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HomeMy WebLinkAboutTR-9238A ti0�� UTyo Michael J.Domino,President of SU . Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Glenn Goldsmith lhc Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams couPm Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1539C Date:November 27, 2018 THIS CERTIFIES that the installation of an 8.5'x23' bbq/kitchen area with a counter approximately 36" above existing pool patio, a paver floor and a 16"wide stone sitting area; proposed±2.5'x4' steps to ground off existing,patio;the as-built 1.5'x23' wooden planter using 6"x6"railroad ties constructed to approximately 1.5' above grade off of pool patio is to be removed and not replaced; At 675 Hill Road, Southold Suffolk County Tax Map #1000-70-4-28 Conforms to the application for a Trustees Permit heretofore filed in this office dated May 25, 2018 pursuant to which Trustees Administrative Permit#9238A Dated June 20, 2018,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of an 8.5'x23' bbq//kitchen area with a counter approximately 36"above existing pool patio, a paver floor and a 16"wide stone sitting area; proposed f 2.5'x4' steps to ground off existing patio; the as-built 1.5'x23' wooden planter using 6"x6" railroad ties constructed to approximately 1.5' above grade off of pool patio is to be removed and not replaced. The certificate is issued to George Rigas owner of the aforesaid property. e Authorized ignature ' L .. T �F SDUl r Town Hall Annex Michael J. Domino, President k /y0 John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski • �Q Telephone(631) 765-1892 Greg Williams Oenu Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: s� Itl Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection. INSPECTED BY: W COMMENTS: < �o- CERTIFICATE OF COMPLIANCE: Michael J. Domino, President SdFF0Q-.00 Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith Ca P.O. Box 1179 1_� A Nicholas Krupski i::) 4,, Southold, NY 11971 Greg Williams 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 1st day of construction % constructed V/7"- Project complete, compliance inspection; Michael J.Domino,President rjf SOUIy� Town Hall Annex John M.Bredemeyer III,Vice-President h0 01 0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams ��l Fax(631) 765-6641 Cou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9238A Date of Receipt of Application: May 25, 2018 Applicant: George Rigas SCTM#: 1000-70-4-28 Project Location: 675 Hill Road, Southold Date of Resolution/Issuance: June 20, 2018 Date of Expiration: June 20, 2020 Reviewed by: Board of Trustees Project Description: Install an 8.5'x23' bbq/kitchen area with a counter approximately 36" above existing pool patio, a paver floor and a 16" wide stone sitting area; proposed ± 2.5'x4' steps to ground off existing patio; the as-built 1.5'x23' wooden planter using 6"x6" railroad ties constructed to approximately 1.5' above grade off of pool patio is to be removed and not replaced. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Heidtmann & Sons, Inc., dated May 4, 2018 and stamped approved on June 20, 2018. Special Conditions: None Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. r � • Michael J. Domino, President Board of Trustees 'i0W224.87PROPERTY LINE uj - i STONE WALL MAY 2 5 2018 ¢ BBQ/iGITGNEN PLANTER )z COUNTER PE IG PT STONE STEPS — L Board offd gown 2'X2' PAVERS 1N O Bar isices SAND ` STONE SEAT D i WALL Ir " H1C�N Om0FIFT PT0 0l -1 0� (LK APPROVED i, -BOARDr OF TI�STEES SI,U l i„f M I NG n POOL DATE '2 ° O w , F.F. EL. 16 -011 T o L l i _ 4 rge Rigas - 75 Hill Road,Southold :- CTM#: 1000-70-4-28 /13/18 • Michael J. Domino, Presic Town Hall Annex John M.Bredemeyer III,Vice-President V- 54375 Route 25 Glenn Goldsmith y a P.O.Box 1179 A.Nicholas Krupski -"7 Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: o ( � Completed infield by: !