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HomeMy WebLinkAboutTR-9026 Michael J.Domino,President �o��oE Soyolo Town Hall Annex John M. Bredemeyer III,Vice-President P.O. Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �p� Telephone(631) 765-1892 Greg Williams �O ,Y Fax(631) 765-6641 � UNT`l,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1508C Date: September 18, 2018 THIS CERTIFIES that the installation of a 20'x40' in-ground swimming pool with a brick paver pool patio for overall dimensions of 24'x54'• install a pool dmyell• install pool enclosure fencing; remove existingbrick rick patio and install a 600sg.ft. composite deck at grade; as built sprinkler system installed throughout the seaward side of the property; as-built fire pit with seating area; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk and to no less than 12" in height; on an as-needed basis; with the condition that a split rail fence with gate be installed landward of established non- disturbance buffer, and a 4' wide hand cut path to the dock; At 830 Clearview Road, Southold Suffolk County Tax Map #1000-89-3-11.5 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 12, 2017, pursuant to which Trustees Wetland Permit#9026 Dated May 17, 2017,was issued and Amended on July 18, 2018 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 the installation of a 20'x40' in- ground swimmingpool with a brick paver pool patio for overall dimensions of 24'x54'; install a pool drywell• install pool enclosure fencing,• remove existing brick patio and install a 600sg.ft. composite deck at grade; as-built sprinkler system installed throughout the seaward side of the property as built fire pit with seating area; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk and to no less than 12" in height; on an as needed basis; with the condition that a split rail fence with gate be installed landward of established non-disturbance buffer, and a 4' wide hand cut path to the dock. The certificate is issued to James &Maureen Levelis owners of the aforesaid property. n Authorized Signature i Michael J.Domino, President �\N,rjv S�(/jjyo Town Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski • Telephone(631) 765-1892 Greg WilliamsO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: / �l V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction / Y constructed V Project complete, compliance inspection. INSPECTED BY: Y14 _ X47v,�� COMMENTS:® Z D CERTIFICATE OF COMPLIANCE: Michael J.Domino,President O���F S0(/j,�,o 1 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �pQ Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 18, 2018 James & Maureen Levelis 133 Stratford Avenue Garden City, NY 11530 RE: 830 CLEARVIEW ROAD, SOUTHOLD SCTM#: 1000-89-3-11.5 Dear Mr. and Mrs. Levelis: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 18, 2018; RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit#9026 for the as-built sprinkler system installed throughout the seaward side of the property; as-built fire pit with seating area; and that the previously approved outdoor shower will not be constructed; and as depicted on the project plan prepared by Maureen Levelis, received on June 11, 2018, and stamped approved on July 18, 2018. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Michael J. Domino President, Board of Trustees MJD/dd APPROVED'.-BY BOARD 0F,TRUSTEES ORCHARD LANE TOWN -OF. SOUTHOLD DATEcm vp PF � Ngfi i •ice PROPOSED POOL ORYWELL A&AGF ivi PROPOSED POST&RAIL FENCE WITH 4'GATE oo VEGETATED WETLAND BOUNDARY AS IDENTIFIED \ k y $ \ BY J.PATANJO ON 3-24-17(PHRAGMRES) ALLOW AREA SEAWARD OF PROPOSED FENCE REMOVE EXISTING BRICK PATIO &INSTALL F yq! TO RE-VEGETATE NATURALLY NEW 600 S F.COMPOSITE DECK �s• � ` - MAINTAIN 4'WIDE PATH TO DOCK / PROPOSED 20' X '40' IN-GROUND _ I L POOL W/BRICK PAVER SURROUND fi4�'��i s�ci 1 ' �rJ� ` 4.2 W ry?2o� 40-C W W y . W W ^ 3 p► } TRIM EXISTING PHRAGMNES TO 12'HIGH FOR + y W W �• I I JUN 11 2018 ' A WIDTH OF 2'ON BOTH SIDES OF CATWALK I M ON AN AS NEEDED BASIS. o ` 2�W W I� �� sn51f,iiid Town Board f T orLsie�s 3 J PROPERTY OWNER PREPARED BY AUR1 I MEEN &JAMES LEVELIS JEFFREY PATANJO NOTES 133 STRATFORD AVENUE 106 HEWITT BOULEVARD GARDEN CITY, NY 11530 CENTER MORICHES, NY 11934 ` 1 } June 4,2018 Board of Town Trustees Town of Southold PO Box 1179 Southold, NY 11971 RE:APPLICATION FOR AN AMENDMENT TO WETLAND PERMIT#9026 Dear Board of Trustee's: Please let this letter serve as written request to amend wetland permit#9026. We would like to add to the permit an as-built sprinkler system seaward side of the home as well as a firepit seating area. Additionally,we have decided NOT to add an outdoor shower,so that can be removed. I have updated the site plan to show the firepit and crossed off the shower. I have also enclosed a check for$50. Thank you in advance for your help. If you have any further questions, please call me at 917-733-3370. Sincerely, Maureen Levelis 830 Clearview Road t;� JUN ® 8 2018 - } Michael J. Domino, Pres OY�Q CSG Town Hall Annex John M. Bredemeyer III,Vice-rresident �� y� 54375 Route 25 Glenn Goldsmith a '� P.O.Box 1179 c� x A.Nicholas Krupski Southold,NY 11971 Greg Williams y,�0 a�! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: JAMES & MAUREEN LEVELIS request an Administrative Amendment to Wetland Permit#9026 for the as-built sprinkler system installed throughout the seaward side of the property; as-built fire pit with seating area; and that the previously approved outdoor shower will not be constructed. Located: 830 Clearview Road, Southold. SCTM #1000-89-3-11.5 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 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: e F r- ILI" JA AJ3F POZ ync - L I have read & acknowledged the foregoing Trustees comments: Agent/Owner: /M. Present were: ° J,. Bredemeyer Domino . Goldsmith JZN. Krupski G. Williams Other Michael J.Domino,President �� SUUTjyO Town Hall Annex John M.Bredemeyer III,Vice-President �� lQ 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G • Q Telephone(631) 765-1892 Greg Williams ,,��aa� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection. INSPECTED BY: - COMMENTS: o �tirik tJ'1� CERTIFICATE OF COMPLIANCE: �OFS0UTy Michael J. Domino, President Town Hall Annex� olO John M. Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® aOQ Telephone(631) 765-1892 A.Nicholas Krupski lif'COU 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 V Project complete, compliance inspection iilllll-i}f�/�•i ' � a'i11ij`•-•1•'%f" '•` �n'��1N 1t'ry�=.. "_ ` '�t1{f••++l%'!°' i j1t19'frD�r` •n 1111~IiOljr �'d�19f 1'ij°p"• •E'er y ,,,,'7+ri.:C •Q jn` �--.�r�:.,.;;.'',�;'..��� r•'. '� u {U� r•.�•..-- ,;,5• i n•' c.ay,'• ° ....:` `\�\ �=^'� ���, �` `;e'%%"z. -iw;_�"'d...'•. '° \ /-� �y„�+w_: "�E�'T.i�+� .� "mus { � /,-r�'�'tt,''' ,. =� a. .( nr•�nr rrrrnp�r r,q,t• rrmrr+r ..t.tn„nr..irriremrmr ttr uvy` y,•,q nMR(,r .c,,,,r u.an:rr.tsu,ur�,..nro;,rr{,t,:.,vc,.4r. nnt'n. .,,��}}, BOARD OF SOUTHOLD TOWN TRUSTEES � f •'f SOUTHOLD, NEW YORK r �% t 0 PERMIT NO. 9026 DATE: MAY 17, 2017 I � ,;;�{ 7T T JAMES p� y� �7 �7 i e•�'�' ISSUED TO: JAMES & MAUREEL\ LE tl ELIS }�y F PROPERTY ADDRESS: 830 CLEARVIEW ROAR, SOUTHOLD v'�I SCTM# 1000-89-3-11.5 i Y AUTHORIZATION 7 Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on May 17, 2017, and in consideration of application fee in the sum of$250.00 paid by James & Maureen Levelis and subject to the `s. Terms and Conditions as stated in the Resolution the Southold Town Board of Trustees authorizes and permits the following- Wetland Permit to install a 20'x40' in-ground swimming pool with a brick paver pool patio for ?: - overall dimensions of 24'x54'; install a pool drywell; install pool enclosure fencing; remove existing brick patio and install a 600sgf.ft.composite deck at grade with outdoor shower against the seaward side of the dwelling; and for the trimming of the existing phragmites to not more 'gsc' I than 2' in width along each side of the existing catwalk and to no less than 12”in height; on an as-needed basis; with the condition that a split rail fence with gate be installed landward of ;t4 i established non-disturbance buffer,and a 4' wide hand cut path to the dock; and as depicted ! _ on the revised site plan prepared by Jeffrey Patan]o,dated May 19 2017 and stamped 1` s+r, approved on June 7,2017. s I IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, r r• z I and these presents to be subscribed by a majority of the said Board as of this date. Lt:,r. 1 EgN,t �i„ .• v ; 0 AF _ •�w � ,'1.ifLLY`!�'17iF3S:AiitiCFtiaGin(aZ.1'W..i.�3C�tia�iil7:iirav:lue�UU4.Y9.f4.:iu7Uti43:.C(Pa.e'^-rs7.4i.Jui4UeS��SaJ7i}Y27hu�P:4SWi.�iirL'u'iT'X7�.5..w,�2Cty,US.{S�Tilhis'�iW.u2fMi�h 'a'C(idO.tCG`YYd.�'rfie'.-:.(,offr�i�.e:r%,�>GY•rStlu,x�tiou•,�.sz�s,ai,�:naeaa;?'��;. •/ y'•. _ 'kt({�f` - y.� .`moi''- — J � v� _ •fir — f1;' _:r, ittir�y* 4��•e:- �r+ N��.r .r;°y t�i�:r •=:;�r t;'• �d�1 `{{{,.. .,y „{�.,. Kok µ4.. TERMS AND CONDITIONS The Permittee James &Maureen Levelis residing at 830 Clearview Road, Southold, 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 Perrzit 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. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. 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. 10. 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. I �pE SO(/PI, Michael J.Domino,President � 0l0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 Charles J.SandersP.O.Box 1179 00 Southold,New York 11971 Glenn Goldsmith • OQ a Telephone(631) 765-1892 A. Nicholas KrupskiC®(fffNFax(631) 765-6641 s BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 17, 2017 Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: JAMES & MAUREEN LEVELIS 830 CLEARVIEW ROAD, SOUTHOLD SCTM# 1000-89-3-11.5 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 17, 2017 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of JAMES & MAUREEN LEVELIS, 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 April 12, 2017, 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 be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 17, 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, 2 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 the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JAMES & MAUREEN LEVELIS to install a 20'x40' in-ground swimming pool with a brick paver pool patio for overall dimensions of 24'x54'; install a pool drywell; install pool enclosure fencing; remove existing brick patio and install a 600sq.ft. composite deck at grade with outdoor shower against the seaward side of the dwelling; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk and to no less than 12' in height; on an as-needed basis; with the condition that a split rail fence with gate be installed landward of established non-disturbance buffer, and a 4' wide hand cut path to the dock; and as depicted on the revised site plan prepared by Jeffrey Patanjo, dated May 19, 2017, and stamped approved on June 7, 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, J Michael J. Domino President, Board of Trustees MJD/dd Michael J. Domino, President �Ff�l 0 Town Hall Annex John M.Bredemeyer III, Vice-President ���� Gy� � 54375 Route 25 Charles J. Sanders 4 oa } " P.O.Box 1179 Glenn Goldsmith 0a Southold,NY 11971 A.Nicholas Krupski _y © p�',y Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: .1A%165+A4AVAe_eW (EV15t45 `Zo TeFF FA-r Please be advised that your application dated )VP-1j_ 121 2-01-1 has been reviewed by this Board at the regular meeting of MA I7, 201and your application has been approved pending the completion of the following items checked off below. V Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) '/ Constructed ($50.00) V 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: P.q.0 TOTAL FEES DUE.. $ fib. 00 BY: Michael J. Domino, President Board of Trustees ORCHARD LANE .