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TR-9316A
Michael J.Domino, President hO�OF SUyOIo Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �O Telephone(631) 765-1892 Greg Williams I�COU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1522C Date: October 19, 2018 THIS CERTIFIES that the as-built 8'x16' deck installed on the seaward side of the dwelling; At 12244 East Main Road, Fishers Island Suffolk County Tax Map#1000-3-2-6 Conforms to the application for a Trustees Permit heretofore filed in this office Dated September 4, 2018 pursuant to which Trustees Administrative Permit#9316A Dated October 17, 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 as-built 8'x16' deck installed on the seaward side of the dwelling; The certificate is issued to Sarah Tremaine owner of the aforesaid property. Authorized Signature O�� (/j�,o Michael J.Domino,President QF S0 1 Town Hall Annex John M.Bredemeyer III,Vice-President ~ 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �pQ Telephone(631) 765-1892 Greg Williams �y`,oU '� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9316A Date of Receipt of Application: September 4, 2018 Applicant: Sarah Tremaine SCTM#: 1000-3-2-6 Project Location: 12244 East Main Road, Fishers Island Date of Resolution/Issuance: October 17, 2018 Date of Expiration: October 17, 2020 Reviewed by: Board of Trustees Project Description: For the as-built 8'x16' deck installed on the seaward side of the dwelling. 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 Chandler, Palmer & King, received on August 15, 2018 and stamped approved on October 17, 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. Michael J. Domino, President Board of Trustees President Michael J. Domino, P �ptiFQI�CG 'Town Hall Annex John M. Bredemeyer, III, Vice-Presidentyah, 54375 Route 25 Glenn Goldsmith y x, P.O. Box 1179 A Nicholas Krupskio • o � Southold, NY 11971 Greg Williams ~y�''ol , �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 % constructed When project complete, call for compliance inspection; C 'H_& COWOU NT COVE S ITE 25� ®-2 25-A 1977 - 19-8 19-9 Mcx.1UN�.lT '19-6 �� 0 / 21 2 \ ; 19- i � rn . 21-10� \� 19- 5 19-419-3 3 13 / ® / Port►ort 1O" 19-2 Rafferty • !� 20-2 MIDDLE a 20-I FARMS PONp • L OGAT t c)" MAP I"= A-cc; 40' 1. -- -- 12 -- —EXISTING CONTOURS �&LOcy_ 19 L-0-F 8 l 2. +8. d EXISTING SPOT GRADE Y11JGA1.1�- s 73. 0 U) 3028.(003. r2 PROPOSED CONTOURS �I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL AND CONSTRUCTION OF ;_ ;SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCE AND \o 4. + PROPOSED SPOT GRADE HILL ABIDE BY THE CONDITIONS SCT FOR THEREIN •- - - --- __ -_ --- = -= _ _ _ -- -_ _ . _._...�.__��--- - ._ _,_ _.._W_..____..-- -.... __ . - . .. __.. _���....-.._._..�.._ __ � ._._._.._-._.._�......_.____._.. �' , 12.5 s 34 z8 40" IE 3sq.o9' � ,\ ..^ � CONSTRUCT. ' ' \ q 5. to,a INVERT ELEVATION APPLICANT --�_ _ �!_J 6. s — BUILDING SETBACK LINES \ 7. BASE FOR LEVELS; NGVD �; :Z \ TOTAL 1�1Z�A 1 moo' 1 r B. PROPERTY TO BE SERVICED BY MUNICIPAL WATER AND ON SITE � \ \ SEWAGE DISPOSAL SYSTEM1; I -� in 9. SUFFOLK COUNTY TAX MAP REFERENCE: 1000-003-2,6 I 10. COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC SURVEY TRIANGULATION STATION "CHOCOMOUNT 2" : / o 'i+ SEPTIC SYSTEM )ESIGN � E) �\ 1 N TEST HOLE DATA 9/19/85 1p \ r } 1. USE ONE 1000 GALLON REINFORCED PRECAST CONCRETE SEPTIC TANK oc&G, " TOPSOIL • `.