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HomeMy WebLinkAboutTR-9088 Michael J. Domino,President �*OF SO(/T�O Town Hall Annex John M.Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski G Q O Telephone (631) 765-1892 Greg Williams O 00 N% a Fax(631) 765-6641 � �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed Project complete, compliance inspection. INSPECTED BY. COMMENTS:A � �� _J o Ano(\ 6tA UC I`d0 o'� Q. 5 a G° Zb � U ✓ � `mow CERTIFICATE OF COMPLIANCE: OGS I` SS'V .C_ Michael J.Domino, President QF SOOT Town Hall Annex John M. Bredemeyer III,Vice-President ,`Oy�lO 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg WilliamsYO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1618C Date: September 9, 2019 THIS CERTIFIES that the installation of a 16'x32' in-ground swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area-,and install a 300sq ft paver patio in between the dwelling and the pool; At 425 Cedar Point Drive East, Southold Suffolk County Tax Map#1000-90-3-19 Conforms to the application for a Trustees Permit heretofore filed in this office dated August 9, 2017 pursuant to which Trustees Wetland Permit#9088 Dated September 20, 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 16'x32' in-Around swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300sa.ft. paver patio in between the dwelling and the pool. The certificate is issued to Ali &Wendy Azmoun owners of the aforesaid property. I B6u-o Authorized Signature 6 *pE SOUTy Michael J. Domino,President Town� Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 jog P.O. Box 1179 Charles J.Sanders Southold, New York 11971 Glenr.Goldsmith O ® y� Telephone(631) 765-1892 A.Nicholas KrupskiCOUNTY 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 /'/z constructed I� Project complete, compliance inspection Z AT BOARD OF SOUTHOLD TOWN TRUSTEES pe A SOUTHOLD, NEW YORK PERMIT NO. 9088 DATE: SEPTEMBER 20, 2017 I g ISSUED TO: ALI & WENDY AZMOUN PROPERTY ADDRESS: 425 CEDAR POINT DRIVE EAST, SOUTHOLD IT SCTM# 1000-90-3-19 & AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and i accordance with the Resolution of the Board of Trustees adopted at the meeting held on'September 20, 2017, and in consideration of application fee in the sum of$250.00 paid by Ali &Wendy Azmoun and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits 1 the following: Wetland Permit to install a 16'x32' in-ground swimming pool with 16"wide coping around Pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300s 'ft. paver patio in between the dwelling and the pool; and as depicted on the project plan prepared by Long Island Pool Care Corp., received on August 9,2017, and stamped approved on I September 20,2017. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. It I-- CD X, - 1931 CCCC• X&Wk.iA(01J'5r........ "X, o'�n �Wo 1-h 77, Id- TERMS AND CONDITIONS The Permittee Ali &Wendy Azmoun residing at 425 Cedar Point Drive East, Southold, New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense,defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee wili obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J. Domino,President if S00k, Town Hall Annex John M.Bredemeyer III,Vice-President '`� l0 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® Q Telephone(631) 765-1892 A.Nicholas K a ski Fax(631) 765-6641 p f�COUNT`I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2017 Long Island Pool Care Corp. 50000 Main Road Southold, NY 11971 RE: ALI & WENDY AZMOUN 425 CEDAR POINT DRIVE EAST, SOUTHOLD SCTM# 1000-90-3-19 To Long Island Pool Care Corp: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 20, 2017, regarding the above matter: WHEREAS, Long Island Pool Care Corp., on behalf of ALI & WENDY AZMOUN applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 9, 2017, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 20, 2017, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, vvHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of ALI & WENDY AZMOUN to install a 16'x32' in-ground swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300sq.ft. paver patio in between the dwelling and the pool; and as depicted on the project plan prepared by Long Island Pool Care Corp., received on August 9, 2017, and stamped approved on September 20, 2017. