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HomeMy WebLinkAboutDubin, Morton D II tral, i Michael J.Domino,President �Qsu �7 Town Hall Annex John M.Bredemeyer III,Vice-President 0`ti�4 Gym 54375 Route 25 t Glenn Goldsmith y z P.O.Box 1179 A.Nicholas Krupski 0 �r� Southold,NY 11971 Greg Williams 'y, app Telephone(631)765-1892 fv. Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 29, 2018 Morton D. Dubin II 355 Pacific Street Brooklyn, NY 11217 RE: 75 WELLS ROAD, PECONIC SCTM# 1000-75-6-3.1 Dear Mr. Dubin:- With ubin:With regards to the above mentioned property, on May 10, 2018 this office received a Wetland Permit Application for a proposed in-ground swimming pool and pool patio. The Board of Trustees reviewed the application and determined that the proposed in- ground swimming pool and pool patio are being constructed landward of the Trustees jurisdiction and does not require a permit from this office. As there are wetlands found on your property, a Letter of Non-Jurisdiction was issued for your proposed project which requires a $50.00 fee. As your check #568 in the amount of$250.00 was deposited prior to the Board making their determination, enclosed is a Town of Southold reimbursement check #1168 in the amount of$200.00, which is the difference between the fees for a Wetland Permit Application and a Letter of Non-Jurisdiction request. If you have any questions regarding this matter, please do not hesitate to contact the office. Sincerely, EI abeth Cantrell Senior Clerk Typist Board of Trustees Enclosure rviicnaei i.Lommo,rresiaemry4wI V W11 IIQ71 H1111GX John M.Bredemeye' Vice-President may` yam, 54375 Route 25 Glenn G-.-...lith � P.O.Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams 'y p� Telephone(631)765-1892 ��� �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 29, 2018 Morton D. Dubin II 355 Pacific Street Brooklyn, NY 11217 RE: 75 WELLS ROAD, PECONIC SCTM# 1000-75-6-3.1 Dear Mr. Dubin: r With regards to the above mentioned property, on May 10, 2018 this office received a Wetland Permit Application for a proposed in-ground swimming pool and pool patio. The Board of Trustees reviewed the application and determined that the proposed in- ground swimming pool and pool patio are being constructed landward of the Trustees jurisdiction and does not require a permit from this office. As there are wetlands found on your property, a Letter of Non-Jurisdiction was issued for your proposed project which requires a $50.00 fee. As your check #568 in the amount of$250.00 was deposited prior to the Board making their determination, enclosed is a Town of Southold reimbursement check#1168 in the amount of$200.00, which is the difference between the fees for a Wetland Permit Application and a Letter of Non-Jurisdiction request. If you have any questions regarding this matter, please do not hesitate to contact the office. x . .,T. ,. a-N, " �,-- ;. a1..•rs6'}"k,i„ ..F«'y`4'M TOWN OF SOUTHOLD 116'8 B®ARQ,QF T,OWN�TRUSTEES P.O.BOX 1179. SOl1THOLD,NY 11971` 50-666-214 DM ry TO �. ...I un dry`�o/lis azd_ %/- -5-OLLARS Bridgehampton National Bank ,, ''� 64870 MAIN ROAD n SOYTNOLO.NY 11871 Ke-W I S Rdi&°Dr1� eWWWabrldgeeb eom `�� r�+-�+l 'Kew "- 1 Michael J.Domino,President so yo Town Hall Annex h0 lQ John M.Bredemeyer III,Vice-President 54375 Route 25P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �p� Telephone(631) 765-1892 Greg Williams Fax(631) 765 -6641 l evu e� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 29, 2018 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: MORTON D. DUBIN II 75 WELLS ROAD, PECONIC SCTM# 1000-75-6-3.1 Dear Mr. Patanjo: The Southold Town Board of Trustees reviewed the site plan prepared by Jeffrey Patanjo, last dated May 15, 2018, and determined that the proposed construction of a proposed 20'x40' in-ground swimming pool with a surrounding brick paver pool patio (25'x67' of pool & patio) is out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Please be advised that pool enclosure fencing was not applied for nor was it shown on the site plan last dated May 15, 2018. If the applicant proposes to install fencing in the area within 1 00' from the landward edge of vegetated wetlands, a permit will be required from this office. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary, or within 100' landward from the edge of vegetated wetlands, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional 2 - boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Michael J. Domino, President Board of Trustees MJD:eac Michael J. Domino,Presides � �QgOFFQ(/�C � Town Hall Annex John M. Bredemeyer III,Vice-Pre-iaent ��� `��� 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 Ze A.Nicholas Krupski 1�_ Southold,NY 11971 Greg Williams y p� Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �0 Completed in field by: p Jeffrey Patanjo on behalf of MORTON D. DUBIN II requests a Letter of Non-Jurisdiction for a proposed 20'x40' in-ground swimming pool, 44'x67' overall size brick patio, and associated pool equipment area and pool backwash drywell. Located: 75 Wells Road, Peconic. SCTM# 1000-75-6- 3.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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: AD,-, P_e, pt!!�,o r ej o4- s� ote q i %J/) I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other S k Photo E t Photo 2 (2/24/18) ^o y l t f i rY' Photo 3 (2/24/18) ` i RAF tS" k 4t* F A` Photo 4 (2/24/18) 11 SEE SEC.NO M 04'. 154(U_ 3 WATCH 1.2 --- _ _�._---_ ___�__ ___�__ SiN_ Aq uz a 1BM(c) ! wx 2- B B CHURCH OF THE 1^, 18.We) t8.84(cl OPEN DOOR ! is t 9 A d 9 pyic\ w Is x0 O M1 d > ? 21- c) AeK 172 a 3 t>t_aA � ,a` axNrtS 4J • 11 YppQ 5 WA - T /.SA 2U SOIxE �1Wq Nmf�t o a a.z s> tzo4NOFlmlmnc V .p 1d1 ,BM � g1ldxBlrlxWlq ^9, 11 4.s4qt2 e1 ts. sr d SON OISf NO S 154 i ,s 4 t.a4 uz tz zWq TOWN OF 5.1 souTNOLo s.1 a.14(q 1 teA Zyyd Z C 2M 13 4 � 13 254 p ° 14 qQ a 1 284 O 1 13.17A 1¢ y ut T4Nq 6./A(q , Y 12 SO +° TOWN OF SOUTHOLO M1ay 15.2 �O FOR PCL NO SEE SEC.NO. 2.2A ,3 FOR PCL NO B g SEE S[S.NO. BB601L1012 FOR ML0.24(0 SEE SEC NO g g e �O1 OSY.t OSEE ESEC NO. NIIt wTc. tic + MATCH —_ _—___ ___— UNE W\�1CN _— Z�---_ _——1 11t1 — E MATCH -Z--- ——� � — ___ SEESM Np OM SEE SEC NO(MS oiaECOUNTY OF SUFFOLK © e a eau SECTION NO ._... :.._.„ ,w .... ServlceAgoncyv -- to --�- �` Cantrell, Elizabeth From: Jeffrey Patanjo <jjpatanjo@gmail.com> Sent: Thursday, May 31, 2018 11:37 AM To: Cantrell, Elizabeth Subject: RE: Dubin application Elizabeth, Per your e-mail and our phone conversation we would like to request a letter of non-jurisdiction for the 75 Wells Road applications.As we understand,the proposed pool is outside the 100' setback jurisdiction of the Town of Southold Trustees and therefore a permit is not required. Please provide a partial reimbursement of the filing fee directly to the owner as listed on the application. Please let me know if you have any questions or require any additional information. Thanks in advance, Jeff Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 631-484-9332 From: Cantrell, Elizabeth Sent:Tuesday, May 29, 2018 1:42 PM To: Ilpatanlo@�mail.com Subject: Dubin application Hi Jeff, I left you a voicemail about this. Your application for Morton Dubin appears to be non-jurisdictional. The proposed pool, pool patio &equipment area are beyond 100'. Is there something else that we are missing? Please call me. 544" &WlevA Senior Clerk Typist Town of Southold Board of Trustees 631-765-1892 S�FF0L/( Michael J. Domino, President �o�A �OGy Town Hall Annex John M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith CO z P.O. Box 1179 A Nicholas Krupski �y • Southold, NY 11971 Greg Williams dol , �a� Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES TO: SOUTHOLD TOWN BUILDING DEPARTMENT RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQU D EON 1 1 2018 7.x 4— BUMDIlNG DEM. SCTM#: TOWN OF SOUTHOLD Property Owner Name: NON Date Sent to Bldg. Dept: 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? 