� I '' �� � �'�" ��''' • � / � / � � J 5"-22" SANDY SUBSOIL I� p� G 2. USE THREE 8 FT. DIA. 4 FT. HIGH PRI'CAST CONCRETE LEACHING POOLS ((Vp'out4 / VU\ i 22"-100" SANDY TILL (MED. COMP.) kiJ �c 100"-132" SAND 3. USE 4"' DIA. j CLASS 2400 PIPE THROUGHOUT WATER AT 120"_ Q r I 8eUCA MM �`\ h.�p�`( *13.s lo 4. USE COURSE SAND AND GRAVEL FOR BACKFILL MATERIAL »� 00 TOP of W)5 4;7,&C1L IL n -QI 1 q � 1 \ ` ( / ;I s 34 24' 50" lzf Q- n4.2s' _C \v NcP �� w \ I �� AUG 1 5 2018 : "c} ��'alir,7,,j'1Cvd� �. \ / \. �, 1 oa, of Tr J es \ N \ 2s 3c,' " + (` -7 ; \ \ \\ \- vMEN ?ZtR ED M2- -T2 2- -T2 JUS,�11J - ', i5 APPROVED BY ISL.AuD, Ulfu ?ov-v- \ ToP cm- Mol.!u Mla1.IT o� IX ° AA \o" _"O - t�wp Z1.04- �=., BOARD OF 1 RUSTEES 20 to o zo - !v TOWN OF UT SOUTHOLD C Le't ► -2d DATE OCWC-e 7 2oi8 C1Als...1DL eZ , PALMEZ_ 4 Y-I l.1(, u`l���'" �,��•-c"1`�' �,� ___... MA1ZcN q, 1989 \ ,d,DUtTl01-iS sS�;'iz.1L �1 ,19g� - ��V1S10U S M.b-�! Zco, 19gq r n -T lI2 Michael J. Domino, 1 lent O�off0t4- Town Hall Annex John M. Bredemeyer I1I,�Vice-rresident y�� 22,' 54375 Route 25 Glenn Goldsmith P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams ®! Telephone(631)765-1892�� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �0 u °� Completed in field by: 9)0 SARAH TREMAINE requests an Administrative Permit for the as-built.8'x16' deck installed on the seaward side of the dwelling. Located: 12244 East Main Road, Fishers Island. SCTM# 1000-3-2-6 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 o Baring 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: �- (2 I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: Bredemeyer M. Domino G. Goldsmith / N. Krupski Williams Other J GO = \\\\ \\ w\ 1 d) M (D q \ ._ co 19-1AW � &00 SI TE 19_8 19-9 /19-10 i Q. Ca .> V \ \ I 19-9A n W -2 Q U \ \ Q a > f � i \ \ PORT PO RM U cn 19-2 _ \ \ 19-3 3-2-13 V .5 L V Lu W Cv cy 19-8 BLOCK 19 LOT 8 \ I `, ,- 19_5 19-4 cn > = N NIF \ 1 i co00 00 JEAN N. CALHOUN i / 25-1 W (n QPT i "`� '�� 11 V 1 I I21-1 20-2 fJ{ 7-4. 7-4. MU M 1 I 2,-2 LAND ST MERESTONE \ \ \ S 3V28'400 E (FOUND) I `` �-�� �k RAFFERTY o 359.09' 20-3 \ N WOOD SHED ,` 20- yO \ \\ S:73. 10 1 11 Hampton F. PotterIII W.3028.60 1 p LOC "_ ' I LOCATION MAP SCALE 1 400 MAP REFERENCES ��'.� � � ~'10 \GCZ�c\ LEACHVAREA _\\, 1 1. SITE PLAN PREPARED FOR SARAH C. TREMAINE BLOCK 19 LOT 7 y \ \ �o I 1 Q I FISHERS ISLAND, NEW YORK, SCALE: 1"=20', DATED: MARCH 9, 1989 if f".' '` ,,£.'t w O \c. N \ 55' 3 i i Z LAST REVISED JUNE 25, 1990, PREPARED BY CHANDLER, PALMER & N' 9AA 7J \Gpoc� \ o KING NORWICH, CONNECTICUT.1O ," .�- ofie\ BUILDING 30 \\`�---------------------------- 044,n"r Z SETBACK LINE Z BURIED OIL 'S ti PHASE 2 TANK \ i i 1. THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE _ INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE 0 'p 3 1 I Q PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR \ GRAVEL DRIVE & PARKING EXCEEDS THE SCOPE OF THE ENGAGEMENT. SEPTIC TANK ,�� ��� `�� 1 ,_J (� \ �' `� �� ;� i 1 2. IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY ` 1 PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. DECK .;.''"r;.:;::::...„::. :."'T:: \ i �\ \ 1 \ �� 1 1 I 3. ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND \ ,�, I SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL }: \�-------- \�� Q 36 \ \ i ARE THE PRODUCT OF THE LAND SURVEYOR. C DECK I'" \ 1 COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND 4 o \� EXISTING PHASE 1 \\ \� ._i Ui j GEODETIC SURVEY TRIANGULATION STATION "CHOCOMOUNT 2" w z. RESIDENCE \\ ; . � GARAGE:;;;;: i COUNTY OF SUFFOLK TAX _ Z � � I �: � 1 SITE IS E U Y -� 2 \ 40' MAP 1000, SECTION 3, BLOCK 02, LOT L 6. Q p \ 1 Q O \ 1 6. TCTAL AREA = 1.81± ACRES. O > ILJJ 7. SITE IS LOCATED IN ZONING DISTRICT 8120. Q 8. PERCENT OF LOT COVERAGE- 4.2%. ALLOWED- 20% 0 STEPS \ 1 , r \ \ } W SCREENED; \ 1 W � H Z p PORCH \ _—i — —S 34!24'50* E —— — Of �Q U Q �1 � \ \ ; i RADIUS = 174.25' w W cn CM Of Y ❑ Y STEPS a' _ U Z O �� 1 \ N W O\ ' i \� NQ N U o 1_1._ � Os �Z\. � Q STONE \\ \\\ V) �1 IRA • I WALL \ \ I BUILDING \\\ \\\ SETBACK LINE \ \ \ 1 \ 0 \\ \\ STS y0. � _ \ \ \\\ \\` \ S 0 \ \ m C) MERESTONE \\ m \ �FOUN�) �\ \\ z \ c'N cA�`� \\ rn o 48 a 7 O \ 53.25' Z _ a \ 8' DIA. \\ `� \ m N 2536'l0• w \ BOULDER O `� \\ \ O cn Ld j ;r, \ S:203.8 \ �O W \ _ F W:3193.60 \ y �Q \\\ \\\ \ > 306.85 » \\ `\ \ tl I AUG 1 5 20 w ao ��. '�o w o OLLJ . \ \ �� SoJtnOid TOvfn o N \<11o \ \ \ \\ Z BLOCK 19 LOT 6 - N/F a \ CRAB COVE LLC Q 0 o 0 00 N m 04 L� 1 04 ..: ...... .. \ LEGEND Li O O o Q Z w PROPERTY LINE o o 2 Q w 00 w ABUTTERS LINE -- a m o o o NOW OR FORMERLY N/F DATE: 07/20/2018 \ BOUNDARY POINT O MERESTONE ® SCALE: 1 �� = 20' QUALITY CONTROL CERTIFICATION GROUP REVIEWED DATE PHOTO e PROJECT: # 2018815 PROJECT MANAGER SURVEY ENVIRONMENTAL CIVIL 20 10 0 20 SHEET STRUCTURAL GRAPHIC SCALE IN FEET 1 OF 1 ARCHITECTURAL Wk ' 1 ~*' ti i r I Z �y � �1 ',y _ . �*�- •s, fir. +rf. ,�,� '`S !�6 '� r' t. .�:� ;S ; � ,J;' •►$: �. `� , �F! t r' rte` K �_4 }• ` ' t r;:p:. �L �'� J i _, � -its . ��1 r'•(S` �. r _,•,�'•• rfr�• ,•�,Y'�1 ',�`.• R. �' 't ,r r • ��r rte. 7 r 1 ��ii'M'r �'b •q •r,�i{r••►-..,`t. } raj°' r. \ • l�f ,� � :f�' t �^ �`�r/ji� S ',/''�rC 't�irT ^i' "' � /.�'�M'!—.�, �M�` y, �,,,,�, r� ' 71, All " .�•'��y'.t i.' -' .. t;�"' r v�� 1if/ �y+ t r',�` �`� 7• �Y. r r r ��� .. �'' ..yrS .'�-_•�„� -,` ' }r f "r �,.,{ S /l r' n ,,s. � i. 1R�.: 1f. ^, 5 •`�'�f .i� ..•. ,.5 . f'r��+r,.�,� ,�rI /.�rF rr f �F�7 1�j�l`` ra ^.l , r'�3'r+ri. i }��� �t. f'Yrr .'"lr r� .� 1's 'Y --.- ?` . � �'-1. � ray '��i �i'•M r. low 41 or -.ttip��r5 rr ( ` �.� ,r ' t -. ,may.� Q �` t r � ''�, i �, .. / ` •-} '.. ,..'•;. r�+ ��� .1. 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M i a a I Y SOUND Sea ._� ISLAND 20A of O PERS It O 5 pp e.M m K Sz K at 2A ].sA IWL 1'3. et 0 tea ++ P h \.. /B B FO.y� 1 �O T 1 ea / to 3.1 3.3 xM 20uq 'Qo 12 t 2.OA e �. 1 11.2 12 J zM 2Buq 2'M 111 17A 23 I� PRryA ee t eAlq O 17A I.IA a teN4 e e 21a(c) ) I 2.2 VA 26a10, B ry I ♦ B t] tBA(q 10 O 2tA V/ t+ I'm FOR PCL.NO. ♦.3 SEE SEC NO j O e � "• m ooA.osoos 10 2.3 iM] B 2.]Alc) 5 11A(q III • "•rL ZeA 2!A ZIA 3 I y SM(a 3 Y 13 5 5OA ' R� 2 I I SBA(l) 9Tf I 9 2.tA < �2 a _� ;P 3,11 22A(c) �`) ♦ 3 2lua :ait�' ten(U 'E p,, zaMc) Z A(C) 3.13 ] C ] s.4A(C) Pi. xz ten © Awa 112 �.+ 2110) 5 " J ' /a \ e S2A(c) ' 2p- 111 3.18 6m MiO f,Fa,ms PoM B.1A1sNc) .p" FOR PCL NO FOR PCL NO. I ,m PO 6.1 SEE BEC NO B SEESECNO. i aae-mice -am 1 - 3 ��1? •". wTc ! _ _ B eF£BB.Iq 001 —�--4N MATCH —.—_ —` MINE (21) NOTICE saN(l, COUNTY OF SUFFOLK © E �n � BglnlOLD SECTION NO Real Property Tax Service Agency v µn „����.,w<> o —_— �� --,�-- t...�.— w•mY c.