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Michael 4" Michael J. Domino, President, Board of Trustees MJD/dd Michael J. Domino, President t oSk F©tK0 Town Hall Annex John M. Bredemeyer, III, Vice-President �;�o`� °iy, 54375 Route 25 Charles J. Sanders o <Y P.O. Box 1179 Glenn Goldsmith 3 Southold, NY 11971 A. Nicholas Krupski �y ® o�y Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOU'THOLD L60.- l SCANO PAY, cam' TO: Please be advised that your application dated ASST Q! 201 has been reviewed by this Board at the regular meeting of S go zod 7 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1St Day of Construction ($50.00) % Constructed ($50.00) Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement(complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ `� BY: Michael J. Domino, President Board of Trustees Rill 2.�� I- � - � --`�^'.�-=•-_�—�---t -1-/-`��"_.��--.T ji f 44- -1 - T __ �5,��- ��)�`� r '—�`�" 41f' ..Sr.-�/t J`t- _ ii( •{°��,�ii�3J FP •� _ _ �'��"�as-,•,' r.dr,� •I =1 i �-�-__ _ _— � 1 -kC), t } S `APPROVED ;BYr -BOARD 0F-i���lR STEES kr�; j i `r;�I I i I � i � I 1 { I< I -' ; _1._1_ I '� � ,.• 1- � --; -- �- ; --- To_ wN=oF_$,OUTHQI.p Jol 77 _ ! � � _ � i -j I I � , � ! I ! � ,I -I II ,�+_ i• ; �, �i- "I1:�•: �, �ti _I _'- —= --- --'- l•,�#" .{ � _1 � orr ''!r �I ..� ... - ' _ J�S` .ar5�-'^�tr.^"1�'!( , �\ ' -r-`-Y-t_.,-��i.^��Yr�'f _ �_ _ _i•= �-- �`$� ' _ 1 fc, -1 11 _ �J] _ _ V��/ _1 (�� J ` I I t _; It.�l �I V, L`-r+ �� '! ! �"V — I I --�--- �t'—i---t- -!--- 'AUG 91 2Q17 � I _ Southold Tov�pi f Tri to a LA- t 4— G ..oroc PRE5 sK�r�rt�F. 14c)OD to -771 � PAnnl B�G' A �� Az Tv ' ��• �— 3z' :w3 ApaNp--V-�s 25/x.v a !- p d 'TSP ) tom. 6-r i �n PLAN VIEVa OF POOL A.%4D wg5o E. c d i Pv S I�i'►€�tF� v ' ���eeav �G1C, �QOt•... ' LONGITUDINAL SECTION N�YY1A�'C1C 1��t�1G � apJG`nrt'� ���S®F�� _b�v�►�� �oa,�tn .-t-a m�E=-c- tom•S,Fo NZLIE:f.�Im-r � DIE C E V E-U P AUG - 9 2017 ot Rh of T To e Azman 475 Cedar St Drive- East ElCOSECTION G106 Southold, NY 11971 L AND PROPERTY TO QOf1FOR.1 TO N.Y. STATE RFSIDENTiAf• ENTRAPMENT PROTECTION REQUIRED ODOE APPENZDIX G 2014 EDITION SECTION G107 i POOL TO OONFOW. 10 AKSI/NSPI STANDARDS AG-103.1 POOL ALARM RDQUIRID � H. R6-,—.JAFFE, P.E. 82 EAGLE CHASE,WOODBURY,N.Y. 11797 516~364-0148 FAX 516-364-0158 May 6 2016 , E C E C v E AUG o 9 2017 • L ._Town. of Southold_ __ .._ _ _ _ Smtho!dTown o rd of Trustees Dear Sir: I 0 This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of Azman 475 Cedar St Drive East Southold, NY 11971 will not require draining because the pool is constructed with a vinyl liner. The' pool water will be continuously recirculated through the filter and will be. reused from year to year. The drainage from the filter backwash is nominal and will not interfere with the public water supply, the existing sanitary facilities or public highways. The proposed pool measures 512 S�' ' . The soil disturbance will be about q06 square feet. Since this less than 5 ,000 square feet as outlined in your Storm Water Management code, no drywell is required. Very truly yours , OF H. Roy Jaffe, P. E. �® k -ce uJlE,.r„- SUFFOLK CO_,HtALTii pI:F�T:''AP 'L': ' H. S. No, a ya`y Tl'LLVJA CCC ( MAT OF P20P�.:.I�-��� � 5UQV AUG - 9 2017 c`a fl_ ` o4T �TANDEE2, 1 ' .., _ 'R___ 5, q I STATEMENT OF INTENT aMp. 9-7.55 AL ` :-. _! i :l° WE � t THE WATER SUPPLY AND SEWAGE DISPOSAL Southold Town tit S5e05 ¢ Q �(E7LAN __ `�"-'- -�-^ \- -,f '� 1� ,,�1 f ~� -~ -' SYSTEMS FOR THIS RESIDENCE- WILL Boar of Trustees oC, ep RA14i F �lD �ne��tG' / . q.