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TR-9050A
Michael J.Domino,PresidentoF S0Ujy0Town Hall Annex John M.Bredemeyer III,Vice-President ,`O 01 0 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith G O O Telephone(631) 765-1892 A.Nicholas Krupski '00UNTI, O a Fax(631) 765-6641 - �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1406C Date: November 1, 2017 THIS CERTIFIES that the installation of a 420 sq. ft.paver terrace on a concrete slab on the seaward side of the dwelling: At 4298 Wunneweta Road, Cutchogue Suffolk County Tax Map #1000-111-14-29 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 20, 2017 pursuant to which Trustees Administrative Permit#9050A Dated July 19, 2017,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of a 420 sq. ft. paver terrace on a concrete slab on the seaward side of the dwelling. The certificate is issued to JULIE ANDERSON owner of the aforesaid property.. Authorized Signature erg SO(/p Michael'JDomino, President � Ol0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Charles J.Sanders C Southold,New York 11971 Glenn Goldsmith ® �� Telephone(631) 765-1892 A. Nicholas Krupski l��+oU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 10130 /r Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: � COMMENTS: CERTIFICATE OF COMPLIANCE: �pE SOUS Michael J. Domino, Presicierit � �Q�O Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith G Q �`Q ® JO Telephone(631) 765-1892 A. Nicholas Krupski ��COUNTV ���, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection hO�*pF Solo Michael J. Domino,Presic'__.- Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J;Sanders Southold,New York 11971 Glenn Goldsmith ® `yQ Telephone (631) 765-1892 A.Nichola ls Krupski ��CQUNV I Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9050A Date of Receipt of Application: June 20, 2017 Applicant: Julie Anderson SCTM#: 1000-111-14-29 Project Location: 4298 Wunneweta Road, Cutchogue Date of Resolution/Issuance: July 19, 2017 Date of Expiration: July 19, 2019 Reviewed by: Trustee A. Nicholas Krupski Project Description: To install a 420sq.ft. paver terrace on a concrete slab,on the seaward side 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 Samuels & Steelman Architects, dated June 14, 2017, and stamped approved on July 19, 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 REVISIONS: LOT C0V = KAG`% E TABLE - SITE DATA 51TE AREA TOTAL: 48,810 sf SCTM # 1000-111-14-29 SITE AREA UPLAND FROM ADDRESS 4298 Wunneweta Road ADDRESS Cutchogue NY 11935 TIDAL WETLAND BOUNDARY: 43,430 sf OWNER: Julie Anderson 333 East 30 th Street Apt 4M 5TRUOTURF-5 EXISTING PERCENTAISE PROP05ED PERCENTAGE New York NY 10016 HOUSE: 1,511 5f 4.1-1% 1,511 5f 4.11916 SITE: 48,810 SQ. FT. = 1.121 ACRES (TO TIE LINES) W &ARAISE: 456 sf 1.00% 456 sf 1.00% WETLANDS: 5,380 SQ. FT. = 0.12 ACRES = z PORCH: 56 5f 0.129 56 5f 0.12 916 DECIK5: 251 sf 0.55% 251 5f 0.5350/0 ZONING: R-40 FM TERRACE: O O 420 5f 1.0% ELEVATIONS ARE REFERENCED TO N.A.V.D. 1989 DATUM O TOTAL: 2,554 sf 5.590/ 2,555 sf 6.52916 I� SURVEYOR: Nathan Taft Corwin III 1586 Main Road SITE AREA UPLAND FROM TIDAL WETLANDS BOUNDARY (NY5DEG Jamesport, New York 11947 ADJACENT AREA AND TOWN OF SOUTHOLD BUILDABLE LAND)" LICENSE # 50467 O DATED AUGUST 18, 2015 W F D EDGE OF ♦n WETLANDS ® v ® O CHANNEL WUNNEWETA POND TIE DATA V 1. S 74°24 20 W 358.30 EXI5TING UNDERGROUND EXI5TING �I- 2. N 58°50'30" W 110.00' 08 D PUBLIC WATER LINE UNDERGROUND + � 3. S 76'41'40" W 269.47'4. N 88°18'20" W 176.73' �/� ELECTRIC LINE 92-86 -4 C) 5. N 08°28'30" E 12.13' cf) 3 -78,57'03 - _ --T _-- \ �O,2a / % , ✓ EX I (Cz -_ STONE ROADWAYF O N 58 / j / \ y. _ - — — - - - _ I6' RIGHT OF WAY GgT OF WA 7 II I — -- 5 R D EXISTING TREES AND / / y �- / — — — -- — _ __ 1 Q VEGETATION, TO REMAIN 1 6 /\ EXISTING ® V) / $ UNDERGROUND REQPUBLIC z N-D15AN WATER LINE RICHARD ANDERSON -� _ Ly. ��: Di 0) W Q -do z C14 X CID Ilk "/ APPARENT HIGH / "� / ��' �/ L` JUN 2 0 2017 /': , EXI5TING TREEAND VEGETATION TO REMAIN WATER \ LINE OF 75 FT SETBACK FROM WETLANDS Southold iown PROPOSED SILT FENCE DURING0{Tf 'ens CONSTRUCTION 5EE DETAIL I, TH15 SHEET �\ /`� / LINE OF 100 FT SETBACK FROM WETLANDS /X. J/ - V.111: X1 Tie � x VI:WA �i� \' / EXISTING FLOATING