� a e � Ata? a4 Trendline &Me,, gt1 FinandalSolutions� 4, A htaaa al' Rae � Yvdd wd m 00 r, N A F? 930 Cti yr i Road- 4 ti t4 c ce- 9tch - ;- 11 qrttW 3 .O N � Hl�ckcCCk = 6 PROJECT LOCATION N6 N.T.S. �S• PROPOSED OUTDOOR SHOWER ENCLOSURE PROPOSED POOL DRYWELL q R � � Ng q SyFo SD F W / \ � PROPOSED POST & RAIL FENCE WITH 4' GATE cao VEGETATED WETLAND BOUNDARY AS IDENTIFIED BY J. PATANJO ON 3-24-17 (PHRAGMITES) ALLOW AREA SEAWARD OF PROPOSED FENCE REMOVE EXISTING BRICK PATIO & INSTALL ` TO RE-VEGETATE NATURALLY NEW 600 S.F. COMPOSITE DECK MAINTAIN 4' WIDE PATH TO DOCK PROPOSED 20' X '40' IN-GROUND I POOL W/ BRICK PAVER SURROUND ` W W \ 2s4• 499 APPROVED BY IV I y y41 y y� %41 %*,. BOARD_ OF TRUSTEES \ \y TOWN OF SOUTHOLDN22°o�I W y � y � W W\ y WWW DATE �'vAF 7 2017 \ �,o'F \, J _— oil TRIM EXISTING PHRAGMITES TO 12" HIGH FOR �W y y y W ' I CEDAR A WIDTH OF 2' ON BOTH SIDES OF CATWALK \W W W W W W BEACH H ON AN AS NEEDED BASIS. o M W of � HARBOR 09, CD In JUN C 2017 z 70 PROPERTY OWNER: PREPARED BY: Permit Drawings SCALE: MAUREEN & JAMES LEVELIS JEFFREY PATANJO 1"=40' NOTES: 133 STRATFORD AVENUE 106 HEWITT BOULEVARD GARDEN CITY, NY 11530 CENTER MORICHES, NY 11934 OPOSED PLAN & LOCATION MAP DATE: 631-484-9332 3-27-17 1. PORTIONS OF PLAN FROM SURVEY PREPARED BY: JPATANJO@OPTONLINE.NET 5-7-17 DESTIN GRAF P.L.S., P.C. 830 CLEARVIEW ROAD 5-19-17 ROCKY POINT, NY SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: TAX MAP NO. f000-89-3-11.5 1 of 1 TAX l.C. 46. tDOsi-rjc, t iT h JOB No ^4 21t;C r�f. l� � StR}4Y P•.BAI�h 11X54 31711T}-LaA'vAl7P IFRTII'FD r1\LY T(1 1(,D.1'.l_79MiN 1 i C3 r� 11 t syr J r?, Ary T .. CEDAR BF,ACH S HARBOR �=a SURVEY Of: LOT"D'r MAP OF MINOR SUBDRWON FOR //tp///SE'S NFSv Y� �j n ^V E ROBERT AND AI.DONTA NORKAS BAYVIEW,TOWN OF SOUTHOLD ISI l�j SUFT•OLK COUNTY,NMV YORK APR 1 2 2017 SURVEY DATE: 05R91?012 SCALE: I"=4V ,, '- - ------Southold Taw � ar of Trus ees Michael J. Domino,PresiS; Town Hall Annex John M. Bredemeyer III,Vice-President ��� Gy54375 Route 25 Charles J. Sanders # P.O.Box 1179 03 Glenn Goldsmith %�5 Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD I Date/Time: Completed in field by: �1,`�l e� _fI✓1 r,+-C;1.�` Jeffrey Patanjo on behalf of JAMES & MAUREEN LEVELIS request a Wetland'Permit to install a 20'x40' in-ground swimming pool with a brick paver pool patio for overall dimensions of 24'x54'; install a pool drywell; install pool enclosure fencing; remove existing brick patio and install a 600sq.ft. composite deck at grade with outdoor shower against the seaward side of the dwelling; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk to no less than 12" in height on an as-needed basis. Located: 830 Clearview Road, Southold. SCTM# 1000-89-3-11.5 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 k/ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment L/Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 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: c4c. t p c.(.r- iU X11�J� "W & � 1, 'lam �1:3 V1.4e C.1 V Present were: /J. Bredemeyer —AZIM. Domino . Goldsmith ✓ N. Krupski �C. Sanders Other Page 1 of 2 Michael J. Domino,Presid O�QSUFFOt�O { J 1 Town Hall Annex John M.Bredemeyer II1,Vice-President �� �� 54375 Route 25 Charles J. Sanders P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski �,�Ol dap! 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 JAMES & MAUREEN LEVELIS request a Wetland Permit to install a 20'x40' in-ground swimming pool with a brick paver-pool patio for overall dimensions of 24'x54'; install a pool drywell; install pool enclosure fencing; remove existing brick patio and install a 600sq.ft. composite deck at grade with outdoor shower against the seaward side of the dwelling; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk to no less than 12" in height on an as-needed basis. ,Located: 830 Clearview Road, Southold. SCTM# 1000-89-3-11.5 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 tinmot lot 4wMiI ww James Maureen 830 Cicarview Road,Southold SCTM#: 1000-89-3-11.5 {7.' r y +t • �• � .: r���•. �r '�rr�'�� ��. �,�.�,. l". { iir M .�t ••{`y 3, :�5+`Y�S Y�g'y����� �1 -, - ' w• r r amen&Maureen Levelis 30 Clearview Road,Southold " CTM#: 1000-89-3-11.5 /9/17 1 e vq wlYp "A' '�, �° lYFiiN.#� 't�� � � �,; ,.r, I,_.�� tt. 1 �aA �9�'1 V � 1 ;���3`: � �� F• 4 VrY Y �..+`� �y(6i9f � s � w'.. .I I ' ti �,. pp �'� � 't:,� e�.' I��Ilg9.y�sR„ a ,fie• nr ,rd t� d �r1C d(+pfyU'IIIIIiiur1.4,id - � - �� rt, -tip,v J. r f-� l 7 t? ..,,55 f 1 I. l 1 el ��F.' ♦ F R f `yry 'k 444 - �t �t�• f�1�R� �✓.,���r �l' f(d N I.�'� �� $�1� �f/ jf ''tI,YP6e� ,•,tly, +„I�� � ,t1t��eh��r` �tY -- 7� t�� ,y �6 J.i ��.r (,� i{ 7�. �•. � AV e ��.1rt 4'�.t.1 ,�I'�t �'' 1�VC f I�l�tj�, IY 'f� yVl� ,�1'� - • �S � r �:, � �s;• ��� � � "�1� �,� ��, R�1 IIn��4k�� }e�l� ��i �i'�k"{�`�7 i�$°�, r� �� �f � 1 ,�'.It�li t�� �1]i `�1 'I i;f v I t• jv3.. - � .�E� �14,t�y'.i�,'�,�C��'• .�y..e �'tfr� � ��`�p{5���pP t'�' r ��'�..��, i ���� p 9ti 1�E�,�.a�� ��e _ �L 10 �',i ,43 ,r"'Yc"•� �! t� I `�. ) �yrv.Aif)W � ' ♦ � F P �I `f� � �� �tlr I -�fiv a^ � y ••. r \� �t =; � \r `r of f• '� <_ +4 � � �r,�y'�,.I°�.