— » f� >s t a CONFORM TO THE STANDARDS OF .,THE AT t: t SUFFOLK CO. DEPT. OF HEALTH SERVICES. (SI 1 {.1i_HCA 'D W.Y. APPLICANT SUFFOLK COUNTY DEPT OF HEALTH C Eli "1T SERVICES — FOR APPROVAL OF. v CONSTRUCTION ONLY DATE v ic��r"1 AUG — 9 2017 H. S. REQ. rv0.. #, .. �2 5 APPROVED: -- ; 1 Southold Town �.7• i'?EEt�,c� SEPTfC � ,. I STY. ► i � ' ,-' T��J� Boar of Trus ee SUFFOLK CO TAX MAP DEQ.,'I+�N'ATIO►V: 2 0 DIST. 'SECT. ®LOCK PETE.. I i0w 09Q 0:3 19 JVFL EL 19 1 F2ANE WOJ f `,{ AUL �� f Ise _t I ' ►�FE-a �� �,f �IQ�:;�t 1 04 _�,� OWNERS ADDRESS: y. Ae Deck, W F1 RE AREA-27,56,? a.,F +,S.A 'x \\ t a ^' r ( ..•..���._.�+_��) •-}�_{._}-.�.+..... N— 5 �f •` rat y � � f,/� t♦ 1 I ,v1y � .Y 1 /1... �,.J'11 R Ef 5yii yam', <�� �tl DEED: L.-74'Zt P. a`7 ( �• c. , TMT HOLE ~Z _ \ f� �!� - IAw'Slllu'-" ,t^ 5.• Jn•..aR�ul `^ III's II>>Nnw Yr t`rt:,fr 1 Lawcf ; ' I h SS survey,I' urveyors ln'Aed7 n. :f L a,od seal shall not hs cc.s.c.- r a valid true copy, indica-ed hereon shzi't- `\ �, �•(�� / `� ` / t t Icthe person forwhomtrio-_,' , W i'`r FJ EYf�.f IC N5 i-"--`—Y. �'-T --M--. �_ SEA LEVEL. ,rec.andonhsbahuIt:o4 Y ,... e.E: .�./ �':,�:.�{ ,.� •, `J ''�/\ t , i R `t.. '- - �7��,i,,1li/rL, t < -- I t•_aS'�L'a f 't'�'. At-141ENOr'D IG � bx� �L. -�'`� , k^j� ' )��4'. �'ao-/y�M-6. t t. � •!rznsw.,....z i _... AV %Nkf CHICK09, 4WP* -�1. Aa�S, A �-i r i - ' :•ki~ a >L_ � q '�{ E ?� �d K YA'NYL, P.. . `2,17 LC D'?, . .: '� 1` lei6 1 PA ir 6CENSED LAND SURV �?RS t:.rr xh,y^-r..•. 40 W, -»=. ....r......+x.. .. . N&I �— � G.,B.0 �t._ ``�. GIEENP+QRT NEW Yo`R�c _ IL �, � ' '.i '• h�� alht,ffi _- , . {. - -fir( •� .{� a • , mph ` � ECEC_ i-E AUG 9 2017 ` ti 9- nr Southold Town �� ,r 4`" BoaW f Tr s �Ik CC-, , T^tR D � b1�' �"6 e ' ;. 4�a„a•%'a"�"° ��t « ' { '1 �may,w•.* �.��14y� a<'u yypgM hse'MnrtyM"w . {yw q fQAC4 G 1• W'St+tbne � ;'�w,,,,.✓ -ry €.,,{o•Ci- -�•- �,i� ',��•nit't 4{` `��..k�'+� 'G"'1,`�tt�'�{�i�' F 00 ' Tr 44 t TZA Yptc��+gME• �rri Nr Is kxo IN ie '•,a '+�,�,�'' r�il. - `�t',�'•1 P`i r' - - n, Sj� a 0'4• A 5`�. +"�� .,kr!Ir,Kc' t. ''fir,., r�'' ^2" ,,f ��t','� �a,sM •�Fi" � '`'��1ti.M��4•,,,Y,�� �'k,��`'±,�•�yr{' .m*t4,7�.'��',��`� �"M '��y�y, {4'i, � •w{yary�„r. 7 .,�.-"ii�.�`�}'..`` . Michael J. Domino, Pres'_ �Q `'O Town Hall Annex John M. Bredemeyer 111, Vice-President ��� G�� K 54375 Route 25 Charles J. Sanders cz y z P.O.Box 1179 Glenn Goldsmith — Southold,NY 11971 A.Nicholas Krupski 'y ® p� Telephone(631)765-1892 ��� �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ( i�;� � �`� MA Completed in field by: zed Q 11, Ltf Long Island Pool Care Corp. on behalf of ALI & WENDY AZMOUN request a Wetland Permit to install a 16'x32' in-ground swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300sq.ft. paver patio in between the dwelling and the pool. Located: 425 Cedar Point Drive East, Southold. SCTM# 1000-90-3-19 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 JZ� ' 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 LJ Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: J 0 � 4-rz �--o Akl�n Present were: /J1I redemeyer M. Domino ' " G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino,Pre:', ;, O�"of MIA,COG � Town Hall Annex John M. Bredemeyer I11,Vice-President 54375 Route 25 Charles J. Sanders y z P.O.Box 1179 Glenn Goldsmith l Southold,NY 11971 A.Nicholas Krupski A p! Telephone(631)765-1892 HCl �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Long Island Pool Care Corp. on behalf of ALI & WENDY AZMOUN request a Wetland Permit to install a 16'x32' in-ground swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300sq.ft. paver patio in between the dwelling and the pool. Located: 425 Cedar Point Drive East, Southold. SCTM# 1000-90-3-19 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 Michael J. Domino, Presi QSFO(�COG Town Hall Annex John M. Bredemeyer III,Vice-I're"sident {��� �J, 54375 Route 25 Charles J. Sanders M z P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 .L BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 1 I Date/Time: I Completed in field by: Long Island Pool Care Corp. on behalf of ALI &WENDY AZMOUN request a Pre-Submission Inspection for a proposed in-ground swimming pool, pool patio/decking, and pool fence. Located: 425 Cedar Street Drive East, Southold. SCTM# 1000-90-3-19 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 7. 