•e..w..n+.a.Nv nam ® � $ p77 tee0 PROPERTY IMP r 8 OFFICE LOCATION: ��OF SoUryO MAILING ADDRESS: Town Hall Annex �� l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) G Q hone: 631 765-1938le Southold, NY 11971 � • a0 Telephone: O Fax: 631 765-3136 W11 1 11 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: October 15, 2018 Re: Local,Waterfront Coastal Consistency Review for SARAH TREMAINE SCTM# 1000-3-2-6 SARAH TREMAINE requests an Administrative Permit for the as-built 8'x16' deck installed on the seaward side of the dwelling. Located: 12244 East Main Road, Fishers Island. SCTM# 1000-3-2-6 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is INCONSISTENT with the below listed Policy Standard and therefore is INCONSISTENT with LWRP. Policy 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. The 8'x16' as—built deck was constructed without the benefit of Board of Trustee review or permit. 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 i \ l� s Y� Michael J. Domino, President gUFFO(,�eoG Town Hall Annex John M. Bredemeyer, III, Vice-President y� 54375 Route 25 Glenn Goldsmith N P.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams �Ol , dao Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEE D =CEIVE D SEP 1 2 2018 TO: SOUTHOLD TOWN BUILDING DEPARTMENT Uq(;D • RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQUIq ®�®I,D SCTM#: Property Owner Name: 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: 11 Al U 4siginatur of Reviewer Date p �t I � J Michael J Domino,President �gyOf SO(/TyOlo Town Hall Annex John M.Bredemeyer III,Vice-President jw 54375 Route 25 P.O.Box 1179 Charles J.Sanders ac Southold,Now York 11971 Qlenn Goldsmith Telephone(631)765-1892 A.Nicholas Krupski �y�U Fax(631)765-6641 J BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application SEP - 4 2018 Administrative Permit AmendmentlTransfer/Exten off} Received Application: `fe` �� Southold Town oard of stees 2tReceived Fee: $ 900'W —14S-13va— Tr C Application: lZ•(g lops'' Incomplete: T __,,v/_SEQRA Classification: Type I_ Type II�_ Unlisted Lead Agency Determination: Coordination:(date sent): LWRP Consistency Assessment Form Sent: •T.CAC Referral Sent: q,26,6 `/ Date of inspection: 1040-187 Receipt of CAC Report: Technical Review: Public Hearing Held: !0,l Resolution: Legal Name of Property Owner(s): o- m Aj C Mailing Address: 3(0 2z-Cj3-z-- Phone Number: 4 FA — -'94z? -pvsk - s em. - 2ca Lo`r Suffolk County Tax Map Number. 1000- O 0 — Co Property Location: 12,-2,4 A '�Z dLi;� i-s_ (If necessary,provide LILCO Pole#,distance to cross streets,and location) AGENT(If applicable): Mailing Address: Phone Number: GENERAL DATA Land Area(in square feet): 1 pc-g, _ -Qz 96 4'54v 50.1 Area Zoning: 1z -12(7 w Previous use of property: -2- _ Intended use of property: ®✓ 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?__LYes No Prior permits/approvals for site improvements: Agency Date ►fit.'-(Z M &J _ kG , 1CISC) ` a lc�a `fir Lk I -2bF- + No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? y� No Yes If yes,provide explanation: Project Description(use attachments if necessary):. C Agg=�VS, Ut Zy S roc, iZ�� C UJ pia oaO4 °1I ➢� , Qv mss' V,3 r WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: �ic nr\.`c-A- A-o pd e bje:!�AfA i� ® y_ 0 X I tof Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? V' —No- Yes If yes,how much material will be excavated? 1 cubic yards How much material will be filled? _ cubic yards Depth of which material will be removed or deposited: feet 1J/A- Proposed slope throughout the area of operations: Manner in which material will be removed or deposited:' 1 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): p 5 JL �C.