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Home My WebLink AboutTR-9061A Michael J.Domino,President ��OF S0(/lyO Town Hall Annex 01 John M.Bredemeyer III,Vice-President �� IO 54375 Route 25 P.O.Box 1179 Charles J.Sanders ing Southold,New York 11971 Glenn Goldsmith G Q ® � Telephone(631) 765-1892 A. Nicholas KrupskiO a Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1408C Date: November 1, 2017 THIS CERTIFIES that the removal of the existing 1180 sq. f. dwelling, including existing sanitary and drainage structures; and restore the area with clean fill, grass, and natural vegetation; At 4660 Blue Horizon Bluffs, Peconic Suffolk County Tax Map #1000-74-1-35.52 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 21, 2017 pursuant to which Trustees Administrative Permit#9061A Dated August 16, 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 the removal of the existing 1180 sq ft dwelling includingexisting xisting sanitary and drainage structures,• and restore the area with clean fill grass and natural vegetation. The certificate is issued to HJHW PECONIC SOUND, LLC owner of the aforesaid property. A Authorized Signature Michael J. Domino, Presid, ,rQ �'®t r Town Hall Annex John M. Bredemid eyer 111,Vice-President 'a® �� '54375 Route 25 Charles J. Sanders � P.O.Box 1179 Glenn Goldsmith � Southold,NY 11971 A.Nicholas Krupski yl gyp! '•}' Telephone(631)765-1892 Ol Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD p Date/Time: Completed in field by: 19, Richard Principi, Jr. & Eric Martz on behalf of HJHW PECONIC SOUND, LLC request an Administrative Permit to remove the existing 1,180sq.ft. dwelling, including existing sanitary and drainage structures; and restore the area with clean fill, grass and natural vegetation. Located: 4660 Blue Horizon Bluffs, Peconic. SCTM# 1000-74-1-35.52 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: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 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: lm ( Goc d Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 t �pF s otI& Michael J.Domino, President 1.10,Off® Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders G Southold,New York 11971 Glenn Goldsmith ® �® Telephone (631) 765-1892 A.Nicholas Krupski �if'C®UN �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: `b' ?6`17 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction Y2 constructed V Project complete, compliance inspection. INSPECTED BY: Arles ��✓P COMMENTS: CERTIFICATE OF COMPLIANCE: DQE SO(/jy Town Hall Annex Michael J. Domino, Pi ent ®� o� John M.Bredemeyer III,Vice-Pesident , 54375 Route 25 �, P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® �O� Telephone(631) 765-1892 A.Nicholas Krupski �iy�+ouNTI, 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 Michael J.Domino,I �'ident 'of soupy® Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 Charles J.Sanders ! E P.O.Box 1179 Glenn Goldsmith =� Southold,New York 11971 �' ® Q Telephone(631) 765-1892 A.Nicholas Krupski 'Q �DUI� Fax(631) 765-6641 fi�`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9061A Date of Receipt of Application: July 21, 2017 Applicant: HJHW Peconic Sound, LLC SCTM#: 1000-74-1-35.52 Project Location: 4660 Blue Horizon Bluffs, Peconic Date of Resolution/Issuance: August 16, 2017 Date of Expiration: August 16, 2019 Reviewed by: Board of Trustees Project Description: Remove the existing 1,180sq.ft. dwelling, including existing sanitary and drainage structures; and restore the area with clean fill, grass and natural vegetation. 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 Jenna Principi Design, dated July 7, 2017, and stamped approved on August 16, 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. 0 f-O Michael J. Domino President Board of Trustees 1L1 rry �I ry1� -t , i in AY AT B IULL z � 2017 � DESIGNER ' / \ BOARD OF TRUSTEES ,, Southcltl Town J E N N A TOWN OF SOUTHOLpoar ,trr, ec� I P R i N C I P I \ D E S I G N ` PRINCIPI.J@GMAIL. OM Av`TE avvr l6I 207 CPHONE 631.291.7753 \ �7V LOT 2 w CONTRACTOR PRiNCiPI BUILDERS B L E HORIZONS phone:(516)852-0651 ny� / II. 1 /G�'� j `/] T O`,%"i% CF S O U T F Q L D ENG NEER 'i X- -,, ! ! ! / M...LJ: tJi_ V'✓t ' 4 /% (, e . i IS-7 C r- _Z 6'Lt . I;' t LOT JIM DEERKOSKI.PE XD 'i - d. i `.:..t �..t_...s. e' ' 3 +.:v,.�..:... .ol �. j '�% raj - (1� // `_ / ` v. phone:(631)298-7116 'ks / / N. / t ala � y / \ Il.� w /. / � ✓ \ 0 l ?'ma ° \ ' 14 /?A;1 0 LD 000l _ l r so f1w LL L r / ` ✓ �� m 41, / iliav �`�, \\` `\ / `� `\\ ` \ \ 0 Z •.