111 ring Card Posted: Y / N Ch. 275 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: L 6--t�Z e) Q t R 4 Cl C eej Present were: J. redemeyer . Domino G. oldsmith pski C. Sanders Other Page 1 of 2 Michael J. Domino, Presi OQ �OG Town Hall Annex John M. Bredemeyer II1, Vice-President �a y ' '- 54375 Route 25 Charles J. Sanders co P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski 4 p! ' Telephone(631)765-1892 a��l Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Long Island Pool Care Corp. on behalf of ALI & WENDY AZMOUN request a Pre-Submission Inspection for a proposed in-ground swimming pool, pool patio/decking, and pool fence. Located: 425 Cedar Street Drive East, Southold. SCTM# 1000-90-3-19 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 RECUVE J U L 2 1 2017 Southold Town _ ! � Board of Trustees r.arra. 55 l 1. E ti� Gvoo ') °J5 IY 4 f.�•�5 r- F -f t I_ �, ..fkut„ 1*2NMa I' �i.l (.Wry. V. [w"tib }{r^�� � -,r•. �\ � 1� � �` IA - -: - - L4 AL rh • � � ' . . -�-�-'�-.;fix _. � _ _ =��. - . _ . iv, �� - Ali&Wendy Azmoun 425 Cedar Point Drive East, �h, . i00�•i � w\ All • L— _ n s'r 8 11 ' 30 AL z 9A(c) 16 'OF SOIfiHOLU "" 14 8,, •h 04 3 ItIt It 2 2-Wc) 3 4 om -Z cl 6 1�p I OA Tom ol� ----- 13 -- 0 Cef)AR SOUTHOLD 11A TOWN OF SOUTHOLD Pollo lwv 0 -A 11 4 5kc) 27 2V (5% a 0 vill WEST g nro n.4 zi 23 OIL LAKE '6 ---------- 41 6. SOIJRHOLD 131 141 (5T) 29 W LAKE 24f I-) : Is 25 19 op 4 is 21 n 2D :1 7A(l) I !1 17 18 to 23 5 "N.)6 'N ::2 3 HOG NECK BAY COUNTY OF K SOUTHOLD SECTION NO -MW S.-Ice Ag y E 090 �77 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.) Southold, NY 11971 ® �� Telephone: 631 765-1938 ®lyc®U LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: September 18, 2017 Re: LWRP Coastal Consistency Review for AL1 &WENDY AZMOUN SCTM# 1000-90-3-19 Long Island Pool Care Corp. on behalf of AL1 &WENDY AZMOUN request a Wetland Permit to install a 16'x32' in-ground swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300sq.ft. paver patio in between the dwelling and the pool. Located: 425 Cedar Point Drive East, Southold. SCTM# 1000-90-3- 19 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the below listed Policy Standards and therefore is CONSISTENT with the LWRP provided the below BMP's are required to further Policies 5 and 6: 1. Require a Pool dewatering drywell. 2 Require a vegetated, non-turf buffer. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. I � y ��OggFFOj�.C�� Peter Young,Chairmanti Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 f ' Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., September 13, 2017 the following recommendation was made: Moved by Greg Williams, seconded by Keith McCamy, it was RESOLVED to SUPPORT the application of ALI AZMOUN & WENDY AZMOUN to install a 16'X 32' in-ground swimming pool with fencing around pool; filter and pump to be located at the side of the house; 300 sf. patio will be installed between house and pool. Located: 425 Cedar Point Drive East, Southold. SCTM#90-3-19 Inspected by: Peter Meeker, John Stein, Keith McCamy The CAC Supports the application with the Condition of a drainage plan. Vote of Council: Ayes: All Motion Carried i l� S4:375 Main Koad Michael J Domino. vice-President. z� `�� ri P O. Box 1179 James F. King. TrusleC So Id New York i 1971-0959 x Dave Bergen.Trustee �- �O Telephone(631) 765-1892 Charles J_Sanders.Truslce � Utf['lFax(631) 765-6641 lyCO ,� - - BOA-RD OF TOWN TRUSTEES