�S YLGI.C� l�C) I tv I�QZC." b . CKXUA2_t roc., V XL'�C, QQ- &k-A 40 C CV.._skv� uod_-5 \-,o 617.20 Appendix B Short Environmental Assessment Form Itistructions.Tor Comnletin 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 l based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: `moi 2eM a��ma c.( Project Location(describe,and attach a location map):. Brief Description of Proposed Action: 1n L ac 1Gg�t - Ago � �-leo ,�Q i 1~• C �` X 1(O`> ,yE-p�-�C.r� �'�-�— 1rv� �.C�l� � `"1^�S Name of Applicant or Sponsor: Telephone: 454 --..�4oa_® 1 { I;t-j t E-Mail: Address: `C A 5M(V City/PO: State: Zip Code: 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 o� 3.a.Total acreage of the site of the proposed action? _ acres b.Total acreage to be physically disturbed? < 0-A—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. []Urban ❑Rural(non-agriculture) [-]Industrial ❑Commercial OResidential(suburban) ❑Forest ❑Agriculture F-1 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? ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 1�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: _ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NCO{ YES b.Are public transportation service(s)available at or near the site of the proposed action? (YJJ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? LMri C ❑ 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: ,i1��_ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: {�j ❑ 11.Will the proposed action connect to existing wastewater utilities? lNOO�! YES r If No,describe method for providing wastewater treatment: ® El 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? TT 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? F] 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 ErEarly 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? M ❑ 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 b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: F]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: ❑ 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 REST OF MY KNOWLEDGE Applicant/sponsor ���- - a pr N Date: . Signature., Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part t 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? El 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 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 ❑ affect existing infrastructure for mass transit,biking or walkway? El 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: El ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ El 8. Will the proposed action impair the character or quality of important historic,archaeological, F] ❑ 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)? El 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? El 0 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. r] 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. r] 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 Page 4 of 4 AFFIDAVIT BEING DULY SWORN DEPOSES AND-AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF , GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner �7 SWORN TO BEFORE ME THIS - �� DAY OF 14JU4v5 r , 20 aryPublic- 1 g,� �Z ZZ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSUIM,FORM The Town of Southold's"Code of Ethids prohibits conflicts of interest on the part of town officers and cmnlovees The nuroose of this form is to',provide information which can alert the town of possible conflicts of interest and allow-rt to takembatever action is, nec�ssary to avoid same. YOUR NAME: I Re M phi Pi ` Spro—A-0r- -(Last name,first name,diddle 