte. 25 TOWN OF SOUTHOLD P.O. Box 1179 Southold, New York 11971 RE: 2100 OLE JULE LANE - MATITUCK, NY SCTM No. 1000-122-4-8 COVENANTS Dear Trustees: Attached please find copy of filed covenants for the non-turf buffer for the above referenced property. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 Cc: Harper o CC# : C17-11252 14 COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in my office on 03/21/2017 under Liber D00012905 and Page 215 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 03/21/2017 SUFFOLK COUNTY CLERK (;7-c�(z Q. 41-�� JUDITH A.PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Recorded: 03/21/2017 Number of Pages : 5 At: 10 :25 :56 AM Receipt Number : 17-0047084 LIBER: D00012905 PAGE : 215 District: Section: Block: Lot: 1000 122 . 00 04 .00 008 .000 EXAMINED AND CHARGED AS FOLLOWS Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $25 . 00 NO Handling $20 . 00 NO COE $5 . 00 NO NYS SRCHG $15 . 00 NO TP-584 $5 . 00 NO Notation $0 . 00 NO Cert.Copies $6 .25 NO RPT $200 . 00 NO Fees Paid $276 .25 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County 51 51 RECORDED 2011' tsar- 21 1-0.25:56 AM Number of pages -� .JUDITH A. PASCALE CLERK ��F SUFFOLK COUNTY This document will be public L D0001205 record. Please remove all P 215 Social Security Numbers prior to recording. Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 FEES ]Page/Filing Fee Z 1950 Mortgage Amt. 1. Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-52 17 (County) Sub Total Spec./Add. EA-5217 (State) TOT.MTG.TAX Dual Town Dual County — Held Held for Appointment Comm.of Ed. 5. 00 � Transfer Tax Affidavit �`' Mansion Tax Certified Copy The property covered by this mortgage is or will be improved by a one or two NYS Surcharge 15. 00 �� Ssfamily dwelling only. Sub Total 2 YES or NO Other Grand Total Z-7 0, Z�' If NO, see appropriate tax clause on page# of this instrument. 3 9��e'► 4 Dist. 3354545 1000 12200 0400 0080oo 5 Community Preservation Fund Real Proper p T S Consideration Amount $ Tax Servic R LPA , III��III�IIIII����III Agency 20-MAR-1 CPF Tax'Due $ Verificatio Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address a RECORD & RETURN TO: Vacant Land TD %6 to w)tt ;6)vd .0 TD 0, cJ%-0s, TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name www.suffolkcountyny.gov/clerk Title# g Suffolk CounLy Recording & Endorsement Page This page forms part of the attached ILA/� made by: I (SPECIFY TYPE OF INSTRUMENT) JA, p0b IM W The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of m M+4U Pon C j�� a�r In the VILLAGE (^� t� B_ 1 L'21-5- or HAMLET of S�t�40[j BOXES 6 THRU 8 MUST BE PED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12-0104..10108kk (over) 0 1 - DECLARATION OF COVENANTS THIS DECLARATION made this day of /L1,�/Zloi�� , 20 (77-, by Ryan Harper- & Christine Harper, residing at 343 '6t"' St. Brooklyn, NY 11215, hereinafter referred to as "DECLARANT (S) ": W I T N E S S E T H WHEREAS, DECLARANT (S) is/are the owner(s) of certain real property located on 2100 Ole Jule Lane, Mattituck, Town of Southold, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 122, Block 4, Lot 8 which is more particularly bounded and described as set forth in Schedule "A" annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval of the Trustees prior to being conducted; WHEREAS, the DECLARANT (S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a 10' wide x 90' long "non- turf buffer" adjacent to and landward of the bulkhead; o NOW, THEREFORE, the DECLARANTS) do/does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be established and subsequently maintained 10' wide x 90' long "non-turf buffer" as defined by Chapter 275 of the Town Code; and as depicted on survey/site plan last dated January 22, 2017 and stamped approved on January 26, 2017, see Exhibit A attached; and 2) These covenants shall run with the land and shall be binding on the DECLARANT(S) , his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a public hearing and upon resolution of the, Trustees. N WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this I day of �� 20 3 OWNER'S IGNATURE OWNER'S SIGNATURE STATE OF N y��C Ss: COUNTY OF 1 On the � day of �� 2�I in the year 201-/ , before me the undersigned, a Notary Public in and for said State, personally appeared 2 f A*-j personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity, and. that by his/her/their signature(s) on the instrument, the individual or the persons on behalf of which the individual (s) acted, executed the instrument_. Notary Public A.AYKMTEL NOTARY WaiC,STATE Cf NEW YM I. QlyWRED IN TONGS COUNTY REG#0IPMI&%54 4�a` MY COMMISSION EXP.001/4018 3 i Fidelity National Title Insurance Company TiTLE NO,F16-7404-102223-SUFF SCHEDULE A-1 (Descriptioli). Amended 08/09/2016 ALL that certain plot, piece or parcel of land, situate, lying and being in the Town of Southold, County of Suffolk and State of New York,known and being more particularly bounded and described as follows: BEGINNING at a point on that course of the Westerly line of Ole Jule Lane about 1650 feet more or less Southerly from New Suffolk Avenue, said point of beginning being the Southeasterly corner of land now or formerly of Andrejack and Northeasterly corner of premises conveyed herein and then from said point of beginning; RUNNING THENCE along the Westerly-line of Ole Jule Lane South 03 degrees 03 minutes 20 seconds East 80,00 feet; THENCE along land now or formerly of Boera North 83 degrees 25 minutes 40 seconds West 200.80 feet to a point; THENCE on a tie line course North 14 degrees 03 ininutes 20 seconds West 90.00 feet to a point; THENCE along land now or formerly of Andrejack South 82 degrees 02 minutes 10 seconds East 220.34 feet to the Westerly side of Old Jule Lane at the point or place of BEGINNING, TOGETHER with a nonexclusive Right of Way ovor a certain 25 foot private road leading from Southerly line of New Suffolk Avenue Southerly to Peconic Bay. 7HE POLICY TO BE ISSUED tinder this commitment will Insure the title to such buildings and Improvements on the premises which by law constitute real property. FOR CONVEYANCING ONLY, Together'Pith all the right, title and Interest of the party of the first part, of In and to the land lying in the street in front of and adjoining said premises, .'