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TR-9211
Glenn Goldsmith,President �QF soar Town Hall Annex Michael J.Domino,Vice-President Q y�lO 54375 Route 25 John M. Bredemeyer III l�[ P.O.Box 1179 Southold, New York 11971 A. Nicholas Krupski cn -Nr G • Q Telephone(631) 765-1892 Greg Williams �'� Fax(631) 765-6641 e4UNTl,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: INSPECTED'BY:' Ch:k275-. :: • ' Ch. 111 INSPECTION SCHEDULE X.t&v i V ,c,¢ f Pre-construction;'.haybale•:line/silt boom/silt curtain 1 St day of construction` constructed Project complete, compliance inspection COMMENTS: 11 Pc'o�eG"T r�.oes .r�n�.MatG� pla�5 — �eeo1 �o aMeno4- . V —•��� lon4` oc� e.ro`S� S►�e, l sb� �/ on c�IatiS� CX��►a�cl S� S T�a�� w� I v - 1 Y _ O a. w��l, p�Qs�;c S1,ed ov., ��,e lucx�ll,e�s� s� ae Past �l,e Panl Fence CERTIFICATE OF COMPLIANCE: �Ve p)QoS. jv c'� was E,'.Aee\ce_ 1 SUFFO(,� Michael J. Domino, President �o� 4o�,y Town Hall Annex John M. Bredemeyer, III, Vice-President _1 54375 Route 25 Glenn Goldsmith H : P.O. Box 1179 A Nicholas Krupski �y • Southold, NY 11971 Greg Williams 0( , �a� Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction / Y2 constructed V Project complete, compliance inspection; t Y zr: BOARD OF SOUTHOLD TOWN TRUSTEES �'fr SOUTHOLD,NEW YORK PERMIT NO. 9211 DATE: APRIL 18, 2018 ISSUED TO: PETER & ELAINE PSYLLOS PROPERTY ADDRESS: 2886 RUTH ROAD EXTENSION, MATTITUCK a. SCTM# 1000-105-2-1 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in _ accordance with the Resolution of the Board of Trustees adopted at the meeting held on April 18, 2018, and in consideration of application fee in the sum of$250.00 paid by Peter& Elaine Psyllos and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a 20'x40'(800sq.ft.)pool with surrounding 1,370sq.ft.at grade patio; install a 55' foot long retaining wall along the landward side of the pool patio; install 196 linear feet of pool enclosure fencing; install a pool drywell and pool equipment area; relocate existing gazebo;and relocate existing lawn steps in order to accommodate the pool; and as depicted on the site plan prepared by Suffolk Environmental Consulting,Inc.,dated March 9,2018,and stamped approved on April 18,2018. .r s IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this. gUfF04 co co �Ypl �.ao 41 r . \� l` ', r `* TERMS AND CONDITIONS The Permittee Peter& Elaine Psyllos residing at 2886 Ruth Road Extension, Mattituck, New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2.1 That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J. Domino,President ��0f SOUjyo Town Hall Annex John M. Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski • Telephone(631) 765-1892 Greg WilliamsyC4U O Fax(631) 765-6641 � NT'I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 18, 2018 Bruce Anderson, President Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932-2003 RE: PETER & ELAINE PSYLLOS 2886 RUTH ROAD EXTENSION, MATTITUCK SCTM# 1000-105-2-1 Dear Mr. Anderson: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 18, 2018 regarding the above matter: WHEREAS, Suffolk Environmental on behalf of PETER & ELAINE PSYLLOS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 9, 2018, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 18, 2018, at which time all interested persons were given an opportunity to be heard, and, 2 WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of the PETER & ELAINE PSYLLOS to construct a 20'x40' (800sq.ft.) pool with surrounding 1,370sq.ft. at grade patio; install a 55' foot long retaining wall along the landward side of the pool patio; install 196 linear feet of pool enclosure fencing; install a pool drywell and pool equipment area; relocate existing gazebo; and relocate existing lawn steps in order to accommodate the pool; and as depicted on the site plan prepared by Suffolk Environmental Consulting, Inc., dated March 9, 2018, and stamped approved on April 18, 2018. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, LOU.-I-0 Michael J. Domino President, Board of Trustees MJ D/dd G ISLAND SOUND ,JONG ED S N60.34'00"E 150.68 (DE ) SITUATE MATTITUCK ALLY) 590 TOWN OF SOUTHOLD 05 5g"E 151 BwAT (A ^ SUFFOLK COUNTY, N.Y. .057- MTAN"' ' -� SURVEYED: DEC. 20, 2014 g0 W UPDATED: MAR. :20, 2017 IS A --� to W w � i- i - COAS% EROSION HAZAR�uNE - � 44 TOP OF BLUFF �O 4'WIRE FENCE \\ p Pat \\\ � � (Z) q 3 GA2EaoO q r/) NOTES: 7.r�� r 1. PROPERTY KNOWN AS TAX MAP# 1000-105-02-001 2. LOT AREA -103,956.94 SQ.FT. (2.387 ACRE(S)) N 3. THIS SURVEY WAS PREPARED USING A TRIMBLE E, O S3 ROBOTIC TOTAL STATION. 4. PROPERTY CORNER MONUMENTS WERE NOT SET AS PART OF THIS SURVEY. OV o 5. ELEVATIONS REFER TO THE NAVD88 DATUM. 6. PLAYGROUND NOT SHOWN OR GUARANTEED. Ty K PIPE pw q Licl? DESCEN N �c �3 WOOD D ®STS \389 39 � o 11.2 24.1 15 WOOD DECK e, m (241 13S 4'PVC 2'R O Z 56.3 -2NDECKTM a n �y 3' v TANWOOD L K K_., .;c-.. rRETAINING - /1/C 0.3 WALL r! � �Si V 2.0 2 Story. C BED Fr. Res. $ m I 0 #2886 0 ,3�. ' MAR 2 4 2017 5' F.FL�141.64' O x4'x4'DEEP SVENT 0I TANK 1 ° a 002'DEEP 0'Flu1101!;i;Y+'(n a 2 CAR 11 LEACNk1G POOL �Q2F(�ut T�US�n DECGARAGE o K G.F.�132.23' N C Lgd N 52.1' R0 _WISOHRY 2ND Sly Y RETAINING DECK OVER ._ WALLS CONC. `6 0 x � two � STANDARD NOTES: a 1. COPYRIGHT 2012 MICHAEL K. WICKS LAND SURVEYING ^ 2. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY MAP BEARING A d MAS LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209, SUB-DVISION 2, OF NEW YORK STATE EDUCATION LAW. VI� 3. ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL r ARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL > MAS. S WORK AND OPINION. 4. CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED IN ACCORDANCE WITH THE CURRENT EXISTING CODE OF m .11, PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS, INC. THE CERTIFICATION IS 39•B' LIMITED TO PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED, U TO THE TITLE COMPANY, TO THE GOVERNMENTAL AGENCY, AND TO THE 1gLENDING INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP. PIPE 5. THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. 6. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED. IF ANY UNDERGROUND p; WELL IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN, THE ~ �y DID WELL �, IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY, w 7. THE OFFSET (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE oIRRIGATIONARE NOT INTENDED TO GUIDE THE ERECTION OF FENCES, RETAINING WALLS, _ BOX POOLS, PATIOS PLANTING AREAS, ADDITIONS TO BUILDINGS, AND ANY OTHER Q TYPE OF CONSTRUCTION. w w CID .O 00 COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED N OR EMBOSSED SEAL,,HALL--N BECONSIDERED TO BE A VALID COPY. uj N ,. S66S6600116011fir= , ,� �, ° 50.00 '�� �L K. BRIM BRICK cb (b PILLAR APRON []PILLAR to O �� 11� *r ` s". y.•.v r Z! v tQa�i .'�3If[1 c .::=. Kdd a 3 T PAVEMENT j 67.68 �� m �* i o S66'01'50"12' 100.00F� la'g0 E LANG-) ..• V . u _ . MICHA K. WICKS, P.L.S. #50390 3 C`11 LAND N/F OFJANE C. SHANNON Y �+ RESIDENCE W/ WELL MICHAEL K. WICKS a S.C.T.M.# 1000-106-01-1.12 50.16 LAND SURVEYING 200 BELLE VIEW AVENUE, o �O CENTER MORICHES, NEW YORK 11934 RUTH RD. VOICE: 631.874.0156 FAX.• 631.909.3845 [1- (50') RECORDS OF RICHARD C. DRAKE (Y �I SCALE: SURVEYED BY: DRAWN BY: SHEET: ^y 1"=40' B.W./J.W. W.C. 1 OF 1 z a LONG I D S OUND SLAN EED) SURVEYOFPROPERTY N60'34'00"E 150.68 (D SITUATE MATTITUCK ALLY) 59°' TOWN OF SOUTHOLD � (A SUFFOLK COUNTY, N.Y. �1514 N57-05'61"to wA� -� SURVEYED: DEC. 20, 2014 UPDATED: MAR. 20, 2017 q CONTOURS/PROP. INFO: JULY 3, 2017 REVISED: SEPT. 8, 2017 ADD. TOPO: DEC. 4, 2017 cs to co to co @ UNE b b �b b �m �h LOT COVERAGE INFO: LOT AREA =103,956.94 SQ.FT. (2.387 ACRE(S)) N Lq AREA OF BEACH= 9,110 SQ.FT. AREA OF BLUFF= 30,610 SQ.FT. TOTAL AREA= 39,720 SQ.FT. (38.2% OF LOT) TOP BLUFF �C o AREA OF UPLAND= 64,236.94 (61.8% OF LOT) EXISTING RESIDENCE= 3,765 SQ.FT. PROPOSED POOL= 800 SQ.FT. M� o � c' o PROPOSED LOT COVERAGE OF UPLAND AREA= 4,565 SOFT. (6.9%) 3 hq NOTES: c AND ,F1 Y BME TO'BE^ h q 1. PROPERTY KNOWN AS TAX MAP# 1000-105-02-001 \ t>SFD olxaNc CONSTROGnON / I �] 3. T�S AREA WAS=103, S6.94 PREPARED US NGBA TR MACREBLE) o m S3 ROBOTIC TOTAL STATION. r �9 4. PROPERTY CORNER MONUMENTS WERE NOT SET AS PART OF THIS SURVEY. 