o _ D TOWN OF SOUTHOLD To: Southold.Tow6 Building Department AUG 1 1 2017 Re: Verification of Building Department Permit Requirements BUILDING DEW- TOWN OF SOMOLD SCTM#: L o_3_1 q 1 Property Owner(Mame: ' AZW1D0IV ��ND�f A-Lt Date Sent to Bldg" Dept-: 911f,17 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated befovr. YES NO iff the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of t1is application be considered as Demolition as -described under Town Code? COMMENTS: Date Signature of Reviewer John M.Bredemeyer III, President ���®v S®Ur�Q� Town Hall Annex Michael J.Domino,Vice-President ~ 54375 Route 25 qB P.O. Box 1179 Glenn Goldsmith en Southold, New York 11971 A.Nicholas Krupski ® a� Telephone(631) 765-1892 Charles J. Sanders < 00 NTN'ok Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit / Amendment/Transfer/Extension V Received Application: q•17 TReceived Fee:$ 9019,40 D E G EV II p 0 2 Completed Application 8,11 1 11 L� _Incomplete ID _SEQRA Classification: Type I Type II Unlisted AUG — 9 2017 Coordination:(date sent) jKLWRP Consistency Assessment Form CAC Referral Sent: gr 0617 Southold Town Board of Trustees _Date of Inspection: q.124-1 _Receipt of CAC Report: _Lead Agency Determination: Technical Review: Public Hearing Held: 1 Resolution: Name of Property Owners) � � �2(��1 Address /.{1__s �sZ S ✓�� _1 1 9 Phone Number:() Suffolk County Tax Map Number: 1000 - '91c:) Property Location: (provide LILCO Pole#, distance to cross streets, and location) AGENT: L—o rv� OD\ �-� (If applicable) �� II Address: 1)®® o CJS\%' Y'\ 1 I 0[} 1 Phone: r'.oard of Trustees Applicat z GENERAL DATA Land Area(in square feet): J (O S u Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. r Will this project require a Building Permit`as per Town Code? Yes No If"Yes",be advised this application will be,reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of-decision. Will this project require any demolition as per Town Code or as determined'by the Building Dept.? Yes �/ No J Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date JNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes,provide explanation: Project Description(use attachments if nece_ssary): l6" - �.�� � O �n c.��1 q ate©�✓1� �v4�1 . r`1\4C S ct c��- �?wry.o 11 U be oard of Trustees Applicat 1 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: W i Mm"rV04 Area of wetlands on lot: square feet Percent coverage of lot: ? % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? / ©® cubic yards How much material will be filled? ' 0?0—9 0 `cubic yards C�,Jkvj- 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: e- 15 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): r 1\ 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): VVx'A&- Sa���� Brief Description of Proposed Action:. o, Z i-OAACI rAfV11 -/-� e-'fiO VQ lat Name of Applicant or Sponsor: Telephone: C-S 1) 17—r.S —�Zg� 151ond c�a� C-0E-Mail l� �C cc-r' 0- i awn 5 0o'00 i City/PO: State: Zip Code: lc�> ®a�_V.�, d tj y 1 l l '4_f 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ �✓��d?I�h � l..r�Nl:� 3.a.Total acreage of the site of the proposed action? �QdQ��_ _acres b.Total acreage to be physically disturbed? CJ. ON acres p c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? O acres 4. Check all land uses that occur on,adjoining and near the proposed action. �( E]Urban ❑Rural (non-agriculture) ❑Industrial ❑Commercial ( 1Residential(suburban) ❑Forest ❑Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 i 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ FLI ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ IZI 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: TI ` ❑ 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: F" F] 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: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ ❑ b.Is the proposed action located in an archeological sensitive