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HomeMy WebLinkAboutTR-9130A Michael J.Domino,President o���F SO(/T�OI Town Hall Annex O 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith • �� Telephone(631) 765-1892 A.Nicholas Krupski �lif'COU Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction % constructed � compliance Project com lete inspection p Michael J.Domino,President 0f SOUly� Town Hall Annex John M.Bredemeyer III,Vice-President �� lQ 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith G • Q Telephone(631) 765-1892 A.Nicholas Krupski O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9130A Date of Receipt of Application: November 6, 2017 Applicant: Arthur W. Hahn IV & Russell W. Hahn SCTM#: 1000-53-4-15 Project Location: 2295 Bay Shore Road, Greenport Date of ResolutionlIssuance: December 13, 2017 Date of Expiration: December 13, 2019 Reviewed by: Board of Trustees Project Description: For the as-built seaward side 12'x15' wooden deck. 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 survey prepared by Michael W. Minto, L.S.P.C., dated September 21, 2017, and stamped approved on December 13, 2017. Special Conditions: None. Inspections: Final Inspection If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. o Michael J. Domino, President Board of Trustees Michael J. Domino,Pre' t O�Q$uFFO(�COG Town Hall Annex John M. Bredemeyer III,Vice-'rresident �� ��, 54375 Route 25 Charles J. Sanders o 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 Date/Time: 1;-lo Completed in field by: ARTHUR W. HAHN IV & RUSSEL W. HAHN request an Administrative Permit for the as-built seaward side 12'x15' wooden deck. Located: 2295 Bay Shore Road, Greenport. SCTM# 1000-53-4- 15 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 f�Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: 67?"� 1 have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: ' Br demeyer M. Domino G. Goldsmith N. Krupski 5C i. Sanders Other Page 1 of 2 Michael J.Domino,Pr(, ,it SOMA,OHO CSG Town Hall Annex John M. Bredemeyer III,Vice-rresident V_ 54375 Route 25 Charles J. Sanders o "� P.O. Box 1179 C* z Glenn Goldsmith 0 Southold,NY 11971 A.Nicholas Krupski ?, ® p! Telephone(631)765-1892 ��� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: ARTHUR W. HAHN IV & RUSSEL W. HAHN request an Administrative Permit for the as-built seaward side 12'x15' wooden deck. Located: 2295 Bay Shore Road, Greenport. SCTM# 1000-53-4- 15 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 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF DRAWN CHECKED std M SIPT. 2017 -. DRAWING,&JOB AD. 17-817 SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. REVISED: ADDED TOPO AND WETLAND FLAGS DATE OCTOBER 19, 2017 1 17-944 COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED Area= ,932 s.f, TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY e°a IS PREPARED, AND ON HIS BEHALF TO THE _ b� TITLE COMPANY, GOVERNMENTAL AGENCY AND NG IION S LISTED ENDI TOTHE ASSIGNEES OFTHE NG INSTI— TUTION. GUARANTEES ARE NOT TRANSFERABLE. 29,2 F ry6� ,°9 p THE EXISTENCE OF RIGHTS OF WAY tSob,o�6 \�r' 4. ?k AND/OR EASEMENTS OF RECORD IF \ \`� �s ANY, NOT SHOWN ARE NOT yrs 'S0/ GUARANTEED. L7CIZ��0 � ® �R� v� ��ir'.`` o'\\` /~ ®� Premises known as: QIOa-inos �O NM01 pro,,�' ti^ +�' ti �' �;` �M ��a 2295 Bay Shore Road, Greenport 333isn I. ,jo Q O3- �` +� 4 ` , °o 0 ° ��-- ELEVATIONS REFER TO NAVD 1988. �� m �� - A ,.,4/ AL p \�°P � _? X90 C `• \ \\ DE E I E �� ;' � �•` � °tea��� `•`�� � ``� NOV - 6 2017 �� �hV ``` �� , ' \�� ��,;' A. Southold Town ��5 \?