0 o - / `_ 5. ELEVATIONS REFER TO THE NAVD88 DATUM. W _Y W PROP 4, CaoE 6. PLAYGROUND NOT SHOWN OR GUARANTEED. Q � I _ y PROP.PATIOIN R ' ' PROPOSED 2Ox GROUND POOOL - q 23.6 G g 1359 CON'�IRI1Gt10N-I1Np1R1E/ '' x 0 � b 24.1 WOOD DECK 2'R 0 3 GA 563 `DEDECKtt' N ,rooD w.' Ll FENCE a A;v. W -REf MASONNG g A/C 0.3 WAIL 2.0 C o� 2 Story. '� Fr. Res. m �� .0 #2886 x4'z4'DEEP 39.5' FTIL-141.1;4' 0 $SPDC TANK VENIi 8'iz12'DEEP `,y 2 t.. LEACHING POOL 14. SG.F13223' r d 73' 3.7 52.1' WNL 3� `2 R 0 2ND SIY. WALLSDEQ STANDARD NOTES: 1. COPYRIGHT 2012 MICHAEL K. WICKS LAND SURVEYING , 2. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY MAP BEARING A LICENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, w►�j °�`` FEB 2 3 2018 SUB-DIVISION 2, OF NEW YORK STATE EDUCATION LAW. 3 ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL C -'4 ARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL WORK AND OPINION. 4. CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP Southold IDWn WAS PREPARED IN ACCORDANCE WITH THE CURRENT EXISTING CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE Roard of Trustees ASSOCIATION OF PROFESSIONAL LAND SURVEYORS, INC. THE CERTIFICATION IS -', 39.8' LIMITED TO PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED, - TO THE TITLE COMPANY, TO THE GOVERNMENTAL AGENCY, AND TO THE lg• LENDING INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP. PIPE 5. THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. 6. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE Q CIILVE111 NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED. IF ANY UNDERGROUND w WELL IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN, THE TT OLD WEU IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY. fy ro 7. THE OFFSET (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE .\Z n�X w .{'�) ARE NOT INTENDED TO GUIDE THE ERECTION OF FENCES, RETAINING WALLS, low ` POOLS, PATIOS PLANTING AREAS, ADDITIONS TO BUILDINGS, AND ANY OTHER T�♦ TYPE OF CONSTRUCTION. -CONStRUCDON MACHINE ACCESS b �V to • �� COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED OR EMBOSSED SEAL SHALL OT BECONSIDERED TO BE A VALID COPY. S66'01'60" FE8 2 2 201 y N.E y 50.00 v*- K. R��4� c BRKx o % j I co� PIUAR i T PAVDAENT j 67.68 Z r!''b ve • D. 566'01'50"W 100.00 5�v f V E y LAtdG LAND N/F OF MICHAEL K. WICKS, P.L.S. #50390 JANE C. SHANNON PUYGWM RESIDENCE W/ WELL 0 S.C.T.M.# 1000-106-01-1.12 MICHAEL .K. WICKS 50.16 LAND SURVEYING 200 BELLE VIEW AVENUE, O CENTER MORICHES, NEW YORK 11934 RUTH RD. VOICE: 631.874.0156 - FAX: 631.909.3845 W (50') RECORDS OF RICHARD C. DRAKE SCALE: SURVEYED BY- DRAWN BY: SHEET: 1"=40' B.W./J.W. W.C. 1 OF 1 �o��pF SOol Michael J. Domino, President Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 Charles J_Sanders P.O. Box 1179 N Southold,New York 11971 Glenn Goldsmith O ® ,�a�� Telephone(631) 765-1892 A.Nicholas Krupski ly`'�U �`'` Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: PeaTe? z F-G cite- tsyL o5 �0 s�Ffbce_ ENvckoNM t� Please be advised that your application dated . mpwn-i- Q, 201 S has been reviewed by this Board at the regular meeting of / kit-(g9 24 d and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1" Day of Construction ($50.00) Y2 Constructed ($50.00) Final Inspection Fee ($50.00 Dock Fees ($3.00 per sq. ft.) 30- Year Maintenance Agreement(complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ BY: . Michael J. Domino, President Board of Trustees G I S LAN D S 0 UND 'ON WOIt4'OD"E 150.68 (DEED SURVEYOFPROPERTY SITUATE MATTITUCK (ACTUALLY) 59° TOWN OF SOUTHOLD O� 151 84 (ACTt1 SUFFOLK COUNTY, N.Y. N5VO5'S8"E � +"ta+Wp'o` -. SURVEYED: DEC. 20, 2014 5g0 W UPDATED: MAR. 20, 2017 q CONTOURS/PROP. INFO: JULY 3, 2017 REVISED: SEPT. 8, 2017 A ADD. TOPO: DEC. 4, 2017 A to - -'4 ar _ --- cO to to _ R �p�RD _m x �x �h LOT COVERAGE INFO: LOT AREA =103,956.94 SQ.FT. (2.387 ACRE(S)) N W AREA OF BEACH= 9,110 SQ.FT. —,4 N AREA OF BLUFF= 30,610 SQ.Ff. Fzj TOTAL AREA= 39,720 SQ.FT. (38.2% OF LOT) _o muTOP ELM AREA OF UPLAND= 64,236.94 (61.8% OF LOT) EXISTING RESIDENCE= 3,765 SQ.Ff. " `POLE \ o W 00 PROPOSED POOL= 800 SQ.FT. RAGPROPOSED LOT COVERAGE OF UPLAND AREA= 4,565 SQ.FT. (6.9%) C\lNOTES: HROSION AND sEw o q q q W �D��r�UI ; ^"�' 2 ,,, � 1. PROPERTY KNOWN AS TAX MAP# 1000-105-02-001 / AREA 3. THISRVEY WASSB PREPARED ED US NGA TRIMB ) LE U Lo m i 9S3 ROBOTIC TOTAL STATION. 4. PROPERTY CORNER MONUMENTS WERE NOT SET AS PART OF THIS SURVEY. V O 5. ELEVATIONS REFER TO THE NAVD88 DATUM. PROP 4. CME 6. PLAYGROUND NOT SHOWN OR GUARANTEED. r� /I D. PROPOSED 20x40 ATIO �� IN GROUND POOL 1 3 � o � 7 x ODIi57TtUG1101! / W O ri 24.1 JL5 WOOD DECK (24) 3� 4' r:. .YA 2'R 0 WOOD _ N 3 56.3 2ND STY. c a 1 WSIS�ONRY t-' r t c 3 G: DECK N N O . W..3' fiNCE XY. i(1 K 11/. - n a A;rn DINING ri _ A/C 0.3 WALL x - 2.0 Z 2 Story. G '� c �a^ Fr. Res. m ' FEB 2 7 2018 0 #2886 r 39.5' n 0 x4'x4'DEEPVEX a F.FL.=141.64' SEPTIC TANK of y Southold lawn .c --%I B'Ox12'DEEP 3> E a 0 .1 ---c' LEACHING POOL2 CAR z ^jc E 144 c R 0 G.F.13223' C4 C " 'rte 0� 1.7 to 52.1' c WN1 3T�3 2'R 0 MASONRY 20 STY. a Y. WALLS DECKO ,3� } WPL- STANDARD NOTES: , 1. COPYRIGHT 2012 MICHAEL K. WICKS LAND SURVEYING PYv" 2. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY MAP BEARING A t p� LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209, C 1> OCK SUB-DIVISION 2, OF NEW YORK STATE EDUCATION LAW. f W� WI 3. ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL j �qARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL AVIS. O WORK AND OPINION. Y WALL ` 4 CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED IN ACCORDANCE WITH THE CURRENT EXISTING CODE OF C {H� PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE a ASSOCIATION OF PROFESSIONAL LAND SURVEYORS, INC. THE CERTIFICATION IS LIMITED TO PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED, a $. TO THE TITLE COMPANY, TO THE GOVERNMENTAL AGENCY, AND TO THE C 1g' LENDING INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP. litU PIPE 5. THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. CYJ CULVERT6. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE - O NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED, IF ANY UNDERGROUND m WELLIMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN, THE ~ (o o OLD WELLI IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY. v 7. THE OFFSET(OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO IRRIGM 1THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE s BOX FsT ARE NOT INTENDED TO GUIDE THE ERECTION OF FENCES, RETAINING WALLS, .c, POOLS, PATIOS PLANTING AREAS, ADDITIONS TO BUILDINGS, AND ANY OTHER W ? y. Q TE OF CONSTRUCTION. - w z -CONSTRUCTION MACHINE ACCESS Q3 x w m ° COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED x OR EMBOSSED SEAL SHALL NOT BECONSIDERED TO BE A VALID COPY. s66•01'50" p tsFl i 50.00 1k DRICI( co p PILAR ^xi to Q - [iai' xa 14 ------- URGE / 3� T PAVDIEM / 67.65 , ' t c O`a DENM D.D. / S66.Of'50"lY 100.00 �' Q3g0 s \�-- LAND LAND c a LAND N/F OF MICHAEL ICKS, P.L.S. #50390 E JANE C. SHANNON [� ��ND RESIDENCE W/ WELL MICHAEL K. WICKS 0 3 �i s.c.T.M.# 1000-106-01-1.12 50.16 LAND SURVEYING 200 BELLE VIEW AVENUE, I� RUTH R D. CENTER M4.0156S, AX. YORK 11934 a � YOKE: 63f.874.0156 — FAX. 631.909.3845 (50')� RECORDS OF RICHARD C. DRAKE i SCALE: SURVEYED BY: DRAWN BY- SHEET: ^� 1"=40' B.W./J.W. W.C. 1 OF 1 SITE PLAN SITE PLAN DETAIL ' 135 I ►v ,. _ ,+ Scale: 1.0"=10.0'± i I ►�, Scale: 1.0 —100.0 _ 134 133 2� M� EROSION &SEDIMENT CONTROL HAYBALES c CROSS-SECTIONAL DETAIL 132 Scale: 1.0"=2.0' •N PROPOSED RETAINING WALL 13' c (55'Long(over 111 x 4.0'High) '36 PROPOSED POOL ' ; ; `CD V FENCE 130 I Ln --------------------- 00 O _ --00N _ 4 ' a 6" x 6 Poo Patic � � p , \ oil i -' 1 --- •moi U l W w • i ! 