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HomeMy WebLinkAboutTR-9179A Michael J.Domino, President �� S10 Town Hall Annex 54375 Route 25 John M. Bredemeyer III,Vice-President h0 lQ P.O. Box 1179 Glenn Goldsmith Southold, New York 11971 A. Nicholas Krupski • Telephone(631) 765-1892 Greg Williams �COUFax(631) 765-6641 � M`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection Michael J. Domino,President ��OF SOUTTown 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 • Telephone(631) 765-1892 Greg Williamsy00U O Fax(631) 765-6641 1M'I,�+c� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9179A Date of Receipt of Application: February 16, 2018 Applicant: Richard & Siobhan Hans SCTM#: 1000-98-1-13 Project Location: 2125 Pine Tree Road, Cutchogue Date of Resolution/Issuance: March 23, 2018 Date of Expiration: March 23, 2020 Reviewed by: Board of Trustees Project Description: To remove the two (2) oak trees growing through the existing rear 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 Peconic Surveyors, P.C., dated December 11, 2017, and stamped approved on March 23, 2018. 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. 9 Michael J. Domino, President Board of Trustees Michael J. Domino, Pres►d'f \. o�QS�FFOtIrG Town Hall Annex John M. Bredemeyer III, Vice-Pres►aent ,`� y� 54375 Route 25 Glenn Goldsmith o < P.O. Box 1179 vn z A.Nicholas Krupski ® Southold,NY 11971 Greg Williams 'y p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES / TOWN OF SOUTHOLD Date/Time: `�S /fig I� Completed in field by: Suffolk Environmental Consulting, Inc. on behalf of RICHARD & SIOBHAN HANS requests an Administrative Permit to remove the two (2) oak trees growing through the existing rear deck. Located: 2125 Pine Tree Road, Cutchogue. SCTM# 1000-98-1-13 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related.structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch 275 ✓ Ch. 111 SEQRA Type: 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: � for3e o4j 6-t« ,aD Deck S).)6 f [e. f-;'W'ar UaXe, d V_ ✓`2MoVC. I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith . Krupski G. Williams Other Page 1 of 2 Michael J.Domino, Presid Town Hall Annex John M Bredemeyer III, Vice-Presiaent �� yam, 54375 Route 25 Glenn Goldsmith ti z P.O. Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams 'y ® p� Telephone(631)765-1892 ��� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Suffolk Environmental Consulting, Inc. on behalf of RICHARD & SIOBHAN HANS requests an Administrative Permit to remove the two (2) oak trees growing through the existing rear deck. Located: 2125 Pine Tree Road, Cutchogue. SCTM# 1000-98-1-13 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 G. Williams E. Cantrell D. Di Salvo Other Page 2 of 2 LOT NUMBERS REFER TO "MAP OF NASSAU FARMS" I am familiar with the STANDARPS FOR APPROVAL SURVEY OF PROPERTY FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON AND CONSTRUCTION OF SUBSURFACE SEWAGE N MARCH 28 1935 AS FILE NO. 1179 DISPOSAL SYS7EMS FOR SINGLE FAMILY RESIDENCES AT CUTCHOGUE and w111 abide by the conditions, set forth therein and on the TOWN OF SOUTHOLD permit to construct. + SUFFOLK COUNTY, N. Y. The location of wells, cesspools I& public watershown hereon are .1000-98-01-13 from field observations and or from data obtained from others. SCAL& 1'=30' JANUARY 10, 2012 OCTOBER 18, 2017 (CER71f7CA710NS) (D N� A,no% UNKNOW) DECEMBER 11, 2017 (SETBACKS) 11C WAN Cr CW �CQQ:.Zrz ROAD 06 2M4 329.84! c w.teo►� �N83'09'50ME x x - `-� I zsa _ ZONE x � FE �� Xarx x�x — �` •a WOE +tea' ��►`� pNE STORY �` +taer F'RfWE�i�� � � , ZONE � 'de. �� `� ; \ PAVERS 11.2' LOT 1wal;1 v` (EL 6) ���1 ' iN�oNc. oon�ER °� ��� � � .� 9 a p G a �-0� a wAu. 363.47' to , 4 Q 1.4"S 0.4 N:6 - _Mn SB5-09'50"W �MMUNG) c q LOT 18 0 �� Certified Richard Hans O F E 8 1 b 2018 pJ Siobhan Hans Fidelity National Title Insurance Co RAP , °' sn�ttc�Q?;svn TEST HOLE DATA Citibank ROVED BY' - eYweDONOALDcosaENce " APP D��I rrTi'tl �??S '�^2 BOARD OF TRUSTEES, -TOW DM N OF SOUTHOLD BROWN LOAM CL ---- ,• i AREA=21,653 SQ. FT. OF ,- eROWN San Um stiTO TIE LIN r:. DATA ►ry��kct�- 23� ?�,�.g ® t.SET - ------ 4 ELEVATIONS REFERENCED TO N.A.V.D. FLOOD ZONE FROM FIRM RATE MAP NUMBER - PALE BROWN FM SAND SP 36103CO164 H SEPTEMBER 25, 2009 - a• 00 vAiii &r � O WELL N0. 