� Heidtmann & Sons, Inc. on behalf of GEORGE RIGAS requests an Administrative Permit to install an 8.5'x23' bbq/kitchen area with a counter approximately 36" above existing pool patio, a paver floor and a 16" wide stone sitting area; proposed ± 2.5'x4' steps to ground off existing patio; and as-built 1.5'x23' wooden planter using 6"x6" railroad ties constructed to approximately 1.5' above grade off of pool patio. Located: 675 Hill Road, Southold. SCTM# 1000-70-4-28 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledge a foregoing Trustees comments: Agent/Owner: / Present were: V J. Bredemeyer M. Domino G. Goldsmith 6-"�N. Krupski Williams Other i 2g 7 JP 1 G •' d `<'� ,� aa �' � .4*�`�'.k~vr°" •"` Y R`�r ;.r.4�•�t° .jig;. 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) CA Alc Southold, NY 11971 a Tel 631 765-1938 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: June 13, 2018 Re: Local Waterfront,Coastal Consistency Review for GEORGE RIGAS SCTM# 1000-70-4-28 Heidtmann & Sons, Inc. on behalf of GEORGE RIGAS requests an Administrative Permit to install an 8.5'x23' bbq/kitchen area with a counter approximately 36" above existing pool patio, a paver floor and a 16" wide stone sitting area; proposed ± 2.5'x4' steps to ground off existing.patio; and as- built 1.5'x23' wooden planter using 6"x6" railroad ties constructed to approximately 1.5' above grade off of pool patio. Located: 675 Hill Road, Southold. SCTM# 1000-70-4-28 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. 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 HEIDTMANN & SONS, Inc. P.O.Box 932 Cutchogue,NY 11935 infbAgfhbuild.com (631)734-7484 June 13th,2018 Southold Town Trustees D p P.O.Box 1179 � II Southold,NY 11971 JUN 1 3 2018 } Re: Exterior Planter Southold Town ar of e Dear Trustees, We are removing the"as-built"planter at the east side of the pool and not replacing same. .I Thank you AIL4- Sincerely, Glenn F.Heidtmann GFH/ll U j JUN 1 3 2018 1 ;,;,;;,n Cantrell, Elizabeth From: info@gfhbuild.com Sent: Wednesday,June 6, 20 8 11:30 AM To: Cantrell, Elizabeth Cc: The Office Subject: Re: 675 Hill Road, Southold Hi Elizabeth, The planter is aprox 20" below the existing pool area patio elevation. It measures 1.5'x 23' built with 6"x6" railroad ties. It is aprox 1.5' above grade. There will also be 2 steps built into the Masonry patio 3 risers.The area measures 2.5' x4' aprox. Thank you, j Glenn i On Jun 6, 2018, at 9:29 AM, Cantrell, Elizabeth <elizabetiic@town.southold.ny.us>wrote: Good Morning, i I am reviewing the application for the proposed bbq area and discovered that the proposed planter, stone steps to ground next to the planter, and height of the extended stone wall along the bbq area are not described in the required areas. Please submit(via email is acceptable)the dimensions (L x W x H) of each of the mentioned proposed items. Dimensions for each proposed structure is a requirement of a Trustee application. Glenn did give us the dimensions for the bbq/kitchen area,just not the other items. Thank you. 56�.� Senior Clerk Typist 4 Town of Southold Board of Trustees 631-765-1892 I i I I I i i Michael J. Domino, President Town Hall Annex John M. Bredemeyer,1ll, Vice-President �� y� 54375 Route 25 Glenn Goldsmith P. 0 1 NEI A Nicholas Krupski � • a� Sout Greg Williams of ,� Telepho e� 3 4892 Fax 631) 765-6641 MAY 3 1 2018 SOUTHOLD TOWN BOARD OF TRUSTEES ALDING DM. TG--WN OF SOUTHOT TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIREMENTS SCTM#: Property Owner Name: �fCS� OP Date Sent to Bldg. Dept: I The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? I Will the proposed project require a variance determination from the Zoning Board of Appeals? Will any part of this application be considered a Demolition as described under Town Code? I ! COMMENTS: (,V ! Si ignature of Reviewer j Date I { I .ti Q 'S-1 Town Hall Annex Michael J.Domino,President ." �•� ' John M.Bredemeyer III,Vice-President ' d 54375 Route 25 1 P.O.Sox 1179 Charles J.Sanders .,' ' ,` Southold,New York 11971 Glenn Goldsmith `. _ yo' Telephone (631) 765-1892 A.Nicholas Krupskilf(COUN A Fax(631) 765-6641 f F 9 DOAR.D OF TOWN TRUSTEES TOWN OF SOUTHOLD This Seciion For Office Use Only Coastal Erosion Permit Application __Wetland Permit Application ` Administrative Permit 4.Ainendment/Transfer/Extension - Received Application, s� ' g 7_7Received Fee: $ ® ��^ r'f -E L I C_ Completed Application:. Incomplete:_ SEQRA Classification: Type I- `Type_E V Unlisted MAY '2 5.'2018 Lead Agency Determination: ; Coordination:(date sent): - - + �/ LWRP ConsistencyAssessment Form Sent: Southold Toarn , - - - - oar of T usiees• ` ,� E CAC Referral Sent: ; Date of Inspection: Receipt of CAC Report: Technical Review:, ' Public Hearing Held: Resolution:---- Legal esolution:---_Legal Name of Property Owner(s):- _61to � Mailing Address:. (�'7� �r lL _2c�Q(:Q _,aSo�,�(a6Ld�, )1 L( -�.q`Zil _-_ Phone Number: b I_T� X--Z 1) —L, Suffolk County Tax Map.Number: 1000-. 