\`- ' Board of Tr t e °� ti�tib ti� o - --� /' ,rLO o• � (I. 0 o ` °j o ro �6 v� 2s 5 01. �a e�,� \'G\Ce ° oe� S`�h ��dry��+^�y �`\ - - 6_ ��J`� 4�A + 6 �� ?ogP�80 92s ,os +e `��n'eo! /. O��f +8,� °°`° ry�'h0� ,� Ah°/f 87 �'d9e dr Pte_`oj h O IIF HE 8�e°Dien f kas8 ��o >.0>°/Pf �S9 �ry+6�� `1� �.t`�+,rpE1. W 0'� Po1,82s �g �d9e 8 8 i2 ?s9 C P O #41s2jr8'eA- p°� 9 j ®50821 4J + s� '80 s� ®CANo 5J 49460 10 di Island View Lane (Avenue) Survey of Lots 38 and 39 Certified to: AMENDED MAP A PECONIC BAY ESTATES IPA'0.E ZR1C VAGI AND SUSAN COYO VAGHTEIR FILED MAY 19, 1933 AS FILE NO. 1124 EMINENT ABSTRACT, INC. (EA1967-S) sat�aate at WESTCQR.,LAND ,TITU'INSUROCE COMPAW CITIBANK, N.A. Arshamomaelue Town of Southold 'Michael W. Min to, L.S.P. C. Suffolk County, Now York LICENSED PROFESSIONAL LANE) S&kVEYOR District 1 �(1F�Q S��¢i��. 53 B[��k 4 L�¢' 15 NEW YORK STATE LICENSE NUMBER 050871 U1 t ► p 87 W®®dvlew Lane Scale 1 "= 40' Surveyed September 21 , 2017 Centereach, N. Y. 11720 GRAPHIC SCALE PHONE/FAX: (631) 580-1202 �qT CELLULAR: (631) 766-9714 ' 40 0 20 �0 8o Iso EMAIL.: mflkemintolspc®gma;J.com ( IN FEET ) 1 inch = 40 ft. I d wner HAHN RESIDENCE 2295 BAYSHORE RD. � /� GREENPORT N.Y.' e0- °n`b ePe�d e EXISTING HOUSE NOT CHANGED EXISTING: SINGLE FAMILY RESIDENCE SCTM # 1000-53-4-15 E C E I V PROPOSED: ZONE R-40 0 81ACRES . D 15'-0" X 12'-0" AS BUILT WOOD FRAMED DECK — NOV — 6 2017 GENERAL NOTES -0 1 "1-01 shag-1-ral to me regWrements d Ire Residental Coda d h New Yo6 I 6 0 State,County and Town Department Regulations.Utility Company requirements and best trade practises 15'-0" 2 Before commencing work the Contractor shall file all documen6 required by the FSouthold Town ��Department.Pay all fees required by local agencies and obtain all required Board f Tru t 3 The Contractor shall visit the site and verify all Omensors and the exsting �+k �O x19 prior to construction An Qrsc ~ tofldtiofn afial the work y repancros which would { IED� y /©� `gf Interfere with the mtsfacta y completetlon d the York dascnbed herein shall be AS NOTED � � reported m the architect«Poparty owner Do ret start work until such condgiars 7 f w.J W W have been examined and a wlxsa d action oris will agreed DATE: _p. yL/ //] ° the veno «run to t d ly Perifact y g noon Failure Iq rorty cry corud�twns vin be oonstrued as an acceptance 1 O' o or the cwark ons to ProPelomformY the rt the required coo k U' O 4 All vatic rs to CoM«m to tint drawings and specGiCau«IS d the arcnliec[and 0 FEE: rpm) O—^' 5�I The Cont Is to maintain a complete and up to date set d plans on the Q V )'`r'• (O lob s¢e at an bmf O 6 The dre-rigs are nor to be scaled Md.an/clrcumsances 1u ,^r_r ��// pI �I 0. 7 It shall be the Contractors responsibility[o ascertain ail prevading procedures NOTIFY gUlLO" L ,i 1�IVI EIh JA! d HANDRAIL @ 36' TYP. including storage and tale[facAmes,pmleawn of existing work to remam,access to 7CC (k ' ' i ru[� THE O work area,tours of permitted wak,avallabNry d rater and electric povver and all UJ 18U2 $hl 4 I Vt - 'l anter condmosaq restncdons t«this particular location In order to execute re FOLL�`tr I 1X6 DECKING work m a careful and orderly manner with the least possible dsturbance to the public v•v irtiu l 1:'ti �, 8 The Connact«shall make the neccesery arrangements to utilities and services +� �•Y , Is porany disconnected while performing the work as mqulred. 1. F` 1-11 RATIO, - �.'