= •Sf KED ULE A•1 Dexcrtplion) ~ OF S�(/r Town Hall Annex John M. Bredemeyer III,President �� /y0 Michael J.Domino,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Q Telephone(631) 765-1892 Charles J.Sanders �OOUN'f`(, O 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/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection ------ -- - -- - - - - - - - - MAP OF PROPERTY - N SITUATE: MATT I TUCK TONIN: SOUTHOLD SUFFOLK COUNTY, NY W E SURVEYED 05-0I-2016 SUFFOLK COUNTY TAX # 1 S 1000 - 122 - 4 - 8 CERTUMTO; I I I RYAN HARPE j C1EIDMT `lam HARPER FO EI[.M Y NAMNAL TIlT><B INSURMCE SERVICE3,]LLC. 1 Land now or formed i Jacqueline And y of: John Jack o I Andre�'ack BFIQA,D 1.T N, � 1 yy�21® EZ t i ®Lf s r� FE.I$N. s� shed 1� 98' ° PE ON P/1. �� 1 `® �11 i 185' 90S' O b Frame N ai' i N deck m14 N O N N 0 �r rams p Ir (� in! v���71 I conc. 16.6' a W 1' L4 1 i FE a,�� N s l D EC - 2 2016 I{I 1483026940 19 FE'I'N pp//''�� Southold Town °OV9Board of Trustees Land Susanne f ormerl of: Andrew L.oera Boero ` I 'Un•thor!!Ao altarotlon or Damtlan to a ewroy lcl�l04 metlon ift sub-41199sion S ofAtho Noy Yate noft peueatlon Lm.' 'an]p taalN frau tN aMNNI Df tMa VAN" oareea aleft N orlalNl Df tN lem3 arWayor'a atemea aNl bull De eonale.pae to pa valla tru - eoplaa' 'ON'tlHeetloN lnmat'a Nrean alpmfy tD't Me aw wD Praearaa In aeeo'A rite tN N- i NOTES: latuu'X of Pratt,"far LNa sY»pa laoptN i i by tN Ibr Yate Stet.ANDelegml op i9'af.M= Low Gurvvoyara. Bala eartlfleatlona aaua ran DNy to t"p'paan for lelall t110 auvmp la praDar'4 .0 an Ma U Nf to tN tltla CO�Dny. Dararnln- AREA TO TIE LINE _ = 1"1,156 50 FT OR 0.3q ACRES tD tl,,map Us:L@pIt bl=;t ; "q;,M tl'na w Nt tPaNfaroN.!a Naltfmml lanituefDna HOUSE IS IN FEMA FLOOD ZONE SHADED X JOHN Cr EHLERS LAND SURVEYOR I AS SHOWN ON F.I.R.M. 36103G0482H - 6 EAST MAIN STREET N.Y.S.UC.NO.50202 GRAPHIC SCALE I"= 30' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 R18F. %UwrsVohn\Doeaments\My Dropbox\16\16-175.pro i �S82•02�}0„E f A; PROPOSED POOL DRYWELL -a,,,r� I M PROPOSED CONCRETE PAVER PATIO �� ... 3' PROPOSED o I N GROUNDI PO 6'X3 , w ® L.. ^ 26' WOOD DECK O — — j EXISTING TIMBER BULKHEAD TO BE REMOVED no z o�` �� MHw & MLW ALONG FACE OF BULKHEAD /� c-4 ` O PROPOSED 10' WIDE NON-TURF BUFFER ' PROPOSED 102' LONG VINYL BULKHEAD IN SAME 24' #21002 STORY KRAUS • ee KLANE 1 ( LOCATION AS EXISTING DETERIORATED BULKHEAD FR. RESIDENCE 1i PROPOSED 6' LONG VINYL BULKHEAD RETURN IN SAME LOCATION AS EXISTING SHED 1e CONC. PATIO oo N83°25' 29 _ S o 200.802 `- -- � �` � - - AP,PROVED BY BOARD OF TRUSTEES, #21 1 R I . STORY TOWN OF SOUTHOLD FR. RESIDENCE �DA EC IV ED] �` PJ u17 7 JAN 2 6 2017 I PROPERTY OWNER: ' RYAN & CHRISTINE HARPER Southold Town 343 6TH STREET Boardf Trustees BROOKLYN, NY 11215 BULKHEAD PERMIT PLANTS SCALE: NOTES: PREPARED BY: 1"=20' JEFFREY PATANJO PROPOSED PLAN DATE. 1. SITE PLAN PREPARED FROM SURVEY PREPARED BY: I 106 HEWITT BOULEVARD 11-10-16 JOHN C. EHLERS LAND SURVEYOR CENTER MORICHES, NY 11934 12-30-16 6 EAST MAIN STREET RIVERHEAD, NY 11901 I 631-484-9332 2100 OLE JULE LANE 1-22-17 DATE SURVEYED: 08-01-16 JPATANJO@OPTONLINE.NET TTITUCK, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: MA PTAX YAP W0. 1000-122-4-8 1 OF 2 I I I - Tho Vll°q°Ce.sQ SFwr -' .._ •'i ktN ylin'k Arc+ - _ ° - �_- . a -, ,, ° s,,.� `�.,.p.-rte..', •o,: ,.,� ;._ _ LL ,, . .. , � sE lkia.Arm• - ..w.:_-„-.-.: °-.,.s.�.^:"""""" � y Krn,vl ftp.,. + _ n PROPOSED TOP CAP PROPOSED 5 CY CLEAN °"" SAND FILL LANDWARD OF PROPOSED 25' LONG 10" BUTT BULKHEAD CCA TIMBER PILE, 6O.C. PROPOSED CCA 3"x6" REAR CLAMP =a i APPROXIMATE M.H.W. EL 2.5f PROJECT LOCATION MAP — -------- 1 0 °D PROPOSED 6'x6” CCA TOP, MIDDLE & BOTTOM WALE ' j PROPOSED 8" TIP CCA LAY—LOG PILE APPROXIMATE M.LW EL. O:Ot PROPOSED 8" TIP CCA PILE, 6' EXISTING BULKHEAD O.C. 8' LENGTH, BOLTED TO IT BE REMOVED IN LAY—LOG WITH 3/4" ITS ENTIRETY. GALVANIZED THRU—BOLTS. ! t PROPOSED 16' LONG 1" DIA. ` \�/\�/\//\/ GALV, TIE ROD, 6' O.C. \\ NOTE: REMOVE AND REPLACE EXISTING D BULKHEAD IN SAME LOCATION AS EXISTING WITH A RAISED HEIGHT OF 6" ABOVE EXISTING I JAN 2 6 2017 PROPOSED 16' LONG CLOC 9000 VINYL SHEETING Southold Town TYPICAL_ SECTION A—A DoaW of.Trustees N.T.S. 1 - PMATTAX "EAD PERMIT PLANS SCALE: AS NOTED OPOSED SECTION & DATE: LOCATION ,SAP 11-10-16 � 2100 OLE JULE LANE ,-22-17 TITUCK, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY MAP NO. 1000-122-4-8 2 of 2 BOARD OF SOUTHOLD TOWN TRUSTEES M iq SOUTHOLD,NEW YORK :5 V A PERMIT NO. 8948 DATE: JANUARY 18, 2017 q ISSUED TO: RYAN & CHRISTINE HARPER PROPERTY ADDRESS: 2100 OLE JULE LANE, MATTITUCK SCTM# 1000-122-4-8 AUTHORIZATION D ursuant to the provisions of "hap, r 275 oF the Town Code of the 'r win of Southold and in . kA Ec LO accordance with the Resolution of