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HomeMy WebLinkAboutTR-9095A Michael J. Domino, Fresident �*®v S® yo Town Hall Annex John M. Bredemeyer III,Vice-President h0 l0 54375 Route 25 P.O.Box 1179 Charles J. Sanders Southold, New York 11971 Glenn Goldsmith ® �� Telephone(631) 765-1892 A. Nicholas Krupski OIi�CQUi 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 1 st day of construction V2 constructed �° Project complete, compliance inspection Michael J.DominPresident ®F SOUj T ®�� y0� own Hall Annex John M.Bredemeyer III,Vice-President ® 54375 Route 25 Charles J.Sanders P.O.Box 1179 Glenn Goldsmith G Southold,New York 11971 ® COQ Telephone(631) 765-1892 A.Nicholas Krupski O Fax(631) 765-6641 �y�aUNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9095A Date of Receipt of Application: August 9, 2017 Applicant: Kasha Cacy SCTM#: 1000-135-3-26 Project Location: 235 Mill Creek Drive, Southold Date of Resolution/Issuance: October 18, 2017 Date of Expiration: October 18, 2019 Reviewed by: Board of Trustees Project Description: To install an on-grade 12'x46'3" stone patio against the seaward side of the dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan prepared by McCarthy Management, received on October 16, 2017, and stamped approved on October 18, 2017. Special Conditions: Installation of a French drain along the seaward edge of new patio and landward of the berm; and to establish and perpetually maintain a 35' wide non-disturbance area seaward of the berm. The Permittee is required to provide evidence that a copy of this 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. 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. m Michael J. Domino, President Board of Trustees 43 Y g n Z ^ bot^ V6 d -�I�eneN aDP�A�H EY IiAg # sf/#yU�Yyfkkzss �Y9V�'i i w s xe i.s I -x t 'i i7bdb)"4 's 2'gy.'Cj '"'•r ^f,a . - t Rot ft" ---____-- "1 cc APPROVED BY-' '- 17 -.`BOARD OF 1-RUSTEES., TOWN"OF SOUTHOLD De4TEoc7�W Ig(2017ECE IV, ED D OCT 1 6 2011 Southold Town Michael J. Domino,Presic Y O�QS ,�COG Town Hall Annex John M. Bredemeyer III,Vice-Presiaent �� yam,, 54375 Route 25 Charles J. Sandersy a P.O.Box 1179 Glenn Goldsmith 0 Southold,NY 11971 A.Nicholas Krupski 41 ® p! Telephone(631)765-1892 ��� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ��-/�✓ / Completed in field by: v Jac McCarthy Management on behalf of KASHA CACY requests an Administrative Permit to install an on-grade 12'x46'3" stone patio against the seaward side of the dwelling. Located: 235 Mill Creek Drive, Southold. SCTM# 1000-135-3-26 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: I 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 r/gview/consultant/application completeness/comments/standards: / f���s� 'D � 6 CSV No- V< C Present were: J. Bredemeyer Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 Michael J. Domino, Presia �QS�FFO(K�,O Town Hall Annex John M. Bredemeyer III,Vice-Prestnent �� Gym 54375 Route 25 Charles J. Sanders y x P.O.Box 1179 Glenn Goldsmith 1_� Southold,NY 11971 A.Nicholas Krupski 4w,- p!� Telephone(631)765-1892 �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: McCarthy Management on behalf of KASHA CACY requests an Administrative Permit to install an on-grade 12'x463" stone patio against the seaward side of the dwelling. Located: 235 Mill Creek Drive, Southold. SCTM# 1000-135-3-26 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: 1. 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 3 Planting Plan - T, For - • : '•�;-.,`,,.� �� t;.,,,=r"q �: � , - ,;y� , Joseph Farrell E C E - ituate: ?35 01 Creek �r®ve D DD Southold, New York AUG 9 2017 _ - SCTM#1000-135-3-26 Southold Town Prepared by. Suffolk Environmental Consulting,Inc. grdotTust� :- •:�; ,`w,—`r ` ` =� - ��� Bridgehompton,New York I Date: May 22, 2009 �`. - > I i7 3`t+� fi �� " E ) `°:�a, � I Plan Scifications: �._� CO w ae Berm = 2'-3' x 100' (200-300 square feet) T"" _ LUa 8� p�j,T �z• GS _ 6" - 6" height U Plantings: Rugosa rose ��' z•� (. (2 gallon potted) PROPoSED (2' o/c- 125 total) �p r _ p�+�'rtp��g ��(� 2ST BIOLANT�N6�DETAI� (I B�DRo()ADWELLNG I t 13.54' i �C pRt VFt_ ffi*WpK� 1. NAY BUFFER LAWN w.OD' 3Eag'?j�{ r' ` r a nty Rugosa Rose2. 