49618 OLATION PECONIC SURVE WATER IN PALE BROWN FINE SAND SP ANY ALTERAnON OR ADanON 7t7 THis SURVEY Is A N . - Z✓ OF SEC770M 7209 OF THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 FAX (631) 765-1797 ExcEPT AS PER SECTION 7209—SUBDI WS/ON 2 ALL CERTIFICATIONS P.O. BOX 909 ■=MONUMENT HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF 1230 7RAVELER S7REET tr =WETLAND FLAG SAID WiOSEM SFG AA7 RE'pp�HER SEAL OF THE SURVEYOR 12 101 SOUTHOLD, N.Y. 11971 I ^ —Bargain; le Deed,with Covenant against Grantor's Acts—Individual or( 1tion(Single Sheet) CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE, made the 20`h day of December, in the year 2017 %.aipy BETWEEN Esther Matelli,as Trustee of the Esther Matelli Revocable Trust,dated August 3, 2015, having an address at 169 Pebble Lane, Hewlett, NY 11557 party of the first part,and Richard Hans and Siobhan Hans, as husband and wife,residing at 60 Knollwood Drive, Larchmont,NY 10538 F party of the second part, WITNESSETH,that the party of the first part, in consideration of One Million Two Hundred Fifty Thousand and 00/100($1,250,000 00)dollars and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the SEE ATTACHED SCHEDULE A DESCRIPTION Said premises known as 2125 Pine Tree Road,Cutchogue,NY 11935 Section 98, Block 1,Lot 13 Being and intended to be the same premises as described in deed made by Esther Matelli, as successor Trustee of the Arthur Matelli Revocable Trust dated September 19, 2000 and Esther Matelli, as Trustee of the Esther Matelli Revocable Trust dated August 3,2015, recorded 08-13-2015,Liber 12827 Page 824. TOGETHER with all right, title and interest, If any, of the party of the first part In and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part In and to said premises, TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the Improvement before using any part of the total of the same for any other purpose. The word "party"shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF. Esther Matelli,as Trustee of the Esther Matelli Revocable Trust,dated August 3, 2015 Fidelity National Title Insurance Company ' TITLE NO. F17-7404-105762-SUFF SCHEDULE A-.l (Description) ALL that certain plot, piece or parcel of land, situate, lying and being at Cutchogue, Town of Southold, County of Suffolk and State of New York, known and designated as Lot No. 19 on the Map of Nassau Farms at Peconic, Town of Southold, Suffolk County, New York, made by Otto W. Van Tuyl, Licensed Surveyor, Greenport, New York, and filed in Suffolk County Clerk's Office as Map 1179 bounded and described as follows- BEGINNING at the intersection formed by the Southerly side of Redwood Road and the Easterly side of Pine Tree Road; RUNNING THENCE, along the Southerly side of Redwood Road, North 83 degrees 09 minutes 50 seconds East 329.84 to the tie line of Little Creek, THENCE, along the tie line of Little Creek, South 56 degrees 46 minutes 05 seconds East 108.81 feet to the division line of Lot 18 and 19 on the above mentioned map; THENCE, along said division line, South 85 degrees 09 minutes 50 seconds West, 363.47 feet to the Easterly side of Pine Tree Road, THENCE, along the Easterly side of Pine Tree Road, North 47 degrees 50 minutes 10 seconds West 76.00 feet to the point and place of BEGINNING THE POLICY TO BE ISSUED under this commitment will insure the title'lom 'buil'cli gs and improvements on the premises which by law constitute real property FOR CO1vYE7'A1vClNG ONLY Together with all the right, title and interest o�f•Il;��arty'o�the first part, of in and to the land lying in the street in front of and adjoining said premises lion) ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE State of New York,County of Suffolk,ss. State of New York,County of ss. On the 1,9100 day of December in the year 2017,before me,the On the day of in the year before me,the undersigned,personally appeared Esther Matelli undersign d,personally appeared ,personally known to me or proved to me on the basis of ,personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s)is(are) satisfactory evidence to be the individual(s)whose name(s)is(are) subscribed to the within instrument and acknowledged to me that subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies),and that by he/she/they executed the same in his/her/their capacity(ies),and that by his/her/their signature(s)on the instrument,the individual(s),or the his/her/their signature(s)on the instrument,the individual(s),or the person upon behalf of which the individual(s)acted,executed the person upon behalf of which the individual(s)acted,executed the instrument. instrumentl. JOSEPH F.GAoY NOTARY PUBLIC.STAT NEW YORK No.02GA5082967 Qualitted in Nassau County My Commission Expires August 04.20,41 ACKNOWLEDGEMENT BY SUBSCRIBING WITNESS TAKEN ACKNOWLEDGEMENT TAKEN OUTSIDE NEW YORK IN NEW YORK STATE - STATE State of New York,County of ss. *State of County of ss. *(Or insert(District of Columbia,Territory,Possession or Foreign On the day of in the year before me,the County) undersigned,a Notary Public in and for said State,personally appeared ,the subscribing witness to the foregoing instrument,with whom On the day