the Board of Trustees adopted at the meeting held on January 18, 2017, and 14 0 in consideration of application fee La the sum of$250.00 paid by Ryan & Christine Hai-per and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits 1 the following: Wetland Permit to remove 102 linear feet of existing bulkhead and 61 return,and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 611 above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; o construct a 16'x32' in-ground swimming pool with dedicated pool drywell; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead; and 15 as depicted on the revised site plan prepared by Jeffrey Patanjo,dated January 22,20179 and stamped approved on January 26, 2017. �,lt..t � GI jai ( `x,V, -M, IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, 1 1 and these presents to be subscribed by a majority of the said Board as,of this date. Char es Jganders IN TERMS AND CONDITIONS The Permittee Ryan&Christine Harper, residing at 2100 Ole Jule Lane,Mattituck,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense, defend any and all such suits initiated by third parties,and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees,the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Pennittee is required to provide evidence that a copy of this 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. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 11. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. �pF SO(/j�, Michael J.Domino,President �O� Ol0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders G Southold,New York 11971 Glenn Goldsmith ® �� Telephone(631) 765-1892 A.Nicholas Krupski �+M Fax(631) 765-6641 BOARD OF TOWN TRUSTEES January 18, 2017 TOWN OF SOUTHOLD Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 _ RE: RYAN & CHRISTINE HARPER 2100 OLE JULE LANE, MATTITUCK SC T M# 1000-122-4-8 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 18, 2017 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of RYAN & CHRISTINE HARPER, applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated December 2, 2016, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application for for the removal of 102 linear feet of existing bulkhead and 6' return„and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 18" above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, the LWRP Coordinator recommended that the proposed application for the construction of a 16'x32' in-ground swimming pool with dedicated pool drywell be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered the Local Waterfront Revitalization Program policy to the greatest extent possible through the imposition of the following Best Management Practice requirements: re-locating the pool drywell landward; and, 2 �1 WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on January 18, 2017, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268 of the Southold Town Code, and, RESOLVED, that the Board of Trustees APPROVES the application of RYAN & CHRISTINE HARPER to remove 102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 6" above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead; and as depicted on the revised site plan prepared by Jeffrey Patanjo, dated January 22, 2017, and stamped approved on January 26, 2017. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Michael J. Domino, President, Board of Trustees MJD/dd ��Qf S®(��' Town Hall Annex John M.Bredemeyer III, President /yo Michael J. Domino,Vice-President '`� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® Q Telephone(631) 765-1892 Charles J.SandersyC4UN111 Fax(631) 765-6641 � �� BOARD OF TOWN TRUSTEES I u Qr TOWN OF SOUTHOLD TO: p TT2L&-%/ fk-1"YD Please be advised that your application datedDEC- 2 00* has been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project AvwF b� Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) '/2 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: TOTAL FEES DUE: $ Glib ` BY: John M. Bredemeyer III, President Board of Trustees f 0 r IVA. k^ 1 John M Bredemeyer III, Pres' t �0 UFFQ(,��o Town Hall Annex Michael J. Domino, Vice-Presidenty0 Gy�a - _54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A Nicholas Krupski o �,- Southold, NY 11971 Charles J. Sanders y,�j o� Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: G G© s►r Jeffrey Patanjo on behalf of RYAN & CHRISTINE HARPER requests a Wetland Permit to remove 102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 18" above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead. Located: 2100 Ole Jule Lane, Mattituck. SCTM# 1000-122-4-8 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 f Ch'. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: -To � 6010e-aa aleCe_ojy 3` above- 6 1;06 Present were: V0 J. Bredemeyer M. Domino ✓ G. Goldsmith ✓N. Krupski \//C. Sanders Other Page 1 of 2 John M Bredemeyer III, Prev, f 0FFOtAr r Town Hall Annex Michael J. Domino, Vice-Presaen't54375 Route 25 Glenn Goldsmith oma` P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J Sanders 4,- aprA Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Jeffrey Patanjo on behalf of RYAN & CHRISTINE HARPER'requests a Wetland Permit to remove -102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 18" above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead. Located: 2100 Ole Jule Lane, Mattituck. SCTM# 1000-122-4-8 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- d Photo 1 b` Photo 2 ECEIE F 2 Southold Town Board of Trustees w ,1 'U r Photo 3 Photo 4 RiE C E IVE DEC - 2 