31 - 0 gQFFO(,f James F King,President Q� PO Box 1179 Jill M Doherty,Vice-President �� Southold.NY 11971 Peggy A Dickerson Telephone(631)765-1892 Dave Bergen „� M Fax(631)765-6641 Bob Ghosio.Jr Southold Town Board of Trustees Field InspectionMorksession Report Date/Time: AWY Gi 0 T FARRELL BUILDING CO. requests an Amendment to Permit#6276 to allow for the 35' buffer and for the paved driveway with installed drywells. Located: 235 Mill Creek Dr.,Southold.SCTM#135-3-26 (Original Permit required 50' non-disturbance buffer and a pervious driveway.) TM of area to be impacted: Saltwater Wetland _Freshwater Wetland _Sound _Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: �Chapt.275 �Chapt. 111 _other Type of Application:_Wetland_Coastal Erosion"Amendment —Administrative—Emergency Pre-Submission Violation Info needed: Modifications: 0L ri'� G' 3S- / xi",4.7 9,.9 Conditions: Present Were:- King _!�-J:Doherty AP.Dickerson6�.Bergen 4 B Ghosio, D. Dzenkowski 6Scott Hilary_other Form filled out in the field by J` / Mailed/Faxed to:' I Date: 1 tl James F.King,President rg so �® Town Hall Annex 1 Jill M.Doherty,Vice-President h4 54375 Main Road Peggy A.Dickerson P.O.Box 1179 Southold,New York 11971-0959 Dave Bergen ae Bob Ghosio,Jr. • Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 20, 2009 Mr. Bruce Anderson Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932-2003 RE: FARRELL BUILDING CO. 235 MILL CREEK DR., SOUTHOLD SCTM#135-3-26 Dear Mr. Anderson: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., May 20, 2009: RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Permit#6276 to allow for the 35' non-disturbance buffer and for the paved driveway with installed drywells, with the condition of a planted berm along the landward edge of the 35' non-disturbance buffer, and as depicted on the plan prepared by Suffolk Environmental Consulting, Inc. dated May 22, 2009. This is not a determination from any other agency. Sincerely, o Jam s F. King, PresfidInt Board of Trustees JFK:Ims Planting Plan i:.�'i✓OF TR , t� Or R;;�"� � For Joseph Farrell _J: 11 OF scu Situate: 235 Mill Creek Drive Southold, New York SCTM#1000-135-3-26 Prepared by: Suffolk Environmental Consulting,Inc. Bridgehampton,New York 't Date: May 22,2009 i Plan Specifications: Berm= 2'-3'x 100'(200-300 square feet) o�L"film PLA 6"-8"height 22.7Plantings: Rugosa rose I — (2 gallon potted) PROPosED 2 o/c-125 total I-' ��� sroRv =i ( ) BEWLAidTING DETAIL o 3 BF F F 3 5W0'ELLBVC; i i rn „� ` °ROPOsED sa i XV. �.� l GRAVEL DRNElN.4Y N i � evi°�vss -- BUFFER XK MULCH \��1 7500\LAWN �� asp : 50 Ali/ \ ;\ �.. Rugosa Rose 2'-3' -- c,�FFO(,� Michael J. Domino, Presi', O�Q COG Town Hall Annex John M. Brederneyer III,Vice-President yam, _ 54375 Route 25 Charles J. Sanders ti P.O. Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski ?� ® p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD I Date/Time: ;S�`� Completed in field by: C `-►c(,d4 X J .-SR"Oto McCarthy Management on behalf of KASHA CACY requests an Administrative Permit to install an on-grade 12'x46'3" stone patio against the seaward side of the dwelling. Located: 235 Mill Creek Drive, Southold. SCTM# 1000-135-3-26 - 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 aring Card Posted: Y / N Ch. 275 Ch. 11' SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland 1 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: \! mt! Present were: J�Breeyer M. Domino G. Goldsmith N. Krupski Sanders Other Page 1 of 2 Michael J. Domino,Press_ 1 O�,�'SoF04ell G Town Hall Annex John M. Bredemeyer III, Vice--President ,`� yj, _ 54375 Route 25 Charles J. Sanders y 