area? © ❑ 1 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? ❑ JV b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑Agricultural/grasslands El Early mid-successional ❑ Wetland ❑Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? M ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ❑NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES 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: n F I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE yy Applicant/sponsorname: 4Lbs sl&\d � 6a-e-64 Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 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 occu occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 91/ 0 2. Will the proposed action result in a change in the use or intensity of use of land? 9/ 3. Will the proposed action impair the character or quality of the existing community? El 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? LVJ 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 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. F1Check 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 imp cts. Town of Southold-Board of Trustees �� Name of Lead Ag�y0 Date —T• -M- President Print or Type Narrie of Resp o ible ficer in Lead Agency Title of Responsible Officer Signature of Respon6le Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 -loard of Trustees Applicai_ a AFFIDAVIT 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 roperty Owner SWORN TO BEFORE ME THIS DAY OF ZO , 20 Il d'otary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2AB . oard of Trustees Applicata' -,n AFFIDAVIT wk/\' �/j ZBEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, 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. ignature of r e O ner Signature of Property Owner SWORN TO BEFORE ME THIS th DAY OF A u 20j otary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2j0je •,oard of Trustees Applicat • a a AUTHORIZATION (where the applicant is not the owner) I, 41, k(noi11 residing at "c Z� c�Jif- (print name of owner of property) (mailing address) S� -� hereby,1 �Jddo authorize � y gent) Qj �� C.A(`Q to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's si ature) / ;oard of Trustees Applicat', \'i AUTHORIZATION (Where the applicant is not the owner) I/We, F-/1 d ✓Ylo�✓1 owners of the property identified as SCTM# 1000- I in the town of .. ,New York,hereby authorizes 0�4 Car `�`t �- -Vo `'�1 Q g ` ' +©� � 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. >< perty O ner s S ture Property Owner's Signature SWORN TO BEFORE ME THIS �--� DAY OFic,-,4 , 26r01 Notary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.011 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2®I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of p9ssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: A 1)I A-z/m OL//? (Last name,first name,griddle 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 Tnrstee 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 50X f the shares. YES NO _ Ifyou answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Q l Submitted this 1 dW2fA-15 2flgSignaturePrintName Form TS 1 , 1 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The puroose of this form is to provide information which can alert the town of pgssible conflicts of interest and allow it to take whatever action is necessary to avoid same. VQ C 01 LLn ®U� YOUR NAME: (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 Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.`Business'interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay of 20VI Signature Form TS 1 t Print Name r-!: �1 2 M 0 o PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: cz b'' , loo , S � J1,01J STATE OF NEW YORK COUNTY OF SUFFOLK ��� pIZMo.�✓� W�d, qz,,,,,� residing at 4L!