�. W 41 o DENOTES STAKE ON PROPERTY LINE L014 AREA 62,252 SQ.FT. = 1.429 ACRES \ \ `' ' r ` � REVISED 7.07.17 JP LOT.2 AREA SQ.FT. = ACRES �\ \ \ `a\ �'��q DRAWN BY:JD/JP \ \ SCALE: SEE PLAN 3 1 0 3 66 9 1A 156 18 216 240 8N HEFT S O SCALE: 1" = 60' \ \ A - 0 FUDp) __ . i�-` ' : ' It ' i al, 2 DESIGNER k � 1571011a illi I -------------------------------- -------------------- .� ""' J E N N A P R I N C I P I D E S I G N m PRINCIPI.J@GMAIL.COM in PHONE 631.291.7753 _ I N Lr) Ln CONTRACTOR PRINCIPI BUILDERS phone:(516)852-0651 ID I -�----- ENGINEER , I JIM DEERKOSKI, PE phone:(631)298-7116 _ I [ NORTH ELEVATION 11l f_ 1,i 1 f SCALE 1/4"-1' -------------------------------------------------- 1212 6__ I' _I_ I' _[__I.7_I_,t- 12 � 6 p _I� 5 51 ) ,2 In I I W I:I[_I1[':III T- -- -- [Ill i_L 1?IT I Ii 0 -------------- - - 1. 11 2 ---- T T 00 Q rn WEST ELEVATION W DD � SCALE-- 11 LL_ Z ---------------------------------- Li— J gm m � U Z Z -- O I U_ N N In 7 0 Z 11 i U W w 1_ I.LI1 1 J I ❑ I i 1 i I,l: 1,[ I w a. [ I: :I 1 .ICI IIT 1 I r I T I 1 IrII_ . -- co T (.07 --- ID l M T- it 12 12 J SOUTH ELEVATION [ SCALE 1/4"-1' t C I.:I. ------------------------- ------- -- I I L- ,L [ ' Li "L T I I [ 111T[T I - 0 12 r 1`, r in I 30 [ I .1..�.. I_ I'l. I'I,i ;, I,: I l..[ 1 1 I T [ TT -[_I LT I [ T i ' DO �� ------ REVISED 7.07.17 JP -f-I-I1.-[- f DRAWN BY: JD/JP I L..I,1_ [ Ilti. .l [ 1 ' 1i [ fILI _i T 11_ I L L_I__I'1-,I_,_[, -_I.7 I :1: L I C ------------ l -I I ,_I-_,[.�[-_[� -r>> -- I-` - ------------ SCALE: SEE PLAN SHEET N0: EAST ELEVATION SCALE Al DESIGNER J E N N A U L 2 2,017 P R I N C I P I D E S I G N PRINCIPI.J@GMAIL.COM f, PHONE 631.291.7753 CONTRACTOR PRINCIPI BUILDERS phone:(516)852-0651 _''6'-5' -2-2 10'-3' ENGINEER -14 JIM DEERKOSKI, PE phone:(631)298-7116 E 01 j BEDROOM -3• 20-3�— ------------- U UP 16 R P 16 R Uj Cn DICK ABOVE BEDROOM LIVING / DIN J 00 Lr) 1 0 ------------- ------------- —A------------- W 01 ---------------- LL Z 00 00 LL Z KI TCHEN m C) C/) C/) El Z Q nO ref. LAUNDRY z 0 0 N 11 2'-4" --------- --- -------- close 0 -r 0 —------- ........... LAUN 0 0 ITC -4" W LLJ --------- DECK ABOVE shower tub BATH In C) ----------------- -13-31' 14— 5-10' r. -36-2 FIRST FLOOR PLAN SECOND FLOOR PLAN SCALE 1/4"=1' SCALE 114"=1' REVISED 7.07.17 3P DRAWN BY:� JD/JP SCALE: SEE PLAN SHEET NO: A - 2 Michael J. Domino, Presid; J { �OSV�FQL CD r Town Hall Annex John M. Bredemeyer III,Vice-President Gym, 54375 Route 25 Charles J. Sanders z P.O.Box 1179 Glenn Goldsmith 0 Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 o . a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: Richard Principi, Jr. & Eric Martz on behalf of HJHW PECONIC SOUND, LLC request an Administrative Permit to remove the existing 1,180sq.ft. dwelling, including existing sanitary and drainage structures; and restore the area with clean fill, grass and natural vegetation. Located: 4660 Blue Horizon Bluffs, Peconic. SCTM# 1000-74-1-35.52 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� 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: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino, Presid o�QS�fMtlreo ; Town Hall Annex John M. Bredemeyer III,Vice-President � 54375 Route 25 Charles J. Sanders z P.O.Box 1179 Cn Glenn Goldsmith 0 Southold,NY 11971 A.Nicholas Krupski p! Telephone(631)765-1892 Fax(631)765-6641 ram BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Richard Principi, Jr. & Eric Martz on behalf of HJHW PECONIC SOUND, LLC request an Administrative Permit to remove the existing 1,180sq.ft. dwelling, including existing sanitary and drainage structures; and restore the area with clean fill, grass and natural vegetation. Located: 4660 Blue Horizon Bluffs, Peconic. SCTM# 1000-74-1-35.52 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 uDESIGNER i u J U L 2 1 2017 1. J J E N N A 1 0 PRINCIPI D E S I G N 71 PRINCIPI.J@GMAIL.COM PHONE 631.291.7753 3. 1v r �� SURVEY OF LOT 2 CONTRACTOR e / J PRINCIP1 BUILDERS BLUE HORIZONS phone:(516)852-0651 ^ 1+ / r�OPEC01\ Ic -1 O'i I'�' 0 F- S�0 J T H-)'L D ENGINEER / ��`, ""ii. -i� /F S T -5.5' I ; I -C. 74 BLK� 01 LO S C. D!,-,T. 3 S JIM DEERKOSKI,PE phone:(631)298-7116 is z 100, \ - 0 .-�. /All j , .� , w —Aw 111�1 U) 0 ol < co W LO -llkzk let LL- LL- Z cl) Sg ` Iliz 0 N z 0 w 0 W \ \ `` ♦ ♦ C\i 0 o DENOTES STAKE ON PROPERTY LINE REVISED 11.07.17 IP LOT.2AREA SQ.FT = ACRES DRAWN BY.JD/JP SCALE: SEE PLAN A 1 0 3 66 9 126 156 18b A 240 210 SHEET NO: SCALE: 1" = 60' A - 0 � R .'