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 Date/Time: Completed in Work Session by: McCarthy Management on behalf of KASHA CACY requests an Administrative Permit to install an on-grade 12'x46'3" stone patio against the seaward side of the dwelling. Located: 235 Mill Creek Drive, Southold. SCTM# 1000-135-3-26 ,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 CACY RESIDENCE 235 Mill Creek Drive, Southold, NY 11971 APRIL 24, 2015 r. l Y i t � 1 1 �h _ _ 1 1 .k 0 CACY RESIDENCE 235 Mill Creek Drive, Southold, NY 11971 APRIL 24, 2015 i' AI P SOUND i ISU\NO - LONG v s^ m � Pp /Za 40 43 \. J ° + �1 za 1 25.1 ry, .,, 26 �_s�j1 1u (66) 7 9 1224 _ EACH NOS�9�N 5 P ` m C .' Imo.aMurF 1 S(FOR SECnIX !p 'O N C s NO 13501) RR,q 4 '32 SD 3 w a`• 1$4 a b S Cl. R � / - 93 tot 4SA 9]A ' YI/ O ,Qo < 1 M1 > e / 3 � / 6 7� �6 6 91 P // $ LONA ISIPN H-h---k Pond = R •i' w 3Hbex �. O� 25 a'' •0 4 a G m1 �' 3r oBF` ee' c EKm 32 X11 I +`+ B\ Rg B 3Q •\ p 35.1 .r• Rs OR s e ` 361 ` pR � a3 423 a 37 SpUNp \ s� w 3e d. J h B m 39, 41 w M w NOTICE emus COUNTY OF SUFFOLK © x +m sounlo�o sECTION NO Real Property Tax Service Agency v jjjjj� - - - - __ — - - eBw.l uBe,.w.�,,,..a.nrnam ,3s os ---- - B M 135 ._ - ._ •a:� ^'' e.•ra:.y,aeti�;- _ aorea,v luw s t. OFFICE LOCATION: ®;�'OF SO(/��®l MAILING ADDRESS:, Town Hall Annex '` ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Telephone: 631 765-1938le Southold, NY 11971 � ® �® TeP ®lycoum LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President SEP 1 5 2017 Town of Southold Board of Trustees From: Mark Terry, LWRP CoordinatorSouthold Town Board of Trustees Date: September 14, 2017 Re: LWRP Coastal Consistency Review for KASHA CACY SCTM# 1000-135-3-26 Wetlands Permit 0423C (Amended) was issued for the property in 2009. The permit required a 35' wide non-disturbance buffer and a planted berm along the landward edge of the buffer. McCarthy Management on behalf of KASHA CACY requests an Administrative Permit to install an on-grade 12'x46'3" stone patio against the seaward side of the dwelling. Located: 235 Mill Creek Drive, Southold. SCTM# 1000-135-3-26 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 to further Policy 6. 1. Verify the 35' non-disturbance wide buffer is intact. 2. Require passive.storm water control in the patio design. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. John M.Bredemeyer III,PresidentT_ " ' own Hall Annex Michael J.Domino,Vice-President ® ® ' 54375 Main Road ' a , . P.O.Box 1179 Southold New York 11971-0959 James F.King,Trustee �,, _ . , Dave Bergen,Trustee Telephone(631) 765-1892 Charles J.Sanders,Trustee � ��� �����' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only T - _Coastal Erosion Permit Application -..-Wetland Permit Application Administrative Permit �Amendment/Transe i 1nsion l/ Received Application: Received Fee:$ 00, Completed Application: 2P.11,71 _ Incomplete: �a 2 p q� E _SEQRA Classifica,t}'on: D C E U lU/ Type I Type II V Unlisted Coordination:(date sent): LWRP Consistency Assessment Form: AUG " 9 2017 CAC Referral Sent: Date of Inspection: _Receipt of CAC Report: Southold Town Lead Agency Determination: f e Technical Review: Public Hearing Held: Resolution: Name of Applicant: Kasha Cacy 4Cd ¢- Mailing Address: 68 Bradhurst Avenue, Apt. PH2C New York NY .10039' Phone Number: 646-247-9641 Suffolk County Tax Map Number: 1000-135-3-26 Property Location:. 