I � / �`+� fes„ \ � x Z. DOCK, RAMP AND ; FIXED DOCK Y� / �ijiG ,, ', r N Q• W CD 'Ai j J :E STI Lvk;AT1 %j1m MAL LOCATION OF EXISTING PRE-CAST o M CONCRETE SANITARY SYSTEM ORI G I NALLY // /,/ W -� 3 Mud /' /� Q Z LL S \ APPROVED BY 5GDH5 FOR THREE ro dwaters// //, / - ,�/// /, _ Creek / i, ,�ove/�. � //, /�i/,. / /i � uj v, 2 U BEDROOM RESIDENCE ' W• o I �r /;/' °a are R ' % � �/ W• a N = 4 \ \ - WIRE FENCE W/ i �', //// '% FILTER CLOTHF- \' TING ,'' `\ EX i� ' LINOF 100 FT SETBACK FROM WETLANDS j 1 I E EXISTING TREES AND G RAGE \� r VEGETATION, TO REMAIN 436 5P i 1 SURFACE FILTER CLOTH MIN. DRA I NAGE '�'j; 6 ' BELOW GRADE -. FLOW '/%Pe conic Bay � EDGE OF O - / GONG. i \ / -i J 18.4' �/ / WETLANDS G // �, 1 '•: P + �� LINE OF '75 FT SETBACK FROM WETLANDS 6 / \ 2 /i / ,/ /, / i �\P tk EXISTING ELECTRIC METER II, j/ •y TEMPORARY STORM WATER �j;;%;% " // / �r s c. s EXISTING - � Y\\, < � - � RUNOFF CONTROL MEASURE I I, % \/ / \/ ✓ m RE51 DENGE 1 % , , ,,;' ,:�' /, / ;i �' I /�. 1,8U SP,2 STORIES i \ NO SCALE i, // , \ // ` l i 1310180 \ // /,,/ ;�r// ,/r,i ,�/ 1ST G UNDE G ND/ z I ~ O 5T©RM `T RUNOF FROM — c /g - j, i///j,' II, / �ILI ST o , / �u r'\� DECK _ 1 PROJECT NO: w I / >/ I TSPS - �. /L��' 0o n WETLANDS �/ �, yi �/ N \ I /, 'tr ,Lp�, P�, 1508 \ Q / 3 /� �• T DRAWN BY: ARSUT E EXIFiQb ---7 y� �'� / ti� Ioo� CHECKED BY: GK / �,; �+ / ,��� TS 5TEP5� -�\ \� PROPOSE q �\ / . /X �. DATE: \ / 1 ',✓ { \ t� \ NEW _ z �, 6/14/17 v' � < � RASE = 1 '�"/\ EX a G\� / N s . I' v" .� / �.� / E ��n' \/` / X obs,% % SCALE: .. .. 828' \ \ \ x\; w \ / \� 7n . E'A. 1 = 20' - 0 J", / /� �' \ � \�' ' _ NO fS, B" Ctzo� SHEET TITLE: APPARENT HIGH APPROVED BY WATER SITE PLAN BOARD OF TRUSTEE -- S TIE LINE ALONG II, ` �- ` - %/ /- N05 EXISTING TREES AND APPARENT HIGH WATER \v �/ /��ylh VEGETATION TO TO REMAIN WN OF SOUTHOLD 9 MARK ON AUGUST 18, 2015 9 = 5 V y II, , h EDGE OF DATE �u14 !4, 2017 i EDGE OF WETLANDS WETLANDS _ I I WETLANDS I y °56+38 --- -- —. 5 �3 6q..65 �� SHEET NO: N 85043901" W APPARENT HIGH 86.67' ATER TIE LINE ALONG EXI5TIN6 TREE5 AND APPARENT HIGH WATER ++ VEGETATION, TO REMAIN MARK ON AU6U5T 15, 2015 SCALE: 1 " = 20'-0" WUNNEWETA POND U ST E ES Michael J. Domino,Presic% Town Hall Annex John M. Bredemeyer III,Vice-President ��O G�.� 54375 Route 25 Charles J. Sanders c a P.O.Box 1179 Glenn Goldsmith 0 Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: i�bZ/% Completed in field by: K�„��L," Samuels & Steelman Architects on behalf of JULIE ANDERSON requests an Administrative Permit to install a 420sq.ft. paver terrace on a concrete slab on the seaward side of the dwelling. Located: 4298 Wunneweta Road, Cutchogue. SCTM# 1000-111-14-29 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 L/eoCh. 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: QK Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino, Presid; o��SVFFO(, C�G Town Hall Annex John M. Bredemeyer III,Vice-Presfdent �� ��; 54375 Route 25 Charles J. Sanders y = P.O.Box 1179 Glenn Goldsmith v- 07 Southold,NY 11971 A.Nicholas Krupski �?,�0 �Ol41� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Samuels & Steelman Architects on behalf of JULIE ANDERSON requests an Administrative Permit to install a 420sq.ft. paver terrace on a concrete slab on the seaward side of the dwelling. Located: 4298 Wunneweta Road, Cutchogue. SCTM# 1000-111-14-29 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 ANDERSON RESIDENCE, • : Wunneweta ' • . • 12/18/15, 11 11 am, View • l ANDERSON RESIDENCE, 4298 WunnewetaRoad • 1 / am, View 'ts ANDERSON RESIDENCE, 4298 Wunneweta Road 12/18/15, 00 am, View East ANDERSON RESIDENCE, 4298 Wunneweta Road k ,r if y x ' ,i � x �, ,Y ,3r �,,^! `�M,+�rw5'C7;L a ''�'�°P'k, � '�t• Y'XQ�. • 00 I - West i .. 77. ANDERSON RESIDENCE, 4298 Wunneweta Road 12/18/15, 11:00 am, View Northwest ry AMA IRW r t .