1 1 I 1 I O U 1 I Y Q u I I 11\ .rl ' 1 x x !M8.6 ,� O See ,< SITE PLAN - , - DETAIL __ - _o r _ E ----------------- --------- -----_' , 1 I 1 � N50, 1 1 1 APPROVED BY PROPOSED RETAINING WALL 138 O " BOARD F TRUSTEES P OPOSED STEPS EXISTING STEPS (55'Loth*[overall] x 4.0'High) 0 0 < < (to be removed) (fj s s TOWN SOUTHOLD ;= - 137 �„p 1 I L DATE �np-iL(p p ; O nOI 20lO �`-- ; ; 1 n E 1 1 136 EXISTING DECK PROPOSED POOL 1 DRYWELL A A v a Michael J. Domino, Presi, �0jtFFQ1,f C� , + Town Hall Annex John M. Bredemeyer III, Vice-Prc—,iuent =� Gyl� 54375 Route 25 Glenn Goldsmith o P O. Box 1179 co at A.Nicholas Krupski ® Southold,NY 11971 Greg Williams y p! Telephone(631) 765-1892 ��l ° �a Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD / Date/Time: q/11 IC 4*-20 Completed in field by: Suffolk Environmental Consulting, Inc. on behalf of PETER & ELAINE PSYLLOS request a Wetland Permit to construct a 20'x40' (800sq.ft.) pool with surrounding 1,370sq.ft. at grade patio; install a 55' foot long retaining wall along the landward side of the pool patio; install 196 linear feet of pool enclosure fencing; install a pool drywell and pool equipment area; relocate existing gazebo; and relocate existing lawn steps in order to accommodate the pool. Located: 2886 Ruth Road Extension, Mattituck. SCTM# 1000-105-2-1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4 Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 ✓ Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment ✓ Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: 1ofVI/aVA I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: ✓ J. Bredemeyer V/0- M. Domino. G. Goldsmith N. Krupski /G. Williams Other Page 1 of 2 Michael J. Domino, Presu o��SOFFO(,�loG Town Hall Annex John M. Bredemeyer I11, Vice-Presiuent �� y�Q 54375 Route 25 Glenn Goldsmith y a P.O. Box 1179 A.Nicholas Krupski ® P" 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 PETER & ELAINE PSYLLOS request a Wetland Permit to construct a 20'x40' (800sq.ft.) pool with surrounding 1,370sq.ft. at grade patio; install a 55' foot long retaining wall along the landward side of the pool patio; install 196 linear feet of pool enclosure fencing; install a pool drywell and pool equipment area; relocate existing gazebo; and relocate existing lawn steps in order to accommodate the pool. Located: 2886 Ruth Road Extension, Mattituck. SCTM# 1000-105-2-1 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 ,tea i Peter&Elaine Psyllos 2886 Ruth Road Extension,Mattituck SCTM#: 1000-105-2-1 r` 4/11/18 � �{ Li{illlllillllll'� � �tiii � � ter ,�lllatt�1111111�t1'IIIIIIII��l�ilFfT���. , _,. lllllllll Il,alluul nllunli+iui itittttutlttu; ttitttttt I 4/ 11 I r 1 . Michael J. Domino, President h�� Ol0 Town Hall Annex John M. Bredemeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Charles J. Sanders Southold, New York 11971 Glenn Goldsmith ® �� Telephone(631) 765-1892 A. Nicholas Krupski lif'Com Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Q q , -7 - P ! -2-7 � wo . P'6n-' �{_,' I1�, O.I,J' ��i,GdA.�•'-'�- f r�'VIA�V, OY�\ �' I�' �� ' > ' IO�! r 1'%�o�I�f�CO *� t Pcrc?.�' c� cz:i c �s-�e' i��S i}.. � a;�' � '7 ec :Pan. - � '� ��i�f�-� v,'�'O� /�:c�r� �`'- ;, ''" , .,< ��_::{�o�o r �S � 4:�c�. r'a` •S°eaf. =`�: A, �►. ass_:'�-L9er`e ? � `j-' „ I r - _ - r. - _ n - ;�,�,. ed # s .---y, - :- •^ - - Pro �. �� `+ -`•�t:'�y ` .,. �JV9'r�'-vv}ii'i Jibi- i- .�i-'�:`'C.i`Oir.' " '•v ~ ❑ Surve of property, please refer to Chapter 275-6. ❑ Proiect Plan must be to scale, show dimensions, and have a side elevation view, please refer to Chapter 275-6. ❑ Photographs current photos of subject area, please refer to Chapter 275-6. ❑ Application Fee for a Wetland Permit is $250.00. Application fee for a Wetland Permit & a Coastal Erosion Permit is $500.00. Check made payable to: Town of Southold. ➢ Upon receipt of a completed application to this office, the applicant is responsible for staking/marking out the proposed project prior to the date of the Board of Trustee Field Inspections. ➢ Upon receipt of a completed application to this office, the project will be formally reviewed by the Building Dept. Department Head to determine if the project will require a Variance by the Zoning Board of Appeals. If the project will require a Variance, your application will immediately be tabled with the Board of Trustees for the applicant to apply to the Zoning Board of Appeals through the Building Department. Upon receipt of a Zoning Board of Appeals Determination Letter, the application will be placed onto the next available Board of Trustees Public Hearing. C 5N—Co u s vbrA-,vTS R.oB 1f�e. 4 VAl �631� 283 - G 3�Od l 3/ q V, &EA- ROAD sdv r1f"f"A1, A!�. 6tZn/nl Z"vsT 1,IM.0. 12l S6s5UO AVr ( UUO&VF( 3 A Po. M4 70 7 sib) S�vr�(,D N�- 1171 0 1 I R-7 1 Jeanne Follet, Art Teacher 2 Jl 31 Z2 &2A4Q MAIO 171 r 5.3 mu FOR PCL NO, SEE SEC NO. ___—__Z-_—____ —————--Z—————— ——————Z-- E —TC. SEE SEC.NO.112 SEE SEC.NO.112 NOTICE COUNTY OF SUFFOLK @ soun,om SECTION No E lip L (21) Real Property Tax Service Agency y 105 '1 m tM k E A P —Prr!W� No OFFICE LOCATION: O�*QF SU(/jyOl MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 pQ Tel 631 765-1938 O Fax: 631765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark.Terry, LWRP Coordinator Date: April 16, 2018 Re: Local Waterfront Coastal Consistency Review for PETER & ELAINE PSYLLOS SCTM# 1000-105-2-1 Suffolk Environmental Consulting, Inc on behalf of PETER & ELAINE PSYLLOS request a Wetland Permit to construct a 20'x40' (800sq.ft.) pool with surrounding 1,370sq.ft. at grade patio, install a 55' foot long retaining wall along the landward side of the pool patio; install 196 linear feet of pool enclosure fencing; install a pool drywell and pool equipment area; relocate existing gazebo; and relocate existing lawn steps in order to accommodate the pool. Located: 2886 Ruth Road . Extension, Mattituck. SCTM# 1000-105-2-1 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 actions are CONSISTENT with the Policy Standards and therefore are CONSISTENT with the LWRP provided the following is considered to further 4.1 Minimize losses of human life and structures from flooding and erosion hazards. 1. The Zoning Board of Appeals granted a variance (7124) for the action on February 1, 2018; requiring that the in-ground swimming pool be located 75' (setback) from the top of bluff and implementation of all recommendations set forth by the Suffolk County Soil and Water Conservation District in their November 13, 2017 letter. The gazebo is to be moved to a conforming bluff setback. Irrigation sprinkler heads near the bluff are to be removed. 2. The bluff slope is vegetated and appears to be stable. The threat of future loss to the property due to the threat of erosion is low to moderate under normal weather conditions. During storm events, the threat increases. 3. A pool de-watering well, construction machine access and erosion and sediment controls have been provided. 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 - Fo��.c�G s Peter Young,Chairman V Town Hall,53095 Main Rd. Lauren Standish,Secretary %ji.-I P O Box 1179 ♦ Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 10, 2017 the following recommendation was made: Moved by Greg Williams, seconded by Peter Meeker, it was REs6LVED to SUPPORT the application of PETER PSYLOS for the installation of an in- ground swimming pool, 20'X 40' with 1,050 sq. patio with fence. Located: 2886 Ruth Road Ext., Mattituck. SCTM#105-2-2.1 Inspected by: Peter Young, James Abbott, Greg Williams The CAC Supports the application and recommends an updated survey depicting the actual location of the pool. Vote of Council: Ayes: All Motion Carried Michael J.Domino,President O Town Hall Annex John M.Bredemeyer III,Vice-President `' 64875 Route 25 P.O.Box 1179 Charles J.Sanders Southold;New York 11971 Clean Goldsmith Telephone(631) 765-1892 631 765-6641 A.Nicholas Krupski Fax( ) BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application D � � 2 B � ��� , X Wetland Permit Application Administrative Permit E Amendment/Transfer/Extension Received Application: 10, Received Fee:$ 01 (L_y�/j3�)1 7 MAR - 9 2018 9E V Completed Application: 3/30//O TIncomplete: SEQRA Classificatio r oad oflTruste _ Type I Type II Unlisted Tr Coordination.