� �I �IIL"��"��� 1n�. �r F } � �rtd'� y��}Y r,��. .,•�� � -4.'.. � - i�;" `{�y.r"�"h�.._�r� 'I •.�*l�l �,Y:1�1*"` �`.��C.trr i ,..''� �", Y�rr� R�YM .i{+�v�{l. yj i t.�:. - _ -. • I wM 'i 4 " q r / `,� dY: h, Y �;y � 7.'�'�, � •"� y1VT�1r iY,,. i +��- .� j �� ;+i, at>�. � ��y�''X0.'1;� I.Y � k`�E:;` � .♦ i /r w;�',.' � Jxk� i � * r� �j►' ��7iF•r�°`�� .F3, .Y�S� .."�. ��I�a .. - � r._ '►�- y . Photo 1 Photo 2 : 1 � n pq 9 ?n17 Southold lows Board of Trustees ` h �i a+�art rt. +fin Photo 3 � -•:err• Photo :i. � � z tee-_7 103 -- ------------- - Ct I k5m I CEDAR B�.GH 2 M(c) 2 DWMs 37A(.) Basin To"OF S= 4 "--- -T------------- 16A(,) s1 p 7 3.2 ORCHARE) 2,M LA (SO) so W) PA 'SOUTH 13AYvIEW F?D, 166) 4N.) 4 JMG) NOTICE COUNTY OF SUFFOLK K I—C, SOUTHOL13 SECTION NO E L —————- Real Property Tax Se ice AgenCy Y E (21) 13 .-ty —.d.NY—, 089 G E P M DWRICTNO 1000 PROPERTY MAP (1,ON I. N� OFFICE LOCATION: � s �® MAILING ADDRESS: Town Hall Annex �® �® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 ® aQ Telephone: 631 765-1938 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 JAMES & MAUREEN LEVELIS SCTM# 1000-89-3-11.5 Jeffrey Patanjo on behalf of JAMES & MAUREEN LEVELIS request a Wetland Permit to install a 20'x40' in-ground,swimming pool with a brick paver pool patio for overall dimensions of 24'x54'; install a pool drywell; install pool enclosure fencing; remove existing brick patio and install a 600sq.ft. composite deck at grade with outdoor shower against the seaward side of the dwelling; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk to no less than 12" in height on an as-needed basis. Located: 830 Clearview Road, Southold. SCTM# 1000-89-3-11.5 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. {-S � 4%4fFo�k��� Peter Young,Chairmany Town Hall,53095 Main Rd. Lauren Standish,Secretary d P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 10, 2017 the following recommendation was made: Moved by John Stein, seconded by Greg Williams, it was RESOLVED to SUPPORT the application of MAUREEN & JAMES LEVELIS to install a 20'X 40' in-ground swimming pool with brick paver patio and pool drywell, removal of existing brick patio and installation of 600 sf. composite deck at grade and outdoor shower adjacent to residence and trimming of existing phragmites for a width of 2' on each side of existing catwalk on an as-needed basis. Located: 830 Clearview Rd., Southold. SCTM#89-3-11.5 Inspected by: John Stein, Keith McCamy, Peter Meeker The CAC Supports the application with adequate drywells for the pool backwash and outdoor shower. Vote of Council: Ayes: All Motion Carried Michael J Domino, vice-Presiden_ �O 1p 54375 Main 1 � s� r '� . P O. Sox 1179 James C 1Gng, Trustec "�` g thold, New Yock 1197L-0959 Dave Bergen- Trustee � � Tele hone(631) 765-1892 Charles J. Sanders, "Trusteeae0�� IyC�Ut�(`(,�`� BOA D OF TOWN TRUSTEES APR 2017 TOWN OF SOUTHOLD To: Southold.Towir Building Department BUIELDITGDEPT, TOWN OF SoUii66 Re: Verification of Building Department Permit Requirements SCTM#: ills- Property Owner[Mame: ° tC_V670S Date Sent to Bldg- Dept-: q- 14,17 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Departfnent's permitting requirements stated below: YES NO i f the proposed project require a Building Permit? -7NWil the proposed project require a variance determination from 2 he Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: Signature or Rev ewer Date John M. Bredemeyer III,President so Town Hall Annex Michael J.Domino,Vice-President ~ O 54 Main Road P.O..Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee �O Telephone(631) 765-1892 Charles J.Sanders,Trustee O ly(,'QU ffm�'C•~ Fax(631)765-6641 ; BOARD OF TOWN TRUSTEES ' TOWN OF SOUTHOLD Office Use Only _LCoasta'Erosion Permit Application M1 _Wetland Permit Application _Administrative Permit Amendment/Transfer/Extension >/Received Application:_qL12_( Received Fee:$ 0-S- fl Completed Application: Incomplete: _SEQRA Classification: HECE � VED Type I Type Il Unlisted oordination:(date sent): FAPR 1 2 2017 LWRP Consistency As essment Form: ` CAC Referral Sent: �� �7 Date of Inspection: < <•�- -Receipt of CAC Report: Southold Tovwn _Lead Agency Determination: a o r e Technical Review: Public Hearing Held:: 3—,17=, Resolution: Name of Applicant: 1Agvreebi Ta'Ac5 Level's Mailing Address: 133 5Tr,4-Fvrk AVe. GRr l04 C,ty NK 11 Sia Phone Number: 9 1 - - 73 3- -3-37P Suffolk County Tax Map Number: 1000- 8 9 . 3 • 11• S Property Location: 3O C(ccryiecA.-, AU- $ ,,Jke1d, rjLj 1IQ'7/ Tu l`� ©rU'►a r ce L....+� �'v e h f1. �n d2 rru�2 �y b f �.► Chu/vlaw ✓1c(. - (provide LILCO Pole#, distance to cross streets, and location) AGENT: pke!d A+"g n 1 a (If applicable) Address: gevji-'-V QIy&t• ee✓1+_Cr 44artCl4ef, N Phone: )eP 1 4\ Hoard of Trustees Applic?,,_on GENERAL DATA Land Area(in square feet): 51 51?— Area 92Area Zoning: 12 e S Previous use of property: Res . Intended use of property: R cs . 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 Does the structure(s) on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date 603A 31 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): See Maureen& James Levelis 830 Clearview Rd. Southold, NY 11971 SCTM No.: 1000-89-3-11.5 Project Description Project includes installation of 20' x 40' in-ground pool with brick paver patio (overall dimensions of 24' x 54') and pool drywell, removal of existing brick patio and installation of 600 S.F. composite deck at grade and outdoor shower adjacent to residence &trimming of existing phragmites for a width of 2' on each side of existing catwalk on an as-needed basis. Board of Trustees Applic___Jon WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Sc.eg,-1--t•a e-Ack . Area of wetlands on lot: �� °c'° square feet Percent coverage of lot: 3 Closest distance between nearest existing structure and upland edge of wetlands: 16 feet Closest distance between nearest proposed structure and upland edge of wetlands: k6 feet Does the project involve excavation or filling? No ✓ Yes If yes, how much material will be excavated? / Sd cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: 6 feet Proposed slope throughout the area of operations: - 3 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): TAA,rL w,11 6t n. 4-(�Fec_4 m .