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HomeMy WebLinkAboutTR-9006A ®� Michael J. Domino, President so& Town Hall Annex O� John M. Bredemeyer III,Vice-President 54375 Route 25 ! P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith �l ® aQ Telephone(631) 765-1892 A. Nicholas Krupski ��+oUNT`1,� Fax(63,1) 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 1 st day of construction •� Y2 constructed "' Project complete, compliance inspection oE S®(/p Michael J.Domino, President ®� ®l® Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 Charles J. SandersP.O.Box 1179 CA ='' d`. ' Southold,New York 11971 Glenn Goldsmith Telephone(631) 765-1892 A. Nicholas Krupski ®l�c®U�n�`L`' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9006A Date of Receipt of Application: April 21, 2017 Applicant: William Giacone & Cindy Nance SCTM#: 1000-111-14-17 Project Location: 1130 Little Peconic Bay Road, Cutchogue Date of Resolution/Issuance: May 17, 2017 Date of Expiration: May 17, 2019 Reviewed by: Board of Trustees Project Description: To construct a 400sq.ft. paver patio seaward of the dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Creative Environmental Design, dated April 5, 2017, and stamped approved on May 17, 2017. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Michael J. Domino, President Board of Trustees Michael J. Domino, Presr Town Hall Annex John M. Bredemeyer III, Vice-President 54375 Route 25 Charles J. Sanders ;o P.O.Box 1179 Glenn Goldsmith D Southold,NY 11971 A.Nicholas Krupski ��0 gyp! 4 Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: `� /� la`�S Completed in field by: Creative Environmental Design on behalf of WILLIAM GIACONE & CINDY NANCE requests an Administrative Permit to construct a 400sq.ft. paver patio seaward of the dwelling. Located: 1130 Little Peconic Bay Road, Cutchogue. SCTM# 1000-111-14-17 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275_�z 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: r No ) r �L) Present were: ✓ J. Bredemeyer M. Domino G. Goldsmith N. Krupski `�Sanders Other. Page 1 of 2 Michael J. Domino,Pres Town Hall Annex G John M. Bredemeyer III, Vice-President 54375 Route 25 Charles J. Sandersc P.O.Box 1179 Glenn GoldsmithSouthold,NY 11,971 A.Nicholas Krupski �'�0 ®� Telephone(631)765-1892 d Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Creative Environmental Design on behalf of WILLIAM GIACONE & CINDY NANCE requests an Administrative Permit to construct a 400sq.ft. paver patio seaward of the dwelling. Located: 1130 Little Peconic Bay Road, Cutchogue. SCTM# 1000-111-14-17 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: i Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 o APR 2 1 2017 -- - - GamN NAND - - -- QTY FLOWER,GRA5.15-1 FoRE51- GRA55, GOLDEN JAP4EH 7 FFOUNTAINCRA-93 GRA55 LHY PINK - ----- 3 ; FLOWER, PERENNIAL yCARYOPTER15VARKKNIC441-'GRA55 N&IDEN . LAVENDER -'(03p , SIL . IL FEROV5KIA RU551AN 5AGE 3 1 ALVIA 5ww MILLI - A SHRUB DECIDUOUS HYPERIC SUNBURST LEuco- �-�0 DODDS VAPIEGATEDE, --5PIREA, FROBELI1400 e 5wu3, EVERGREEN BROADLEAF \o /1NDROWD LILLY-oF--rt-E-VALLEY -5 _BOXWOODGREEN GEMS - 2 -f HOLLY DRAGON LADY - _® PEE DECIDUOUS . " � SIL SIL CRAPEMYRTL CoRALFINK T EvEPGRaNt CEDAR JAPANESE 00 , SIL SIL COL�VINAfi� aRBIAN 5PRUCE PI VAN- 1-)ERWOL + IL RESIDENCE �L - I SIL • ;. I si-wvrz z . GRADE . o „ A PERNEABLE PAVER BRICKS i e O ` , p \7 \� p \7 p p p 0 p p r BI1E5 ac 5�I� --- SIL SIL ,- iIL i D � [ �? �' 10"CRL5 E0 NATURAL.GRAVEL BASE t _ V_ Ti Ct`` PERW-.A[3LE PATIO DETAIL f{t, .� SIL �� sIL /SIL •i" _ /- ILLIA M ACONE APPROVED BY LrrTLE ECONIC [3AY BOARD OF TRUSTEES TOWN OF SOUTHOLD Cu-r.r,L--,v.lGUE DATE rn � ? zot7 SCT1000—111,--14e—17 e LandscapePlan : 4-5- 1.7 or^ jft If Date: A-10112017 Scale: LandscapeDesignDave SURVEY OF LOT 237 AMENDED MAP A OF NASSAU POINT OWNED BY STORMWATER MANAGEMENT NOTES: NASSAU POINT CLUB PROPERTIES, Inc. 1. ANY WORK OR DISTURBANCE, AND STORAGE OF CONSTRUCTION FILE No. 156 FILED AUGUST 16, 1922 MATERIALS BE CONFINED TOOF CLEARING AND/OR GROUNDL DISTURBANCE SHOWNE ONMIT THE APPROVED PLANS. SI T UA TE 2. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, NASSAU POINT A CONTINUOUS LINE OF SILT SCREEN (MAXIMUM OPENING OF �,MIN. U.S. SIEVE #20) SHALL BE STAKED AT THE LIMIT OF CLEARING OR TO 0' SUFFICIENT TO THE SCREEN SHALL AND GROUND RBANCE BE MAINTAINWN ED,ON THE EPAIREDPANDVED PLANS.REPLACED AS k I KEEP SEDIMENT ON SITE TOWN O F S 0 U T H 0 L D OFTEN AS NECESSARY TO ENSURE PROPER FUNCTION, UNTIL ALL 4Q SLY�NAND/OR �\•\•\A (�R DISTURBED AREAS ARE PERMANENTLY VEGETATED. SEDIMENTS L SUFFOLK COUNTY, NEW YORK 0`N W A TRAPPED BY THE SCREEN SHALL BE REMOVED AWAY FROM THE _ SCREEN T AN APPROVED UPLAND LOCATION BEFORE THE S.C. TAX NO. 1000-111 - 14-17 USES SCREEN � 3. PRIOR TO THE COMMENCEMENT OF ANY CONSTRUCTION ACTIVITIES, ��,� I `� ' SCALE 1 »_20 x�'a• ; O (, A CONTINUOUS ROW OF STAKED STRAW OR HAY BALES SHALL a ------------ BE STAKED END TO END AT THE BASE OF THE REQUIRED SILT R JULY 1 , 2013 <le- �� SCREEN AT THE BASE OF THE REQUIRED SILT SCREEN. THE BALES SEPTEMBER 16, 2013 ADD PROPOSED HOUSE • C , • ;, e J�•� (p SHALL BE MAINTAINED, REPAIRED AND REPLACED AS OFTEN AS IS OCTOBER 15, 2013 REVISED NECESSARY TO ENSURE PROPER FUNCTION, UNTIL ALL DISTURBED JANUARY 6, 2017 REVISED PROPOSED HOUSE 1\.J S•\REE� i�.°• •. 19 �9. AREAS ARE PERMANENTLY VEGETATED. THE AVERAGE USEFUL LIFE \N ,,p • .• Q/ OF A BALE IS 3-4 MONTHS. SEDIMENTS TRAPPED BY THE BALES I TOTAL AREA - 11,920 s ft. R ,5,�v a .• MAY BALES AND/OR C'- _ _.•r _F (, ,,. WP X1� A• af` SHALL BE REMOVED AWAY FROM THE BALES TO AN APPROVED SILT FENCING ( � q• L UB\-\C' n• ; Y�",.::'.':".` UPLAND LOCATION BEFORE THE BALES THEMSELVES ARE REMOVED. ! -� �-'' - �' a�' (TO TIE LINES) 0.274 ac. P :.°.. . ... .. L y °.• + a' d 4. STRAW BALES SHALL BE RECESSED TWO TO FOUR INCHES INTO THE GROUND. ✓f r_ ° • / PLAN VIETTW ;!, 1:• ::; ;;'•;;(•'••\ 5. SILT SCREEN SHALL BE RECESSED BY TRENCHING SIX INCHES INTO THE GROUND. 6. LEADERS AND GUTTERS THAT EMPTY INTO DRYWELLS SHALL BE INSTALLED r UPLAND AREA = 11 ,265 Sq. ft. °�• d "a °4 e•: Q' _. ' ` 1, 110* ON THE PROPOSED RESIDENCE. APR 2017 -( 0.259 ac. y' P`� 7. ALL PROPOSED SWIMMING POOL DISCHARGES SHALL BE DIRECTED TO DRYWELLS. 8. PROPOSED DRIVEWAYS MUST BE CONSTRUCTED OF PERMEABLE MATERIALS WETLANDS AREA = 655 S ft. OR IF PAVED, BE EQUIPPED WITH DRAINAGE SUFFICIENT TO PREVENT RUNOFF j a• ° p0� E I N --- (TO TIE LINES) 0.015 a c. O/ .';... PRO,�RL\N FROM BEING DISCHARGED ONTO THE ROAD OR OFF-SITE. ROAD llt��ld ,V1 EDGE OF PAVEMENT Spm ° Q , • R \I\A 9. ALL AREAS OF SOIL DISTURBANCE RESULTING FROM THIS PROJECT SHALL BE a " PAVER'-""' A ' .• �1' , r1P0 �0 W SEEDED WITH AN APPROPRIATE PERENNIAL GRASS, AND MULCHED WITH STRAW SILT DAM FENCING AND/OR B k_If<<•�1 TrnS^�.5_- ___.__ 1 APRON a \ �•_ ""\"" �^yl Gip \� y� �\NCS IMMEDIATELY UPON COMPLETION OF THE PROJECT WITHIN TWO 2 DAYS OF �yN °. '7 1'•'•'•'•'•t',•.. U ,.., ' (r L '( \� • ( ) CONSTRUCTION CE BASE OF /STONE DRIVEWAY. 1 / I `v �/ / I'.':'. 1 ° J 3OV FINAL GRADING, OR BY THE EXPIRATION DATE OF THE BUILDING PERMIT, COMPACTED 3/4 STONE BLEND f �•W,•• ', O \O ���>rN� OR N.Y.S.D.O.T.APPROVED R.C.A. NOTES. A: ,GONG. 5� r ." �t �?\ '70 WHICHEVER IS FIRST. MULCH SHALL BE MAINTAINED UNTIL A SUITABLE FILL TO 18"MIN.ABOVE EXISTING ° WALL ° 14 �� ST HO " d \O t`\Gn O\, G �,O VEGETATIVE COVER IS ESTABLISHED. IF SEEDING IS IMPRACTICAL DUE TO GRADE TO ALLOW FOR WbUNAGE .": �.... TIE LINE ' 1 F ND 1� •; -( •; O \O M\\"p -( t' TIME OF YEAR, TEMPORARY MULCH SHALL BE APPLIED AND FINAL SEEDING CROSS SECTION 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM Oy�P` v, �i O PERFORMED AS SOON AS WEATHER CONDITIONS FAVOR GERMINATION 27 E�m co c N. \ ,.:;:.I:; p �Ft\ D �o t� AND GROWTH. EXISTING ELEVATIONS ARE SHOWN THUS: xJu '53 J TEMPORARY CONSTRUCTION ENTRANCE N 7g G / I• /1 '••'.:.:I'e%; \gC\N VAO� X G x� 10. SUITABLE VEGETATIVE COVER IS DEFINED AS A MINIMUM OF 85% AREA ��((�� 26 X E� G � �GN� �., ,ZW t't VEGETATIVE COVER WITH CONTIGUOUS UNVEGETATED AREAS NO LARGER (NOT TO SCALE) EXISTING CONTOUR LINES ARE SHOWN THUS: - -5- - - - /!v SOIL STOGR131LE v 115PN GA` THAN 1 SQUARE FOOT IN SIZE. D 237 i'....'. pRP` \D o �c� 2 t� FDR FOUNDATION 12 LD : i';,.;: \�N 50 qg p G1 ,_, 11. ALL CONSTRUCTION ACCESS WAYS SHALL BE RAISED SUFFICIENTLY AT THEIR F.FL _ FIRST FLOOR !.� EXCAVATION TO BE ;•y W \\,\�\.• \� C7 SITE ACCESS LOCATIONS WITH THE EXISTING ROADS, TO PREVENT RUNOFF G.FL. GARAGE FLOOR bm� ,'1j, REMOVED 5EFORE .