(date sent) LWRP Consistency Assessment Form:—%(� /rCAC Referral Sent:` o_�D 17 _�1Date of Inspection: �1 1 Receipt of CAC Report: Lead Agency Determination Technical Review: _Public Hearing Held. Lill 1)1' Resolution: Name of Applicant Peter and Elaine Psyllos Address 213-35 40th Avenue - Bayside - New York • 11361 Phone Number: ( 917 ) 846 - 5447 Suffolk County Tax Map Number: 1000— 105 —2— 1 Property Location: 18,67 Ruth Road •Mattituck• 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 S�' C�` I �z � �' Board of Trustees Application GENERAL DATA Land Area (in square feet): 103,956 square feet± Previous use of property: Residential Intended use of property: Residential with pool, patio and retaining wall Covenants and Restrictions: Yes X No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? . X Yes No If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals X Yes _ 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 X No prior permits/approvals for site improvements. Has any permitlapproval 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 construct a 20' x 40' pool (800 square feet) with surrounding 1370 s.f. at grade patio, 55-foot retaining wall, and surrounding 196 1. f. pool enclosure fence, pool drywell and pool equipment and relocateag zebo. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed operations: Construct a Swim, ng Pool, Pool Patio,Pool enclosure fence, Pool Equipment and Pool Drywell and relocate gazebo. Area of wetlands on lot: 0 ± square feet Percent coverage of lot: 6.9 ± Closest distance between nearest existing structures and upland edge of wetlands: 290 feet (pool enclosure fence) Closest distance between nearest proposed structures and upland edge of wetlands: 333 feet (Proposed Patio) Does the project involve excavation or filling? No X Yes If Yes, how much material will be excavated? 165 (cubic yards) How much material will be filled? 0 (cubic yards) Depth of which material will be removed or deposited: 8' max Proposed slope throughout the area of operations: flat t Manner in which material will be removed or deposited: Small Excavator. 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 anticipated in that the proposed swimming pool and patio meet are suitably setback from the bluff. Additional, siltation fencing & haybales will be installed seaward of the project site. Board of Trustees Application COASTAL EROSION APPLICATION DATA N/A Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 61Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. if additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part l -Project and Sponsor Information Name of Action or Project: ro oStG/ O'x D f /h Vb Sw i..,..-t roa Project Location(desc 'be,and attach a location map): P c._� +,ci If 75 Q Brief DescriptionofProposed Action: Name of Applicant or Sponsor: Telephone: 603 ^� � Co94^ 39oa Vl r c (••.'�. 5 2L�� -Thw�r owls) E-Mail: j�tO-e.- 308 [�vQ. Address: 3CQ lam 6\ City/PO: State: Zip Code: !✓t e-d PC�o ft' //7 CQ-3 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: Tot++.. oF IcA l atc).►...1 fie 3.a.Total acreage of the site of the proposed action? •387 acres b.Total acreage to be physically disturbed? O. Q$_ acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? ,acres 4. Check all land uses that occur on,adjoining and near the proposed action RI' ❑Urban E-1 Rural (non-agriculture) E]Industrial ❑ RCommercial Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify) ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ ET b.Consistent with the adopted comprehensive plan? ❑ ❑ ff 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: ❑ 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? (;71 ❑ 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: ❑ L.J 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Ef ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO I YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? _07 EJ 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? Er ❑ 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: �horeline El Forest EtAgricultural/grasslands El Early mid-successional ,Wetland ❑Urban [}'Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a Ela.Will storm water discharges flow to adjacent properties? ❑NO OYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: [- ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 0 ❑ 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: ET ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 31 14 17 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 l and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ 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? �J 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate Er ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impacf existing: ❑' ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ET ❑ 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)? -FET I 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 F] problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts . Town of Southold-Board of Trustees I �/I Name of Leadncy t Date M11 A—Q,L( (TJ Z O-YYL I President Print or Type Nam of Responsible Officer in Lead Agency Title of Responsible Officer ignature of Respo able Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) ZSQ� We, Peter and Elaine Psvllos residing at 21367 Ruth Road Extension•Mattituck NY 11952 do hereby authorize Suffolk Environmental Consulting, Inc. to apply for permit(s)from the Southold Board of Town Trustees on my behalf. (Owner's _gia.}�e) T (Owners jign�`re) Board of Trustees Application County of Suffolk State of New York Peter and Elaine Psyllos 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 TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Sigiatu 5i atu' SWORN TO BEFORE ME THIS 23 DAY OF 20/4-3 Nota: �P,utiic SHELLEY KARTEN Notary Public, State of New York No.01 KA6310000 Qualified in New York County Commission Expires August 18,201—eA APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees The purpose of this form is to provide information which can aleR the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Psyllos,Peter and Elaine (Last name,first name,middle initial,unless you are applying in the name of someone else of other entity,such as a company.If so, indicate the other person's or company's name.) NATURE 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 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 then 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 Submitt d day of Print nE�:P&r and Elaine Ps Il"os 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 RELATIONSW Submitted this 19`h/day of Februar ,22018 Signatur� 4 " , Print Name Bruce A.Anderson Form TS 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 106.4-2.1 Siddhartha Mukherjee and Sarah Sze 133 W 17th St PHB New York,NY 10011 106.-1-1.12 Psyllos Peter&Psyllos Elaine 213-35 40th Ave Bayside,NY 11361 106.4-1.10 RRE ROW LLC 213-35 40th Ave Bayside,NY 11361 105.-2-2.1 Prithpal Kandhari 1623 Third Ave—Apt 27 New York,NY 10.128 STATE OF NEW YORK COUNTY OF SUFFOLK Bruce A. Anderson, residing at Suffolk Environmental Consulting, Inc, P. O. Box 2003, Brid eg hampton, NY 11932, being duly sworn, deposes and says that on the 9th day of January, 2018, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Bridgehampton, that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20-1 MCHOLE L PAnNO Notary Public,State of New York No.01PA6240712 Notary Public Qualified in Suffolk Courtly Commission Expires May 16,2018 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: PSYLLOS Project SCTM# 1000- 105-02 - 1 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 construct a 20' x 40' pool (800 square feet) with surrounding 1370 s.f. at grade patio, 55-foot retaining wall, and surrounding 196 I. f. pool enclosure fence, pool drywell and pool equipment and relocate gazebo. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 2886 Ruth Road Ext. -Mattituck-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: April 18, 2018 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: Peter and Elaine Psyllos MAILING ADDRESS: 213-35 40th Ave Bayside - New York - 11361 PHONE #: ( 917 ) 846-5447 AGENT: Bruce A. Anderson O_ 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. Michael J. Domino, 1 dent �yO�QS11FF0(,�-�OG Town Hall Annex �J` John M.Bredemeyer III,Vice-President y�Q 54375 Route 25 Glenn Goldsmith ok. 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of PETER & ELAINE PSYLLOS COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE SUFFOLK ENVIRONMENTAL CONSULTING,INC.. I,'3(wcJ- �►- �`"" , residing at/dba 20. BOX 2003 being duly sworn, depose and say: That on the 6% day of p� , 2019, I personally posted the property known as '" L-Llys by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, April 18, 2018. 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N 6 3 11n�trd�itti -------- Sveof an Co.,ofiYo. airy;"34aie.7lAtd+, D- ----------------------------------------- i ��ry;3Yaie;7TP+df - ( oo t I" '' ' C PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: rc- ^e STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn,deposes and says that on the day of , 20____, deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAHJRETURN RECEIPT. i 1 Sworn to before me this Day of , 20 Notary Public I ,NUTILt: Ulm H 't. A1< 1NG , NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: PETER & ELAINE PSYLLOS cv SUBJECT OF PUBLIC HEARING : For a Wetland Permit to construct a 20'x40' (800sq.ft.) pool with surrounding 1 ,370sq.ft. at grade patio; install a 55' foot long retaining wall along the landward side of the pool patio; install 196 linear feet of pool enclosure fencing; install a pool drywell and pool equipment area; relocate existing gazebo; and relocate existing lawn steps in order to accommodate the pool. Located: 2886 Ruth Road Extension, Mattituck. SCTM# 1000-105-2-1 TIME & DATE OF PUBLIC HEARING : Wednesday, April 18, 2018 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: 105.-2-1+106.4-1.12 Psyllos Peter&Psyllos Elaine 213-35 40th Ave Bayside,NY 11361 106.4-2.1 Siddhartha Mukherjee and Sarah Sze 133 W 17th St PHB New York,NY 10011 106.-1-1.12 Psyllos Peter&Psyllos Elaine 213-35 40th Ave Bayside,NY 11361 106.4-1.10 RRE ROW LLC 213-35 40th Ave Bayside,NY 11361 106.-1-1.11 Peter&Elaine Psyllos 2867 Ruth Rd Mattituck,NY 11952 105.-2-2.1 Prithpal Kandhari 1623 Third Ave—Apt 27 New York,NY 10128 STATE OF NEW YORK COUNTY OF SUFFOLK Bruce A. Anderson, residing at Suffolk Environmental Consulting, Inc, P. O. Box 2003, Brid e�pton, NY 11932, being duly sworn, deposes and says that on the 9th day of January, 2018, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Bridgehampton, that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20_ NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: PSYLLOS Project SCTM# 1000— 105—02 — 1 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 construct a 20' x 40' pool (800 square feet) with surrounding 1370 s.f. at grade patio, 55-foot retaining wall, and surrounding 196 I. f. pool enclosure fence, pool drywell and pool equipment and relocate gazebo. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 2886 Ruth Road Ext. -Mattituck - 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: Peter and Elaine Psyllos MAILING ADDRESS: 213-35 40m Ave Bayside - New York - 11361 PHONE #: ( 917 ) 846-5447 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. i 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# 105 - 02 - 001 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ Building Dept. ❑ Board of Trustees Zoning Board of Appeals ❑ 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 construct a 20' x 40' pool (800 square feet) with surrounding 1370 s.f. at grade patio, 55-foot retaining wall, and surrounding 1961. f. pool enclosure fence, pool drywell and pool equipment and relocate gazebo. Location of action: 2867 Ruth Road Extension; Mattituck;Town of Southold, NY Site acreage: 2.387 acre± Present land use: Single family dwelling with related appurtenances Present zoning classification: R- 80 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: Peter and Elaine Psyllos (b) Mailing address: 2867 Ruth Road Extension; Mattituck, New York 11952 (c) Telephone number: Area Code(917) 846-5447 (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 ❑ Not Applicable As indicated within Policy 1, "Development that does not reinforce the traditional land use pattern of the Town of Southold would result in a loss of the community and landscape character of Southold.", this proposal is to construct a swimming pool with surrounding patio which are common appurtenances in the Town, The proposal, as designed, will not result in adverse effects to the surrounding environment in that the project has been designed in such a way as to maximize the extent of all required reaulatory conditions associated with these activities on a lot situated in proximity to the surface waters surrounding the Town of Southold, Accordingly, this project is consistent with this policy, Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Policy 2 is not applicable in that subject lot and the surrounding neighborhood cannot be deemed a substantial historic and/or archaeological resources. 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 ❑ Not Applicable Subiect proposal will not adversely impact the visual quality of the surrounding area in that the proposed activities are adequately screened from adjacent properties and the structures are at grade . No current visual resources will be impacted by these activities. Therefore, this proposal is consistent with this policy. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ® Yes ❑ No ❑ Not Applicable Subiect proposal will fully comply with Policy 4 in that the location of the improvement within subject property is to be situated 60.3' landward of the top of bluff and hundreds of feet landward of the Coastal Erosion Hazard Area Boundary. The chances of any loss of life or structures from implementation of this project are negligible. Therefore, the proposal is consistent with this policy. 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 will comply with Policy 5 in that the proposed pool will be served by a drywell that will handle any and all runoff. Construction of the proposed activities will utilize hay bales and siltation fencing, thereby protecting situate surface waters. Therefore, the proposal is consistent with this policy. 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 Subiect proposal will comply with Policy 6 in that proposed activities, especially the proposed pool is designed to meet the environmental guidelines and requirements of the Town of Southold Board of Trustees and is not regulated by the New York State Department of Environmental Conservation, and consequently, will maintain the integrity of the surrounding ecosystem. Therefore, the proposal is consistent with this policy. ach 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 is simply construct incidental improvements which historically do 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 Subject 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 This policy is not applicable to the proposal in that subject parcel is a private lot and has no possibility for public access to coastal waters or public resources. However, as the proposed construction is occurring landward of the bluff, the proposal could in no way impede the use of the contiguous Long Island Sound off the subiect parcel. 