22C,," ' Southold Town a f Tr to 61915 SEE SEC NO 111 SEE SEC NO 110 ,i,auT 49] - � - MATCH _Z —UNETC1i. __z- a LIN 2-91 xa.em m i`-xo - I&99 24 1%99 20A • Sq �p 161A(0) [699 aNOg11N�50un�p0 5.2 53 - 03 1 16A �1�� I x4-99 fix.Sxy 3 n+ ata � 0 —j ' O m 11n M 15 - v •a 4� ztAldM.01 a' I NLE P01 w zzm souxo a 2a s es § Y �5 pp ,+ a`°a w –1 )� oLE 3° 13 5 ° 13-03 2 1 q w b N.3 i 9 aeA s_„ 303 11 �'ib6 S` 1B y 9 a 36 _ i3M 3 g�T177' dd a Y'`d19 Ld $ �m t O m q IAN 2 9805 m `OM1 O •(!S A , a / i 52 x.4 4 1 2� 2406 J m 5 244 O 32 m 6 81-08 I 69A O '�'•A 4 <'� b ++ ! am w p .n �m m 9547 8607 u,�++ b a,m v m ,2 tlo® m• a p'111$$ 366 1+ 1 8 s r e s 8 S m5 1511 i �r q N m u E LEGION a RD $ (w1 a :361 m al U —13 OA S m x6.8. y 1016 36 _3T _ 36 3613 13 i n'+ - -t413 s .n za I JafM1�®'��'- � suFF� m� -22-1° / - ®\\• �,6 n� $ x 1SA� / b 11y 1137 d s a m Cm 4 w FOR PCL NO t �, j ryJ SEE SEC.NO +3'4+b Sy a2 121-0S00a5 - ry `'�+p a bpa+ a / � a,te6 r 'p+ �• • ,�,•,a ,(?e � 12A /1/ 'a 713 SUFFOLK COUNTY /- MAI / • 7 M �' _` Y � /5.1A(4 WATERAUTNOwrY 'S'�O / �`�p <•' a42 720 1U/A(c) ,! l ito H �� 138Are) TOWN m Dsomow 9 A° 9 I G�� Et' ryy 26.fin Ca \ i s5p I 1 2 1 a 723 SSG Q 1 a .a X04 A Co 9 `1t 94 e 8 N ,p 69 s \;5 15P 90 FOR PCL.NO 1 O 1 _ SEE SEC NO t� ' I 121-05005.1 b �� as 1OA(G) 7 B a =I -(as _ 9 _ a _ SffgG N0. --z— s >~ __________________ —_—_—_---__--_---_—UNE NAS— -- o NATCN SEE sec NO t28 P.-GO_`LG ,r a �NOIE.AN APPAREN MCOET—N El(I ., .. SIS WITHINHBLOBUDOBCKBETWEEN PARCFv a 95°6158 -- COUNTY OF SUFFOLK © K ,u ,a °f SOUTHOLD SECTION No _ __ NOTICE E Q QpReal Properly Tax Sernce Agency r n OOOO,Yeenterwve0v0,NYn9m M ,a 122 H _ - _ p 1006 - n �i iK ».Yav S. :,. ".t' .rY".aM1♦.. ,.x. s :.. ar.... r _:. ...- J: _ .., "a. .. 5'�J January 22, 2017 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 2100 OLE JULE LANE - MATITUCK, NY SCTM No. 1000-122-4-8 REVISED PLANS Dear Trustees: Attached please find four (4) copies of revised plans based on comments received. during the January 18th public hearing. Plans have been revised to reflect relocated pool drywell and raised height of proposed bulkhead no higher than 6" above existing. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, 1 Jffre?Patanjio 106 Hewitt Blvd. Center Moriches, NY 11934 p EC- EIVE JAN 2 6 2017 Southold Town __FZoard of Trustees OFFICE LOCATION: S® �®l MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 ® �®� Telephone: 631765-1938 ® Fax: 631765-3136 c®UNTY,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: 'Mark Terry, ,LWRP Coordinator Date: January 17, 2017 Re: LWRP Coastal Consistency Review for RYAN & CHRISTINE HARPER SCTM# 1000-122-4-8 Jeffrey Patanjo on behalf of RYAN & CHRISTINE HARPER requests a Wetland Permit to remove 102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 18" above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead. Located: 2100 Ole Jule Lane, Mattituck. SCTM# 1000- 122-4-8 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 action remove 102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 18" above existing top cap; add 15 cubic yards of clean sand.fill landward of proposed bulkhead and 10" wide non-turf buffer is CONSISTENT with the below listed Policy Standards and therefore is CONSISTENT with the LWRP. The proposal to construct a 16'x32' in-ground swimming pool with dedicated pool drywell is recommended as INCONSISTENT. The jurisdictional setback to the pool is not shown on the plans. Re-locate the pool drywell to maximize the distance from the drywell to the waterbody. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. f Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 �► ' Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., January 11, 2017 the following recommendation was made: Moved by Greg Williams, seconded by Caroline Burghardt„ it was RESOLVED to Support the application of RYAN & CHRISTINE HARPER for the removal of 102 If. timber bulkhead and 6 If. bulkhead return and replacement in same location with vinyl bulkhead with raised height of 18" above existing top cap. Provide 15 cy. of clean sand fill landward of proposed bulkhead. Also included is a proposed 16'X 32' in-ground swimming pool adjacent to existing-residence with pool backwash directed to dedicated drywell. A 10' non-turf buffer will be placed along the existing bulkhead. Located: 2100 Ole Jule Lane, Mattituck. SCTM#122-4-8 Inspected by: Peter Young The CAC Supports the application, however, there is no justification for raising the bulkhead. There is a concern that the raised height will set a precedent for the ; neighboring bulkheads. The CAC recommends the drywell for the pool is located on the landward side of the pool. Vote of Council: Ayes: All Motion Carried k i i OT - _ John M.Bredemeyer III,President SO �� , ` Town Hall Annex Michael J.Domino,Vice-President O 54375 Main Road P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,TrusteeG �pQ Charles J.Sanders,Trustee `Q Telephone(631) 765-1892 ��boUNTI,� Fax(631)765-6641 y BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD -Office Use Only Coastal Erosion Permit Application D (y qi y V Wetland Permit Application ii 5 _Administrative Permit / Amendment/Transfer/Extension Received Application: u �E� - 2 2016 Received Fee:$250,CO Completed Application �2�7� Ij Incomplete: Southold Town _SEQRA Classification: —— RQnd 0f Trustees Type I Type II Unlisted Coordination-(date sent): i 17 LWRP Consistency Assessment Form: CAC Referral Sent: 12,22t((p Date of Inspection: 1610117 _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: 11 I Resolution: Name of Applicant: &1 , Sri A{ 1qa Te r Mailing Address: 3 y 3 h 5 r: r®o k y n ,� y t 12 i Phone Number: 9 1' ' 9-o a-• t1g Suffolk County Tax Map Number: 1000- Property Location: 9-1 0 o p le vJes? of 1Gro..