- / �� R 1� -1 a +�+ OF WATER SILTS AND SEDIMENTS FROM BEING DIRECTED OR DISCHARGED ONTO T.B. - TOP OF BULKHEAD 9:e& /"p,�'�OSEPTIG INSTALLATION - 4 ;fa`"• ��,�'�* C� to �, THE ROAD. A NON-LOAM BASE MATERIAL, SUCH AS CRUSHED STONE, GRAVEL, B.B. - BOTTOM OF BULKHEAD • 1,{� 1. �0 H OR RECYCLED CONCRETE BASE, SHALL BE PLACED ACROSS THE DRIVEWAY OR T.W. - TOP OF WALL �� 4j '�• '¢ EXIST. WATER UNE (� 11 I '7-' �'O aF' - B.W. - BOTTOM OF WALL TO BE RELOCATED z O CONSTRUCTION ACCESS WAY AT THE ACCESS POINT ALONG THE ROAD. °•I 2. FLOOD ZONE INFORMATION TAKEN FROM: 40 a 10 In. 3 :::;: ( • '\ • O p, co 3 M EXIST. CESSPOOL WOOD f • ' ° FLOOD INSURANCE RATE MAP No. 36103C0164H Z v nt TO BE REMOVED BOR I ;:::: ::::::' ;;;::::;r:: \ ZONE AE: BASE FLOOD ELEVATIONS DETERMINED 3 J SEE NOTE No. 7 rF ::::::::A;�:?idC' :: :ii::::i:::':::::::•::•;:.. \ o m �,����,,/ * ANNUAL CHANCE FLOOD; AREAS OF 1% ANNUAL w FENCE 14.6' "' �' '} ' " ^'"' ' I HOUSE 36" HIGH POLE (MAX.) ZONE X AREAS OF 0.290 o Z 4. O 1.5'W. fi:: .:$Fipt::�:::::::: :::1::::::::::::::' I \_�, 8' DIA. X 4' DEEP STEEL OR wooD STEEL OR WOOD POST F I"': r:5`.•�•:::•::::`•::::•:::•: g EXTRA STRENGTH FILTER fABR POST(TYP•) CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT 0 Ny '`: ':, ,r ; ;,:::k,.r.;?^ 1 \1�• STORMWATER REO o.WITHOUT WIRE MESH SUPPORT FLOW HAY BALES 2x2" STAKES .{ '. :•;;;, DRYWELL �- '� OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; O�-1 5 EXISTING �" � ' ' ` 1 �•"• FOR DRIVEWAY 10' MAX. O.C.SPACING (TWO EACH BALE) „� ;•;::.y:;•:;•;:.....•::;•::..........: :;;;;•::;:;;:;;.... V::::::::: w W/WIRE SUPPORT FENCE FLOW AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD. SHED TO I :11 a rn e' MAX.D.C. SPACING `; W/O WIRE SUPPORT FENCE .,'•. GRADE ZONE X: AREAS DETERMINED TO BE OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN. BE REMOVED 10.1 : J N ::i'::.•+ '`• COMPACTED I ; . . '- BACKFILL I :::: ' .. .......... 57i ! ::: �oS� .----�-' <� �� '••_+•:�.� �� ��" ' DRAINAGE 3. MINIMUM SEPTIC TANK CAPACITIES FOR 4 BEDROOM HOUSE IS 1 00 GALLONS. 8' DI X 5' DEEP (�4CJ1:::::::r:. 1tAF ' OUSE:::... 1 0 .?.:.,r., c 5 ORMWATER a`:: SFQI�`(:;.:...::::: ::::: : ::::::: m :•^: R / / S<� O .• :•r: f INLET �� > .�::. :.:............ � coy ,`ti..,;s�'-�*'•�� ..��- � �%\ DR WELL5 TTP. s :1'::,0:;: """ ra ,��^� ``'"' 1 TANK; 8 LONG, 4 -3 WIDE, 6 -7 DEEP FOR ROOF ' • • :...PROPOSED 2 STORY;;:;:;;;;:; �i TER �{ 11c�."::I 6ARA6E:`. 1 .6' oo r.•.,;.:..: .Ar:, r\�' ���\� �'` " ;:;(4 BEDROOM);;;:;;;;;:;;::::::: �i ..t;;:,';'„.... . 'ATTACH FILTER fA9RIC SECURELY N / �. " 4. MINIMUM LEACHING SYSTEM FOR 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA. T°UPSTREAM SIDE OF POST SI .. . . '1: : : :: :::::::F.FL...!�:�:: : ::::;:: �- a � 4 x 6" TRENCH 3 POOLS; 4' DEEP, 8' dia. W/ COMPACTED 5 i I: •••• """""" / BACKFILL BALES TO BE SET r1 1;:.:::::::.:: :::::............... BACKFILL;:: SILT PENCE DETAILS " N ` I AR ErNTRANGE.•::;•:•:.,.% •;:•:• `� \t�j\NG MQ�� NOT To IN 4 TRENCH ELEVATION 1 EX p� TRENCH DETAIL PROPOSED FUTURE EXPANSION POOL •' •.'♦"' $ NOTES: SILT FENCE SHALL BE PLACED PARALLEL TO SLOPE CONTOURS TO ;; ;•;•;•; ;•;;;•;; w xx� ,,/ \JGE 0 it MAXIMIZE PONDING EFEACH STO M EVENT FICCIENY.INSPECT AND REPAIR SILT FENCE AFTER (NOT TO SCALE) HAYBALE BARRIER ® INLETS HOUSE I :.. .:..:.:.:.::::.::::.::::::::.:.:::..::..::.:::..::.:.:::.:.: / @.ff 1 � \�� SEDIMENT SHALL E DEPOSITED TO ANVE AREA THAT WILL NOT ALLOW REMOVEDENT WHEIR NECESSARY. (NOT TO SCALE) •••••.......•••••• 0\\' OFF-SITE TRANSPORT. PROPOSED 8' DIA. X 4' DEEP LEACHING POOL :::::. :: , pROPOgE OOf F N �` 61 Ao CS EP ' `�v °°o? �.y � 9 UFS � \ / o Oo 1 � �o� P� ��61eI I ® PROPOSED 1,000 GALLON SEPTIC TANK I FENCE b2 x�G /���� �z ` �os°`' 5. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD 'tel w. �Jo" / 6� w �� TYPICAL STORMWATER UNIT o� �oltie / / ��OF°°NS (TOPS TO BE TRAFFIC BEARING) OBSERVATIONS AND/OR DATA OBTAINED FROM (OTHERS. Q y X �Oy � (NOT TO SCALE) NOTES: 6. EXISTING SEPTIC SYSTEM STRUCTURES SHALL BE PUMPED CLEAN AND �G' s•. \ S CAST IRON INLET FRAME&COVER((FLOCKHART 063518 TYPE 6840) TO BE USED WHERE TOPSOIL IS NECESSARY FOR 1. AREA CHOSEN FOR STOCKPILING OPERATIONS OR 6'THICK REINFORCED CONIC. LOVER REGRADING & VEGETATING DISTURBED AREAS. REMOVED IN ACCORDANCE WITH S.C.D.H.S. STANDARDS. A FINISHED GRADE SHALL BE DRY AND STABLE. I / �\ ° F e"TRAFFIC BEARING SUB 1'-0" TEMPORARY STOCKPILE STABILIZATION MEASURES INCLUDE 2. MAXIMUM SLOPE OF