of in the year before me the I am personally acquainted,who,being by me duly sworn,did depose undersigned personally appeared and say that he/she/they reside(s)in Personally known to me or proved to me on the basis of satisfactory (if the place of residence is in a city,include the street and street number jf any,thereof); evidence to be the individual(s)whose name(s)is(are)subscribed to the that he/she/they know(s) within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), that by his/her/their signature(s)on to be the individual described in and who executed the foregoing the instrum It,the individual(s)or the person upon behalf of which the instrument;that said subscribing witness was present and saw said individual(s)acted,executed the instrument,and that such individual make such appearance before the undersigned in the execute the same;and that said witness at the same time subscribed his/her/their name(s)as a witness thereto (add the city or political subdivision and the state or country or other place the acknowledgement was taken). Bargain and Sale Deed With Covenants SECTION 098.00 BLOCK.01 OC Title No. Fidelity National Title Insurance LOT 013.000 Company (Title No.: F17-7404-105762-SUFF) COUNTY OR' OWN-Suffolk Esther Matelli,as Trustee of the Esther Matelli Revocable Trust, dated August 3,2015 TO RETURN BY MAIL TO: Richard Hans and Siobhan Hans 7Judicial RIBUTED BY David Worthington Olsen,Esq. Olsen&Olsen,LLP ITLE EXPERTS 32495 Main Road,P 0 Box 706 TInsurance Agency LLC Cutchogue,NY 11935 8485) FAX: 800-FAX-9396 HANS Property Situate: 2125 Pine Tree Road ■ Cutchogue ■ New York SCTM #: 1000 — 098 -01 — 013 4 r ,. da Photograph indicating the existing trees to be removed (arrows). Photograph taken from the shoreline of subject property and Little Creek, facing southwest. HANS Property Situate: 2125 Pine Tree Road ■ Cutchogue ■ New York SCTM #: 1000 — 098 -01 - 013 .xa r i #t w q -14 r � jll, T 7„ .: ..i a yb z I AV•q7FyF ,/ tell pFn , f� { M .�5•. � e�v A ^ �" +� t 4 9y Ott d Photograph indicating the delineated wetlands boundary along the shoreline of subject property and Little Creek. Photograph taken from the easterly section of the property, facing northwest. HANS Property Situate: 2125 Pine Tree Road ■ Cutchogue ■ New York SCTM #: 1000 — 098 -01 - 013 Photograph indicating the delineated wetlands boundary along the shoreline of subject property and Little Creek. Photograph taken from the easterly section of the property, facing southwest, along Little Creek. HANS Property Situate: 2125 Pine Tree Road ■ Cutchogue • New York SCTM #: 1000 — 098 -01 - 013 y n f,..' - +gna�•.y.+ .'ga'i`n:, r x1 4 L p• �ty, Photograph indicating the delineated wetlands boundary along the shoreline of subject property and Little Creek. Photograph taken from the dock, facing west. Z12 I urE • �/ SEE SEC NO.666 I 'A �N3Gro I SEE SEC.NO OB9 2 WTCN__ZZ---J UNE , + cl �6 WATCH E ' �i 12 NN 46 ~ -9 E—z— FOR PNO OSEESEC yyy,, tJ oes o3 o,lz tii+ O u.sA a +y 'b' b'a .'6 w 7.5 0P-1 a' m� J� 4/S �oN a �, J•/ Q SEE SEC.NO.1S1 (� � P • m'r1 �'L w SEE SEC NO. J awmoto.a � \z? �.�'�+N-`1`m " +9 0♦ /. 162 `.- I 4sr I SEE SEC W. ta+ I o7r 12 1 � 1 ;BHT ,wi y I N� a L�c) 23 w \ I A., 1zv" N � � � `CF�� J.' +„1\M1 •n - '.yn.r(+\ FOR SEEMPCL NO .NO DUNE COUNTY OF SUFFOLK © E of SOUTHOLD SECTION Na '. 098 i �3 R t P opeRy Ta 5 rvlce Agertcy r OFFICE LOCATION: �O�*Of SU(/ryOlO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor Main Rd. &Youngs Ave.) G • �O Telephone: 631 765-1938 Southold, NY 11971 O Fax: 631 765-3136 COMM, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: March 15, 2018 Re: LWRP Coastal Consistency Review for RICHARD & SIOBHAN HANS SCTM# 1000-98-1-13 Suffolk Environmental'Consulting, Inc. on behalf of RICHARD & SIOBHAN HANS requests an Administrative Permit to remove the two (2) oak trees growing through the existing rear deck.' Located: 2125 Pine Tree Road, Cutchogue. SCTM# 1000-98-1-13 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 Policy Standards and therefore is CONSISTENT with the LWRP.. The previous Exempt determination on a previous action that involved the removal of a tree was considered in context of maintenance and repair of the deck. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination,regarding the consistency of the proposed action Cc: Damon Hagan, Assistant Town Attorney r John M.Bredemeyer III,President � '- - - ��2•-�- . Town Hall Annex ` 54376 Main Road Michael J.Domino,Vice-President '7- P.O.Box 1179 James F.King,Trustee r ; Southold,Now York 11971-0959 Dave Bergen,Trustee Telephone(631)765-1892 Charles J.Sanders,Trustee �'f Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit Amendment/Transfer/Extension Received Application: 216.1$ Received Fee:$ 100.60 Completed Application: - i! rR LE ,�1 C�� .