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 n/ 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,.si6ling,.paren-t,,or'child)have a relationship with tiny ol'ficcr o_employee oflheTown 8f•S66thold? "Relationship"includes by,blood,marriage,,or business interest:.."Business interest'411cans a business, including a partnership,in which the town officer or enlpioyee has even a partial ownership.of(or employment by,)a corporation in whicii dic•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/ag4nt/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 applicont (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200_ -Signature Print Name Form TS I 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 District Section Block Lot SCTM# 1000 _ 003 _ 2 6 PROJECT NAME Sarah Tremain Deck The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 0 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: 0 Nature and extent of action: Approve existing deck (constructed in 2014) located 88 feet from AHW. Deck is attached to existing dwelling (constructed in 1989- 1990. Deck is 36'+/- landward of the Coastal Erosion Hazard Line. Location of action: i".' .��` Site acreage: 1.81+/- acres Present land use: single family residence Present zoning classification: R-120 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: (b) Mailing address: (c) Telephone number: Area Code( ) (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No n 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. Incomnplete 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 Q Not Applicable Site is currently developed with a single family dwelling (constructed in 1989-1990) in the R-120 zone of Fishers Island. Site is on the north shore of Fishers Island adjacent to Fishers Island Sound. All development is landward of the Coastal Erosion Hazard Line. No site work or ground disturbance is needed. Deck (8' x 16') was constructed in 2014. 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 0 Not Applicable tS C v ca.ra ccr��v -d� wf�c� ,_,`Le - � -I- extends 8 it. trom the wall or the dwelling. 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 0 Not Applicable Deck attached to rear of dwelling is not visible from the road, Fishers Island Sound (natural, native tree buffer between dwelling and shore) or adjacent properties. 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 0 Not Applicable Deck is on concrete piers and above FEMA 100 year Base Flood Elevation. No ground disturbance is planned. Existing level grass area at deck is not subject to erosion No areas of the site are currently disturbed. Deck is 36'+/- landward of the Coastal Erosion Hazard Line and 88'+/- landward of AHW. 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 0 Yes F1 No n Not Applicable Deck does not provide point discharge of storm water. It does not impact existing septic system location or demand (see site map) and has no impact on the community water system. 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. ❑ ❑ 4 Site has rocky shore adjacent to Fishers Island Sound and is not listed as one of the 21 Significant Coastal Fish and Wildlife Habitats in Southold. 168 sq. ft. deck is located 88'+/- from AHW and limits of tidal wetlands. No inpact to wetlands or natural existing buffer between the dwelling and shore. Deck is constructed in a small lawn area adjacent to the residence. The location conforms to zoning setbacks. There is no impact' to on site habitat. 