7t0* = h,J- Property Location: . Jbt&"d (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable):_ ,el CffinaC4 A A 4—`�is L S5 _ Mailing Address: '� 61G `�6�Jy� Ck. CicbCu.c ),)\1.PI lnaa Phone Number: Board of Trustees Appli,–.:-;ion GENERAL,DATA Land Area(in square feet):, Area Zoning: Previous use of property:. VIIi.Cau--t– Intended use of property: Covenants and Restrictions on property? Yes No If"Yes",please provide a copy. _ ' F 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. i Does this project require a variance from the Zoning Board of Appeals? Yes-4---No If"Yes",please provide copy of decision. } Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes - No t Does the structure,(s)on property have a valid Certificate of Occupancy? Yes No # Prior permits/approvals for site improvements: i Agency Date �V No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V No Yes If yes,provide explanation: Project Description(use attachments if necessary):- a _ cft7X -3.6 w ot,6�,z - FE-)q Sig- ?'O.771-4-, cyt;o T- -OR hoo se, j-�, MXC,, «cu' (Un Zit . 4 .► cle - Hoard of Trustees Appli�;a,;ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: i Area of wetlands on lot: 11 W C�t 6J square feet q , Percent coverage of lot: 1. Closest distance between nearest existing structure and upland edge of wetlands: - 570A ' . feet Closest distance between nearest proposed structure and upland edge of wetlands., cLAv k V0 + feet Does the project involve excavation or filling? - _ - - No - Yes r If yes,how much material will be excavated? cubic yards How much material will be filled?- -_ -cubic yards Depth of which material will be removed or deposited: _ r feet f Proposed slope throughout the area of operations: M;VJc WV-Q } Manner in which material will be removed or deposited,." A wo)'k 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): Board of TruStee$ Applin-tion AFFIDAVIT �..- �.,. BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/TIER 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 II GES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PE IT(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, 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 PROPERTYAND 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. Signa o Property Owner Signature of Property Owner -SWORN TO BEFORE ME THIS � DAY OF..Q20 Not lic LORMA LAMB i - Notary Public,State of New York - #011A6179883 Glualified In Suffolk County Term Expires December 31,20'se l e) Board of Trustees Applic lou AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified,as SCTM#1000- in"the town of New York,hereby authorizestky&a&16= f to act asmyagent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF \J LORMA LAMB Notary Public,State of New York #011A6179883 Qualified in Suffolk County Term Expires December 31,nwiv APPLICANT/AGENT/REPAPPLICANT/AGENT/REPR1+ ENi°, TWE TRANSACTIONAL DISCLOSURZ.FORM rb.- i t P deTch can Ae-rte fbil,c %v •�s ' "�rs�gjl�-carne. - YOUR NAM& (Wt name,first nusne,.gildaite Initial,unless you are applying In the name of someone else or other entity,such as a company.Ifso,indicatr,,the.oihcr person's or company's name.) iiAm r or-APPLICATION: (Check alt that apply.) ° ' . S Toac grievance Building .` Variance __,. Trustee Change of Zone Coastal Erosion AppravA of plat Mooring Exemption from plat or official map �® Planning Other , (If"Other",name the activity.) Do you peawnafiy(or through y�oure+o nptjV,Mousa.,ribilft Wizat,or child)Iia".A tai '' tip with 6sty'6w'qr p $ Of the'i'66rf6f6bu fi"Ids Wosid,•mbrr3aga,Or-tholt=tatorteL.