!�i �� 7• _.� L. � 1 r ., �\�r-u ate" ;� - - _ _ aL "ro, • � ,� � - I A F � Y w Y wa .,_.a. .. a gT - Ia .Y: ..e► �' fir• i _ AM ' .� ;' f '� �g�--�,� � �4 illi• "' /� 1, �r • • 4a, ~t•!To `•—f s~• ?fie h�. +.7 `• .t X. 'rti 'a 5Fr t' � � s. Y��,_ y ! 11 ,'f}i �b. .;iM 1 tf i-a"• '-0' ��. .... _ • .s' _.s Q.t�i►- ; ..lf' 4T♦. �L y* � f.�r �" 'L x , < s Di, q. . C ax Service J r 124 14A(c) 35,u OStL0300] vua (4. 47A RD lo 410 5.3A(C) IS 7 OAIC) 48�Afq A M`Nc- 242 4- o_OF S01.111IOLD 4.3A Is 3.a, 15�7A(C) 4 FOR ML No 5, 0 SEE SEC NO 08801-0031 ) mFOR ML NO 28AQ2M1a SEE SEC NO —14(D 3 42] m. I Q5 C) FOR PCL FOR NO FOR ML NO SEE No SEE SEC NO SEESEC.NG s 2B ��92 08801-015 2-2A(C) 426 UNE 426 MATCH 7———— MATCH SEC NO 085 rain SEE SEC NO 085 LINE SEE SEC NO L SOUTHOLD SECTION NO COUNTY OF SUFFOLK K @ E E G ea o� R I Property Tax Service Agency y 074 —.1 N Y 1-1 m =I--T. N A P IGDO PROPERTY MAP OFFICE LOCATION: ®� so 01 MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor. Main Rd. &Youngs Ave.) CA Southold, NY 11971 ® � Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: August 14, 2017 Re: Local Waterfront Revitalization Program Coastal Consistency Review for ROSE CURTO SCTM# 1000-74-1-35.54 Richard Principi, Jr. & Eric Martz on behalf of HJHW PECONIC SOUND, LLC request an Administrative Permit to remove the existing 1,180sq.ft. dwelling, including existing sanitary and drainage structures; and restore the area with clean fill, grass and natural vegetation. Located: 4660 Blue Horizon Bluffs, Peconic. SCTM# 1000-74-1-35.52 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 provided: 1. Erosion control and construction BMP's are employed. Pursuant to-Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. of soti John M.Bredemeyer III,President Q � 1��, Town Hall Annex Michael J.Domino Vice-President �' 54375 Main Road ' P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee _ ® �4 Telephone(631)765-1892 Charles J.Sanders,Trustee if'�+a '�yi j Fax(631)765-6641 a BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ' r Coastal Erosion Permit Application /Vetland Permit Application i t!Administrative Permit Amendment/Transfer/Extension a Received Applic tion: �'Z�•�� E E C s _Received Fee:$ U0,0D D , Completed Application: _Incomplete: � _SEQRA Classificatigln: J U L 2 1 2017 1 Type I Type II Unlisted /Coordination:(date sent): �� I 1 Southold Town LWRP Consistency Assessment Form: CAC Referral Sent: 8oard of Trustees ; Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: ,a Resolution: a Name of Applicant: HJHW Peconic Sound LLC Mailing Address: 11 E. Broadway, New York, NY 10038 q Phone Number: (646) 710-0790 Suffolk County Tax Map Number: 1000- 74-1-35.52 Property Location: 4660 Blue Horizon Bluffs, Peconic, NY 11948 s County Rd. 48 & Henry's Rd. (provide LILCO Pole#, distance to cross streets,and location) AGENT: Richard J. Principi Jr. & Eric Martz (If applicable) ; Address: PO Box 1248, Southold, NY 11971 Phone: (516) 852-0651 & (917)916-3724 4660 Blue Horizon Bluffs Project Description July 21 , 2017 The applicant proposes to remove existing 1180 sqft residence including existing sanitary and drainage structures and restore areas with clean fill, grass and natural vegetation. Hoard of Trustees Applicat:-';.— GENERAL DATA Land Area(in square feet): 54014 Area Zoning: RR/R40 Previous use of property: Seasonal Residence Intended use of property: Same as Above 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.? X Yes No Does the structure(s)on property have a valid Certificate of Occupancy? Yes X No Prior permits/approvals for site improvements: Agency Date X 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): Remove existing residence, sanitary and drainage structures, and restore areas with natural vegetation and grass. Board of Trustees 1pplicat-. - WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Remove existing residence, sanitary and drainage structures, and restore areas with natural vegetation and grass. Area of wetlands on lot: 4963 square feet Percent coverage of lot: 9.18 % Closest distance between nearest existing structure and upland edge of wetlands: 35 feet Closest distance between nearest proposed structure and upland edge of wetlands: 125 feet Does the project involve excavation or filling? No X Yes If yes,how much material will be excavated? 0 cubic yards How much material will be filled? 