-'ie_ S tc w I hG C', -f �e0 w t-r , -C, L+ fen cf- j tiu� 10 d.le f V�+; to r t -2�c.Ti o.,s or in D_ re-- v c J e 4-4-t1 0 nJ Shoat Environmental Assessment Form Part I ®Project Information Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1, Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. ]Part 1-]Project and Sponsor Information Name of Action or Project: 830 Cleanriew Rd Proposed Pool/Phragmites Trimming Project Location(describe,and attach a location map): See Location Map-House is located at south end of Clearview Road off of Orchard Lane Brief Description of Proposed Action: Trim phragmites 2'wide on either side of existing catwalk as needed. Install proposed in-ground swimming pool with pool drywell. Install 600 SF composite deck. Install outdoor shower. Name of Applicant or Sponsor: Telephone: 917-733-3370 Maureen&James Levelis E-Mail: maureen.levelis@gmail.com Address: 133 Stratford Ave. City/PO: State: Zip Code: Garden City NY 11530 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, INTO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that O 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: NYSDEC/Town of Southold Trustees El FV 3.a.Total acreage of the site of the proposed action? 1.207 acres b.Total acreage to be physically disturbed? 0.032 acres c. Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1.207 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 Page Y of 3 5. Is the proposed action, NO YES N/A a.A pennitted use under the zoning regulations? 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? ® Z 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:Cedar Beach,Name:Peconic Bay and Environs,Reason:Significant coastal fish&wildlife habitat, Reason:Protect public health,water,vegetation,&scenic beauty,Agency.z5outhold, I own of, prn.a�srrffn4k-F.ntmtvf?-- 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? Z 0- c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 7 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: 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: P-1 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: Z 0- 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 [I 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 ®YES b.Will storm water discharges be directed to established conveyance systemsrunoff and storm drains)? If Yes,briefly describe: NO ®YES Page 2 of 3 i r 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 naryle:Maureen Levefis,Owner Date: Oq Signature: PRINT FORM Page 3 of 3 d Agency Use Only[If applicable] Project Date: ciiv^^i i ir..vi onmer.tal Assessi�l�ent I'Voi m Part 2 -Impact Assessment Part 2 is to be completed by the Lead Agency. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur, -occur 1. Will the proposed action create a 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? El 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 El available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? El 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 ad%erse change to natural resources(e.g.,wetlands, l-fj Elwaterbodies,groundwater,air quality,flora and fauna)? ��]] 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? PRINT FORM Pagel oft Agency Use Only[If applicable] Project Date: Short Environmental Assessment Form Part 3 Determination o f Signi ficance 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 actionwillnot result in any significant adverse environmental i acts. 17 V1 Na of bead A ency Date Print or Type Name of Resp nsi Officer in Lead Agency Title of Responsible Officer Signature of Respo able Officer in Lead Agency Signature ofPreparer(if different from Responsible Officer) PRINT FORM Page 2 oft EAF Mapper Summ,y' Report Monday,April 03, 2017 8:56 PM Disclaimer: The EAF Mapper is a screening tool Intended to assist protect sponsors and reviewing agencies In preparing an environmental assessment form(EAF).Not all questions asked In the EAF are answered by the EAF Mapper.Additional information on any EAF 1 question can be obtained by consulting the EAF Workbooks. Although the EAF Mapper provides the most up-to-date digital data available to DEC,you may also need to contact local or other data sources In order 7' k to obtain data not provided by the Mapper.Digital data is not a substitute for agency determinations 1'ti f Vii_ `fr Gt9:al:to Atonlro, So Toronto, r' ":'ti., ' ti;;y� .