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 ❑ NoF;-] Not Applicable Construction of the deck has had no impact on air quality. 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 El Not Applicable There has not been and will not be any discharge of toxic pollutants and substances hazardous to the environment as a result of the deck construction. 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. ❑ Ye❑ No rX] Not Applicable Construction of the deck has had no impact on existing access or views to Fishers Island Sound. No clearing was needed to construct the deck and none is proposed. There was no impact to the rocky shore because of the deck construction. Attach additional sheets if necessary 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 0 Not Applicable Site is not in Marine Zone I or II. Zoning and use is single family residential (R-120) . Deck is permitted by zoning and complies with zoning setbacks and has no impact on any water dependent use. 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 0 Not Applicable Deck does not impact the long term maintenance and health of living marine resources in Long Island Sound Attach additional sheets if necessary Policy 12. Protect agricultural Iands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes F] No n Not Applicable Site is developed (single family residence) and wooded. There is no agricultural land on or adjacent to the site. 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 Q Not Applicable Deck does not have an impact on energy resources. No excavation planned. PREPARED BY Richard H. Strouse, P.E.L.S. TITLE Surveyor DATE 08-28-2018 Tremaine- Fishers Island o ,�J �August 13,2018 AUG CMESouf Town Mike Domino, President o ar n e Board of Trustees,Town of Southold Southold Town Hall Annex 53095 Route 25 Architecture PO Box 1179 Engineering Southold, NY 11971-0959 Planning Land Surveying RE Tremaine Residence-12244 East Main Road SCTM#1000-3-2-6 Environmental Services Dear Mike, I am writing on behalf of the owner of the captioned property,Sarah Tremaine In 19891 prepared a site plan for a proposed residence(2 copies of site plan enclosed) A building permit was issued, the entire shell of the house constructed, the interior of Phase 1 was completed and a certificate of occupancy issued. The interior of Phase 2(master bedroom, bath and additional bedroom)was completed a 1996-97 In 2014 a small deck(8'x 16')was added to the northwest corner of the house This was always part of the plan as French doors from the master bedroom were included in the original design and installed during the initial construction in 1989-90 That created confusion about the need for a new building permit and one was not obtained There is currently not a certificate of occupancy for the deck Mike Verity is asking for Trustee review The deck is 87 feet from apparent high water and 36 feet landward of the coastal erosion line I have enclosed 2 copies of our recent survey and 3 photos I will be happy to forward more, if needed Please review and contact me if there are any questions or if any additional information is required Let me know the am nt and I will forward the appropriate fee Sincerely, Richard H. Strouse, P.E.L.S. Email:rstrouse@cmeengmeering.com CME Associates Engineering, Land Surveying, &Architecture, PLLC % 860 885 1055 e4 a ® www.cmeengineering com A 33 Wilbur Cross Way,Suite 105 P 0 Box 535 Mansfield,CT 06268 Commitment, Meaning&Excellence. In All We Do.