� E Incomplete: DID SEQRA Classi icati9n:Type I Type II �/ Unlisted ;� FEB 1 6 2018 �Coordination-(date sent) LWRP Consistency Assessment Form: Q? CAC Referral Sent: Sc it!��d frvn Date of Inspection: Boardf'Inislins Receipt of CAC Report: Lead Agency Determination Technical Review: Public Hearing Held: 3,24 Resolution: Name of Applicant Richard F. Hans and Siobhan Hans Address 60 Knollwood Drive, Larchmont, NY 10538 Phone Number: 9( 14) 450-4337 Suffolk County Tax Map Number: 1000—98—01 -13 Property Location: 2125 Pine Tree Road • Cutchogue - New York (provide LILCO Pole#, distance to cross streets, and location) AGENT: Bruce A. Anderson - Suffolk Environmental Consulting, Inc. . (If applicable) Address: P.O. Box 2003, Bridgehampton,NY 11932 Phone:—(631) 537—5160 Board of Trustees Application GENERAL DATA Land Area(in square feet): 21, 653 s.f. Previous use of property: Residential Intended use of property: Residential . Covenants and Restrictions. Yes X No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes X 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 a 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 Trustees Permit #4492 (bulkhead, steps, walk) 7/28/95 Trustee Permit #8323A (replace decking/railings and remove trees 11113L*o 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):Applicant proposes to remove 2 oak trees growing through the existing rear deck. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed operations: Increase safety to house Area of wetlands on lot: 1, 520 square feet Percent coverage of lot: 8.0 (bldg) 21% (total impervious) % Closest distance between nearest existing structures and upland edge of wetlands: 1' (bulkhead) feet Closest distance between nearest proposed structures and upland edge of wetlands: N/A feet (Proposed Deck) Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? N/A (cubic yards) How much material will be filled? N/A (cubic yards) Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): No impact to the wetlands are anticipated because the trees to be removed grow within the deck surface. NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Richard and Siobhan Hans SCTM# 1000 — 98 — 1 - 13 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to conduct regulated activities: Applicant Proposes to remove 2 trees growing within existing rear deck 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 2125 Pine Tree Roadll Road • Cutchogue • New York 3. That the project which is subject to Environmental Review under Chapters 96, 111 and/or 275 of the Town Code is open to public comment on: DATE: You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME: Richard F. and Siobhan Hans MAILING ADDRESS: 60 Knollwood Drive • Larchmont • NY • 10538 PHONE #: (914) 450 - 4337 AGENT: Bruce A. Anderson @ Suffolk Environmental Consulting, Inc. MAILING ADDRESS: P. O. Box 2003, Bridgehampton, NY 11932 PHONE #: (631) 537 - 5160 Enc: Copy of sketch or plan showing proposal for your convenience. Form TS 1 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 pumose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME. Bruce A.Anderson (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company If so,indicate the other person's or company's name.) NAME OF APPLICATION (Check all that apply) Tax grievance Building Variance_ Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 12'' day of February.2018 SignatureA_ A - Print Name Bruce A.Anderson Form TS 1 Board of Trustees Application AFFIDAVIT Richard F.Hans and Slobban Hans 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 REPRESENATTIVES,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. Siobhan Hans SWORN TO BEFORE ME THIS DAY OF 2018 o Public HERNANDO AGUILAR Notary Public,State of New Yak No.01AGS357M duallfied In westGMs conwft n Eq#n Apig 2 20 0 c Board of Trustees Application AFFIDAVIT Richard F.Hans and Slobhon Hans 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 1N 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 REI;RESENATTIVES,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. Richard F.Hans SWORN TO BEFORE ME THIS / DAY OF2018 -A- aw Notary P' lic rimywrw 7 �Qf haN 101 ' 'i ,i�tl(:� :',!,��$ F� Y�.•2614 ( r ' 1 Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) We, Richard F. Hans and Siobhan Hans, owners of the property identified as SCTM# 1000-98-1-13.in the Town of Southold,New York,hereby authorizes Suffolk Environmental Consulting, Inc.