250 +/- cubic yards (Fill in existing foundation.) Depth of which material will be removed or deposited: 1 +/- feet Proposed slope throughout the area of operations: 1:4 Max Manner in which material will be removed or deposited: Material to be removed and deposited by an excavator and by hand. 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): No negative impacts to the wetlands or tidal waters of the Town of Southold are anticipated. 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 Name of Action or Project: 4660 Blue Horizon Bluffs. Project Location(describe,and attach a location map): 4660 Blue Horizon Bluffs, Peconic, NY 11948 Brief Description of Proposed Action: Remove existing residence, sanitary and drainage structures, and restore areas with natural vegetation and grass. Name of Applicant or Sponsor: Telephone: (646) 710-0790 HJHW Peconic Sound LLC E-Mail: Address: 11 E. Broadway City/PO: State: Zip Code: New York NY 10038 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that —1 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: ❑ Southold Building.Dept. 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? .25 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 124 acres 4. Check all land uses that occur on,adjoining and near the proposed action. C]Urban El Rural(non-agriculture) [:]Industrial ❑Commercial ✓❑Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page I of 4 5. is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? _KR 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? s 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: Z 0 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: On-Site Sub-Surface private well ❑ to be approved by Suffolk County Health Department. 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Private on-site wastewater W1 ❑ ire-at ment_to be_approved_by_S_utt I�Eou-n-W Health DeP-artment. 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? YES 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? / 1/ If Yes,identify the wetland or waterbody and extent of alterations in.square feet or acres: V 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 ❑Early mid-successional ❑D 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? Z ❑ 16.Is the project site located in the 100 year flood plain? NNOO� YES �_ 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? ❑NO DYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO DYES 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: W1 ❑ 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: D ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applican r nam Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of theJollowing 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 In ay may occu occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate D reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: Fitl ❑ 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 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 l0. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? P�4 1 l. 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. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental i pacts Town of Southold-Board of Trustees rrName of Lead Agency Date ( (/VL&ie/� �s �oyV (VAO_ President Print or Type Nam o Re po sible Icer in Lead Agency Title of Responsible Officer ignature o Respons' e Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 t ` Board of Trustees Applicatloxi, AFFIDAVIT HJHW Peconic Sound LLC BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of P operty Owner SWORN TO BEFORE ME THIS DAY OF �y`� ,20j C.JILNICKI F;Qugn Y PSTATE OF NEW YORK Notary Publi , egiNo.02JI6340747 Suffolk County Commission Expires May 9,2020 Board of Trustees Applicati.,.. AUTHORIZATION (where the applicant is not the owner) YJA i, HJHW Peconic Sound LLC residingat 11 East (print name of owner of property) (mailing address) Broadway, New York, NY 10038 do hereby authorize (Agent) Richard J. Principi Jr. & Eric Martz to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's Signa re) APPLICANT/AGENU/REPR t'SENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emogms.The aur op se of this form is to provide inforinationwhich can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. yon u, /".; YOURNAYM: HJHW Peconic Sound, LLC. (Last name,first name,q,iddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name,) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) — Do you personally(or through your company,spouse,sibling,parent,or