� 1,` ('uF,�� 9The Contractorshall provide ail dimensions and cm-outs for other trades ^r -'RETE 4X4 ACO POST ANCHORED TO ri The Commct«shall provide proper shoring aro timing for all remaining structure FORPOUR-L. 2-2X10 ACO GIRDER FASTENED TO 4X4 POSTS TYP. prl«ro removal d evlstim structure qq A DN RISER @ 7" SONOTUBES TYP 11 Plumbing,decukel,HVAC and similar work Snell be performed by licensed 2. ROI;GH' - F Q PLUh`:�ING C _ persons who shall arrange f«and obtain all required inspections The General Comrector shat)be responsible for scheduang all other Inspections as requirecL 3. INSULAE�til - 10" DIA SONOTUBE OR EQUAL 12 The Corimmr is solely responsible for construction safety,and shall hall the Y TO 3'-0" MIN BELOW GRADE 4. FINAL comer am architect harmless from litigation ansirg out d the Concactofs(allure to r, I - -v provide construction safes - •.Jt��+r '�' —, y meats aro methods BE COr _ E PLAN CONSTRUCTION NOTES ALL CON 0TP`Ir-Ynu� MEET TH 1/4" =1' 0" /�� 1 All footings shag rest m undisturbed sal at a mirdmum d 36"below fin grade. `x�/�• 2 Poured cpncrela shall have a minimum psi d 2800 at 28 days unless wed REOUIREMEN i v:-THE COMES OF NE ��" 3 Sill Ones shall ba preserved,treated wood and be Installed above a 16 oz copper mnnite Snead YORK STATE. NOT RESPONSIBLE FOR 4 Shrgle siding shag cond«m to ASTM D 3679 aid nsml ed In accordance /I� 1^- 1/g7.r.� with the New York State Building Code and manufacturers specification ` ` v 5 Plllrgs snail be Irsalled q•a licensed cI vict«to a deport and bearing agreed DESIGN OR CONSTRUCTION ERRORS. X upon by an engineer and cent katal slWl ¢sued stating same j� 6 Unless otherwise noted all framing and sauctuml Wood comporems shag be 1 v 92«better Douglas Fir 7 All framing mchnquas and methods shall be as pr dpton ne design based AFSP Wood Fmme Corsiruc[on Manual for One and Nov Family D-Ig gs(WFCM) (lam o `V or as specified in R301 211 8 An budding envelope components Shall CWPly will,Chapter 6 of the Energy COMPLY WITH ALL CODES Or Conservation Cade d the State or New Yoh 9 Fireblocking shag be provided m all wood framed corsuucuon m accordance m with NYS Code R 602 8 to form an e8eatia fie barrier between stades and NEW YORK STATE TOWN GOD 11" �� Y� �� '��` �I � +( beween me Top story and mofSpade 9, ��_//f��� 10. Pmtenne panels shall be jaolded f«gla-ed openigs in accordance with AS REQUIRED AND CONDITIONS OF / `� _C� ��\b �S �� N'S Al'P.0-2of Ixil tIle t re are designed to campy-'nth local geogmpnk 1!!1�] IIIV•\/ \ and dimanc cmena as acted in uo fdkvnng table. Qf'1f m 1nl n T111A111 7�/i �Q� ;�. Il`� GEOGRAPHIC & CLIMATE DESIGN CRITERIA HANDRAIL @ 36' TYP. WIND SPEED W LQiO 120 psMl MPH SEISMIC DESIGN CATATGORY B WEATHERING SEVERE o FROST LINE DEPTH 36" TERMITE THREAT MODERATE TO HEAVY DECAY SLIGHT TO MODERATE _�fl4' CRS" WINTER DESIGN TEMPERATURE 11 PI 1 J (JC1� 1X6 DECKING FLOOD HAZARD AS NOTED ��r ® ,� ` 2X10 @ 16" OC DECK JOISTS A-101 PLAN, SECTION, NOTES �qq//pp��{��{71�yy�l11 e` �i a "TER 148 STRAPPED TO GIRDERS TYP �p ,-;� ��`: ::.�!„• g����' f� 2-2X10 ACQ GIRDERS t� + r,� FASTENED TO 4X4 POSTS TYP ,�� F NEIV PLAN AND SECTION OCCUPANCY OR ��- ( �Q' S DEE, OP SCALE AS NOTED AUG 12, 2016 L L L 4X4 ACQ POST ANCHORED TO GJ vf-O SONOTUBES TYP. sFaL USE IS UNLAWFUL �� A 101 WI10' DIA SONOTUBE FTGS � -- �r '!J f � WITHOUTCERTIFICATE I @ 3' BELOW GRADE MIN, m ;° v 1� W 1 OF 1 OF OCCUPANCY SECTION #1 OF 1/4” = 1'-0" ESSION PO BOX 49 RETAIN STORM WATER RUNOFF "aro- JOAN CHAMBERS SOUTH LD NY 11971 PURSUANT TO CHAPTER 236 C� Q OF THE TOWN CODE" ct nna� be r�u�re� r } 1 f , t F > sgm � _ _ .r s Ar 111 y . 40 46w AV R fir; •~.�+ � ' '`=' .v�+ to 1� �,`� � ' �•�std_ i J55��',�• �' .�� .a '! ec� • ' tit i t '! +§-`�,''- .:ir&+§� .