%; I lilltl,9r'r rn4lhCaal [i�tlt�lt Bocaon raI' Sti• � s;.Er ii,HERE.,CeLcxrne,UBCs, { Iry :at�i '" if'rc'itlrttce Int=msp,yltI" tglE(,I`F, l• Can,s'Esri:, Japat tdETlyEsciChina,(Hcn kcn E-rli `� YF P.E. r 1 Q:' 9 , / �, pitlamicin 5ctcaFs, ri, Kcrzj,; ESrl,Thai Isno),,tvlapmylnois,NG�CC„, ' ociumt�uc, ` Dc-UVI I--dIMSMS,Intsrmap, _~ ®C VtStr =t�v1s nfribu trs,and the GIS � - I�,CA'Et:4ElJT P, t•lRCgn,ES IT UsterCctYiriiurity- Iclr3n;lra J 4 fu1ETl,Ese.i,Chins;`4li Part 1 /Question 7 [Critical Environmental Yes Area] Part 1 /Question 7 [Critical Environmental Name:Cedar Beach, Name:Peconic Bay and Environs, Reason:Significant Area- Identify] coastal fish&wildlife habitat, Reason:Protect public health,water, vegetation, &scenic beauty, Agency:Southold,Town of, Agency:Suffolk County, Date:3-9- 90, Date:7-12-88 Part 1 /Question 12a [National Register of No Historic Places] Part 1 /Question 12b [Archeological Sites] Yes 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 Yes 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 Board of Trustees Applic,- ,-�on AFFIDAVIT tt�rGcn 'SameS �cv��i5 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 J OF THE PERMIT. X S' + afore of operty Owner SWORN TO BEFORE ME THIS D DAY OF , 20_Al Noky Public WAYNE ULRICH Notary Public,State of New York No.9411880 Qualified in Nassau County Commission Expires Sept.30,2018 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) Me, owners of the property identified as SCTM# 1000- 89' 3" in the town of S V .+j'.1A .New York,hereby authorizes f -r cl , Va-tk �,,.b to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Prop, Owner's Signature SWORN TO BEFORE ME THIS DAY OF U ��l R- ,20 1 Notary Public Notary Public,State of New York No.9411880 Qualified in Nassau County Commission Expires Sept.30,201� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics,prohibits conflicts of interest on the part of town officers and emplovees.The_numose of this form is to provide ioforination-which can alert the town of possible conflicts of interest and allow it to take whatever action is ne_cessary to avoid same. YOUR NAME: I e v c h s A-A e.,.*r-ec h (Last name,first name,itiddle initial,unless you are applying in 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 Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has•even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the 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 relationshipbetween 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 �i (when the applicant,is acorporation); B)the legal or beneficial owner of any interest in u 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 I Submitted this day-of APYu 20 j 7 Signatm•e Print Name Form TS 1 I } APPLICANUAGENWREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on-the part of Town 6f6eers and emnlQyees.The.nurnose of this form is to provide information which can alert the town of passible conflicts of interest and allow it to take-whatever uedon is nes&sary to avoid same. YOUR NAME: ),Gwa I's, , To-fte L (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other ` person's or company's name.) NAME OF APPLICATION: (Check all that apply.) ' Tax grievance Building Trustee Variance Change of Zone Coastal Erosion Approval of plat Mooring I Exemption from plat or official map Planning G Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership.in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which,the town officer or employee owns more than 5%of the 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 f t 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 50/6ofthe shares of the corporate stock of the applicant (when the applicant,is a corporations 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. t DESCRIPTION Or RELATIONSHIP Submitted this day of 200 Signature Print Name Form TS 1 �-� 65 ��✓'�L1S r i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest oif a part of town officers and emnlovees.The.nuose of this form is to Rodde inforination which can alert the tbivn of possible contlrcts of trrtetost and allow it to take whatever action is necessary to avoid same. T YOURNAME: (Last name,first name,4iiddle 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 i Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring �� 3 Exemption from plat or official map Planning i Other (If"Other'',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer of employee of the Town of Southold? "Relationship"includes by blood,remarriage,or business interest."Business interest"means a business, including a partnership,is which the town of ccror employee has even a partial ownership of(or employment by)a corporation in which the town officeror 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 i Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check k the appropriate line A)through D)and/or describe in the space provided. f{ The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): { a A)the owner of greater than 5%of the shares of the corporate stock of the appuc*nt (when the applieW is a edrporadon); B)the legalor6ene�iciat wsvnerof any interest in,a pon-corporate entity(when the applicant is not a corporation); 1 C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. I DESC_RIMON OF RELATIONSHIP Submitted thisd of �%'t' Zoo V Signature Print Name awcdi.. 0���,•i+ Form TS 1 a U.S..Postal © RECEIPT 7,1 Service- U.S. Postal Service"' CERTIFIED MAIL -0 D�Mesti&mw-Only CERTIFI I%- I ED IWA[L!l�.RECEIPT ' . ru For delivery'firif-0 jw" - ' - rMa J = otoo.4yawiloppik OM .Y'i � MJEK- 10-TORM.A.W.."M F M OUTHx ru 7 j C3 certified Mail Fee SOUTHOLD,! NY' �M'i Er M C3 $ $3.35 Extra Services&Fee 0934 C3 Return Receipt(hard s(check box,add tee ir Certified Mail Fee ❑ copy) $3.35,, 1934 _Wrate) C3 $ C3 EJR $ I— C�5- Sc" 1-16 etum Receipt(electronic) Extra Services&Fees(check box,add-tee a M El certified Mall $ rq [I Return Receipt(hardcopy) $ Ej Restricted Delivery $ 0St!ndrk el - I lr:_3 C3 0 ReturnReceipt(electranic) $ 171 itrn rk Adult Signaturii Required $ Here C3 [:]Ad,lt Signature Restricted Delivery j C3 LICertified all Restricted Delivery $ Here C) Postage , (0 C3 E]Adult Signature Required $ M $ $M9 U, .4p% C4 Adult Signature Restricted D.I.,I M Total Postage and Fees I M roslage $0.49 $ 3 A Sent To $ 84 $ Ltir=1 lf�iii ii)1:11:119411 3—nd;! 