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? COMMENTS: Iryuff 'e> 025' S, CYC Uy-J- Se-� ack No ?LA mbis a w a vik-d ice IVed 5 A4 I/ Z� 5 � ure 'o Reviewer Date May 15, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 1 VE P.O. Box 1179 Southold, New York 11971 tAY 21 201 RE: 75 WELLS ROAD- PECONIC SCTM No. 1000-75-6-3.1 Southold Town REVISED PLANS Board of Trustees Dear Trustees: - We hereby submit one (1) original and three (3) copies of the revised plans showing the 25' setback from proposed pool to the property line as requested. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Ve truly yours, )eLffreyy P.O. Box 582 Bohemia, NY 11716 uTy Michael J.Domino,President soTown Hall Annex h0� Ol4 , John M.Bredemeyer III,Vice-President 54375 Route 25 J [ [ P.O.Box 1179 Charles J.Sanders en Southold,New York 11971 Glenn Goldsmith �� Telephone(631) 766-1892 A.Nicholas Krupski Olif'C�U{�.{�9 W Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal ErosionPermit Application Wetland Permit Application Administrative Permit � {{�; Amendment/Transfer/Extension Received Application Received Fee: $ Z50, Completed Application: MAY 10 2018 Incomplete: } ! SE RA Classification: Type I Type II Unlisted `�-" "` , ' Q Yp — YP ' S�utfirlc?noon Lead Agency Determination: ' Boald of"5 � LCoordination:(date sent): ►/ LWRP Consistency Assessment orm Sent: CAC Referral Sent: 5`3a< —Date of Inspection: 6 13,t Receipt of CAC Report: Technical Review: Public Hearing Held: aZD� Resolution: Legal Name of Property Owner(s): AA®r+q n ®®n u- Mailing Address: 3 5 P4 c t•FI C- sT• Q(V®1<lVe) , rj1 17 Phone Number: 6 `i - 3--t ° _q`l q 5 Suffolk County Tax Map Number: 1000- -7 - b - 3 •I Property Location: -7 S H 1 e 1I 5 4®CaOC. Pt C 04 15-z _ see LoeA41on lne4e (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: P. O . (3o x 5-34- 13 A e'---1 ee'L, /Q I 11-7 16, Phone Number: 6131- g 8 y - 13 3, -- Board of Trustees Applica"on GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: Rc S Intended use of property: ��S 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 ✓ 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 Does the structure(s)on property have a valid,Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date i 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): �N ST f( 2 0'x,y o' ' N -9 rP.JN4Q Poo L w1 q4 `x t7I overall Si -i�e, brrc(L ft+tc, 4JSaGlw7t,-ecQ pop --lVieni .il-t, ntL baGlc&JL"s op 1 Hoard of Trustees Applica"On WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: _ S-r , I! 20'X40' i^� - 7 f- POOL A 12-C GGA-( .ENJQ 1'ac1(-1..0^S4 GPr.'wcrL( Area of wetlands on lot: square feet t Percent coverage of lot: _ % f Closest distance between nearest existing structure and upland edge of wetlands: /at feet Closest distance between nearest proposed structure and upland edge of wetlands: 11b,I feet Does the project involve excavation or filling? No ✓ Yes If yes,how much material will be excavated? 10° a cubic yards How much material will be filled?, cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: p Manner in which material will be removed or deposited: —w"r°A— Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): 11 n $ L4 Cn GG w l 6e- c✓�s-e.-Ilea -('r. P r--f'ia + We-T 14wtoS c i - Short Environmental Assessment Form Part I -Project Information Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: Proposed pool at 75 Wells Road Pecornc Project Location(describe,and attach a location map): See location map Brief Description of Proposed Action: Install proposed 20'x40'in-ground pool with associated drywell and equipment Name of Applicant or Sponsor: Telephone: 646-320-9449 Morton Donald Dubin II E-Mail: annam785@gmail coin Address: 355 Pacific St City/PO: State: Zip Code: Brooklyn NY 11217 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: ❑ ❑ NYSDEC-Town of Southold Trustees/Building Dept 3.a.Total acreage of the site of the proposed action? 1.54 acres b.Total acreage to be physically disturbed? 