STOCKPILE SHALL BE 2:1. XM / x / E� y0�o m°x.) VEGETATIVE COVER, MULCH, NONVEGETATIVE COVER, AND 3. UPON COMPLETION OF SOIL STOCKPILING, EACH 7. NO ADDITIONAL FILL TO BE TRUCKED IN FOR FINISHED GRADES. / <J PERIPHERAL SEDIMENT TRAPPING BARRIERS. THE PILE SHALL BE SURROUNDED WITH EITHER SILT �G _-� �o Zp PIPE FROM ROOF GUTTERS STABILIZATION MEASURE(S) SELECTED SHOULD BE FENCING OR STRAW BALES, THEN STABILIZED WITH �vR j v/ \ // e-o• APPROPRIATE FOR THE TIME OF YEAR, SITE CONDITIONS, VEGETATION OR COVERED. / 2.S AND REQUIRED PERIOD OF USE. 2 SLOPE OR LESS / /X• CRUSHED 3 4"- 1-1/2"STONE 1 Q 9 / �0 / w0° / n ALL AROUNt� STABILIZE ENTIRE PILE OQOsj / S��°5 \ w / LEACHING RINGS WITH VEGETATION OR COVER R �o Y REINFORCED PRECAST CONC. \V � � � y y 12 Q 3•_0" 4000 PSI O 2a DAYS 3.�. N ^/ 4' min. � 1P � 4 P O NY �Y 41 �Y NY %P \V y y .v .t' � IV S�01F�• 1,G / '�-� OF MPagN w �v .v .v .t' y y y � Q Z � G� GROUND WATER 1 ZR \11 41 g�1 / -1.s O DRAINAGE SYSTEM CALCULATIONS: i �, ,v ,v .v 0 m , ROOF AREA: 2,223 sq. ft. 2,223 sq. ft. X 0.17 = 378 cu. ft. 6$°1 378 cu. ft. / 42.2 = 9 vertical ft. of 8' dia. leaching pool required Gj PROVIDE (2) 8' dia. X 5' high STORM DRAIN POOLS STRAW BALES OR SILT FENCE o°D of°K eye 1"� � EXISTING LOT COVERAGE w DRIVEWAY AREA: 900 sq. ft. / BULKHEAD 900 sq. ft. X 0.17 = 153 cu. ft. SOIL STOCKPILE DESCRIPTION AREA % LOT COVERAGE O.a E. 153 cu. ft. / 42.2 = 3.6 vertical ft. of 8' dia. leaching pool required (NOT TO SCALE) PROVIDE (1) 8 dia. X 4 high STORM DRAIN POOL HOUSE 1,723 sq. ft. 15.3% ROOF OVER WALK 48 sq. ft. 0.4% q SHED 146 sq. ft. 1.3% OUTSIDE SHOWER 15 sq. ft. 0.1% TOTAL EXISTING 1,932 sq. ft. 17.1% TEST HOLE DATA (TEST HOLE DUG BY MCDONALD GEOSCIENCE ON SEPTEMBER 23, 2013) PROPOSED LOT COVERAGE EL. 12.5' 0. DESCRIPTION AREA % LOT COVERAGE DARK BROWN LOAM OL 0.5' HOUSE (INCLUDING " FRONT PORCH) 2,234 sq. ft. 19.8% e BROWN SANDY SILT ML TOTAL PROPOSED 2,234 sq. ft. 19.8% LOT COVERAGE OF TOWN DEFINED 11,265 sq. ft. BUILDABLE LAND" (11,920 sq.ft. (TOTAL LOT AREA) PROPOSED SEPTIC SYSTEM DETAIL - 655 sq. ft. (WETLANDS AREA)) HOUSE TOP BURIED (NOT TO SCALE) ;;,•,; ;.' ., F.FL. 12,Q 4' DEEP max, FINISHED GRADE �:' PALE BROWN FINE TO MEDIUM SAND SP PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED ELEV. 12.0' FINISH GRADE FOR SUCH USE BAND APPROVED AND AIDE PTE D PRECAST REINFORCED CONCRETE COVER 24"dia. LOCKING, WATERTIGHT & INSECT PROOF ELEV. ,U,Q BURIED 1' DEEP min. 2' DEEP max. CAST IRON COVER TO GRADE ,�:;,•. . TITLE ASSOCIATION. MIN. 4" dia. 20" n min. FURTHEST LEACHING POOL EL 10' 115' APPROVED PIPE 20"min MIN. 4" dia. s TOP EL. 10. 3. OFA 3 POOL SYSTEM PITCHED 1 4" 1' TOP ELEV. 11.0 APPROVED PIPE INLET_� PITCHED 1/8"/1' 8" B WATER IN PALE BROWN N O _� INL 3' CLEAN FINE TO MEDIUM SAND SP _ _ 4" dia. SAND INV:. EL. INVERT S°i °D INVERT a CROSSOVER ° COLLAR 10.0' ° PIPE e ELEV. $ . ELEV. 3 P' 3 FLOW �1 0. BAFFLE a i � 17' 8' 81 BOTTOM I 3 GROUND WATER N.Y.S. Lie. No. 50467 ELEV. 4,Q' ' ELEV. 1,Q �^ TO THIS SURVEY UNAUTHORIZED ALTERATION TI ADDITION ON OF Nathan T of t Corwin I I I SEPTIC TANK 1 SECTION 7209 OFSTHE VNEW TYORK STATE 1. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1,000 GALLONS, EDUCATION LAW. Land Surveyor 1 TANK; 8' LONG, 4'-3" WIDE, 6'-7" DEEP COPIES OF THIS SURVEY MAP NOT BEARING 2. CONCRETE SHALL HAVE A MINIMUM COMPRESSIVE STRENGTH OF 3,000 psi AT 28 DAYS. THE LAND SURVEYOR'S INKED SEAL OR ,3. WALL THICKNESS SHALL BE A MINIMUM OF 3", A TOP THICKNESS OF 6" AND A BOTTOM THICKNESS OF 4". LEACHING POOLS (3) EMBOSSED SEAL SHALL NOT BE CONSIDERED ALL WALLS, BOTTOM AND TOP SHALL CONTAIN REINFORCING TO RESIST AN APPLIED FORCE OF 300 psf. TO BE A VALID TRUE COPY. 4. ALL JOINTS SHALL BE SEALED SO THAT THE TANK IS WATERTIGHT. 1. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDEALL AREA. 5. THE SEPTIC TANK SHALL BE INSTALLED AT LEVEL IN ALL DIRECTIONS (WITH A MAX. TOLERANCE OF ft/4') 3 POOLS; 4' DEEP, 8' dia. CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. isaksen, Jr. L.S. ON A MINIMUM 3" THICK BED OF COMPACTED SAND OR PEA GRAVEL. 