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 Subiect proposal is not applicable in that the proposal does not involve a water-dependent use (i.e. marina, aquaculture, etc...). 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 Subiect 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(Le. 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 mineral 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 3-29-2006 @ 10:00AM 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 26,2018 Michael Domino, President Southold Town Trustees n E C E �,/� P.O. Box 1179 J L� Fl Southold, NY 11971 FEB 2 7 2018 Re: PSYLLOS 2886 Ruth Road Extension —Mattituck SUM 1000-105—2-1 Southold Town Board of Trustees Dear Mr. Domino, This Firm represents Peter and Elaine Psyllos,owners of the premises referenced above. An application is on file with your Board seeking a permit to construct an in-ground swimming pool. The application has remained inactive pending receipt of a zoning variance. Please be advised that the Southold Zoning Board of Appeals granted a variance for the in ground swimming pool causing the pool to be rotated 90 degrees as to increase setbacks from the bluff. Also,the existing gazebo is to be located to a conforming location and is depicted on the survey. Attached herewith please find: • Zoning Variance Determination dated February 6,2018; • Revised survey prepared by Michael Wicks, L.S. last dated December 4,2017 [four sets]; • Photos of the site depicting the location of the proposed pool [2 sets]; and • Authorization/Board of Trustees Application signature page/Applicant Agent Transactional Disclosure Form. By way of this correspondence, I request that you schedule this matter for hearing and determination at your next regular scheduled meeting. Thank you in advance for your anticipated cooperation. Yours truly, Bruce Anderson cc: P. Psyllos BOARD MEMBERS rjF S 7 Southold Town Hall Leslie Kanes Weisman,Chairperson ��� ypl 53095 Main Road-P.O.Box 1179 O Southold,NY 11971-0959 Patricia Acamporat Office Location: Eric Dantes CA Town Annex/First Floor,Capital One Bank Gerard P.GoehringerO �� a sVR 1 e) Nicholas Planamento Z? 1.5 D http://southoldtownny.gov 7FE 7 2018 ZONING BOARD OF APPEAL TOWN OF SOUTHOLD Southold Town Boar of Tr Tel.(631)765-1809 -Fax(631)765-9064 o.,l $:L/Q usNt FINDINGS,DELIBERATIONS AND DETERMINATION E8 _ 5 2018 MEETING OF FEBRUARY 1,2018 ZBA FILE: 7124 $o old Town Clerk NAME OF APPLICANT: Peter and Elaine Psyllos PROPERTY LOCATION: 2867 Ruth Road Extension,Mattituck,NY SCTM No. 1000-105.-2-1 SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated November 14, 2017 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. The LWRP Coordinator issued a recommendation dated December 19, 2017. Based upon the information provided on the LWRP Consistency Assessment Form submitted, as well as the records available, it is the Coordinator's recommendation that the proposed action is INCONSISTENT with LWRP policy standards and therefore is INCONSISTENT with the LWRP. Furthermore, the LWRP policy cautions to avoid hazards by siting structures to maximize the distance from Coastal Erosion Hazard Areas. He described the two vegetated gullies with slopes equal to or greater than 20 percent that occur on the east and west sections of the property and warned that the 20 percent slopes on the east side of the property are closed to the proposed location of the swimming pool. He remarked that the bluff slope is vegetated and appears to be stable but cautions threat of future loss of property due to erosion and during storm events the threat increases. The coordinator recommends that the Board require that swimming pool be relocated further from the slopes for above described reasons. Based upon the amended application and the conditions imposed herein, the Board finds the proposed action CONSISTENT WITH THE LWRP. During the hearing the applicant presented an alternative plan showing the pool at a more conforming 75 foot bluff setback. The applicant further presented evidence that the bluff is in stable condition and testified that storm water runoff is not 'a problem in this area. The applicant also agreed to follow the recommendations of the Suffolk County Soil and Water Conservation District's letter dated November 13, 2017; thereby making the application consistent with the LWRP. SUFFOLK COUNTY SOIL AND WATER CONSERVATION DISTRICT: This application was referred for an evaluation and recommendation to the Suffolk County Soil and Water Conservation District. According to a letter from the agency, dated November 13, 2017, an inspection of the property was conducted on the same date. The Page 2, February 1, 2018 #7124, Psyllos SCTM No. 1000-105-2-1 agency found that the bluff area appeared to be stable and a dwelling fitted with gutters and downspouts which appear to discharge into drywells. The yard is equipped with an in-ground sprinkler system with two sprinklers installed 20 feet from the bluff face. The District recommends that all heavy machinery, equipment or supplies be stored and used a minimum of 25 feet setback from the bluff top edge, that the two sprinkler heads located at the tip of bluff face be removed and that the homeowner proceed with the addition of a proposed drywell to handle pool run off and drainage. TOWN OF SOUTHOLD OFFICE OF THE ENGINEER: This application was referred to an evaluation and recommendation to the Office of the Engineer. According to a letter from the department, dated January 29, 2018, several recommendations were listed for the applicant to follow in order to seek compliance with the Town Code and Chapter 236 for Stormwater Management. Furthermore, as required, the applicant should submit Stormwater Management Control Plans to the Engineering Department for review and approval prior to installation of the new work and related work. PROPERTY FACTS/DESCRIPTION: The subject property is a conforming 2.387 acre parcel located in the R-80 Zoning District 64,236.94 sq. ft. of which is located upland of the top of the bluff. The parcel measures 151.84 feet (actual) fronting the Long Island Sound fronting the northerly property line, measures 690.17 (actual) along the easterly property line, measures 200.00 feet fronting Luther's Road (Breakwater Road), along the southerly property line and measures 616.60 feet (actual) feet along the westerly property line. The property is improved with a two story home with an attached rear wood deck and a shed, as shown a survey prepared by Michael K. Wicks,L.S., last revised July 3, 2017. BASIS OF APPLICATION: Request for a Variance under Article XXII, Section 280-116 and the Building Inspector's August 31, 2017 Notice of Disapproval based on an application for a permit to construct an accessory in-ground swimming pool, at: 1) located less than the code required 100 feet from the top of the bluff; located at: 2886 Ruth Road Ext., (Adj.to the Long Island Sound)Mattituck, SCTM#1000-105-2-1. RELIEF REQUESTED: The applicant requests a variance to construct an in-ground swimming pool having a distance of 60.3 feet from the top of bluff where the code requires that structures be located no fewer than 100 feet from the top of bluff as shown on survey prepared by Michael K. Wicks,L.S., last revised July 3, 2017. ADDITIONAL INFORMATION: A non jurisdiction letter dated November 10, 2017 was received by the applicant from the New York State Department of Conservation describing the agencies jurisdiction and applicant's responsibilities. At the hearing the Board asked the applicant's agent to provide comparable variances issued for in ground pools with a non-conforming distance to the top of bluff. On January 24, 2018, the agent hand delivered a letter outlining six determinations rendered in prior years as well as copies of the determinations. However, the comps provided were for properties located in Greenport and East Marion, and none were located within the subject community or in Mattituck. AMENDED APPLICATION: During the hearing, the applicant's agent submitted a set of aerial