$ L.4nc (provide LILCO Pole#, distance to cross streets, and location) AGENT: 'J—err-r P&-4-a n)'- (If applicable) Address: ®t'O �ewt'f"T (�1vd - r"tn-t'er �1/lor�cti�s, N� 11934 Phone: 1031. 9 iS'1 •9 3 3 X �Q-�i Board of Trustees AppliL-_I-tion GENERAL DATA Land Area(in square feet): / ,7/ 1 S"b Area Zoning: S Previous use of property: )2,-s - 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 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 any 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 No Prior permits/approvals for site improvements: F Agency Date P IA 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): Ste -�'t"�chtie� GQCSGft(�-f'io•� Ryan& Christine Harper 2100 Ole Jule Lane Mattituck, NY 11952 SCTM No.: 1000-122-4-8 Project Description Project includes removal of 102 LF timber bulkhead and 6 LF bulkhead return and replacement in same location with vinyl bulkhead with raised height of 18" above existing top cap. Provide 15 CY of clean sand fill landward of proposed bulkhead. Also included is a proposed 16' x 32' in-ground swimming pool adjacent to existing residence with pool backwash directed to dedicated drywell. A 10' non-turf buffer will be placed along the existing bulkhead. Board of Trustees Applj!.. -,•tion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: N JA _% Closest distance between nearest existing structure and upland s edge of wetlands: >r feet Closest distance between nearest proposed structure and upland edge of wetlands: is" 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? 1 S cubic yards Depth of which material will be removed or deposited:_ feet Proposed slope throughout the area of operations: o- Manner in which material will be removed or deposited: S X,A ST,4 r 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): I'ke rc w►tl be ro Q�.I`r4 4hA ocdl ,4eear mic+14nd s a.!l f4Le0U.'r1V4s w11) 44 Tul(ea --o evold A f"e-ps'.1 Short Environmental Assessment Form Part I -Project Information Instructions for Commeting 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: d 1®o Dle T,,le ta4e LibAec&cl Project Location(describe,and attach a location map): S e.,-_c. the At-r/OI) /0/0,a? r d%Pff_W?ic.+J K,-&s-r --t 14/...c a Brief Description of Proposed Action:: acrvimv-c asp r-c,,014ee !D a- LF or- o?t-I't,r�olkfcaQ brrUCh^a with 'Ueda Same Gooctt�oit e4S thtsti,+,J, JN'10 r41se& 1%eiy.44, o,< � � " . S�p� v#0 rust-sU IreIf elww�t .4 Name of Applicant or Sponsor: Telephone: 0/17- p 01-1 49 0 y Q 4 4 h Flat r peer E-Mail: .0. All h.t r pErAb. Clw� Address: City/PO: State: �ti p Code: F3 r op Ic A✓ q !a 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: El 12" NnSO-cL1K`-IsOvs �oe✓•v ®F SOJ ¢ti01� Z'l�Ct'tG-S 3.a.Total acreage of the site of the proposed action? O.3 9 acres b.Total acreage to be physically disturbed? 0-05- acres c. Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? D'3y acres 4. Check all land uses that occur on,adjoining and near the proposed action. ®Urban ®Rural(non-agriculture) ®Industrial ®Commercial esidential(suburban) ®Forest ®Agriculture ®Aquatic ®Other(specify): ®Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? ®, 0 El 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ® Er 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:Name;Pecornc Bay and Environs, Reason;Protect public health,water,vegetation,&scenic beauty, gency; u o County, a e: - - 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO 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? 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: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 2- El 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 21" El 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? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ®Shoreline ❑Forest ®Agricultural/grasslands El Early mid-successional ® Wetland ®Urban ®Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: D NO YES Page 2 of 3 r i 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: 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 ABODE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 11 10116 Signature: ip PRO�T F®t2fi� Page 3 of 3 EAF Mapper Suit+ ry Report Saturday, November 12, 2016 9:07 PM Disclaimer: The EAF Mapper is a screening tool intended to assist 122b+J-��rv-2rJaijU 122 n4- �try_�4!�4 'I( 1122�J4} I1�4+ -2Cr4t���'� 't '12 � I I'r�r� project sponsors and reviewing agencies in preparing an environmental t - assessment form(EAF) Not all questions asked in the EAF are ; I t answered by the EAF Mapper.Additional information on any EAF -1220 0-300-10,64."'I 22 k�+=Ivwr 4« � i+ .12 200-9 00-3005 question can be obtained by consulting the EAF Workbooks. Although I` J 1 2200-544-1 x!001;;200-5tsr 344 the EAF Mapper provides the most up-to-date digital data available to ;j L2e�-40L- '4+44'I` zy I_, • -; I DEC,you may also need to contact local or other data sources in order 122t' 4_qr��"- �,j4+ -;;- I;f-tajO.-I 200-1 fi�444122 00-500-WOO to obtain data not provided by the Mapper.Digital data Is not a W-- ~ti;' '• 12200-'500-2,r'(;012200-90,, ,+,4th ty-- �, substitute for agency determinations. 09 Ir2244-4JO-444Up1' %" '0 'r I I220+154+4-•3042 .T,;..�tl.�-:.-m;. '` '�`r rr '�f� r^ I'22G+j:54.4-t'4f 4•'��."