°btu ' iroluoing a ship,:ire Whmbrthe"O ib -"4*imolto has ovum own*' lrip of(or"64$o� .a.' walon In ovhtcit dre izrmt oil r or cmptoy ,9"s tram than.s%of the shaves. YES , 6 tfydu answered"YES",complOe the balance of this form etud date and sign where hidica!td. Name of prm.on employed by thr,Tonvn of Southold Titte br posluon Of dent<pomn Debwtins tEi (dad f>etwccn y i+ttsa applies rttuativa)and the town Oracer or employee,Eltht,cheek The town officer oremployee or his or her spotim,sibling,psren or child is{cheek tllf'ttiat apply): -- _ � i`s�1'a 0 t tlY�Tt%3 'o 4A fl" Ot tlrfis t Rpm a....... itc rut is U carp brz •' QI I tat ;fin? la y In;, tt-co orate cant l3'{ y�, rls.aiea u aspo tae ;• 9 i whir the �J r)n o33itr;dtrtor, r,of bsxtls6oyec oithe nppbcartt;or '' D)the acted appllcant. D6s�G'RlpTlt}Ii OF RELATIOigSH Ip Subm(tted this rgay f Jam, m T5 ,�. l�rlttt n.� for . Name �--� FiltBr4 /D6- fft ' ; • May 24, 2018 George Rigas 675 Hill Road Southold,NY 11971 Town of Southold MAY 2 5 2018 -" Board Of Trustees ; Building Department Southold,N.Y. 11971 Bom of f_: To Whom It May Concern: Please allow this letter to be my authorization for HEIDTMANN & SONS, INC. to be the official agent for all aspects of new construction to be completed at 675 Hill Road, Southold,NY. Thank you Sincerely, ge 'gas Subscribed and sworn before me this -\76— day of , 2018 of Publi LOFIETTA LAMB 4 Notary Public,State of New York #01LA6179883 (jualif i�iember 31,2o�t, Term Exp " ` Bayard of Trustees Appli daarion AFFIDAVIT BEING DULY SWORN DEI SE A THAT HVI SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HERRIN ARE TRUE TO THE BEST OF HISMER 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 ARI(SiNG UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTS D. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVE S, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT TH19 PREMISES IN CONJUNCTION WITH THIS AP'IPLICA.TION, INCLUDING A FINAL INSPECTION, I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE C'OMP'LIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION(PERMIT ISSUED BV THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. of Property Owner SWORN TO BEFORE SIE'Y'HIS j _DAY O �~ f L®RET"t'A LAMB �r Notary Pubfk;,State of New York tf01 LA61 T9M " - QURIWIOd In SuWk County N+� ublic 'Perm EXPIMS C:eCOMber 31,20yj� (� Board of Trustees Applica_ajn AFFIDAVIT BEING DULY SWORN DEPOSES" D'AN_IRMS THAT HUSHE IS THE APPLICANT FOR THE ABOVE DESCRIAEI) PERMIT(S)ANIS THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE-BEST OF HIS/HER KNOWLEDGE ANIS BELIEF,AND THAT ALL WORK WILL DE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY RE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD ANIS THE BOARD OF TRUSTEES HARMLESS ANIS FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PE IT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES",THEIR AGENTS)OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUStEES TO'ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner SWORN TO BEFORE ME THIS 6)0' DAY OP ,20 t� fi LORETTA LAMB Notary Public,State of New York #01LA6178883 Qualified in Suffolk county No ublic Term Expires December 31,20,W1 Soa:rd of Trustees Applicj:a®o AUTHORIZATION (where the applicant is not,the owner) Ij C-1 w4l, 'ki 9&L residingat VrD AW (print n of ow of property) (mailing address) do hereby authorize (Agent) to apply for permits)from the Southold Board of Town Trustees on my behalf. ��Cr s�signature) A.PPLIC /A.GEIQITSE1'd' I'I" t TRANSACTIONAL L DISCLOS 1+6 - . ,:4..,1? �►l `=ttt"tirria.�tl�E�`����h'�le�tt tlta to �;��r� �,pt or9e1 n11Qrr itto_tcik i:s:h a-ao""o�g YOUR""NAMES'Mld . . ; (Last name,ifirstnarne,Middle initial,unless you are applying iiu.he°name of someone,else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATIONS (Check all that apply.) Tax grievance Building Variance' Trustee Change ofZone, Coastal Erosion Approval.of plat Mooring E ccmption from plat or official map Planning Other (If"Otter',name the activity:},-_ i�you,'Pqrsoftialy`(lir,tla'rati h ysaui cotdp uty,spdtise;s6lilit ,;?