0.05 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 1.54 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban E]Rural(non-agriculture) [—]Industrial ❑Commercial OResidential(suburban) ED Forest ❑Agriculture ❑Aquatic EJ Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ ❑✓ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? F-1 ❑✓ 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:Name Richmond Creek and Beach,Name:Peconic Bay and Environs,Reason.Significant coastal fish& ❑ wi i ehabitat, eason ro ec pu is health,water,vegetation, scenic eau gency, ou o , own f-&aettcn.s- 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? W] ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? W1 ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: W1 ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: Z ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Z ❑ 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? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland El 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 DYES ❑✓ ❑ b.Will storm water discharges be directed to established conveyance systemsrunoff and storm drains)? If Yes,briefly describe: In NO AYES Page 2 of 3 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ® ❑ 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: a ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponspIname: Morton Donald Dubin II Date: tyuk (A Signature: PRINT FORM Page 3 of 3 --EAF Mapper gumma., 'Report , d`Monday, April 30, 2018 8:44 PM Disclaimer: The EAF Mapper is a screening tool intended to assist project sponsors and reviewing agencies in preparing an environmental assessment form(EAF) Not all questions asked in the EAF are Q• answered by the EAF Mapper Additional information on any EAF question can be obtained by consulting the EAF Workbooks. Although _ the EAF Mapper provides the most up-to-date digital data available to DEC,you may also need to contact local or other data sources in order "0' 4;,, to obtain data not provided by the Mapper Digital data is not a substitute for agency determinations .fxo rhtt;lV:1 Glaailre�al /'�'�1_y,m-,��._7. ,13�;�' . .. .-;f.?�,..''i.."��'7•�^ £«�.,r:. 'Ray.ilit r'; Tr oroait'b Detfolt Sru 'e'i;1EEPE.Garmin,LtSGS;' rw, fev 9lratl ly .¢'�uaaldence Int4j<crrmsp, NtREroIENT.F;NRCsn,Esii lspsn;rogE,h Es i:616(Hang Kong),Esri t;j„_j `' ".S�tcr�r7Eso i;i IERE.Garmin, 'Es. , ,', 6�a�tvtaiergli” penStre�¢tt ap Icch tutors,,and the:GIS i� Colu buc, ' �_-p J,i,RC n.Estap•, Ip1JCREr�IEN T, _:�!._S;,.FI?>s"�£:an.EseiSs sr,,t11ET,1. Use Cmmairiirlcinnatt ° + $qC'tb1na THcng ng)),Ess ri; Part 1 /Question 7 [Critical Environmental Yes Area_] Part 1 /Question 7[Critical Environmental Name:Richmond Creek and Beach, Name:Peconic Bay and Environs, Area- Identify] Reason:Significant coastal fish &wildlife habitat, Reason:Protect public health, water, vegetation, &scenic beauty,Agency:Southold, Town of, Agency:Suffolk County, Date:10-20-88, Date:7-12-88 Part 1 /Question 12a [National Register of No _ - _ Historic Places] Part 1 /Question 12b [Archeological Sites] No Part 1 /Question 13a [Wetlands or Other Yes-Digital mapping information on local and federal wetlands and Regulated Waterbodies] �waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15[Threatened or No Endangered Animal] Part 1 /Question 16 [100 Year Flood Plain] Yes Part 1 /Question 20 [Remediation Site] No t Short Environmental Assessment Form - EAF Mapper Summary Report 1 Board of Trustees Application AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. TETE 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 Bli THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signat roperty Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF 2 No ry Publ +-**1?yjNP&010O6087040 AWSElA M.FOABE5 udic Sub of Now York Quad in Qumns ooun rh M/rr Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, AV r+o„ A 1� , owners of the property identified as SCTM# 1000- -7 S - " 3 l in the town of P,e C 0 n I c— New York,hereby authorizes F�r 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. Property O er's ignature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF _ ,20 AA N fary Pub . C ,'1 DELA 1J1.FORBES Yotavy Public,State of New York No.Al F050670$6, 0uamod in Owens 06un �^ Cmnihaslo Exp'ff►s 0c' 7.21_•/ e ' 1 AppucANTaGrimwi Pum.NTATXVE TRANSACTIONAL DISCLOSURE FORM Tito 's d oEthic ' ' c i n the w c a n et c a unc iorin to nmvide inforinntion which can alert the town of c)ssible conflict&o ' g n w't take wltntever action is necessary to avoid same. YOUR NAME: 17•� Ia t „ f N�u r-�o it v g w L l (Last name,fust name,.spiddle 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 ofitccr or employes of the Town of Southold? "Relationship"includes by blood,ntnMage,or business interest."Business interest"naeams a btrs'rnss, including a partnership,in which Ilia town officer or cmployec has even a partial ownership of(or employment by)a corporation in which ilia town off icer or employee owns more than 5%of ilia shares. YES NO ✓/ if you answered"YES",complete the balance of this fort and date and sign where Indicated. Name of person employed by the Town of Southold Title br position of that person Describe ilia relationship butween yourself(the applicant/agei)Urepreseittative)and the town officer or employee.Either check the appropriate line A)through D)andfor 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%or tite shares of the corporate stock of the applieont (when the applicant is a corporation); B)the legal orbcncfrcial 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 Submftted thi 9 qday20 !S Signature to Q Print Name Form TS 1 APPLICANT/AGENT/REPRESENTATW E TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the marl of town officers and emnlovices.The nurnose of this form is to provide information which can alert the town of possible conflicts of thterest and allow it to take whatever action is necessaN to avoid same. YOUR NAME: �� -re (Last name,first name,Middle initial,unless y u 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"Othe(',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,nl irriagc,or business interest."Business uiterest"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 applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in(lie 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 applicPnt (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 corponition); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 3 c day f A(14 r L 20 ) Signature--iy �1 Print Name J,k2(, -U _— Form TS 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 si Mi beneficial and adverse;effects upon the coastal'drea(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, lasting 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# -7 S PROJECT NAME (!oa(_ (&2 - -7S- well 5 f ec•-i I c-- The Application has been submitted to(check appropriate response): / Town Board ❑ T Planning Board El Building Dept. El Board of Trustees E 1. Category of Town of Southold agency action(check appropriate'response): (a) Action'undertaken directly by Town agency(e.g. capital 0 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: 7owt Lig ' X L7 ' QjL tiv a n.c9 .4 fS ve la�ek POC. C�u1P/�t a n� k+-,J2 1 Location of action:_ Sc l I s (��:eQ_ . ��cow c Site acreage:- / 72 Present land use: f 2x S Present zoning classification: 90- 2. e2. 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: o t+04 pu Io n 1 (b) Mailing address:_ _B (&r IL 1 L J i l a 1 7 (c) Telephone number: Area Code( ) _ G y 1O 3 x c) '1 q L19 (d) Application number,if any: iu] 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?+-"-t 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. DI+JVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. 