�'�,.._..1 ,,},`. - ' , � t.,•'' 122x34„fCt-`S�tWp 1 ,11 'ai1,-:1r.t2�t2t,Cz!-7 *oldGf3 =3;®IP � '-12nr2..1 I�S 4 9)F0:r•7�:a 3+�i-�01,40122iC2266-4fjC':�� 0Ca 27` tttiji ✓tj', r k:TA2ir'-4i08 ', t- ` ,. .1 ; '1230080€-'50,.�0+' -112200--00-35"0',fj122C012240:400-47001; if4 Taranto<H lr r ; 1224 -lyra-:4i�4�a' r �•t• ` ' 04445i"Jj4°r�.te(a2�''y'i�.Itij'•1aG,2,`-5��U��5a.ha�Ct^s.nu,-w4',Etr1,' 47ti'1i+.i7-'l4300 5A0-140224C ",t ��'L.�w,it)j«iF.wL�tfl4:rsi'I Trr©'1224434 1'It49.','1224d -a4j�M ;I ,35tt s 4t t'1? 1 ._ tN)'r tt�fft;,4p�SG,•,•.tic�G-.r��0, a,,=.'rf-44rG I1:445S44;:2574j, 1224- 54'15��w, P'taa46P, r r,vlG�00x..2244rt1I.4'ioo-5001:iDo Ong --t-t• . u:;4,G,;I:�=.'r,G.rf..,{Ieri rn,=,-tffbFte:,1rt8.P,� �lt�.-�.t atk:, - RI.ri 'E 'I220444-1'7+40\12ssumais'121 'WE t•11=NTR'.C.st;;�' a�rKnmCcYr,.sa'E� Op Sry 2+44? isrtb?l12204-500 00,` '1s, �sRd1ETEstih (tkF+ton tin,. g, E . Part 1 /Question 7 [Critical Environmental Yes Area] Part 1 /Question 7 [Critical Environmental Name:Peconic Bay and Environs, Reason:Protect public health,water, Area- Identify] vegetation, &scenic beauty,Agency:Suffolk County, Date:7-12-88 Part 1 /Question 12a [National Register of No Historic Places] Part 1 /Question 12b [Archeological Sites] No Part 1 /Question 13a [Wetlands or Other Yes- Digital mapping information on local and federal wetlands and Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15[Threatened or No Endangered Animal] Part 1 /Question 16 [100 Year Flood Plain] Yes Part 1 /Question 20[Remediation Site] No Short Environmental Assessment Form - EAF Mapper Summary Report 1 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: ❑ ❑ 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: Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate a ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 00 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 ❑ problems? E4, 11. Will the proposed action create a hazard to environmental resources or human health? El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that 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 environm tal i�)� pacts. Town of Southold-Board of Trustees G —TON ame of Lead Agency IP e (� President Print or Type Name es onsi a Of rc in Lead'Agency Title of Responsible Officer i Signature of risible er in Lead Ageicy Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 80&� Re V,0 -Fru s-f- 7015 1730 0001 0903 2584 CSG 3 ' Alm br. ®, F1 33770 J0 to b6 7015 1730 0001 0903 2577 Al _r1.1 h 5 DI-���J�� L/.�. !�✓LQ--�r�u C.� Or�'�� ) �5�� Tkiu�- 7015 1730 0001 0903 2560 fns 7015 1730 0001 0903 2775 � I C� _ .�'b V //g O/ STATE OF NEW YORK 7015 1730 0001 0903 5011 COUNTY OF SUFFOLK A&&nio , residing at f (P JU)- �bAld . being duly sworn, deposes and says that on the day o ; 20/7' deponent mailed a true copy of the Notice set forth in the Board of Trus s Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessmenA roll of the Town of Southold; that said Notices were mailed at the United States Post Office at 1.r.I&L MWOW ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. i Sworn to before me this Day of °� o ,20_L7 _ Notary Public Lot ann Patan o Notary Pub id State of�ew York Qualified in Suffolk County No:01 PA6150861 Commission Ex0ires 0810712QL8 _I I� Postal Postal Service"' , • © ■ P MAIL`CERIFIED ■ ■ �`- `a ' il only qotpestic Mail Only. 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IS Lr) Sent To Cl Sfreetand �o• OB- o. -------------- ------ Crry State, �4® +� I PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS /74 ctc� �'o P Name: eS Z-1y. 9 STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn,deposes and says that on the day of . 20___, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 J i i Notary Public John M. Bredemeyer III,'rrzsident k"pti� �oG Town Hall Annex Michael J. Domino, Vice-Presidentj� yL 54375 Route 25 Glenn Goldsmith y P.O. Box 1179 A. Nicholas Krupski �4v Southold, NY 11971 Charles J. Sanders Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of RYAN & CHRISTINE HARPER COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS INPEA CE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE J �fd , residing at/dba W S ) Iq4 being duly sworn, depose and say: That on the � day of d , 201-), I personally posted the property known as 21� DI e. IvleLajW by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,January 18,2017. Dated: t q 1-? Sworn to before me this day ofAn 201-7 i :G � lJ Notary Public Loriann Patanl1o� Notary Public State Rew York Qualified in Suffolk County No:01 PA6150861 Commission Expires 08/07/201 January10, 2017 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 2100 OLE JULE LANE -MATITUCK, NY SCTIVI No. 1000-122-4-8 AFFIDAVITS Dear Trustees: Attached please find original affidavits for mailing and posting as required for permit applications. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 i4UTILt: Uim HEL. AK111C NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: RYAN & CHRISTINE HARPER SUBJECT OF PUBLIC HEARING : For a Wetland Permit to remove 102 linear feet of existing bulkhead and 6' return, and replace the bulkhead and return in-place using vinyl sheathing and raise the height an additional 18" above existing top cap; add 15 cubic yards of clean sand fill landward of proposed bulkhead; construct a 16'x32' in-ground swimming pool with dedicated pool drywell; and to install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the bulkhead. Located: 2100 Ole Jule Lane, Mattituck. SCTM# 1000-122-4-8 TIME & DATE OF PUBLIC HEARING : Wednesday, January 18, 2017 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF'TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 -' Board of Trustees Appli\_ tion AFFIDAVIT P`I A n 1 R rpeg- BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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, r 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 PropertyOwner SWORN TO BEFORE ME THIS DAY OF SHELTON LIOU Notary Publio,State of New York Qualftd in King County No.01 L1630902 Notary Public Commission Expires 08m/2o18 Board of Trustees App . '.cation AFFIDAVIT C r c sTin � Pt/L 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. Signature of Prope ner, LI-17 SWORN TO BEFORE ME THIS Z, DAYOF N 0 v , 201 ' r N Public my M WT WOTARYPUM STATEOFNEWYORK r No.01PA4931811 QuaW(n 1Gngs County Conon EVires 5/31/2018 Board of Trustees Appl;---tion AUTHORIZATION (where the applicant is not the owner) f/g f fier residing at 3`13 5T. (print name of owner of property) (mailing address) m iG y „j 1 12)S do hereby authorize —J—,-?L-r"f (Agent) to apply for permit(s)from the Southold Board of Town Trustees on my behalf. X -- (Owner's signature) APPLICANVAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Hart of town officers and employees.The»uMose f this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: ��r��A— 9!1 A e) (Last name,first name,rxriddle initial,unless you are applying to the name of i 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 l Approval of plat Mooring I 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'rown of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO ✓ ' If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check i 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 ot�icer,director,partner or employee of the'applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this /8 day of hl?A0 Signature -/f�, Print Name AJ Form TS 1 AP PLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i The Town of Southold's code of Ethics Prohibits conflicts of interest on the pari of town officals and employees.The nurpos_e—c f this form is to provide inforina6on which can alert the town of possible conflicts bf interest and allow it to take whatever action is necessary to avoid same. i YOUR NAME: t P . AYrsTsele (Laame,first name,.giiddle 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 i Exemption from plat or official map Planning Other (1f"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 blo6d,marriage,or business interest."Business interest"means a business, including apartnership,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 a/ f 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 j 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. 7 The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): j1 A)the owner of greater than 5%of the shares of the corporate stock of the applicgnt 1 (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,panne%or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP i Submitted this-_,aLday of lVd V 204 Signature y PrintName Al QAc Form TS 1 r APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of thold' de of Ethics prohibits conflicts of interest on the part of town officers and employees.Thur ose of this form is to provide information which can alert the town of possible conflicts of rrtterst and allow it to take whatever action is peeessaa to avoid same. _ f} YOUR NAME• �t�'C'a+�1 D' J{•Fs�r�N (Last name,f—first n�ne,.guddle initial,unless jdu 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 i Exemption from plat or official map Planning Other i (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,of 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 lite town officer or employee owns more than 5%of/the shares. YES NO ✓ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person j 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): I A)the owner of greater than 5%of the shams of the corporate stock of the applicant (when the applicant is a corporation); B)the legal orbeneficial owner of any interest in a non-corporate entity(when the ? applicant is not a corporation); C)an officer,director,parmer,or employee of the'appiicant;or D)the actual applicant - r DESCRIPTION OF RELATIONSHIP i Submitted this /G day f !J `� 200 6 Signature PrintName 0' �004PW Form TS 1 r B%jFrqTown of Southold Erosion.-Sedimentation & Storm-Water Run-off ASSESSMENT FORM _ PROPERTY LOCATION: S.C.T.M.d: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A o(, /000 STORM-WATER;GRADING,-DRAINAGE AND—EROSION—CONTROL PLAN, Tilsflcf' eit cfion 'g aT cr T— CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION YITM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within /7/s-6l�,39 Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This item will include all run-off created by site (S.F,/Acres) , b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Z S'S'u �� p� 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 DESCRIPTION (Provlde Additional Pages as Needed) Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and 5-ee 1-te. o ke J_ Slopes Controlling Surface Water Flow. -- - - - - 3 Does the Site Plan and/or Survey describe the erosion / and sediment control practices that will be used to +' control site erosion and storm water discharges. This - item must be maintained throughout the Entire --- - - Construction Period. 