�.y. �a 3 '3 r d , i • �� � �.., , y'�' '} - '"� � / � awe.,: .r ``` y�'y�c. a•.7,+yF," . � •' is 1 yY'a ^¢; '!/Y�%�� . f�".a .'S'V 1/r• •,l` r. ..✓/ '+yam t i � t, A ' • t * ii. w � 'rte r N.- ECism •d , ,. A• r. d! _. /. ' 'fry" ,- �. r rwn 1 , _ • �1 T' . i I� i r l f •6. ' �~ ' 1 v • jam{ ��r�r � .�t .� i'��71��iy �l. ' � r ��� h�� \, �.• .fir - y�,t ,A s�5 t. ;T VVV � r I ,,�{ I'�• yam. ' y i if i o,, r• ,• • vL. f�y xA.? ''. ,�Y _ bpi( '�"_� �i.r i'y,' .•i -./ � ,"�.t.. if i I�?illi",I.. - I b q � , .IF i.Ag99 ��ab � 4 ' -.".'7`-°•y - -moi,. '. :TF^ �.. -'r - Aa,.F elm 17s _ AP Al- lie y . 1 .w • ..w • a Town of Southold 3/2/2017 � P.O.Box 1179 i® r '- 53095 Main Rd Southold,New York 11971 VJ 7a 'yam CERTIFICATE OF OCCUPANCY No: 38852 Date: 3/2/2017 THIS CERTIFIES that the building AS BUILT DECK Location of Property: 2295 Bay Shore Rd,Greenport SCTM T: 473889 Sec/Block/Lot: 53.-4-15 Subdh4sion: Filed Map No. Lot No. confo,gas substantially to the Application for Building Permit heretofore filed in this office dated S '5'2016 pursuant to which Building Permit No. 40955 dated 9/1/2016 -xaz, issued. and conforms to all of the requirements of the applicable provisions of the law. The occupancy for .: ch this certificate is issued is: s built"deck addition to an existing one family dwellig as applied for. , E E i E 1 i E, ,s NOV - 6 2011 Southold Town Boird of Trustees __.. The certificate is issued to Hahn IV,Arthur&Russell of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Ohoed Signature SEE SEC NO 0,15 SEE SEC NO M MATCH UNE i 1TAM O SEE S413 M No MM OF 0, swo� BB 7AFOR 6—CE1-NO 4 SEESEC NO COUNIV/O/F SUFFOLK 14' 17 SAACC) 3 9 p. a T�OF COUNWOFSUFFOLK 4 to -N) 2-504c) MMOF 2 20 11'A(0 T OFSOtJ-IHOLD S, S-Skc)Tt., is- =0F=`" CREEK C) 7- In, to ON.) A.7 .9 4u11 SEE SEC.NO 0 .8 7� Nz —— ------ ------ ———— SEESEC NO 051 SEESEC NO 05F SEE SEC NO W 'T., r50]m COUNTY OF SUFFOLK SOUTHOLD SECTION NO ertv Tax Semine Au Real Proo enm F9d 053 'w TCH OFFICE LOCATION: ®��®F S®�r�®� 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 ® Fax: 631765-3136 c0UNT8,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: December 6, 2017 Re: Local Waterfront Revitalization Program Coastal Consistency Review for ARTHUR W. HAHN IV & RUSSEL W. HAHN SCTM# 1000-53-4-15 ARTHUR W. HAHN IV & RUSSEL W. HAHN request an Administrative Permit for the as-built seaward side 12'x15' wooden deck. Located: 2295 Bay Shore Road, Greenport. SCTM# 1000- 53-4-15 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 INCONSISTENT with the below listed Policy Standards and therefore is INCONSISTENT with LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction The as built structure was constructed without a Wetland Permit and does not meet the regulatory requirements of the Southold Town Board Trustees. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. QF S�Ury Michael J.Domino,President Town Hall Annex�4� " � Olff John M.Bredemeyer III,Vice-President 54375 Route 25 Charles J.Sanders P.O.Box 1179 Southold,New York 11971 Glenn Goldsmith • y4 Telephone(631) 765-1892 A. Nicholas Krupski ©�if'�DUNT`1,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application D E U" E V E Administrative Permit Amendment/Transfer/Extension 4—Received Application: NOV - 6 2017 Received Fee: $ Z00XV S-RZT Completed Application: Sufhoid Town Incomplete:; B oo n Tru n SEQRA Classification: Type I_ Type H Unlisted s Lead Agency Determination: ; �Coordination:(date sent): LWRP Consistency Assessment Form SentZt : CAC Referral Sent:_ Date of Inspection: (K7 :l Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Legal