€�r�attm:or`c(ii[�have-a tdatioinhip with any a ffi &&..�euipl*e. oPtlte'i'rtWat',cal"�tithotil? "iZelatiork�ltilt"i'n�tui3�s ktY.bltttid,'stlara:iit�;t;;;ar"btaskuess intcres�."l3u�it ,intcstn tneaitts a blr;Yia�ca�, ticl,uditt�a partnor:iltiiji,is�.tivhiclt4h�'tist�ri officer or Gtiiptt}ycc,l�s`oven a pattaal pisitt;rsltixa tr�(iar.estai�(tsym�ttt`bj�,St.cptp�?r�tinn in.whtcli the-16AV'Wrak6or einj loyce Darn's ntorc than 5`�a orthe,'sh YES NO _ p If you answered`YES",complete the balance of this form and date and sign.whcre indicated. Name ofpenon employed by the Town of Southold. Title or position of that person _ Describe-the relationship between.yourself(the applicantlai etit/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe-in the space provided. The town,offieer or.employce of 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'Wgal orbenorcial owner of any interest in a non-corpotate entity(when the appii'cant.is not a c6rporation) C) an,officer,director,partner,or employee of the applicant;of D}the actual applicant. . l7ESClt1PTION`CiF RELATIONSHIP ._ 511bmitted this day 20a S Print Nance� .( Pbrnt TS;1 617.20 Appendix B Short Environmental Assessment Form �nst•riiciirans':�iii'Coiiiii�e�iii� Part 1 -Project I»formation. 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 t -Project and Sponsor Information ;Name of Actionor Project: _ Project Location(describe,and attach a locationMap), Brief Description of Proposed Action: 1 z Name of Applicant or Sponsor: Telephone: le3t —z b4 -14 r ; `r1 Li U"�/�fl k�l Vp✓l s� C. E-Mail: Addre .� - - 0& ;City/p0: � O � State: Zip Coder L'Does the proposed action only involve t}ie 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 Pail 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: 3.a.Total acreage of the site of the proposed action? r ®0J.acres b.Total acreage to be physically disturbed? _acres c.Total acreage(project site and any contiguous properties)owned -- 'D I 0 'IF or controlled by the applicant or project sponsor? ���C1 acres aI(2,6L e"t 4.-Clieck all land uses that occur on,adjoining and near the proposed action. E]Urban [I Rural(non-agriculture) ❑Industrial ❑Commercial [Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify):-._ ❑Parkland Page 1 of 4 U 5. is the proposed action, --- _ NO -YES 'N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES' landscape? 7. fs the site of the proposed action located in;or-does-it adjoin,a state listed 06-ti6al Environmental Area? -NO YES- If Yes,identify;; _ _ _ _ - iM ' -8: a.Will the proposed action result in'a substantial-increase in traffic above present levels? NO 1,YES? b.Are public transportation service(s)available at or near the site of the proposed action? c.-A-re any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9--M&the proposedaction meet or exceed the state energy code`re-quirements? NOYIr S' i' If the proposed action will exceed requirements,describe design features and technologies: _ 4 10. Will the proposed action connect to an existing public/private water supply? i NO YCS, 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: TVIEJ s 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? '� s 13.'a.Dociany portion ofthe site-of th-eproposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? J� b.Would the proposed action physically after,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres C-� 14. I ntify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline ❑Forest ❑Agri cultural/grasslands El Early mid-successional Wetland ❑Urban ❑Suburban i 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? - � El: 16:Is-the'picject site located in the 100 year flood plain? - N® 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? [f"NO DYES 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 I tki proposed action'include cons(ruction or athei--activities that result•in the impoundment of ;NO:- YES ` water or other•liquids(e.g.retention pond,waste lagoons dam)? -' `If Yes,explain purpose-and siie: r F1 "I0.'Has.the site oftheproposed action or an ail oinin i j g property been the location of an active or closed 