'F�f , Yes ❑ No ❑ Not Applicable pr, sG C'an Ct s r -r do u C ha rKC -4^A -,ces• - - Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LMW Section III—P oliges 3 through 6 for evaluation criteria 11 Yes ❑ No 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 ,Q No Not Applicable ' t 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 through 16 for evaluation criteria '❑ YesE] No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes F] � 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 c iteria. Yes No Not Applicable Attach additional sheets if necessary ; Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III -- Policies Pages 32 through 34 for evaluation criteria. ❑ Yes No Not Applicable s 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 1:1 No U 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. ElYeO 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 �ot Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ; { ❑ Yes ❑, No � Not Applicable Attach additional sheets if necessary i t Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III —Policies; Pages 62 through 65 for evaluation criteria. Yes r:1No E Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies, Pa s 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY eek Ta.-i o TITLE A jen+ DATE • 3a-I g F May 8, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 DE C RE: 75 WELLS ROAD- PECONIC SCTM No. 1000-75-6-3.1 MAY 1 0 2018 APPLICATION FOR PERMIT Southold Town Dear Trustees: f u We hereby submit one (1) original and three (3) copies of the proposed plans, application and check for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 S.t fid to mme M !l 5 pw IIA+.i}.C;jih:�' •, i 7 j &w 0 w~1 _ rO^ a r lltlwK re arII�IIt�o ,r ,A I. LAW .� ''� � talDrlt IrETtAM[�5 . AS $MOM dN F%fD kW nAV 1 , t t � •�. Ak t L � AOL f mom ,r t 40"OM SWW A49 ORM MV �.. a!Aa_ Cie x'- AMES MO a 040 MUM AMM F I �I� � arl"aft allnlr ,, Olt�Ir Ia ��EIItaltr�,r �.AaI.W i9cO�r rsa ar IWn�tr rplR su .., »K liKl IIID!t m or A" 4�4AW C v An iAKr row vu caft" 040" Ow ` me too"mol%mk _,�ft,ag�` /�I �y K r . gp--'.Y. .:. ,mss.f• a a'/f1' �� +'^"r'►Pm of 40 dmw Ks+ f 40 AW 0OFI.i�LlS Mei I her!QM of VAP JF' It aRnM lot WORM D, oUghFMT O. T. sem» as ftvcmwc %OTMX C*MTY, WW YMo( Volvvll, iftomw LitI #r►e t tM# a�cat '•gip' ar,� i3. 2015 P-0.� "I tf w"' 14W Yeft 1111 fYt t = AC050W-- r+11t (mil me-sim r OST .rrarr .a.wK of arlw♦ O.,n..tr • w... tt �..,. PaA7F1AA�1f1 as"k! � . V� C,�irrtry PM aft,I Id Town T • �� swap L epa?'men& •�� .'� 9 OO' 7D75WeHsRoad N to k R i"I Vwqs A%Ao Body 1 O TreA '13 J r Y��!er., PROJECT LOCATION N.T.S. tl ` c O � PROPOSED POOL DRYWELL PROPOSED POOL EQUIPMENT 140 Q J 1L 41 d C loe ��3 PROPERTY OWNER: MORTON DONALD DUBIN II 00`pG��o / 355 PACIFIC STREET / BROOKLYN, NY 11217 VEGETATED WETLAND BOUNDARY AS IDENTIFIED BY J. PATANJO ON 4-29-18 (PHRAGMITES) PREPARED BY: AND AS SHOWN ON FILED MAP JEFFREY PATANJO / P.O. BOX 582 / BOHEMIA, NY 11716 631-484-9332 PROPOSED 20' X 40' IN-GROUND JJPatanjo@GMAIL.COM POOL W/ BRICK PAVER SURROUND / cp FTAX L PERMIT DRAWINGS SCALE: k AY 10 2018 ' 30 NOTES: �O '� DATE: G D PLAN & LOCATION MAP3-2'-"1. PORTIONS OF PLAN FROM SURVEY PREPARED BY: SKENNETH M. WOYCHUK LAND SURVEYING, PLLC "'� ``'` "" '� " ' 75 WELLS ROAD LATEST DATED 10-16-17 ONIC, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: MAP N0. 1000-75-6-3.1 1 of 1 Bdarcl,ftSod 9 ' ✓f bc'"Opon Florist CaLvrtry Petals/ • d To+Nt► tron+tte�lx�M +y 35 Wells Road v C sr _' . f3CCF}iSj}°ft Ft>s►ltfX r'• a^ �'� . �1 R�\�CSlt#Stlk14L.. tig< t #cat Class Am f-M Custom Tseattasr t <0 � S° -70 PROJECT LOCATION s , � /., N.T.S. / \ �� y 4, .v �• .� v� 4e PROPOSED POOL DRYWELL y PROPOSED POOL EQUIPMENT 'O ��'► 140 O y 1 X0.0 �L°' PROPERTY OWNER: ��! '3 0 MORTON DONALD DUBIN II �l G2�� / 355 IC STREET BROOKLYN, NY 111217 VEGETATED WETLAND BOUNDARY AS IDENTIFIED F��,•. BY J. PATANJO ON 4-29-18 (PHRAGMITES) PREPARED BY: JEFFREY PATANJO s. AND AS SHOWN ON FILED MAP P.O. Box 582 BOHEMIA, NY 11716 631-484-9332 44' PROPOSED 20' X 40' IN—GROUND JJPatanjo@GMAIL.COM POOL W/ BRICK PAVER SURROUND •� .. z-. � � SCALE: v'. D "-- =-� "_— FPECOMIC, L PERMIT DRAWINGS 1.=30' 2.• / G)� DATE: PAY 2 1 2018 3-27-17 NOTES: �6 D PLAN & LOCATION MAP 5-1s-1s 1. PORTIONS OF PLAN FROM SURVEY PREPARED BY: oKENNETH M. WOYCHUK LAND SURVEYING, PLLC • 75 TELLS ROAD TOTN OF SOUTHOLDSUFFOLK COUNTY, NY SHEET: LATEST DATED 10-16-17MAP N0. 1000-75-6-8.1 1 of 1