\r ANDERSON RESIDENCE, 4298 Wunneweta Road 12/18/15, 11:00 am, View Northeast ON ID ilR `C j a (y' ig�� tea �VF w M b w i � i a New York State ®( irttnF- of Environmental G,,viserv, on Division of Environmental Permits, Region 1 _ SUNY @ Stony Brook V 50 Circle Road, Stony Brook, NY 11790-3409 Phone: (631)444-0365 • Fax: (631)444-0360 Website: www.dec.ny.gov LETTER OF NO JURISDICTION TIDAL WETLANDS ACT January 25, 2016 Ms Julie Anderson 333 E 30th Street, apt 4M New York, NY 10016 Re: Application #1-4738-00039100003 4298 Wunneweta Rd. Cutchogue SCTM# 1000-111-14-29 Dear Ms Anderson: Based on the information you submitted, the Department of Environmental Conservation has determined that the portion of the property listed above which is above the 10 foot contour, as shown on the survey by Thomas C Samuels dated 1/11/2016 is beyond Tidal Wetlands Act (Article 25)jurisdiction:, Therefore, in accordance with.the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required. Be-advised, no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. ' It is your responsibility to ensure that all precautions are taken to prevent any sedimentation or disturbance within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the jurisdictional boundary and your project (i.e. a 15' wide�construction area) or erecting a temporary fence, barrier, or hale bay berm. This letter shall remain valid unless site conditions change. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. 1 Si ere , 'usan Ackerman /Deputy Permit Administrator cc: Samuels & Steelman - BOH-TW File TOWN OF SOUTHOLD BUILDING DEPARTMENT © " TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 41000 Date: 9/19/2016 Permission is hereby granted to: Anderson, Julie 333 E 30th St Apt 4M New York, NY 10016 To: construct additions and alterations to an existing single family dwelling as aplied for per Trustee approval and DEC Letter of non-jurisdiction. At premises located at: 4298 Wunneweta Rd., Cutchogue SCTM # 473889 Sec/Block/Lot# 111.-14-29 Pursuant to application dated 9/9/2016 and approved by the Building Inspector. To expire on 3/21/2018. Fees: SINGLE FAMILY DWELLING-ADDITI OR ALTERATION $408.00 C -ADDITION DW L $50.00 Total: $458.00 Building Inspector Lqq� U 04 :'// 'Little�;%�/%�// // Peconic Bay:!:�/;/./i // Z_ MAI :ii �'%j/i% /' / ANN /j/// / "Z Ile- gel /// E 12 X, PROJECT NO, 1508 DRAWN BY: WN A SEORMENT CONTROLS UT' include but not be limited to: CHECKED BY: 11 maintained Construction Entrance, TS Backed Slit Fencing,stabilization& DATE: Ing of exposed and/or inactive soils. 9/9/16 UNAGE gNSPECTOONS ARE REQUORED SCALE- ,tact TOS Engineering at 765-1560 before SHEET TITLE: kfffl,09 Provide Engineer's Certification t the drainage has been installed to Code. SITE PLAN APPROVAL 8F 57ORMWATER MANASEMENT CONTRO P N - n C p YMS SHEET NO: opts: 93 1 AFP P d . PERMIT & PRICING SET Xl 4, Peco-nic,Bay 7 / j//j/// a' y, �,� ;/��?;"�k�'�"v ^^II,,�� it it-"r�ty, �� :7 II: oq j;. �j/ji,%�///'/,/�//�� // / / >'•i:'' l:.sr".r"el '.F,; sr`,�:k•ii x'R"',,,;rv,`�, 17, l ALL CODES OF TOWN CODES Yo-;:I,KSTfJ AP R IED AS NV7--.0 D"ZYX CONDITIONS OF AS REQUIRED AND B P 1/000 a DATE: CHECKED;- 11 P � " I ;"-11 `K'�� ."�"., HE FE-.— BOARD S@MW4MM P NOTIFY BUILDING DEPARTMENT ATI -LkAING DATE- 765-1802 8 AM TO 4 PM FOR THE n, JSTEES SOUT�' I 'fo'0INTM FOLLOWING INSPECTIONS: Y.q.0111-: 1) 1. FOUNDATION - TWO REQUIRED SCALE FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMB!NG n' ,UUMPANCY OR 3. INSULATION SHEET W 4. FINAL - CONSTRUCTION MUST FUL BE COMPLETE FOR C.O. USE B UNLA ALL CONSTRUCTION SHALL MEET T UT CERTMCATE DES OF-N SITE P,-LA,WITHO, REQUIREMENTS OF THE CODES OF ® � SftE ° ' OK . NEPOSI��R� OF OCCUPANCYIGOCOTRUCTION 'LUMBER CEPT1F100M -R' ON GEA® QOiViENtAtlg&E ECCT� MCAL D.RTIFICA T8,-OF SHEET NO: '60LDER,U5g, --fiNWA,TER IJ ,SUPPLYSYSTSVI PLUMBING EED MO., ALL PLUMBING WASTE XCOF-I &WATER LINES NEED TESTIING BEFORE COVERING PERMIT & PRICING SET RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE, 77- VP 4 --9 16 Is 14 ;A 0 5 4 AT o. I eA(.) 5 164 is 2 4 3A(C) , 15 n lo q 7 c-11 a Ik- pyo iz 3 0 27 Op 2 Com, 64 ------------- 12 GN.) kea- 71'� ') � 12 - 21 -ti2 s t6i am 19?L 55 3;1 'IF o", V�u 5 I 0A(C) Al 2a 6 W7 I 3A(.) 