5 17 0584 C3 --- $ Ln Sent To C3 State, -------------------------- ------------------------------- Pt No, No. 0-clk ctr Sent �Fffa----------------------- ------------------------------------------ ---------------------------------------------------------------------- AM 3BEESUM. U.S. Postal S�ervice`r U.S. Postal Se;rViceTM CERTIFIED MA16LO RECEIPT CERTIFIED MAILO Doh7estic MaR On RECEIPT '1Y i ;M Domesti I _n c Mail On/Y SIOqk F�_�� Ln 'r-7 71 L Er Certified Mali Fee = 2 1, Certified Er $ $3.35, • -934 Certified Mail Fee C3 Extra Services&Fees(check box,add fee S S' $3.37i- 06 $ 0934 El n Receipt(hardcopy) $ a 1-3 Extra Servilies&Fees Retur (check box add fee s �,d 06 r_3 DReturn Receipt(hardcopy) $ .1 El Return Receipt(electronic) $ 0 Retu R p C3 0 Certified Mail Resin Postni OA r3 m Receipt(electronic) $ Restricted Delivery $ Heb _ C]Corti Postm E:3 E:1 Adult Signature Re 101S ted Mail Restricted Delivery $ Required $ r-3 E]AdIt's igrRequired C3 E]Adult Signature Restricted Delivery$ C3 C3 Postage [:]Adult Signature Restricted Delivery$ L 10Z 9- 0 Postage ,n Total Postage and Fees $ $0.49 MIX Total Postage and Fees rq 7 $ $3.24 7 Ln Sent 720 $ $3.84 rq Ln Sent To CC3 _MJeIand A;5(�96.,Yr -------- - ------ r9 --Chubc+ rn r o., i _3 Street and Apt No,of PO Boz_fft ty ------------------------------------------------------------ _5677,�----------------- -------- tate,ZIP+48 --------------------- ---------—---------------- U Posta-1.Serv1CeT" CERTIFIED IWAILD RECEIPT ■ C3 Comestie Mail-0njy Ln r%_ ru C3 GARDEN VTY�i VY­1,1930',� V1 tc;. ST ATI'GN i;NY`�I t -1 a Z il f�-A U, S 746 Ln M I i' , ;! 1� ��:. .' Er Certified Mail Fee $3.35 0934 C3 Cert�ffl,5_d'Man t-ee Er $ 15 �#;rl Art 06 Ir $ $3.35 934 .a &Fe (check n C3 C3 Extra Services as Extra Services&Fees icheckbo,add fee skA-pp- ate) C16 C3 Return Receipt(hardcopy) ❑Return Receipt(hardcopy) $ 0 E]Return Receipt(electronic) �Post -3 $ • r_3 ❑Return Receipt(eleotronlc) $ N lt [:]Certified Mail Restricted Delivery $ C3 El Certified Mail Restricted Delivery $ aa C:3 E]Adult Signature Required $ M C3 E]Adult Signature Required $ r3 ❑Adult Signature Restricted Delivery$ []Adult Signature Restricted Delivery$ tage C3 Postage r-3 $13.49 M -0 ' 7 $1 $0.49 CA _n Total Postage and Fees Total Postage and Fee Ln Senl'roSent To Lrl rq ...................h md-t------------------------------------------------ r-4 Ugdi 90 C3 --- C:3 _gti6etandAjot'&_o_,o_rT ei r%- ------- - ---------------------------------------------- ---------------------------------------------------------------------- ----9tWt5,2jf,:j74W Z1P+4®------------------------- i I I I i i PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS I Name: Q' I oq 90 go - `�- ?0 v L/ 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 r i Notary Public -----. 701c 1660 0000 0995 0263 7015 1730 0001 0903 ,14 ; 701 --1660 0000 0995 0270 7015 1730 0001 0903 I 2751 I� �- 7015 1730 a0al 7015 1660 0000 0995 0287 - 0001 0903 2768 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 12115- Ce,kW'g&Aa, L Lc, Fa J�OX Q'�b C,1�c�,rv�ew �Rc4 . So���d Ilet11 V Gs-ernan C� LLG �l-�I �s 'r�cl�lrlal�g���• Stoox l ls� Sc,►)m�e�-� �� ,USSe I1 �d • � t�t-eV� l 5�vd Ch Obe+ T7am►\j e v -Frt.,5 3-7j3rte -Tr >.. wpm ood STATE OF NEW YORK mi; 620q0 COUNTY OF SUFFOLK `r �U , residingat �� 51 y(,1' 4 being duly sworn, deposes and says that on the 5 day of , 20j3, deponent mailed a true copy of the Notice set forth in the Board of TruiteesApplication, 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 COAnk lr'.,li(, A('fin JS , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of_MM 20j J _ V Vl j Notary Public Lodann.Patanl10� Notary Public s 0 tw York Qualfied in Suffoyk County No:01 PA6150861 Commissioires Q13107120/8 Michael J. Domino, Fi'�1„dent {.'1'O COGS. Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 Charles J. Sanders ® P.O.Box 1179 Glenn Goldsmith D Southold,NY 11971 A.Nicholas Krupski �yy�o �pl � 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 JAMES & MAUREEN LEVELIS COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, V �Lk (� , residing at/dba 10(0 4P-W 1`6E 51 M ou cky s n y l g 3 4 being duly sworn, depose and say: That on the ( day of Mai , 2017, I personally posted the property known as 830 aeox yew Qrj 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,May 17,2017. Dated: na e) Sworn to before me this day of YY1ppoll U�1� Notary Public Lo6ann Patan'o Notary Public State pf�Vew York Qualified in Sutfotk County No:01 PA615MI Commission Expires 08107MLI-F ' 1 May 7, 2017 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 830 CLEARVIEw RD. -SOUTHOLD, NY SCTM No. 1000-89-3-11.5 AFFIDAVITS Dear Trustees: Attached, please find original affidavits for mailing and posting of 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. *e , Center Moriches, NY 11934 NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 (!/lain Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: JAMES & MAUREEN LEVELIS SU BJ ECT OF PU RLIC H EARI NG : For a Wetland Permit to install a 20'x40' in- ground swimming pool with a brick paver pool patio for overall dimensions of 24'x54'; install a pool drywell; install pool enclosure fencing; remove existing brick patio and install a 600sq.ft. composite deck at grade with outdoor shower against the seaward side of the dwelling; and for the trimming of the existing phragmites to not more than 2' in width along each side of the existing catwalk to no less than 12" in height on an as-needed basis. Located: 630 Clearview Road, Southold. SCTM# 1000-89-3-11.5 TIME & DATE OF PUBLIC HEARING : Wednesday, May 17, 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 �oSU Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.K th. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A Q( y1� pep Sg g //.S– STORM WATER,GRADING;-DRAINAGE AND EROSION-CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? I Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within S 2 t9L Generated by a Two(2")Inch Rainfall on Site? /-aaY the Scope of Work for Proposed Construction) (S.F./Acres) (This item will include all run-off created by site �E] 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 1-373 /.0.03- Site improvements and the permanent creation of construction activity? impervious surfaces.) ,. (S.F.!Aces) ` IDE BRIEF PROJECT DESCRIPTION (Protide Addlgonel Pages-Neede li 2 Doan the Site Plan and/or Survey Show All Proposed PROVIDE Drainage Structures Indicating Size&Location?This ,✓� Item shall include all Proposed Grade Changes and 5.ee 44t e,(a cA- 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 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand Li V/ (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction ® — General DEC.SWPPP ReaulreDiants: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres;including disturbances of less than one acre that 7 Will 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? El 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 for Storm Water Discharges from Construction activity-Permit No.GP-0-10001.) Surfaces be Sloped to Direct Storm-Water Run-Off ® .� 1.The SWPPP shall be prepared pdor to the submittal of the NO).The NOI shall 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 shaft describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, / required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction Of any —✓ constructed to reduce the pollutants In storm water discharges and to assure item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(nis item writ NOT Include the lnstaDation or Driveway Aprons.) Identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark i 3.All SWPPPs that require the post-construction storm water management practice in a Box and tha construction alta disturbance Is between 5,000 S.F.&1 Acre in area, component shall be prepared by a qualified Design Professional Licensed In NewYork a Storm-Water,Grading.Drainage&Erosion Control Pian 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.(.I)and/or Answer for each Qusstlon is Required for a Complete Appitcation) SPATE OF NEWYORK, COUNTY OF...........................................SS That I ,4 - 40 een 4 eve l i,j being duly sworn,deposes and says that he/she is the applicant for Permit; (Name`of individual signing Document) And that he/she is the P..l v .......... ... ... ... .. ................ . .................................. ...................... ..... ...(..... C ...... ...... (Owner,Contractor,Agenl,Corporacer,alai Owner and/orrepresentative 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 itt 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 the application filed herewith. Sworn to before me this; A Notary Public: .. .......................................... i .... C. --a. —may........................ AYNE ULRICH (Signalise of Applicant) FORM - 06/10 Notary Public,State of Now YorK No.9411880 Qualified in Nassau County Commission Expires Sept.30,2018 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 nificant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 1 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# 69 - 3 - 11• — PROJECT NAME r 3 o Cl ecia vsew 9-- 1,064LA 40 The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees L`�1 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: S re- P Location of action: 6 3 ee.r v eu., K i i 4 7 / Site acreage: /• 2®7 Present land use: �2tS Present zoning classification: 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: AA &w r r-en #- -s'.1"c s e v e-)I& (b) Mailing address: 13 3 S 7(-. t-4 r k A•mac C7 ccr Ac/i Cc kc,t, &)y I t s-b O (c) Telephone number: Area Code( ) 917 • 73 3 • 3 3 7 0 (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes RfNo❑ If yes, which state or federal agency? �-1� 16 rJ:V C-- C. _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. ✓ Yes ❑ No ❑ Not Applicable lecd us C®nS/5t"uAt u9i{'�► �•acG( Gv.�t�wc�ilt-�.! Ls4� S�ur��cr� Ca�Js2rucY,lo.i Pl��'t«S • tt n,.�Y�s ����c�4.L t>S�- �F C�,ST.s.( L�c��"1•�.-s l✓1.� w.u., B F K��oalsa S ti't7'1'+'t to CJQ w,G G�.fS o .y 6• mel+ �W/ Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—�Poli�cies Pages 3 through 6 for evaluation criteria ElYes ❑ No [9 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable ProJec4 ircg-IvcQcs -%Ika 7-t&-;" ,in.y ®-F P {k�naittS ��,� 60,-'t)A•ue1Q 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 2Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No g 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. ❑ ❑ 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. ❑ Yes ❑ No F—iNot 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 1:1a No [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. El YeO No❑ Not Applicable Attach additional sheets if necessary WORHING 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 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. F] Yes F-1No U 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 L-1 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 •�_ • �a awn 1� TITLE A cK+ DATE Y! 3 ,L April 8, 2017 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179. fJD E C E VE -Southold, New York 11971 (—~ RE: 830 CLEARVIEw RD. -SOUTHOLD, IVY I APR 1 2 2011 SCTM No. 1000-89-3-11.5 APPLICATION FOR PERMIT Southold Town Board of Trustees 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 truk yours, Jeffrey Patenjo 106 Hewitt Blvd, Center Moriches, NY 11934