�' d� Le- being duly sworn, deposes and says that on the ZZ day of 20 f deponent mailed a true copy of the Notice set forth in the Board o Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set p opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at S0�.A4,0 I\ , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this « 1 Day of ��1" b� , 2017 i i otary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. O1 D1475593 Qualified In Suffolk County My Commission Expires April 30, 20__ S�FFD(,� Michael J. Domino,riesident 0�0 CCG Town Hall Annex John M. Bredemeyer III, Vice-President h@ 'yJ, 54375 Route 25 Charles J. Sanders y z P.O.Box 1179 Glenn Goldsmith ® Southold,NY 11971 A.Nicholas Krupski Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD O TRUSTEES: OWN OF SOUTHOLD --------------O( -- ---------------------------------------- In the Matter o the Application of ALI & WENDY AZMOUN COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, �" 42-(MDU(/� , residing at/dba If Z5 ada r being duly sworn, depose and say: rk That on the I I day of s , 2017, 1 personally posted the property known as Ce /19� r3v- 6. SID ctk01& by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, September 20, 2017. Dated: �(&nature Sworn to before me this lqf, day ofd; 201' Awv Ap-er— Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW Yon No. O1 D1475593 Qualified In Suffolk County MY COMM160On Expires April 3p, 20 19 ■ TM I • ■ • :CERTIFIED MAIL@ RECEIPT IFIED MAI0,AECEIPT r,- Domesfic Mail OWy DOML-�Stjc Mail Only Er Er CEi+ ,RE#�H =� i1- ( I 80(1 F OLO r Y Ln i t o wa iS 6t7 ti.. fU Certified Mad Fee 1 w Certified Mad Fee = $3.35 A971 f $ ' 3.35 �G971'� $ R� OL Extra Services&Fees(checkbox,add fee epp te) �® a m�r' -1•�� Extra Services&Fees(check box,add fee p te) i, �kfl ftfi 1-D r-q ❑Return Receipt(hardcopy) $ a(L, ii,( ® ❑Return Receipt(hardcopy) $ -- 0 ,{�� O ❑Return Receipt(electronic) $ Postmar�� ( E3 ❑Return Receipt(electronic) $ et - 1 Post rk. . ED ElCertiffed Mall Restricted Delivery $ �[,( Here ^a 1-3 []Certified Mail Restricted Delivery $ Here y C-3 ❑Adult Signature Required $ �r'1p111 t)®p �11 C3 ❑Adult Signature Required $ E]Adult Signature Restricted Dellvery$ ��1 U ❑Adult Signature Restricted Delivery$ u'•'I-' V 801 —8 2017 � C3 Postage d Postage .moo $ $0.49 � $ $01.49 3 Total Postage and Fees f.1 Total Postage and Fees _ /�)8 17 LO $ $6.59 $ $6.59 P� Sent To Ln Sent To a Soo � 0.n 1 C_2- k VQ \\��.n a ��e e•� C3 - �c � c-"st -------- C3 ----- ------------------------------- we.,Apt.No.,or P(7 Box o. §(reef a Apt o d Box IYo: --------------------- m = City,State,ZIP+ City,State,ZIP+4 0—A— S ®,,��, S�{ ,lie - f�2,0 5 I V 7 1 I :11 1 11 1a1•I — I :11 1 111 _ I ■ • Tj­ Ln R Fl RECEIPT ® 1 O ■ ■ Iome fU 0qY IF , .Ln ROLA!sY "11:56 o;€ " €- fU Certified Mall Fee 971 ?yb I r y .....x $3.35 1 fU Certified Mail Fee W_ $ 7 $ $73.35 r (.1971 Extra Services&Fees(check box,add fee pr&te) �-°� 119? i Ln 02 a ❑Return Receipt(hardcopy)_ $ t,0 0 `i Extra Services&Fees(checkbox,add fee te) h1 a q o ❑Return Receipt(electronic) $� r 0 ® POStfq ( ❑Return Receipt(hardcopy) $ '� Y if 1" 0 ❑Certdied Mad Restricted Delivery $ $0 flo H ` C3 E]Return Receipt(electronic) $ ¢r— �tr� � P st ,� E-3 ❑Adult Signature Required $ 1-3 E]Certified Mall Restricted Delivery $ -' ❑Aduk Signature Restricted Delivery$ 8 C3 ❑Adult Signature Required $ r-311 '� t��•. []Adult Signature Restricted Delivery$ ' d 2Q �_ Postage $0.49 r3 Postage Total Postage and Fees J �� �- $11.49 .r1 $ 1- f_i�/� $ $6.59 M Total Postage and FeesLill $6.59 Sent To Ul Sent To / ,or ---- rlr /(i Street an Plo.