12 14 14A(C) 31 Z14 OAXC) 6A(C) FOR PCL NO"Oft d 368 ME SEC.NO. 4A am 11""11 1 sch 9 UN 1-----mnrcH Z E 0-. SECTION NO COUNTYOF SUFFOLK K I— SOUTHOLD NOTICE E L Real:,roP.ertY Tax Service Agencyy M(21) A l000 A,64, E p PROPERTY MAP G E D V 01 ouostmpiaon runs XMM t -j OFFICE LOCATION: ®��®f s® 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 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Mike Domino, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 14, 2017 Re: Local Waterfront Revitalization Program Coastal Consistency Review for JULIE ANDERSON SCTM# 1000-111-14-29 Samuels & Steelman Architects on behalf of JULIE ANDERSON requests an Administrative Permit to install a 420sq.ft. paver terrace on a concrete slab on the seaward side of the dwelling. Located: 4298 Wunneweta Road, Cutchogue. SCTM# 1000-111-14-29 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. John M.Bredemeyer III,President 4�'��" /��n� Y Town Hall Annex Michael J.Domino,Vice-President �� T lc7 54375 Main Road :y P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Telephone(631)766-1892 Charles J.Sanders,Trustee � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicatio / _Wetland Permit Application �� Administrative Permit -Amendment/Transfer/Extension Received Application: Received Fee:$ /001 D E E W/ c' Completed Application ^Z©a lJ Incomplete ' _SEQRA Classifica on: JUN ® 2��� Type[___Type I[ Unlisted ,,Coordination:(date sent) 17-17 e/ LWRP Consistency Assessment Form Southold Town CAC Referral Sent:_ r of Trustees Date of Inspection: 7-11-17 _Receipt of CAC Report: _Lead Agency Determination: Technical Review:_ M Public Hearing Held: ____Resolution: Name of Applicant Julie Anderson Mailing Address 333 East 30th Street,Apt.4M,New York,NY 10016 Phone Number:( ) 917 975-2935 Suffolk County Tax Map Number: 1000- 111-14-29 Property Location: 4298 Wunneweta Road,Nassau Point,Cutchogue,NY Approximately 600 ft. south of Little Peconic Road (provide LILCO Pole#, distance to cross streets,and location) AGENT: Tom Samuels Samuels &Steelman Architects (If applicable) Address: 25235 Main Road, Cutchogue,NY 11935 Phone: 631734-6405 Board of Trustees Application GENERAL DATA Land Area(in square feet): 48,810 sf Area Zoning: R-40 Previous use of property: Single Family Residence Intended use of property: Single Family Residence Covenants and Restrictions on property? Yes X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? X 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 X 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 X No Does the structure(s)on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency Date NYS DEC 1/25/16 Letter of No Jurisdiction Board of Southold Town Trustees 3/23/16 Permit #8749 Town of Southold Building Permit 9/19/16 Permit#41000 expires 3/21/18 111 --App-r--ovBhof—S#�or-r wal-ef I�gt�nt-Cs el—W I Ot No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): Proposing a new terrace at grade Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Add a new terrace at grade. Area of wetlands on lot: 5,380 sf square feet Percent coverage of lot: 11 % Closest distance between nearest existing structure and upland edge of wetlands: 57.11' feet Closest distance between nearest proposed structure and upland edge of wetlands: 76' - 6" feet Does the project involve excavation or filling? X 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): There will be no effect to wetlands nor tidal waters,as all required precautions will be instituted., i i ' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics hibits conflicts of interest on the part of town officers and emntoyees The Mose of this form is tQ provide infot ination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Julie Anderson (Last name,first name,4iiddle initial,unless you are applyingin tlic 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 X 7Administrative) Change of Zone Coastal Erosion Approval of plat Mooring f Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you perso►ially(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of theTown 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 X i 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/aggnt/representative)and the town officer or employee.Either check ' the appropriate line A)through D)and/or describe in the space provided. t 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); j 13) orate entity(when the the legal or beneficial owner of any interest in a non-corp 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 th)shbA dav of 2000 Signature Print Nae ie Anderson Form TS l " 4 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) Julie