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.03 - M BOARD OF SOUTHOLD TO TRUSTEES SOUTHOLD,NEW YORK I-Ell PERMIT NO.9459 DATE: MAY 15,2019 •X ISSUED TO: ROBERT&MARYBETH POLKE r PROPERTY ADDRESS: 1325 LUPTON POINT ROAD,MATTITUCK SCTM#1000-115-11-9 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in M accordance with the Resolution of the Board of Trustees adopted at the meeting held on May 15,2019 and in consideration of application fee in the sum of$250.00 paid by Robert & MaDLbeth Polke and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits 4 the following: Wetland Permit to stabilize the eroded bank with coir logs,rip-rap,and plantings; a total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be staked with oak stakes and planted; a total length of 80 lineal feet of rip-rap will be placed along the eroded bluff in areas shown on plans; rip-rap to have a stabilization fabric placed 3 beneath and be installed in an interlocking fashion; all work to be landward of the normal mean high water line and no additional fill will be added to the site; and as depicted on the site R 5plan prepared by Jeffrey Patanjo,dated February 26,2019 and stamped approved on May I 10 2019. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 15'h day of May,2019. Fat V 4-10 coo IL 1V Cantrell, Elizabeth From: Cantrell, Elizabeth Sent: Tuesday, August 10, 2021 8:06 AM To: 'Jeffrey Patanjo' Subject: RE:Application Question Hi Jeff; If this is the property owner I am aware of,they need a new wetland permit plus as built fees for said application as the work began under an expired permit. 5&tea Senior Office Assistant Town of Southold Board of Trustees Office: 631-765-1892 Email: elizabethc@southoldtownny.gov From:Jeffrey Patanjo <jjpatanjo@gmail.com> Sent: Monday,August 9, 202111:15 PM To: Cantrell, Elizabeth <elizabethc@town.southold.ny.us> Subject:Application Question Good morning Elizabeth, Quick question....I have a client that started work on a project and mid-project realized the permit expired. How do we go about getting it re-newed? Is it a whole new application or can it be internal administrative ? Thanks in advance, Jeff Jeffrey Patanjo P.O. Box 582 Bohemia, IVY 11716 631-484-9332 JJPatanio@gmaii.com ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i SUfF DiA- Michael J. Domino, Presidentcow,` Town Hall Annex John M. Bredemeyer, III, Vice-President "�� y1 54375 Route 25 Glenn Goldsmith ' y ?�' P.O. Box 1179 A Nicholas Krupski k y • o���f+ 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 1 st day of construction % constructed Whenjroect complete, call for compliance inspection; p - ----- -- ---- - - - - -- --- - - - - - q'y11+•rl/ii'j°i• C'11111 SSy,11+1 •1IIj�L ���111''r10//s✓ '•0111+Orll%OD- _ - iZA111'+1110 S•ii111•11%jai• •t / 4 %' 4 Uf1 0°• S•.":..w l /°• \ l r• \ /'• uaUa..ua y /r' r •(�goalil:rmnxml.G.ar yrr.rcrrwmjn�rr. ,�xn, v,.x,3.wi l:rrrnwrr.t wnrgarw;:a}mWbns�.i .nP.