235 Mill.Creek Drive,.Southold, NY 11971 In front of home. Pole#3 (provide LILCO Pole 11 distance to cross streets, and location) AGENT:,_McCarthy Management,,Inc. (If applicable) Address: 46520 County Road 48, Southold, NY 11971 Phone: 631-765-5815 ward of Trustees Applicai" )n GENERAL DATA Land Area(in square feet): 10,094 sq.ft. Area Zoning:.. R-40 Previous use of property: Single family dwelling_ Intended use of property:, Single family dwelling Covenants and Restrictions on property? Yes x No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? _x, Yes - _: _..No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes - x No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes x__ - No Does the structure(s)on property have a valid Certificate of Occupancy? x Yes No Prior permits/approvals for site improvements: Agency Date Southold Town Trustee's 5/20/2009 permit#6276. Southold Town Trustee's 5/29%2009 Certificate of Compliance#0423C. NYS DEC 12/27/2002 Letter of Non-Jurisdiction application# 1-4738-03099/00001 Southold Town Building Dept. 10/06/2008 permit#3420-2- Southold 4202Southold Town Building Dept. 06/05/2009 Certificate of Occupancy Z-33760 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): _To construct a 12 x 46'.3"-stone patio at grade as drawn on attached survey. � u _toard of Trustees Applicaf._ oa WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To construct a 12 x 46'.3" stone patio at grade as drawn on attached-survey Area of wetlands on lot: see map square feet Percent coverage of lot:_ Closest distance between nearest existing structure and upland edge of wetlands: 50' feet Closest distance between nearest proposed structure and upland edge of wetlands: 35' feet Does the project involve excavation or filling? X No Yes If yes,how much material will be excavated?_ cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: .__ _ feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect,if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): -NONE - --- - - - i 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 l -Project and Sponsor Information Name of Action or Project: - Kasha Cacy Patio Project Location(describe,and attach a location map): 235 Mill Creek Drive, Southold, NY 11971 Brief Description of Proposed Action: To construct a 12 x 46'.3" stone patio at grade as drawn on attached survey Name of Applicant or Sponsor: Telephone:646-247-9641 Kasha Cacy - Address: 68 Brad hurst Avenue Apt..PH2C City/PO: State: Zip Code: New York NY 10039 L 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 xn 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: Town of Southold Building Department 3.a.Total acreage of the site of the proposed action? 232. acres b.Total acreage to be physically disturbed? see map acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 232 acres 4. Check all land uses that occur on,adjoining and near the proposed-action. ❑Urban ❑Rural(non-agriculture) []Industrial ❑Commercial ®Residential(suburban) El Forest ❑Agriculture El Aquatic ❑Other(specify): _ ❑Parkland Page 1 of 4 5. is the proposed action, - - -' - T NO YES N/A a. A permitted use under the zoning regulations? T x] b.Consistent with the adopted comprehensive plan? ❑, , ❑ 1XI 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ❑ 7. Is the site-of the proposed aotion-located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify:. - -- `❑: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES r X b.Are public transportation service(s)available at or near the site of the proposed action? 0 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? X ❑ 9.Does the proposed action meet-or-exceed the state energy code—req direments? NO YES If the proposed action will exceed requirements,describe design features and technologies: - NA __ __ _ __ F 1D 10. Will the proposed action connect to an existing public/private water supply? NA NO YES If No,describe method for providing potable water: _ _ ,❑ ❑• 11.Will the proposed action connect to existing wastewater utilities? NA W YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ a, 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 ❑Forest ❑Agricultural/grasslands ❑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? FX I FT 16.Is the project site located in the 100 year flood plain? NO YES X 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? X❑NO AYES 5 ❑. b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: QNO AYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size_ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Kasha Cacy Date:--I L 77 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 I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? ( ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the F-1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ( ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 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 El problems? 