Anderson I/We, owners of the property identified as SCTM# 1000- - 1-11-14-2_q in the town of Cutchogue ,New York,hereby authorizes Tom Samuels Samuels and Steelman Architects 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. v 41odperatylOwner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF "f!1 k_ �,20_a— LAUREN M MCKISSICK Notary Public . -07 PUBLIC-STATE OF NEW YORK No.01 MC6U2306 Qualified in Suffolk County My Commission Expires May 23,2020 i A]PPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of l;thies prohibits con llicts of interest on the Wert of town officers and emlttovegs.The nurnase of this form is to provide infod iatinn which cad alert the town of lin5sible conflicts Orin terest and allow,rt to take whatever action is neeessato avoid same. YOUR NAME: Tom Samuels (Last name,first name,ipiddle initial,unless you are applying in-the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee �dministrative) Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you,licrsonally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of theTown of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"•means a business, including fl 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 X j , 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/aggntfrepresentative)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 al I that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant j (when the applicant is a corporation); 13}the legal or beneficial owner of any interest in a noncorporate entity(when the applicant is not a corporation); i C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP I Submitted this �'" day of oil Signature d4 , -- Print Name Tom Samuels Form TS I i Board of Trustees Application County of Suffolk State of New York Julie Anderson BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS'APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property Owner SWORN TO BEFORE ME THIS /C'r - DAY OF ,20 ' t LAUREN M MCKISSIC( NOTARY STATE OF NEW YORK ' NO-OIMC6342 08 Ots�ti�ed in Suffolk County 1C My Commission Expires May 23, 2020 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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 New Terrace (at grade) Name of Action or Protect Anderson Residence Project Location(describe,and attach a location map): 4298 Wunneweta Road,Cutchogue,NY Brief Description of Propose Action: Propose a new terrace at grade. Name of Applicant orSponsor: Telephone: 631 734-6405 Tom Samuels,Samuels&Steelman\Architects E-Mail: tom@samuelsandsteelman.co Address: 25235 Main Road City/PO: State: Zip Code: Cutchogue NY 11935 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, -N-07— YE 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 governments Agency? If Yes,list agency(s)name and permit or approval: Southold Town Building Permit, Southold Town Board of Trustees, NYS DEC (non jurisd) , 0 .X❑ Approval of Stormwater Mgmt Control Plan 3.a.Total acreage of the site of the propose action. 1.121 acres b.Total acreage to be physically disturbed? ,008 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 2.0 acres 4. Check all landuses that occur on,adjoining and near the proposed action. ❑Urban E3 Rural(non-agriculture) []Industrial ❑Commercial [M Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ X] 0 b.Consistent with the adopted comprehensive plan? ❑ X❑ ❑ 6, is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ D 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ❑ ❑ 8. 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? F'-1 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? [K] ❑ 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: new sanitary system as approves I, eCDHS 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? F b. 1s the proposed action located in an archeological sensitive area? X 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? El E b, Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? R-1 0 If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: [X Shoreline ❑Forest ❑Agricultural/grasslands C3Early mid-successional [X 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? 