� RJ- %-� r9 (— J O V Street and Apt.No.3-3 ,or PO Box No. �- ��` - n aren1Z1PL+4 5 i 1\G�t Ivy l7 City State,ZIP4 ' �5 7-( J rr l P� :oe 1 la 11••1 I :11 1 11 111•1 _ — I PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS �� e 7 - esa" Name: y� �a/ylaPUu�b. s STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn,deposes and says that on the ° f day of , 20__, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were.mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAILIRETURN RECEIPT. i Sworn to before me this Day of , 20 i i Notary Public NUTILt: Utl� Ht: AKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD : ALI & WENDY AZMOUN SUBJECT OF PUBLIC HEARING : For a Wetland Permit to install a 16'x32' in-ground swimming pool with 16" wide coping around pool; install 4' high pool enclosure fencing; install a pool equipment area; and install a 300sq.ft. paver patio in between the dwelling and the pool. Located: 425 Cedar Point Drive East, Southold. SCTM## 1000-90-3-19 j- TIME & DATE OF PUBLIC HEARING : Wednesday, September 20, 2017 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 r' 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# PROJECT NAME �- rvw A ^�x%116 n o The Application has been submitted to(check appropriate response): Town Board ❑ Planning ,Board❑ Building Dept. ElBoard 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: c C X 32 ��� �� a 6 l` � �`n a a,� 001 �►��' `'"''P �� S 0® � ;o Location of action: CCI& ►�' JL ��cS� �,J}"�o�d �� Site acreage:' Present land use: Present zoning classification: 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: oV,1 (b) Mailing address: ZI Ct, t 1 -'vt aSk (c) Telephone number: Area Code (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 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Secti 'n III—Policies Pages 3•through 6 for evaluation criteria ❑ Yes No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No 10 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 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 1� No 1 ,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. ❑ ❑ �\ I Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes 0 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 evaluation criteria. ❑ Yes ❑ No $Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Yes[] No Not Applicable 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 Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes "❑ No 10 Not Applicable ` Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No�Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable DATE g PREPARED BY TITLE \ B l Dear Board of Trustee Committee, I, Ali Azmoun, would like to pre-submit an application to meet and inspect the proposed pool and fence construction with Board of Trustees Inspector at property located at 425 Cedar Street Drive East, Southold NY 11971. 1 am giving authorization to my agent Oguz Kiran/Bill Altintoprak (Long Island Pool Care Corp) to inspect the property at the time of the inspection as well. Agent Contact Name: Oguz Kiran/Bill Altintoprak— Long Island Pool Care Corp Phone Number: 631-765-8285 Owner Name: Ali Azmoun Phone Number: 516-840-6448 Signature: �9 F E VE 21 2011 Southold Town r f s Board of Trustees Applica :')n AFFIDAVIT - �`^ 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. N\x Signature of P e y Owner Signature of Property ner SWORN TO BEFORE ME THIS 5 DAY OF 3LA , 20-0 _ J/Iac� otary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of pgssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: K t f'cn I O 9✓z f1 p (Last name,first name,griddle 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 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 -- ifyou answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/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 2 day o��S"� 204 Signature Print Name K lemur Form TS 1 f 'Board of Trustees Applica' ,)►n AUTHORIZATION (Where the applicant is not the owner) I/We, ��`• �z-dY�s� owners of the property identified as SCTM# 1000- in the town of Jo �S .New York,hereby authorizes \ DCA c'- E)Y �Z KI Rte• I�\��\ WW\%& ►Gkto 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. "o 0 Prope wne s Signature Property ner's Signature SWORN TO BEFORE ME THIS p DAY OF 20 I Notary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,�g Y