2. LEACHING POOLS ARE TO BE CONSTRUCTED OF PRECAST REINFORCED CONCRETE (OR EQUAL) ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S, LEACHING STRUCTURES, SOLID DOMES AND/OR SLABS. IS PREPARED, AND ON HIS BEHALF TO THE 6. A 10' min. DISTANCE BETWEEN SEPTIC TANK AND HOUSE SHALL BE MAINTAINED. TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout 3. ALL COVERS SHALL BE OF PRECAST REINFORCED CONCRETE (OR EQUAL). LENDING INSTITUTION LISTED HEREON, AND 4. A 10' min. DISTANCE BETWEEN LEACHING POOLS AND WATER LINE SHALL BE MAINTAINED. TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727 5. AN 8' min. DISTANCE BETWEEN ALL LEACHING POOLS SHALL BE MAINTAINED. TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. 6. AN 8' min. DISTANCE BETWEEN ALL LEACHING POOLS AND SEPTIC TANK SHALL BE MAINTAINED. OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS S OF RECORD, IF THE EXISTENCE RIGHT WAYS 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 William Giacone&Cindy Nance 1130 Little Peconic Bay Road,Cutchogue __,_ SCTM#: 1000-111-14-17 5/9!17 f ? n r s - - i 4t ®Adi v r 40, Oka da. i i v r e Ar 1 C.• i t• . t • u A two el �■ N �. 5 �•, r_,X f.. ..fir � yM W d #M. � t.�" �... a. r� _ I r" • "�"",Z_--_� s`��,QTR U) pgop L1 el — � `- / ,t:.: Q �R1W� v► e he f6 xO ��\ IGH 8OX G f `t v �N GPS O ZIP- < 'A 41 LO to ' �•:,., ' {C cam€. ,v ,{ = �- sz. - .1 1 ::::.::,r:.:.:..: ;:r �. =—� :;.. ::.:�::'f. ::':: :•; HOUSE 3 :::_::::::;::' 5' DIA. X 4' DEEP ei; F .. l"' .�,.. .......... ��� 5TORMWA _:! :: �- ;•:aaa 1.5 TER DRYNELL = 5 , =: ? ''::`:':, FOR DRIVEWAY .. -r::::.......' :.a T O r -- 6ti:::i' 41. :. O 'PROPOSED 2 --ORY:;{: :. .:HOUSE +< 6AR�6E.... . ` 1 6 s�o '�==:•" :F.FL. 12.0 . .'::::•::::::; A� 15�1NC��{,Mp./� : 8pp�W pF 6l r. a r \ OW000 'i (3% ON�Su'\g r�;�a:1 -; i 41�t,:: �M,��Ge%: 1.sst�Y�;, �a}n .f�,... w.�`b wW. h v,�� M� / V �•! S. Y:- / Z a R7 49 NO3������f Ids �l_fr, �1� �!�•� � fl ^'l I �( - .�l.Q APR 2 1 2 /SNE s oc� eV�yC13W ��nE N GRP`' O OZ /1� OF MFRS 0 Southold Town ,.,Boardto•Truse s z '' � • m 6 ro ~ ��175 000 OEOK .e•Z�� S JI. SCTM # TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET 30 VILLAGE DIST. SUB.✓ LOT fit-/ 4 �a�� � � JI �ACR. , C?/ f -7 l RE ARKS / 0 z, L t v 7-�� 9� "71A 5 V TYPE OF BLD. '�0 5 �,�� sf� 1112,� fz — Llz�ipz,�;3-nc � �� G���o v 00 PROP. CLASS 6 Ile -Z-/-) 62 11L-7 L D IMP. TOTAL DATE 70000PA 3700 / 7 l 4 FRONTAGE ON WATER HOUSE/LOT BULKt!"D TOTAL OF'SUFFOLIC-„- ��®. (�`_ N TdWGFtir SUUTf10� -'ACTION N © szili,w.w. 'a'.ra: ReaiP o e ,Taz �*�m,. 4x'Fa1a1+o.YOO _r. IN tt 1A E>ein 5,,. �.4.' - "'^" ftp:~ .w,�•, •_ts. - -.r...,.;--F++-z-x�-�'w-a.•+.�Lo++4.' _ PP.R!»saRo'� antp Rlw,Mcd.N'Yf1lDt% L!i�.. .l "ref. - `�V'�TxOyryyyryj, �m •.CLAI&lar�,�s. ;fiQ y. �/ /� - �.. �_'n� >•1 ..ri __ _ - � _ _y aiinsrariuriwz.�rs. 'C:.,. > -�£ '1si'�: ;�.s:.:�- .> :;$?;r`"�`T Y,a'�1`.g,. I�V=® \\ � M1,i ` 7H .`�c•"p o s,y.. `�� ,\'._ `-' __'_. -___ _ ..-, _ �M .''b �+ -*"' cs�wrE � 9,. m^° a '0iV IQ d � � 0a E�.sl 1„� E st x m9 4 d s 62 \ 1 Y V. •� qr1 $�' „ O Q+H m m •m _ 4 wn 21 9 w ,9 3 ym LOOPI (�r w� 3 '" $w,,,2� ` w• e a 4 . w•, ,°+ y z m•+ >i .M +H .,d H ,ey H ��lA, on \ 422Nc1 I 9 6 m mn $© y0� I / + cna 7] p, H 6' 19 q P•' Y-1.7A(c) - t2 E 9 't'�` ,3 i 0Nc)''d' Cot, Ci •mP m,d ____ iia RO o10 d ,5 U _-- ,9 _____________ m14A(e) - _- ry 7 9 \ r_____� __� �y >e �y Q xza xmveEl I I O w'`` i ®'i �. '* vm. $ O `L ,�`� 19 28.1 wswrH sure rh,m LL°„'� p �• �'m, \ - — m ��-' ' , � I g� •d 101 rmt ------- \3 $ ,2 7A ,� �' rn .,n"' �'A7+c�'�Rj- I 1 w'z o•-9_� cL _ °m p, 6 `N" w' 3 IBNO) 2+ ' 10 ' ��' -r� ''� �' � - ______ a t9 mn {'� �a 11„1 22 •v � !zEAlc) , ,�n 0 \ O^_ � 29 24 09 ,,A(c) <� ® s'� ��"• 1„A(c)' 21 Iq 272 N 'Q 4" \ m n, 17A(c) aP�.fOA cQ� /t i °OHy a • 675 ILY NRe °Y \ g�cl 29 v g 1.3A(U P S+. H2 13A(c) ,/A(c) 31 14 26A(c) y � V,11� FOR PGL NO PoNO 3 /t �H ++ SCH yw '� i,sai-0,No o zaA K F Pn, a' 90 ,1 t6 � 1! 1 IS ` pS NOTICE d31U rT, COUNTY OF SUFFOLK © E cv SOUTHOLO SECTION NO �`"'°'•" —�— "° (21) — Q-- � __ _ ��_—�__ p Real Property Tax Service Agency Y 11 lu°E� eecmyem,e.wvcmre,nnlsm 111 Iz,Na)w+11 Hq vv°vvmrrwx svxvics Ac["cr � x p sieici x0 1000 t, PROPERTY MAP v l OFFICE LOCATION: ®� s®Ury®� MAILING ADDRESS: Town Hall Annex ® 'P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) �s Southold, NY 11971 ® �� Telephone: 631 765-1938 COU LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: May 16, 2017 Re: LWRP Coastal Consistency Review for WILLIAM GIACONE & CINDY NANCE SCTM# 1000-111-14-17 Creative Environmental Design on behalf of WILLIAM GIACONE & CINDY NANCE requests an Administrative Permit to construct a 400sq.ft. paver patio seaward of the dwelling. Located: 1130 Little Peconic Bay Road, Cutchogue. SCTM# 1000-111-14-17 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Michael J Oomino, vice-Presidcr L, 1 U�&_ W 54 75 Main kLo3d / P O. Box 1179 James r Ling.Trustee 1 �'ithold, New York L L97 L-0959 Dave Bergen. Trustee Telephone (63 L) 765-L892 Cltarles J. Sanders,Trustee Ear(631) 765-6641 TOWN TRUSTEES Vp B OAIZD Off' TOWN OF SOUTHOLD To: Southold.TOwrl Building Department APR 2 6 2012 Re: Verification of Building Department Permit Requirements SUMDINGDS"- TOWN OF SOUTEIOLD SCTmff: Property Owner Name: Date Sent to Bldg- Dept-: 4, (7 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO the proposed project require a Building Pen-nit? AM t e proposed project require a variance det6rmination from th oning Board of Appeals? - SII any part of this application be considered as Demolition as 'described under Town Code? COMMENTS: e Sign e of eviewer Date f , % OF SOOT Michael J.Domino,President � ��lO Town Hall Annex 25 John M.Bredemeyer III,Vice-President 54375 Route Charles J.Sanders P.O.Box 11799 vs Southold,New York 11971 Glenn Goldsmith fl �0 Telephone(631) 765-1892 COU A.Nicholas Krapski COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application D Wetland Permit Application Administrative Permit AmendmentlTransfer/Extensionu L J Received Application: 7 APR 2 1 2017 1'`' Received Fee: $ /00,x® Completed Application: Incomplete: Bw- )Olbs"c s ' SEQRA Classification: Type I_ Type I1 Unlisted Lead Agency Determination: VCoordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent:. Date of Inspection: R,l-7 Receipt of CAC Report: Technical Review: Public Hearing Held: ,,17- Resolution: Legal Name of Property Owner(s): � t �1 ��cc��v,f1� Lin (11&A&,/ Mailing Address: t j "hp l i w Q— 1pa-pr,;c— Phone Number: Suffolk County Tax Map Number:-1000- Property umber:-1000-Property Location: l� �i+;�ic P&-4ek`GIl (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable): Mailing Address: ative Environmental Design Pa Box 160 Phone Number: Pec®nic,NY 11958 6�3 ( --7 Board of Trustees Applic " on GENERAL DATA Land Area(in square feet): a Area Zoning: Previous use of property: Intended use of property: 4AIVAA, 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 _ZNo 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 _j-'--'No Does the structure(s)on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency��Y Date 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): , Board of Trustees Appliei on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot:_ square feet Percent coverage of lot:_ A s I _,o Closest distance between nearest existing structure and upland edge of wetlands: 41 feet Closest distance between nearest proposed structure and upland edge of wetlands: P]` 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): ,Board of Trustees Application County ofsumlk . Te,n�es5e� State of A BEING DULY SWORN" DEPOSES A DAPTERMS THAT'HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO.THE BEST,OF HISIBER 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-'DAM.A,GES AND CLAIMS ARISING UNDER OR BY VIRTUE"OF SAID PERNIIT(S),IF GRANTED, IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR ' REPRESENTATIVES(S),.TO ENTER ONTO MY PROPERTY -TO' INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Sianature SWORN TO BEFORE ME THIS 2`fir � DAYOF L ,?o l L��� , a sip; 0 a c �0 � I Board °og" '.trustees Application (where the-applicant-i-&-not the owner) 1, i d1 el .y�CC� residing at C,C B (print-o r of property) (mailing address) L WP e m �L Qotq do hereby authorize David Cichanowi,cz, Pres. (Agent) Creative Environmental,Design to apply for permit(s)from the SoutholdBoard-of Town Thwees on my behalf. C-MA Q•. (Owner's 5i tore) ' 1 APPLICANT'/AGENT/RE-P1�SEN-kA�VE TRANSACTIONAL DISCI;OSURKFORM The Town of Southol&s Code of Ethics prohibits conflicts of interest on the part of town 6fEcers and emRloyees.The purpose of this form is to provide ififorinatibnwhidfi can alert the town ofpossible'confl1cts of interest-and allow it to take.whatever action is necessary to avoid same. YOUR:NAME: (Last name,first mine middle initial,uirlessyoV are applying in the naive 