0 ❑ 16.Is the project site located in the 100 year flood plain? NO YES TT 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a ❑ a.Will storm water discharges flow to adjacent properties? NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ®NO AYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Tom Samuels Date: 6/15/17 Signature:T�afA _ Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? M, 2. Will the proposed action result in a change in the use or intensity of use of land? [4 ❑ 3. Will the proposed action impair the character or quality of the existing community? Vr ❑ 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 ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing. ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 4 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should, in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F] Check this box if you have determined,based on the information and analysis above,and an supporting documentation, that the proposed action will not result in any significant adverse environmental w7ncts. Town of Southold-Board of Trustees 0 Name of Lead Agency Date 0 President Print or Type Name of ResponsiVff�i-cer ficer in Lead Agency Title of Responsible Officer SigMIM of Responsive in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 �osu � Town of Southold w � Erosion, Sedimentation & Storiiln-Water Run-off /ASSESSMENT FORM PROPERTY LOCATION: s.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s r c eS cf ooT W - — oC t 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? 48,810S.F. 1 WIII this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall on Site? V the Scope of Work for Proposed Construction) (S.F./Acres) (This item will Include all run-off created by site — b. What is the Total Area of Land Clearing 349 S.F. clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? (S.F./Acres) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Provide AddlsonalPages asNeeded) Drainage Structures Indicating Size&Location?This Item shall Include all Proposed Grade Changes and — Propose a new terrace at grade Slopes Controlling Surface Water Flow. �13 Does the Site Plan and/or Survey describe the erosion +-2=Q ��`- `\ 2C�i� and sediment control practices that will be used to rr 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 El"Z" of Material within any Parcel? 5 WIII this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F,)Square Feet of Ground Surface? _ 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction — General DEC SWPPP Requirements: or within One Hundred(100')feet of a Weiland or Submission of a SWPPP Is required for all Construction activities Involving soll 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 El Including Construction activities Involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit Is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit S Will Driveways,Parking Areas or other Impervious for Storm Water Discharges from Construction activity-Parmit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off El -v 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of--way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 WIII 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 El 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?(This Item will NOT Include the Installsuon of Driveway Aprons.) Identify potential sources of pollution which may reasonably be expected to effect the quality of storm water discharges. NOTE: It Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice In a Box and the construction site disturbance Is between 5,000 S.F.$1 Acre In area, component shell be prepared by a qualified Design Professional Licensed In New York a Storm-Water,Grading,Drainage&Erosion Control Plan Is Required by the Town of that Is knowledgeable In the principles and practices Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE: A Check Madc(.I')andlor Answer for each Question Is Required for a Complete Application) SPATE OF NEW YORK, Suffolk COUNTY OF...........................................SS I That I, Tom Samuels ................being duly sw6m,deposes and says that he/she is the applicant for Permit, (Name of Individual s'pq Document) And that he/she is the ................AZA nt............. . .........,....... ...................... . .. . .. ..... .............................................................. (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; ............................. 