photographs depicting the coast lines/top of bluff distances of dwellings and accessory structures on neighboring parcels as well as the subject parcel. The applicant' agent also submitted an aerial photograph showing the proposed pool rotated at 90 degrees thereby increasing the bluff setback from the 60.3 foot, as applied for, D conforming to the code. FINDINGS OF FACT/REASONS FOR BOARD ACTION: FEB 2 7 2018 The Zoning Board of Appeals held a public hearing on this application on January 18, 2 18 a 1, , and oral evidence were presented. Based upon all testimony, documentation, personal inspection of �i property— Page 3,February 1, 2018 #7124,Psyllos SCTM No. 1000-105-2-1 and surrounding neighborhood, and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law 4267-b(3)(b)(1). -Grant of the variance as amended will not produce undesirable change in the character of the neighborhood or a detriment to nearby properties. The neighborhood consists of single family water front homes. A pool is a typical accessory use for a house in this neighborhood. The neighborhood is wooded and the property is on top of a high bluff. The pool will be private and will not be seen from the street or from the beach. 2. Town Law 4267-b(3)(b)(2). The benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue, other than an area variance. The applicant could put the pool at a conforming bluff setback. However, there is an existing sloped berm/hill directly on the seaward side of the applicant's home that is high enough to require steps down to the proposed flat location on the subject property. If the applicant were to construct the pool at a conforming setback, the applicant would have to alter the berm/hill which would involve require substantially more land disturbance and have more of an adverse environmental impact than in the proposed amended location. . 3. Town Law $267-b(3)(b)(3). The variance as applied for is mathematically substantial, representing 39.3% relief from the code. However, by turning the proposed swimming pool 90 degrees and placing it at 75 feet from the top of bluff, the variance, as amended is less substantial,representing 25%relief. 4. Town Law 4267-b(3)(b)(4) No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code and must implement all the recommendations of the Suffolk County Soil and Water Conservation District, as conditioned herein. 5. Town Law §267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. However, with the option of placing the pool further from the top of bluff, impacts resulting from granting a variance are minimized. 6. Town Law§267-b. Grant of a variance as amended is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a new in-ground swimming pool while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community., By siting the pool further from the top of bluff, the LWRP Coordinator's concerns will be addressed and the action is less inconsistent with LWRP policies RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Weisman (Chairperson), seconded by Member Planamento, and duly carried,to GRANT the variance as AMENDED, and shown on aerial photograph submitted to this Board on January 18, 2018: SUBJECT TO THE FOLLOWING CONDITIONS: 1. The applicant shall submit a signed/stamped revised survey showing the amended location of the in- ground swimming pool having a 75 foot distance from the top of bluff. FnnpQ 2 2 FEB 2 7 2018 So,,!,NjId Town _j.q8__d of Tru tees i Page 4,February 1, 2018 #7124,Psyllos SCTM No. 1000-105-2-1 2. The applicant shall implement all the recommendations set forth by Suffolk County Soil and Water Conservation District in their letter dated November 13,2017,as cited above. 3. Pool mechanicals shall be placed in a sound deadening enclosure. 4. The existing gazebo must be moved to a code conforming bluff setback as per the applicant's plans. That the above conditions be written into the Building Inspector's Certificate of Occupancy, when issued, Any deviation from the survey, site plan andlor architectural drawings cited in this decision will result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variances)granted herein as shown on the architectural drawings, site plan and/or survey cited above, such as alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Pursuant to Chapter 280-146(3) of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured,and/or a subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from the date such variance was granted. The Board of Appeal's may, upon written request prior to the date of expiration, grant an extension not to exceed three(3)consecutive one(1)year terms. Vote of the Board: Ayes: Members Weisman(Chairperson),Planamento, and Dantes(Member Acampora and Member Goehrmger were absent). This Resolution was duly adopted(3-0) slie Kanes Weisman, Chairperson D E E Approved for filing '2/ — /2018 FEB 2 7 2018 Southold Town B � r Michael J Domino, Vicc-Presiden, '�� lQ 54.175 Main Kosd P O Box L 179 James C Feng TrUSLCe uthold New York L 197 1-0959 Dave Bergen, Trustee iTelephone (63 L) 765-L892 141 Charles J. Sanders, TrusteeFa_e(631) 765-6641 ly�OUMY,�� BOARD OF TOWN TRUSTEES p TOWN OF SOUTHOLD D-D To- Southold Town Building Department APR - 3 2017 Re: Verification of Building Department Permit Requirements BUILDING DEPT. TOWN OF SOUTHOLD SCTM#: J Property Owner (dame: Date Sent to Bldg_ Dept.: ` 3`�7 The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Departr'rient's permitting requirements stated below: YES N-O W11 the proposed .project require a Building Permit? Zthe ll the proposed project require a variance determination from Zoning Board of Appeals? Will any part of this application be considered as Demolition as described under Town Code? COMMENTS: 4 Date Signature of Reviewer Ojf SU!/jl Town Hall Annex Michael J.Domino,President O 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® ^a�� Telephone(631) 765-1892 A.Nicholas Krupski yCo I .'`" Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: Received Fee: $ 25D, ' Application: —Completed A (- = pn ! ' p PP Incomplete: MAR 2 4, 2017 SEQRA Classification: Type I_ Type H Unlisted Lead Agency Determination: } Southeid v��n Coordination:(date sent): LWRP Consistency Asses ment Form Sent: 5.S.I�r . Board f Tu�`ees __1 CAC Referral Sent: 1t z61'7 Date of Inspection: S. I Receipt of CAC Report: Technical Review: —7—Public Hearing Held: i7• Resolution: Legal Name of Property Owner(s): Mailing Address: a 8$ lLu4�j Xd et-Y-4 D;sa Phone Number: 917 `P 1-- S YY 7 Suffolk County Tax Map Number: 1000- I 0,> - o R - o Property Location: 5d Ike cr k. (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): t-et 4- e�-l� � k�-1^�T►�t�.-��c�- (�oa�s Mailing Address: 3(44,t o. e1010c c— Y" Pl. c� ^'"Y //7b-3 Phone Number: �11 (, Rve' Board of Trustees Applica )n GENERAL DATA Land Area(in square feet): I O 3 10 95-( , cly Area Zoning: Previous use of property: Intended use of property: /4LJ i dt*,-fi.:,( Covenants and Restrictions on property? Yes 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. Does this project require a variance from the Zoning Board of Appeals? Yes f No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _Z—No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date o-F SbW . �/a y .3 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? '� No Yes If yes,provide explanation: Project Description (use attachments if necessary): Board of Trustees Applic= pn WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: PSS" - Area of wetlands on lot: V- d-5--o square feet Percent coverage of lot: to % Closest distance between nearest existing structure and upland edge of wetlands: 30 feet Closest distance between nearest proposed structure and upland edge of wetlands: 13 S feet Does the project involve excavation or filling? No ✓ Yes If yes,how much material will be excavated? cubic yards How much material will be filled? 0 cubic yards Depth of which material will be Ev9or deposited: S feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: I„� ,7-3—w. SL.