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 ofZone 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,si>iiing,parent,or child)have a relationship with any officer or employee of the Town of Southold?,"Relationship"`inclades by blood;nl iage,or business interest."Business interesC'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 morethan 5°l0 ofthe shares. YES NO if you answered"-YES;complete the balance ofthis form and"date and sign where indicated. Name ofperson employed by the Town of Southold Title-or position of that person Describe the relationship between yourself(the applicantfagent/representative)and�the town officeror employee.Either check the appropriate line A)lbrough U)and/or desciibe 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%ofthe shares-of-the corporate stock of the applicant (when the applicant-is a corporation); l3)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,of employee bf the applicant;or D)-the actuatapplicant. 'DESCRIPTION OF RELATIONSHIP Submittedis day,of 204-7 signature- print Name Form-TS 1 4 t ` Board of Trustees Applicat2on -Cotmty of Suffolk State of New York UJ 11/uvi � ��' BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE-APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE-TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE-OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR R.EPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. kxle w Signat6e ro SWORN TO BEFORE ME THIS DAY OF ' Y_ ,20 e ublic MARINA K®KKIN®S Rotery Public-State o4 Not York No.011(06191941 Qualified In Suffolk County My Commission Expires Aug.25,2020 1 1 Board. of Trustees Application AUTHORIZATION (where the.applicant is not the owner) I, Utll toq &.;44mlx residing at 113D L i44�L VottL. (punt owner of property) (mailing address) do hereby authorize David Cichanowicz, Pres. i Agent) Creative Environmental Desiqn to apply for permits)from the Southold Bo of To rustees on my behalf. A. - (Owner's s" tore) APPLI CANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town tifficeis and employees.The purpose of this form is to provide information which can alert the town_ of possible conflicts of interest and allow itto take whatever action is necessary to-avoid same. - YOUR NAME: U% (Last name,fiiit name,.middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the:other person's or company's name.) - NAME OF APPLICATION: (Check all that apply.) Tax grievance Building ; Variance Trustee d� 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,ntarriage,or business interest"Business interest'•'means abusiness, 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 5010 of the s es. 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 th• &da2yb 1 20J:7 Signature-y r Print Name _ Form TS 1 f ' r APPILICANUAGENUREPRESlENT'A.TIVE 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 provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: (Last name,fust name,.middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building " Variance Trustee Change ofZone Coastal Erosion Approval of plat Mooring Exemption from plat or official map• Planning Other Of"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 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 V Ifyou 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/representatiye)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space prof ided. 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 applicmt (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 Submi 3 f'L 204T Signature Form TS l r Print Name• [.; r l r ` 617.20 Appendix B Short Environmental Assessment Form Instructions for Completintt 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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information 0 1 eu r ' aw- A Name of Action or Project: Project Location(describe,and attach a location ap): Brief Description of Proposed Action: n5r\*uuc� 4W Name of Applicant or Sponsor: Telephone: r Li E c L E-Mail:C(t'cdi.' dl d�L 9 Address: Creadivo Environmental Design P0 Box 160 City/PO: 'Pcc5-�;1,,�s ����� State: Zip Code: 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: ❑ 3.a.Total acreage of the site of the proposed action? I W1�4acres b.Total acreage to be physically disturbed? — acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? a64 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) [-]Industrial ❑Commercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Pagel of 4 5. Is the proposed action, NO YESN/A - a.A permitted use under the zoning regulations? ' 1:10 _g b.Consistent with the adopted comprehensive plan? ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located'in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: or ❑ 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? 1Vl 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: ❑ iul 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ("7( ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment:- ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � ❑ b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ 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: EV 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑Agricultural/grasslands ❑Early mid-successional [ W etland ❑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 F]YES ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO []YES Page 2 of 4 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 JYES 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/sp r t-114-1 Date: �-(- -1-7 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to-large impact impact may may occur, occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? [4 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ E)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 10establishment of a Critical Environmental Area(CEA)? FM 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: Imo, 1 ❑ 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, L1waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 t 1 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 F] 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? � 1 Fi 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 Part3. 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. r Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impact . Town of Southold-Board of Trustees Name of Leadgency ate C-VV1/tA-1) President Print or Type Name of Responsible Oer in Lead Agency Title of Responsible Officer Signature of Responsible icer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 - 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-actiondist,-policies_and-explanations.of each_policy_contamed_in the_Tomm of Southold-Local Waterfront Revitalization Program. A proposed action will be evaluated as to its si2nificant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# (_ PROJECT NAME The Application has been,submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees IJ l 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: CAR_* f. 402 'S4.T+ P0n'h.LeJ0(e__ IP +a l Location of action: Site acreage:_ 1.p Present land use: ��� i Present zoning classification: +R_4-6 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 14OS �"jG6pd (d) Application number,if any: Will the actio71f tly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse-effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. V/Yes ❑ No eot Applicable Ihr�y d Rdrw�;a(�t� t tt 18 !4 �* 5rkrsr,�� Aon Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—PoZpplicable ages 3 through 6 for evaluation criteria ElYes ❑ No Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No of 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 Sectio —Policies Pages 8 through 16 for evaluation criteria Yes ❑ No E] 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 —P oliPages 16 through 21 for evaluation criteria 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—PoIicies; Pages 22 through 32 for evaluation criteria. Yes No Note--.plicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 througk34 for evaluation criteria. �Yes No Not Applicable--_-- ^_-----_-` -� �------ i—^-�-�--- Q� x(40 Ckl 40 Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substa es and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ZYes ❑ 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. F] Ye Dn NoNot Applicable Attach additional sheets if necessary WORKING COAST POL?_--ES _f Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No ❑ Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No❑ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ❑ Not Applicable PREPARED BY TITLE DATE