1Vf3---YES, solid waste management facility? ,AfYes,describe: ,24.Has the site of the proposed action or an adjoining property been the subject of remediation-(ongo'ing or NO. completed)for hazardous.waste? , If Yes,describe:• ; ". I AFFIRM THAT THE INFORMATION PROVIbE ABOVE IS TRUEAND ACCURATE E TO TNS+ 13F5T OF MY I�NOWLjbGE i ,,��jjpp����,,� f • Ap{3licant/sponsornama:,_ \ oC ''r"�'"I�ate: Signature: m 4 Part'2-Impact Assessment. The1ead Agency is responsible for the•completion of Yart'2. Answer all of the,following questions in'Par(2 using the information contained in Part 1 and'other materials submitted by the project sponsor or otherwise available to the reviewer. When answering(he questions the reviewer should be guided by the concept"Piave my responses been reasonable considering the scale and context of the proposed action?" , No;or Njoderate' small to large s s' ;impact impact may may occur occur 3. W,illtlie pioposed.action create a material conflict with an adopted land use pian or zoning regulations`? ry® El i'2. Will tile-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)? LTJ 51 Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? ®' 6. ;Will-the proposediaction;cause aninerease,in the,use of energy,- itfails toincorporate reasonabl available'ener conservation or renewable o rtunities? 1= 1 1�J 7., Will•theproposed.action-impact`existing: Lj�%] a.public/private water supplies? 1 if b.;public,/private wastewater treatment utilities? 8.� Will thi _proposed action impair-the character or quality of important historic,archaeological, ,architectural oraesthetic resources? 'Q1 9. Will the proposed action result in,an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,tlofa and fauna)? Page 3 of 4 i i — _ ----- - - - No,or Moderate I small to large f t impact i impact may may occur I occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? [7-41 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 particutar ; 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 S cumulative impacts. t i i i i s i v nI' 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,determ i ned,-based on the information and analysis above,and any supporting.documentation,-,;, � - ~ that the proposed action will not result in any significant adverse environmen 1 im acts. Town of Southold-Board of Trustees 6 3 Name of Lead AgencyD ate NiV4A, - .T ��d^-! I�-o President Print or'I' pe Name of Resp isibl Officer in Lead Agency Title of Responsible Officer Signafdre of'Respon' le Officer in Lead Agency-- _ Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Town of Southold, ,,,LWRP.CONSIS7rENC-Y--ASSESSItNT FORM A. INSTRUCTIONS L 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 inforination 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 ininor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action Nvill be evaluated as -to--it& siwiificatit _'l;;ienefxoidl aFid�veise dffeGts'u ari thec+�t�stxal's�ienwhi'cl�irtclucles'all cii Soiat�eal+d'I' 3. If any question in Section C.on this,form is answered "yes" or "no", then the proposed action will affecttheachievement of the.LWRP policy standards and conditions contained' in the consistency review law. '1`lttts .elcla,axtswer must lse,e� 1'�aine4 iat alctail..9lstrr bat#ir sit ortaaa autl anon- IUIVnai rtiaag f its. If an action cannot be certified as consistent with the LWRP policy standards and conditions,itsllalrno(be.g!dlerta�s',en. A.copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown,nortlifork.net), the Board of Trustees Office, the Planning,Department, all local libraries and,the Town Clerk's-office.