Name of Property Owner(s): A r A o r Pv. 66 6 7— a h P� I�Y%'a hn Mailing Address: Phone Number: b Suffolk County-Tax Map Number: 1000-, Property Location: A-eff- R0 (If necessary,provide LILCO Pole#,distance to cross streets, and location) AGENT(If applicable):. _ Mailing Address: Phone Number: Board of Trustees Application GENERAL DATA Land Area(in square feet): L Area Zoning: IF do,,4,4 Y Previous use of property: ppl, den- h( ( _ Intended use of property: I,oil p yy I Covenants and Restrictions on property? Yes 4/ No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. � h Does this project require a variance from the Zoning Board of Appeals? Yes r No If"Yes",please provide copy of decision. s Will this project requir any demolition as per Town Code or as determined by the Building Dept.? Yes p No s Does the structure(s) on property have a valid Certif tate of Occupancy? Yes No t Prior permits/approvals for site improvements: Agency �-7 O1/ Date No prior permits/approvals for site improvements. ' / Inas any permit/approval ever been revoked or suspended by a governmental agency? �' No Yes If yes,provide explanation: Project Description(use attachments if necessary): Board of Trustees Appli< ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: A I fl r (fi016e - L,.r de k e o E-kw 4 , I/w 1/4 d 11m) Ulf Area of wetlands on lot: (*o,. 17,to a square feet Percent coverage of lot: mppnA, 17 % ; Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between n st proposed structure and upland edge of wetlands: /� ' feet Does the project involve excavation or filling? t/ No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? /Y e _cubic yards Depth of which material will be removed or deposited: /�'' feet i Proposed slope throughout the area of operations: � i 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 reasonofsuch proposed operations(use attachments if appropriate): 1 V�� 617.20 Appendix B Short Environmental Assessment Form Instructions for C6hiplethig 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 l 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"I -Project and Sponsor Information Name of Action or Project: o Project Location(describe,and attacb a location map): i Ed two 'rc fide a rp;l fe hl pd et ZZ ' Pie, Ott? P9 6 pP 14 Brief Description of Proposed Action: C'F�19 rel f�'i2.'/lw lfm j f eeri �,} �j- h, it deed, f F Name of Applicant or Sponsor: Telephone: 5-I g -07 �0 6r 41 /W 0 J 9A pt PAP 11 W�� ���`� E-Mail: n0 d3/ OPT ff/VL &E.At t Address: 12N � , I /-7 City/PO: Stat, v / Zip Cod7e: = 1.Does the-proposed action-only-involve the legislative adoption of a plan,local law,ordinance, t 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: 1a 3.a.Total acreage of the site of the proposed action? '' awry b.Total acreage to be physically disturbed? ZUN acres c.Total acreage(project site and any contiguous properties)owned �Q��2�� or controlled by the applicant or project sponsor? a &- 4. Check all land uses that occur on,adjoining and near the proposed action.- ❑Urban El Rural (non-agriculture) ❑industrial ❑Commercial [<esidential(suburban) ❑I:orest ❑Agriculture E3 Aquatic ❑Other(specify):, ❑Parkland Page 1 of 4 5. Is the proposed action, 1 ` " NO YES' N/A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? Q 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 action located in,"or does it adjoin,a state listed Critical Environmental Area? NO YES If identify: - ❑Yes,i s 8, a.Will the proposed action result in a substantial increase in traffic above present levels? N01 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: A/ a 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. A/ n pp' �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? 