11. W ill 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. E Check this'box if you have determined,based on the information and analysis above,and-any supporting documentation,' L_1 that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. F1Check 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 ' pa ts. Town of Southold-Board of Trustees 7 Name of Lead A ncy ----- L 1. Date'- (\ \ a President Print or Type Name of Res onsible icer in Lead Agency Title of Responsible Officer Signature of Response le Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE,FIORM Tlie Town of Sntithol'd's Cadc of>;thics oroliibitc confliofs of intciesl on tlic Hart 6Fkown officerS,and emnloveea'The-Durpose of this form is io pmvide info'ririatiori wlticli can:ilcrt-tlie town'of possible Conflicts of interest and.allow it to,tako whatever action is necessary to avoid same. YOUR NAME- Cacy, Robert Charles (Last name,first name,#fiddle 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 f x= 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 ,relhdonship•with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or busine`ss ittte est.•`,,Business interest"means a business, including a partnership,in which the town officer or employee has even a partial dWhg6hih 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); C)an officer,director,partner,ort employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 9th day of August ZU 9 7 Signature 7 n t Print Name Robert Charre Cacy ' Form TS] Board of Trustees Appli ;ion AUTHORIZATION (where the applicant is not the owner) I, Robert Charles Cacy __ _ residing at 68 Bradhurst Avenue, (print name of owner of property) (mailing address) Apt._PH2C,_New York,_NY 10039 do hereby authorize (Agent) Thomas J. McCarthy to apply for permit(s)from the i Southold Board of Town Trustees on my behalf., (Owner's signature) Board of Trustees Applin _ ;,ion A"IDAVI-T. Robert Charles Cacy BEING DULY SWORN DEPOSES AND AFFIRMS THAT IiE/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 00rop64 Owner SWORN TO BEFORE ME THIS _ �� - -DAY OF- ���QST— 20 ,LZ DERRICK F. HOWARD Notary Public State of New York N0. 0IHO606378,5 --- — - -�- ;'~ Qualified m New York County Notary Public My Commission Expires-9—/ID Board of Trustees Application AFFIDAVIT Kasha Cacy BEING DULY SWORN DEPOSES AND AFFIRMS TIIAT HE/SME 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 WORD 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 Property Own SWORN TO BEFORE ME THIS - 3 DAY OF J , 20 ASHLEY K OU Notary Public—State of New r NO-01 4113 NO T Peed in New York County y My ommission Expires Jun 17,2021 ✓ Board of Trustees AppliCeti®a AUTHORIZATION (where the applicant is not the owner) I, Kasha Cacy residing at 68 Bradhurst Avenue, (print name of owner of property) (mailing address) Apt. PH2C, New York, NY 10039 do hereby authorize (Agent) Thomas J. McCarthy to apply for permit(s) from the Southold Board of Town Trustees on my behalf. l� o (Owner's signature) APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSUU,]FORM The Town of Southotd's Code of Ethics riroltlbits conflicts of intdrest6 the'part of WWn affeers and emptnyees.Tlte,purpose of this'forni ic'to provide can•alert tlto town df possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: CaCy, Kasha (Last name,first name,fiddle 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)•itave a relationship with any officer or employee ; of the Town of Southold? "Relationship"includes by blood,marriage,or business iiiterest.