chili)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 X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applic�ttt (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(whetr the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP ` Submitted this • ' of �� q 2087 Signature Print Name Foran TS I I APPLICANT/AGENUREPRESENI"ATIVE TRANSACTIONAL DISCLOSURE,-FORM Tile'rown of Southold's Codc of Ethics prohibits conflicts of interest on the part of town officers and employees.The nuroosc of this form is to provide intorm&Ion which can alert the town orpossible conflicts of interest and allow it to take whatever action is necessary to avoid same. , YOURNAME: Eric Martz (Last name,first name,Middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building _ Variance Trustee Change 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 busincss,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 If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person -- Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applic4nt (when the applicant is a corporation); B)the legal orbeneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 1.0 day of 204 Signature t Print Name r Form TS 1 w APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The'rown of 5outhold's Code of Ethics prohibits conflicts of interest on the part of town officers and emoees 'rhornuc ofns this form is to provide inforrohtion which can alert the town of possible conflicts or interest and allow d to take whalever_action is necessary to avoid same. YOURNAME: Richard J. Principi, Jr. (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 X 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 X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold _ Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted da f / 204 Signature' 1�- t Print Name L Form TS 1 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- 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# 74 - 01 _ 35.52 PROJECT NAME 4660 Blue Horizon Buffs The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of action: Remove existing residence, sanitary and drainage structures, and restore with grass and natural vegetation. Area near bluff will be restored to natural conditions. 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 0 Yes❑ No ❑ Not Applicable Existing structure 35 feet from the bluff will be removed 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 _Existing structure 35 feet from the bluff will be removed 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 ❑✓ Not Applicable Proiect will have no neaative impacts to water aualitv. 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. ❑ ❑ ❑ P Location of action: 4660 Blue Horizon Bluffs, Peconic, NY 11958 Site acreage: 1.24 Present land use: Seasonal Residence Present zoning classification: RR/R40 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: HJHW Peconic Sound LLC (b) Mailing address:_11 E. Broadway, New York, NY 10038 (c) Telephone number:Area Code( ) (646) 710-0790 (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No❑✓ If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 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 Existing structure 35 feet from the bluff will be removed. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑✓ Yes ❑ No ❑ Not Applicable ❑ Yes ❑ No 0 Not Applicable Proiect will have no negative impacts to town ecosystems. 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 0 Not Applicable Proiect will have no neqative impacts to air quality 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 Proiect will have no negative impacts on the environment. 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. ❑ Yes❑ No ✓❑Not Applicable PrciPrt Will have no impact orlt�ublic access Attach additional sheets if necessary If 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 HI—Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable Project will have no negative impacts on water-dependent uses Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III--Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No 0 Not Applicable Project will have no negative impacts on marine resources. 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 Project will have no negative impacts on agricultural lands. 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 0 Not Applicable Proiect will have no negative impacts on marine resources PREPARED BY Eric Martz TITLE DATE7/18/17