- B: DESCRIPTION O1Ei SIVE AND PROPOSED ACTION PROJECT"NAIVII{a € - 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 Location of action:- Site acreage:, Present land use:. Present zoning classification: V, 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:: . - f (b) Mailing address: -fo p C1'� z (c) Telephone number: Area Code (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? ��--� Yes ,l_rl No', If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. s :DEVELOP-ED 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. QYes ❑; No Not Applicable At a&additional sheets i -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 'LV]rJ' Not Applicable L, Aftac)1 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 Y Yes[ No Not Applicable - ----- - - - - - - - - - Attach additional sheets if necessary - - --_-- — f N 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 T Not Applicable F 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 ',F], YesEJ No IdNot 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. f Yes No Not Applicab e Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies r Pages 32 through 34 for evaluation criteria. Yes i No ; Not Applicable -r f: -k - 1 f Attach-additional sheets if necessary- Policy ecessaryPolicy 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. 5 ' s ;Yes : t - : No Not Applicable S f 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. No� Not Applicable - - - - ,- ----•-- -�...- - ---- - - - - -- Attach additional sheets if necessary - it WORKING•.COAST POL-YCIES Policy 10. Protect Southold!s�water-dependent 'uses,and promote.siting of new, water-dependent uses,id suitable locateon& See LWRP:Section•III-Policies; Pages-47 through 56 for evaluation criteria. U;Yes,YD .ldo [aj; Not Applicable - 4 AtfaNadditional sheets if necessary Policy 11. Promote sustainable use, of living marine resources in. Long Island Sound', ,the Peconic- Estuary and"Town waters. Ste,LWRP Section III—Policies; Pages 57 through 62,for-.evaluation " criteria_. _L=i Yes ;LJ' 14o fx) Not ApplipMble < Attach additional.sheets if necessary - - Policy 12:. -Protect agricultural lands in,the Town of Southold. See LWRP Section III —Policies;,,Pages• ; 62 through•65 f®r.evaluation,criteria. F,Yes , . NJ Not Applicable Attach'additionat sheets-if necessary Policy 13. Promote appropriate -use-,and development of energy and mineral resources. See LWRP 5ectiion III;—Policies; Pages 65 through,68.for evaliuAtion criteria. Yes-.Q:106-0 Not A►pplieable ' PREPAILED B -- — TITLE 90--- �v� DATEt� C� �I SCDHS REF #R10-16-0058 SURVEY OF PROPERTY A T SOUTHOLD "7 TOWN OF SOUTHOLD M AY 2 5 2018 I SUFFOLK COUNTY, N. Y. 1 1 1000-70-04-28 (Pu&tlC Q/Afo) SCALE. Liu NOVEMBER 13, 2015 JAN. 22, 2016 (WETLANDS FLAGS) rp�eo <<lNo) FEB.2, 2016 (PROP. HSE.) 09-25-2017 "Oct.op 72E��) PA APRIL 18, 2016 (REWSION) n MAY 20, 2016 (REWSION) n �eo� 0, AUGUST 4, 2016 (REVISIONS) OF PA OCT 12, 2016 (PROP. POOL) (pu&Uc t�/,vc DECEMBER 27, 2016 (STAKES) 4FEBRUARY 13, 2017 (FND. 1OCA770N) 83' 1114)Z, 0" //v s MARCH 24, 2017 (PROP. ADDITION) OSEPTEMBER 25, 2017 (FINAL) e/. op PA C, r 04�li,lb�ztls CDr op Pi 27t/ t O SEPTIC LOCA 77ON fo, A 8 6D w ,Q, ST 17' 47' sr 10.9' ?6. LP 1 30' 50.5' L P2 Cli 35 40' *100 ,O.y 9.8, ILI SEPTIC SYSTEM Le C (5 BEDROOMS) * ti -Z. 1 — 80 X 5' LIQUID DEPTH PRECAST SEPTIC TANK y, 2 — 80 LEACHING POOLS A& a LOT COVERAGE 8' DEPTH c, J' MIN ABOVE GROUND WATER HOUSE, PORCH 0 GARAGE = 3337 sq.ft. \co \ o,,- 0.,?' WITH j' SAND COLLAR (SW) .1 Ig POOL & SPILLWAY 675 SO. FT s 4012 SO. FT 4012120,384 = 19.7Z N McDONALD GEOSCIENCE ,zo/vc N�t/ 'IOUsTEST HOLE DATA " 9128115 196,�0, EL. 15.0' BROWN SANDY LOAM OL 4+ —-- - 0.5, BROWN SANDY SILT ML sly"D oe, ———— 2.5' 10 PALE BROWN FINE SAND SP QO, r/��� ����F\ �e +\+ ,�*? (b\ 0 EL. 0.5' , 14.5' 6' kN I Nl I WATER IN PALE BROWN FINE SAND SP clt!?n <tqop zo)yz 17' WATER ENCOUNTERED 14.5' BELOW SURFACE KEY LANDWARD EDGE OF TIDAL WETLANDS AS 0 = PIPE DELINEATED BY SUFFOLK ENVIRONMENTAL CONSUL TING INC. ON 12110115 m = MONUMENT = WETLANDS FLAG ELEVATIONS AND CONTOUR LINES ARE REFERENCED FROM NA VD 88 CERTIFIED TO: • FLOOD ZONES FROM FIRM 36103CO166H BRIDGE ABSTRACT N.'r GFH HOMES, LLC TITLE NO. BAL J2065 J- LOT NUMBERS REFER TO "MAP OF CALVES NECK" KNOLLS" FILED IN THE SUFFOLK COUNTY CLERKS OFFICE AS FILE NO. 5673 Z Sl V�Y.,S,-CLIC. NO. 49618 ANY AL TERA TION OR ADDITION TO THIS SURVEY IS A VIOLATION PEC(INIC- l-'ISVqVE YORK,—P.C. OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS AREA= 20,384 SO FT HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF TO TIE LINE P.0. BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y 11971 1 - 212