-"Business interest'•means a business, including a partnership,in which the town officer or employee has even a partiiil owneiship 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); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 21 st day of June 20 j 7 Signature t Print Name Kasha Cacy Form TS l APPLICANT/AGENT/REPRESENTATIVR TRANSACTIONAL DISCLOSURE,FORM The Town of 5authold's Codc of Ethics pdiliibit`c conflicts�f int6re`st on the oarf of town efl cers and emnloyees.•Tiia-nuroose of this form is io Driidide information wliich can nlcrt'tlie town'af possible conflicts of interest andgillow it to tako whatever achon is necessary to avoid same. T - YOUR NAME: McCarthy, Thomas J. (Last naive,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 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 rel'a-tionship with any officer or employee of the Town of Southold? "Relationship"includes by blood,tnarriage,or busines9-inter4t.-"13,usiness interest"means a,business, including a partnership,in which the town officer or employee has even a partial;owgctshiji,o,f(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); C)an officer,director,partner, or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP 77 Submitted this t da June 21197 Signature Print Name Th mas J. cCarth s 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. :Tlhus; each answer must.be-explained in detail,,Iistiitg-:both sa porting, and',non- suyeortinQ 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# 135 .: 3 = 26 PROJECT NAME - Kasha Cacy Patio 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: ❑t Nature and extent of action: To construct a 12 x-46'.3" stone patio-at grade as drawn onattachedmap. x Location of action:_ 235 Mill Creek Drive, Southold, NY 11971 Siteacreage: •232 acres _ Present land use: Single Family Residence Present zoning classification:_ R-40 2.- If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Kasha Cacy (b) Mailing address:_ 68 Bradhurst Avenue, Apt. PH2C, New York, NY 10039 (c) Telephone number: Area Code( ) -646-2477964-1-- - (d) _646-247-9641_ _(d) Application number,k any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No X , 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. F]Yes ❑ No 0 Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑, No 9 Not Applicable Attach additional sheets if necessary _ Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria No Q Not Applicable 0` Yes 0 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 S 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 No Not Applicable 0 Yes 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. n, Yes No Not A i..cable - 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 ' X 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 0 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. ((-�� 0 YeED' No Fx1 Not Applicable Attach additional sheets if necessary WORIKING COAST POLICir.a 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. LLQ Yes Q; No Q Not Applicable Attach additional'sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes ❑ No Not Applicable Attach additional sheetsif necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages 62 through 65 for evaluation criteria. El Yes 0n No❑x 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. Ej Yes El No 0 Not Applicable PREPARED BY TITLE DA s McCARI'IIY 1 ANA =M0ff, INC. s 46520 COUNTY ROAD 48 SOUTHOLD, NY 11971 D JOB NO (631) 765.5815 FAX (631 765-5816 ATTENT[i N ", OL�N o V77- c' ee I mu WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ i ® ^ o o Doll's a Ls_f- Qvio Art THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 1 I I F-111 11 11U)1 AUG 2 1 2017 Southold own Bngrd of,TnES!CE COPY TO SIGNED: If enclosures are not as noted,kindly notify us at once. r -,I-