5�day of.... ..... MCKISS Notary Public: ............. NQT��Y PULL"ICATATE `.. A�.......................................... of Applicant) i FORM - 06/10 No. 01 MC6342306 Qualified in Suffolk County My Commission Expires May"23,,2020 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 significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail;listing both,supporting and non- sumortina 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# 111 - 14 29 PROJECT NAME Anderson Residence The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees ❑ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license,certification: X❑ Nature and extent of action: Proposed new terrace at grade, 4--0 Location of action: 4298 Wunneweta Road, Cutchogue, NY Site acreage: 1.12 ac 48,810 SF Presentlanduse: RESIDENTIAL FAMILY RESIDENCE Present zoning classification: R-40 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: Julie Anderson 333 East 30th Street, Apt. 4M, New York, NY (b) Mailing address: (c) Telephone number: Area Code( } 917 975-2935 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No❑ If yes,which state or federal agency? NYS DEC - Non Jurisdiction received 1/25/16 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 0 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria 0 Yes ❑ No 0 Not Applicable t There are no historic or archeological structures on property. 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 Q Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III-Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No ❑ Not Applicable ecQPD-9-ed-aStion isabcZyP. Fleed 7nnP Attach additional sheets if necessary Policy S. 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 ❑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 No development will take place in the"wetlands"or"natural indiginous environment". 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. X] Yes ❑ No❑ Not 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 ❑ No ❑ Not Applicable All construction materials and waste will be removed to approved solid waste facility 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. ❑ Ye�] No 0 Not Applicable No public land involved. Littoral access unimpeded. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 0 Not Applicable There are no public or commercial activities or uses on site. Historically this property and neighboring properties are residential in use and will remain residential. 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. El 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 0 Not Applicable There are no agricultural lands on site. 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. 0 Yes ❑ No ❑ Not Applicable PREPARED BY Tom Samuels. TITLE Architect DATE 6 /� / i r � S A M U E L S & S T E E L M A N June 15, 2017 Southold Town Board of Trustees Town of Southold n u V PO Box 1179 I� Southold NY 11971 JUN 2 0 2017 Re: Anderson Residence 4298 Wunneweta Road, Cutchogue, NY outho-106wn SCTM# 1000-111-14-29 ofT Dear Board of Trustees, We are requesting an ADMINISTRATIVE WETLANDS PERMIT for the above referenced project, for the renovation and addition of an existing single family dwelling. The project has proposed a new terrace at grade. For your review we are submitting the following documents (original and three copies): 1.Completed application with project description 2. Short Environmental Assessment Form 3. Storm WaterAssessment Form 4.Authorization Form 5. Agent Authorization Form 6. Agent & Owner Transactional Disclosure Forms 7. LWRP 8. Survey of property in current state 9. Board of Southold Town Trustees Permit No. 8749 Authorization 10. NYS DEC non jurisdiction 11. Town of Southold Building Permit#41000 12.Approval of Stormwater Mgmt Control 13 Project Site Plan 14 Photographs 15 Application Fee - check for$100 Please get back to us if you have any questions or need any additional information. Sincerely, Samuels and Steelman Architects --r'W" m wulq Thomas C. Samuels, Architect Enclosures ARCHITECTS 25235 MAIN ROAD CUTCHOGUE,NEW YORK 11935 (631)734-6405 FAX(631)734-6407