< 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part l -Project and Sponsor Information Rt-� Name of Action or Project: Pro oS oo y q o f Sw �oc7 I Project Location(desc ibe,and attach a location map): t oso g P r.ct .k-0 dC.. Brief Description of Proposed Action: IYns Name of Applicant or Sponsor: Telephone: fo3 ^� �� BSc. - 3goa owls) E-Mail: 1e, -&, 305' bvQ. Address: 3c0 L-0` s--6\.lb . City/PO: State: Zip Code: !✓tcd r-,o ,A /t' 1 /17 Lea 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 ET ❑ 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: Tau+ or Sou-tG.laeIdl —.1 Pie ❑ D 3.a.Total acreage of the site of the proposed action? .387 acres b.Total acreage to be physically disturbed? O. flS acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? ,acres 4 Check all land uses that occur on,adjoining and near the proposed action. �/ EJUrban El Rural(non-agriculture) [:]Industrial [-]CommercialIJResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic [:]Other(specify) ❑Parkland Page 1 of 4 5. is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ ff 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: ^' ❑ 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? 1;71 ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ET ❑ 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: El Z 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? 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? E]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: �horeline El Forest ErAgricultural/grasslands El Early mid-successional 51-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, (�� a.Will storm water discharges flow to adjacent properties? ❑NO [:]YES YES ❑ b Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe- [:]NO DYES Page 2 of 4 18 Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size- Ef ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: 3 t 14 1 I 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning 1:1regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? F71 ❑ 3. Will the proposed action impair the character or quality of the existing community? E ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or F/_1 D affect existing infrastructure for mass transit,biking or walkway? �J 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment-utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, 11architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, F]waterbodies,groundwater,air quality,flora and fauna)? M'Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ( ❑ problems? u 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. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental 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 Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT I Page 4 of 4 "Board of Trustees Applica" )n AFFIDAVIT r�70Z-Lm � BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. f frAre of Prop y wner Signature of Property Owner SWORN TO BEFORE ME THIS Z,Z, DAY OF 20 Notary u is =PUbft ANDale of NewYork O65407uffolk County es Oct.15,20L Board of Trustees Applica" -,n AFFIDAVIT !/ J' 1,C�S' �'C1�/'�'� �4 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Sigriature of Pro erty, wner Signature of Property Owner SWORN TO BEFORE ME THIS 2 z DAY OF 20_L7 Notary Public KIKI BLANDA Notary Public,State of New York No.01 BL60W07 Qualified in Suffolk County Commission Expires Oct.15,2042 =oard of Trustees Applical'\ n AUTHORIZATION (Where the applicant is not the owner) vwe, owners of the property identified as SCTM# 1000- l 6,5-- C92 — 2,/ in the town of New York, hereby authorizes (c-+- IS to act as my agent and handle all necessary work involved with the application process for permits) from the Southold Town Board of Trustees for this property. rro erty Owne&Sigoture Property Owner's S- aft SWORN TO BEFORE ME THIS �Z, DAY OF 'rte C , 20 i Notary Pu is KIKI BLANDA Notary Public,State of New York No.01131-6065407 Qualified in Suffolk County Commission Expires Oct.15,20- 3oard of Trustees Applical; `n AUTHORIZATION (Where the applicant is not the owner) We, e�2 �C N`� �flllz Z owners of the property identified as SCTM# 1000- /OS - Oa - in the town of c� S70 U1 ,New York, hereby authorizes 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. Pr"y y Owner's i ature Property Owner's S' ignVure SWORN TO BEFORE ME THIS P-2 DAY OF "71,W,11 , 20 Notary Pu is KIKI BLANDA Notary Public,State of New York No.01BL6065407 Qualified in Suffolk County Commission Expires Oct.15,20L APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town bfficers and employees.The purpose of this form is to Drovide information which can alert the town of wssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,.rpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship.with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.`Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If.you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantlagent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the appliwt (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 2A day of �� 2017 7 Signature Print Name ? s7� 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: (Last name,first name,giiddle 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 Twee 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 Y Ifyou answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay of 200 Signature Print Name Lr^' Form TS 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ' that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of 120 Notary Public i NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD j I In the matter of applicant: P"/os SCTM# 10oo- /of - pa _ a, l I YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 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 j Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NAME: MAILING ADDRESS: ask(. 14,.A A /`Ta f-t- t 9 5 a PHONE #: 917 Tryt, 5'yv-7 AGENT: ID c c,- MAILING ADDRESS: - 3(��►� }-}m,,st61o�/� ✓ M�d -� wy // ��3 PHONE #: (oil (pit, - 34ao Enc: Copy of sketch or plan showing proposal for your convenience. I i Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated. as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# Ior - 0 a - -;k- / PROJECT NAME P-e� '19S 4%s The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,.planning activity,agency regulation,land transaction) ❑ (b) .Financial assistance(e.g. grant,loan, subsidy) (c) Permit,approval, license,certification: ©/ Nature and extent of action: i ao �— R" �, Location of action: o� G / ✓ G—,of wlG f�i�z,�k .GYM 61 3 a Site acreage: Present land use: Present zoning classification: 2. If an application,for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: 1`� e c_c_ Sat Q � (b) Mailing address: �(�,tal 6622-4Z-Jbllac.Ic- 3 (c) Telephone number: Area Code( )(,31 - G9(. - 3 9 o o (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No D If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. ❑Yes ❑ No ❑Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 0 Yes ❑ No allot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No allot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—PoliciesPages8 through 16 for evaluation criteria ❑ Yes 1:1 No u Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria F1Yes ❑ No u Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ U Yes No "'N'ot 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. i ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluatio�p criteria. ElYes ❑ No 2I Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the.Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. � F] Yeo No(U-Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No RNot Applicable Attach additional sheets if necessary r Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. El Yes El No U Not Applicable Attach additional sheets if necessary Policy 13. Promote .appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY �- TITLE—,,47f- 7' DATE-3/-W//—/