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. Richard F. Hans Siobhen4imts SWORN TO BEFORE ME THIS I DAY OF -vIJ % 2018 4 --k 4) Notary-P blic OANICA JOSEPH 80Xd L Notary Public-Sob of Now York N0.01 J062355M 1 Oualified in Kings Counter My Commission Expires Feb 14,2019 r % Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) We, Richard F. Hans and Siobhan Hans, owners of the property identified as SCTM# 1000-98-1-13, in the Town of Southold,New York,hereby authorizes Suffolk Environmental Consulting, Inc. 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. Siobhan Hans SWORN TO BEFORE ME THIS ' 4 DAY OF 312018 No Public NERNAND6 AGUMR Mob"Pdlk stab of New YO& Na 01AGtsRM oUMW m WnftMGW CM* canrNalon ExpNas Aon t�,20.3( 4- APPLICANTIAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the gW of town officers and emvlavees.The ouroose of this form to provideinformation which can alert the town of 2gssibleconflicts of intmg and all w it take whatever action is nemma to avoid same. YOUR NAME: Hans.Siobhan. (Last name,first name,middle initial,unless you arc applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION:(Check all that apply.) Tax grievance Building Variance_ Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES";complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town ot>ficer 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 ( day of �� 2018 Signature Print Name Siobhan Hans Form TS 1 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 possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Bruce A.Anderson (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION:(Check all that apply.) Tax grievance Building Variance_ Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest.`Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 12'h day of Februa . ,2018 Signature I& A. /IA—� Print Name Bruce A.Anderson Form TS 1 z 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 Pro ide information which can alert the town of Possible conflicts of interest and allow it to take whatever action is necessary{g avoid same. YOUR NAME: Hans,Richard.F. (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company. If so,indicate the other person's or company's name.) NAME OF APPLICATION:(Check all that apply.) Tax grievance Building Variance_ Trustee X .Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Othee',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/rcpnsentative)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 :z Submitted this 7day of 2018 Signature Print Name Richard F.Hans 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",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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# 98 - 1 13 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) ❑ (c) Permit, approval, license, certification: Nature and extent of action: Applicant proposes to remove 2 oak treesrg owing through the existing rear deck. Attach additional sheets if necessary Location of action: 21225 Pine Tree Road - Cutchogue -New York- 11935 Site acreage: 0.5 acres Present land use: Residential 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: Richard and Siobhan Hans (b) Mailing address: 60 Knollwood Drive • Larchmon ■ NY • 10538 (c) Telephone number: Area Code(914) 450-4337 (d) Application number, if any: N/A 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? 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 N Not Applicable Subject proposal was previously determined to be exempt by LWRP Coordinator 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 N Not Applicable Subject proposal is not applicable to this policy in that it will have no impact to any potential historic and/or archaeological resources within the surrounding area. 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 5 through 7 for evaluation criteria ❑ Yes ❑ No N Not Applicable Subject proposal was previously determined to be exempt by LWRP Coordinator Attach additional sheets if necessary I 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 Subject proposal will fully comply with Policy 4 in that the trees grow from within an existing deck surface. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable to this policy in that it will have no effect to the water quality/supply within the surrounding area. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria ❑ Yes ❑ No ® Not Applicable There is no relationship between the proposed project and the policy. 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 ® Not Applicable Subiect proposal is not applicable in that the proposal will not result in any form of adverse effects to air quality. Accordingly,this proposal is not applicable with this policy. 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 Subiect proposal is not applicable in that the proposal does not involve disposal and/or transportation of solid waste, hazardous waste, toxic pollutants, petroleum products. Attach additional sheets if necessary 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 Subject proposal is not applicable to this policy in that the proposal is attendant to a private residential use. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependence uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Proposed project has no effect on water-dependent uses. attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound,the Peconic Estuary and Town Waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable in that the proposal does not involve any form of marine resource management (i.e. commercial fisheries, recreational fisheries, aquaculture, etc...). 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 Subject proposal is not applicable in that the proposal does not involve agricultural lands (i.e. the conversion of farmland, the establishment and/or maintenance of new coastal agricultural production, etc...) Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and madneral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable Subject proposal is not applicable in that the proposal does not involve the conservation of energy resources on a commercial level and/or the promotion of alternative energy sources, proper maintenance of fuel storage facilities and/or the extraction of mineral extraction Attach additional sheets if necessary Created on 5125/05 11:20 AM t Short Environmental Assessment Form Part I -Project Information Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Richard and Siobhan Hans Name of Action or Project: Hans Project Location(describe,and attach a location map): 2125 Pine Tree Road,Cutchogue Brief Description of Proposed Action: Applicant proposes to remove 2 trees growing through the existing deck surface. Name of Applicant or Sponsor: Telephone: (914)450-4337 Richard and Siobhan Hans E-Mail: randshans@aol.com> Address: 60 Knollwood Drive City/PO: State: Zip Code: Larchmont NY 10538 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 R1 ❑ 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: RI D ' 3.a.Total acreage of the site of the proposed action? U.b acres b.Total acreage to be physically disturbed? <0.0001 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.5 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial [-]Commercial ®Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑✓ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑✓ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ❑✓ 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:Peconic Bay CEA El 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ❑✓ ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ❑✓ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑✓ ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑✓ ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: a ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? RI ❑ b.Is the proposed action located in an archeological sensitive area? ❑ I El 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? ❑ R 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? W-1 ❑ 16.Is the project site located in the 100 year flood plain? NO YES IVII 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 systemsrunoff and storm drains)? If Yes,briefly describe: 'ENO AYES Page 2 of 3 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: ❑1 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Bruce A.Anderson,M.S. (Agent) 2/15/18 Applicant/sponsor name: Date: Signature:J& A. PRINT FORM Page 3 of 3 Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street,P.O. Box 2003,Bridgehampton,New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson,M.S.,President HAND DELIVERED February 15,2018 Michael Domino, President Southold Town Trustees . ' f� !L—� 1� P. O. Box 1179 Southold, NY 11971 I FEB 1 6 2018 Re: Hans 2125 Pine Tree Drive —Cutcho ue SUM 1000-98—1-13 Board o Dear Mr. Domino, Application for Administrative Permit is hereby made authorizing the removal of two [2]trees growing through the deck surface of the premises referenced above. Application contents are as follows: 1. Completed application for Wetland Permit; 2. Original affidavit:Applicant/Agent/Representative; 3. Short Environmental Assessment Form; 4. Property Deed executed December 20, 2017; S. LWRP Application/Questionnaire; 6. Survey of the property prepared by Peconic Surveyors last dated December 11;2017; 7. Current photographs of subject area depicting the trees to be removed and wetland boundary; and 8. Check made payable to the Town of Southold in the amount of$100.00 covering the requisite application fee. Kindly process the requested administrative permit at your earliest opportunity. Thank you in advance for your anticipated cooperation. Yours truly, Bruce A.Anderson Cc. S. Hans