3 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO- YES wetlands or other waterbodies regulated by a federal,state or local agency? b,Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ " If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: - -ENE], 14.1dentify 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? 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, ,Q 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: E]NO AYES Page 2 of 4 18. Does the'proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? ; If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed -NO YES solid waste management facility? If Yes,describe: a �J 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? 3 If Yes,describe: LL -- _ ❑ ; 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Q JJ / / Applicant/sponsorname. _ RVA? 11 �_ IT.Ah- -_ pr"', 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 occur occur t 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 4"2. Will the proposed action result in a change in the use or intensity of use of land? EX F 3. Will the proposed action impair the character or quality of the existing community? Lel 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action-cause,an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 24, ❑' 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 y problems? _ °a 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. /11.4 z k 5 1 Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. El- 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 impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Sigriafure of Responsible Oiflcer in Lead Agency' Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT, BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE,MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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 3 OF THE PERMIT. Signature of Property Owner SC SWORN TO BEFORE ME THIS DAY OF �e� 20 JEFFREY JONATIidN PICCOLO Notary Public -State of New York, NO. 01P16244437 Oualified m Suffolk,County t8i ublic My Commission Expires Jul 11,,2019 , ,,, Board of Trustees Application AFFIDAVIT _ F BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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 s 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 Owner SWORN TO BEFORE ME THIS D DAY OF 201 ASYED Notary P blliic,iState of New York No,01SY5068806 Comiss on l=acPiin Na-aau r s Nov.12,2018 Notary Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORINT The Town ofSouthold's Code of>{}iics iirohibir5 eonflicts'af interest ori the mrt"o�town officers and�emplovees The nurnose of this form is to"provide inforinatioin ivltich can ill'eit thetown`of nosiible conflicts of i»teicifnnd altnw it to take tyfiatever notion is` neceS5g-M,lo'avoid same: YOUR NAME: Mfr - ''u'• - - -(Ust naine;ffirs me,�i dle 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.) 