4 Will this Project Require any Land Filling,Grading or - Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? - -- - 5 WIII this Application Require Land Disturbing Activities - -- -- - -- -------- -- -- - ----- - -- Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? i • S Is there a Natural Water Course Running through the - - -- - Site? Is this Project within the Trustees jurisdiction — Gerieral DEC--,SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required far all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of fess then one acre that 7 WIII there be Site preparation on Existing Grade Slopes ❑ 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 Including Construction activities Involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious far Storm Water Discharges from Construction activity-Permit No.613-0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off ❑ ✓ t 1.The SWPPP shall be prepared prior to the submittal of the NOI.The NOI shell be Into and/or In the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where Q 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 ,/ f constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder F-1 compliance with the terns and conditions of this permit.In addition,the SWPPP shall Area?(This Item will NOT Include the Installation or Driveway Aprons.) Identify potential sources of pollution which may reasonably be expected to effect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark k 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.81 Acre in area, component shall be prepared by a qualflied Design Professional Licensed In Now York a Storm-Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of that is knowledgeable In the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check Mark(.)')an(/or Answer for each Question is Required for a Complete Application) STATE OF NEW YORK, pp COUNyTY OF.. ...........SS That I, �P. ......................... enj...................being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of tr,d(vtdual signing�poct) l And that he/she is the .........................................w�C/!� . .. .... . ....... .............................................................. (Owner,Contractor,Agent,Corporate Officer,etc) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to die best of his knowledge and belief;and that the work will be performed in the manner set forth in die application filed herewith. Sworn to before npe this; -- rr ...............--�• ................:.... y of.../V Q J'6.w�S_er .........;.201 NotaryPublic: .......... .......... .. ................................ ..... .•. ..... .. _ ................ SHELTON 1_1011 (Signature of Appllkanl) FORM - 06110 Notary Public,-State of New York Qualified in tang County No 01 L16309462 MyQommission Expires 08/11/2015 iy t 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 si iug ficant beneficial-and adverse dffects-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 ansiver must be explained in detail, listhm both supporting and,nou- 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 NAME t o® ®1,e Tv 1e L,.h$- 43,,L16 Ae�� The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate'response): (a) Action undertaken directly by Town agency(e.g.capital ❑ 'construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: 5s4e- A-r-k-o-c ieA t Location of action: ;t 100 v (e- 5'.1e Le e n.)y 11 9 S d- Site acreage: &• 39 Present land use: (2 e 5 Present zoning classification: R e S 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: 12 y u n c�►r i S't'i ne s r�t t (b) Mailing address: 3 N 3 e. �"h s?.' 0 ry®!G 1!2 y N�l l 2.1 r- (c) Telephone number: Area Code( ) X917- • a o 2- - 4-9D q (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ErNo E❑ If yes, which state or federal agency? s Ec 1 J`' 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. aYes ❑ No ❑ Not Applicable efoJeC4 WI-rh l fO L-16 .rs fef V;v.-1l -.. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWR,P Section III-Polici s Pages 3 through 6 for evaluation criteria ❑ Yes 1-1No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section IH—Policies Pages 6 through 7 for evaluation criteria D/Yes ❑ No ❑ Not Applicable Pros-ee4 Qryos&rS eek w [e,& bS nz orc ✓csvall, a,DOt�Itny -Ft'lu.ti -,-xl�jjn5 c e-r,-e-&ort+cJQ rdar Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No ❑ Not Applicable !OI eco 9f®tee- S s+ 5 *1 ns 1" e✓aisco s dva -0--L% Gt- o&4er[o1,L+ecA Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section HI —Policies Pages 16 through 21 for evaluation criteria Z Yes ❑ No ❑Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ Z Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. F1 Yes NoNot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluatiop criteria. ❑ Yes F] No l-1 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. B""Ye�] No❑ Not Applicable Pro)rc+ Pef ej -f— t.,.j4c&jwA Attach additional sheets if necessary r i WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No [�JNot 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 LJ 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. F-1Yes ❑ No E91Not 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 J ' &tA TITLE Ai DATE //•/� November 29, 2016 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179D � I Southold, New York 11971 RE: 2100 OLE JULE LANE- MATITUCK, NY DEC - 2 2016 SCTM No. 1000-122-4-8 APPLICATION FOR PERMIT Southold Town B ar of Tru tees Dear Trustees: We hereby submit one (1) original and three (3) copies of the proposed plans, application and check for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Je rey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934