1 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.) -� O�`1�!t f JohL14- _�`�In�- to 0' . " DO'yoii person�illy(or'thi;a ugh you>compiinj ;spouse,s0i,ng„parent,'or child)have a relationship with lulyot�cet or employee- oftiic Towii Wf•Soiithold? Relationship includesyy 61o6d;Marriage,or busiacss igtereSt.I3usiiiess interest-means wb11Wh4,-;, including a parinershiji;in-which the town_oCGcer.or efnployec.has 4V_ettii partini otivnership of(or cmplgymcul hy)u cprporation in tvhich tlic loon officer or.cmployce owns„morc'thair"5%o of ilio shares, YES _ NO 1 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 Submitted this �/ f�zy of `� �?! A -Signature- Print Name tyl►P 7 <ff c _ Form TS 1 r � \ Town of Southold -LWRP CONSISTENCY ASSESSMENT FORINT 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 Ju :its, significant; .beneficial'and adverse effeets upon tide coastal area�whicli includes all of Southold Town :. s -- [ 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,musf be-explainedlu detail, hitinwboth•sunnortimg.and non- su p6ttingTaefs: If an action cannot be certified as consistent with the-LWRP policy standards and conditions,it slA not,,be,undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's 5 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# PROJECTNAME 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) - .- El (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of actio /p j - -� -'1fir. AIMPORMshln9P41W 1'YP,N9ot" t` ®ter l t -1t ►1 ��f� 'P� �'� ��-fig- - IIa j --��z��c� - o� __ � ����� -r CZo .. 0 b-�V,f d to 1�f1W . .. ........ Location of action:_ P4 Pirm Site acreage: -- -2- Present 2 Present land use: K AP i Present zoning classification: pP 1 Aov b� 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 ofapplicant-_ (b) Mailing address:_ Z Prov � I-e /t pp-� (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 LWIt.P Section III-Policies; Page 2 for evaluation criteria. ❑Yes ❑ No 2/Not Applicable Attach additional sheets if necessary Policy 2. Protect and p serve historic and archaeological resources of the Town of Southold. See LWRP Section III-Po 'cies Pages 3 through 6 for evaluation criteria ❑ Yes 0 No Not Applicable { J Attach-additional sheets if necessary - Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III-Policies Pages 6 through 7 for evaluation criteria 0 Yes,F] No P(Not Applicable - 5 Attach additional sheets if necessary NATURAL, COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWItP Section III-Policies Pa 8 through 16 for evaluation criteria r -E-] Yes El 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 throe 21 for evaluation criteria Yes 0 No Not Applicable Attach additional sheets-if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III-Policies; Pages 22 through 32 for evaluat' criteria. a El 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 5 substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 0 Yes No �4t A licable PP PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town o Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ((��'� 0 Yep ] No Not Applicable J 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. ,LJ Yes ❑ No NOt Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote propriate use and development of energy and mineral resources. See LWRP Section III—Policies- ages 65 through 68 for evaluation criteria. Yes ❑ No Not Applicabie PREPARED BY Rier(? �� �'I �� TITLE � 1� DATE 41 T/// ,~ 1 Russell W. Hahn 12 Honey Drive Syosset, New York 11791 516-816-0349 November 3,2017 Town of Southold E CC` E V Board of Trustees Town Hall Annex NOV - 6 2017 54375 Route 25 P.O. Box 1179 Southold, New York 11971 Southold Town ------- Board-of Trutees Dear Sir/Madam: F` Please find enclosed an Administrative Wetland Permit application from my brother,Arthur W. Hahn IV, and myself. The application is an as-built application for an existing deck which we received a TOS"C of O"on 3/2/17(copy enclosed). If you have any questions, please feel free to contact me. Sincerely, ezz Russell W. Hahn