\.r''KtCPQ,� IX f..mnZn�n rq-lXl=::xr1-'Yr:'n�^�^°1'1Y:-'9.rtF•p E,P._n-'n__„_.r xaCP,gmPn�.nrr�Zrcnl.rrprgnmm�n._ 1)� ti _ ••�1 �, I I /rs BOARD OF SOUTHOLD TOWN TRUSTEES -; SOUTHOLD, NEW YORK PERMIT NO. 9459 DATE: MAY 15,2019 _' ISSUED TO: ROBERT& MARYBETH POLKE 1j'r 2 ? �` ` ?, PROPERTY ADDRESS: 1325 LUPTON POINT ROAD,MATTITUCK }'. s f'+. SCTM# 1000-115-11-9 AUTHORIZATION T% Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in %:4+ accordance with the Resolution of the Board of Trustees adopted at the meeting held on May 15, 2019, and in consideration of application fee in the sum of$250.00 paid by Robert & Mabeth Polke and subject to the ry �5 Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits ,o the following: Wetland Permit to stabilize the eroded bank with coir logs,rip-rap,and plantings; a total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be j staked with oak stakes and planted; a total length of 80 lineal feet of rip-rap will be placed 3 along the eroded bluff in areas shown on plans; rip-rap to have a stabilization fabric placed beneath and be installed in an interlocking fashion; all work to be landward of the normal _ mean high water line and no additional fill will be added to the site; and as depicted on the site plan prepared by Jeffrey Patanjo, dated February 26,2019 and stamped approved on May 15, ,>' 2019. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 15'h day of May,2019. 0N coo �•;;1l1"ti ; ill%;��., r r-- �,;;,,iu u„o,.... ..�,.�.x�,,,.a:..,,..v». „^,•x,:....a.; —^.c.,�:,,.�,,»,.v.:—,.'1;,........v.u...,,,,:u.•vn.,av�„:v.'3'„uav—..,,,,,x n,.�;p ,,.a:;: ua�.o':.,i.+,f,G�,,,•,.., ;..u„v„�n,:,�u.P� '�;, r+J� �; v._•�I - _ "'`t� `ii:�f/"t � 'S e `l\., 'i _, f� �✓1i< <a � c:�l� _ '�e ,.L;J•" _ - !h/`. \.lii. /F,`` + \V\e .r/� li:• P*""".. ; I -c.��s=��"n n/ mm.jnmrt:: nn...R.nm^`nq' / �.'N• _••'iii iiii: ''t!i:i:_i:ii:%'' _ -:iiii :iii:• _ •�ii.i Iii:• ':iiiii iiiia:-' _ '•:iiiii iiid�:'' - •i�IN l��i�•'• '- TERMS AND CONDITIONS The Permittee Robert&Marybeth Polke residing at 1325 Lupton Point Road, Mattituck, New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. , 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. Michael J.Domino,President �QF SOUTH, Town Hall Annex John M.Bredemeyer III,Vice-President Q� �� 54375 Route 25 O P.O.Box 1179 Glenn Goldsmith l�[ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 COUNT`1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 15, 2019 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: ROBERT & MARYBETH POLKE 1325 LUPTON POINT ROAD, MATTITUCK SCTM# 1000-115-11-9 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 15, 2019 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of ROBERT & MARYBETH POLKE, applied to _ the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 28, 2019, and, WHEREAS, said application was referred to the Southold'Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application May 15, 2019, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with-the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees APPROVE the application of ROBERT & MARYBETH POLKE to stabilize the eroded bank with coir logs, rip-rap, and plantings; a total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be staked with oak stakes and planted; a total length of 80 lineal feet of rip-rap will be placed along the eroded bluff in areas shown on plans; rip-rap to have a stabilization fabric placed beneath and be installed in an interlocking fashion; all work to be landward of the normal mean high water line and no additional fill will be added to the site; and as depicted on the site plan prepared by Jeffrey Patanjo, dated February 26, 2019 and stamped approved on May 15, 2019. Permit to construct and complete project will expire two,years from the date the permit is signed. Fees must be paid, if applicable, and permit'issued within six months of the date of this notification. ! Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 ; Very truly yours, Michael J. Domino President, Board of•Trustees MJD/dd i i PROPOSED 40 LF INTERLOCKING RIP—RAP `- 4 N PROPOSED COIR LOG AND PLANTINGS BANK STABILIZATION. TWO ROWS FOR TOTAL HEIGHT OF 6' MAX New SUffolk;Ave � COIR LOGS TO BE PLANTED AS SHOWN IN TYPICAL SECTION 4 OR ACCORDANCE WITH TOWN AND NYSDEC RECOMMENDATIONS a STAKE COIR LOGS WITH OAK STAKES EVERY 2'.O.C. 3 PARALLEL ROWS EACH WITH 3 LOGS IN HEIGHT. ..... 0 1325,Lu0t6ns Point'Road ' (TOTAL LENGTH OF 268 LF) F�OP�11°O° ����/ .00 E 'Po. �'ptogy p l l� 69.13 �' p i obit Rd ` DEEP HOLE CREEK - 2 �' �N j 1 lattituck j 40 \• \ / Ply' \ •1 � " � - - -- -- ' PROPOSED 40 LF INTERLOCKING RIP—RAP of - - , o / �� ,roe � \ 1 � � BOnlJnlq� � TWO ROWS FOR TOTAL HEIGHT OF 6 MAX PREPARED BY: I o x rents .Marr; JEFFREY PATANJO 1 00 pig BE ADDED P.O. BOX 582 NO FILL TO ,..�' �'� BOHEMIA, NY 11716 i c 3 LOCATION MAP 631-484-9332 JJPATANJO@GMAIL.COM !• 59�665Q � ��' EXISTING GAZEBO 4 N.T.S. � / '• I i- / PROPOSED 4' WIDE MARITIME PLANTING AREA ALONG PROPERTY OWNER: /'' Pad , I UPPER BANK. PLANT WITH ARCTOSTAOHYLOS ROBERT & MARYBETH POLKE /' �P��� Q of p�4 I 1 uva-ursl MASSACHUSSETTS - BEARBERRY 0 24'D.C. F �o Y 31 EUSTON ROAD OR APPROVED EQUAL IN EXISNNG SOIL / ../�o�° �� � 11 I --- _ GARDEN CITY, NY 11530i �Q� o �,, PROPOSED 8• COIR LOGS STAKED 2' D.C.WITH 2'X2'X30• LONG OAK STAKES , 1 j to Q.y1 ; a O 1 C EXISTING GRADE J $5 A9 / �/ ----------------------- 1 ! o 1 o APPROXIMATE M.H_W_EL 2.5t------------------ 1 & 1/2 STORY FRAME RESIDENCE I I' I _ AND GARAGE I I ___z APPROXIMATE M_LW EL --O.O±--- EXIST. MBER BULKH 3 _ I PHOTO LOCATION i !1 ': TYPICAL SECTION ® COIR LOGS F" '7' I,� I� jl N.T.S. =�-� 1`°.11 ! APPROVED Y I I I PROPOSED INTERLOCKING RIP-RAP PLACED IN ANGLE BACK TO I TOP OF BANK. MAXIMUM OF 2.5 TONS PER LINEAR FOOT MAR L "s 2019 1 `� iLl -- PROPOSED FILTER FABRIC UNDER PROPOSED RIP-RAP STABILIZATION -BOARD OF T RUSTEES \ i s EXISTING GRADE TOWN OF SOUTHOLD 1 .� DATE ^4 Q Z 1 \ 1 1 I -T=--nPPROpMATE M.H_W_EL 25f------------------ 0 03 W' _i TYPICAL SECTION © RIP-RAP p N.T.S. O — 216.2 0. Proposed Permit Plans SCALE: 1"=30' — PROPOSED PLAN, DETAILS AND DATE: s 73.45 00" �' I NOTES: D 1. LOT AREA: 37,035 S.F. / 0.85 ACRES LOCATION MAP 2-26-19 � Qo •g,0 A ,, o ,A6?" N p PINT 2. PORTIONS OF PLAN FROM SURVEY PREPARED BY: 1325 LUPTON POINT ROAD LUpT 0 PECONIC SURVEYORS, P.C. MATTISUFFOLK COUNTY,TUCK, TOWN OF SOUTHOLD SHEET: 1230 TRAVELER STREET, SOUTHOLD NY 11971 TAX MAP N0. 1000-115-11-09 of i SURVEY LATEST DATED FEBRUARY 28. 2012 ♦,I-I I LIY/J I l/II JffVVLL I-111WILI /Tr OlUL IV LCJ j{t+" •1 ' I will abide by the conditions set forth therein and on the ��� 6�•1�.�0 V 3r��. SURVEY OF PROPERTY mit to construct. ; 5 so. AT MA TTIT UCK K location of wells and cesspools shown hereon are o�if e n field observations and or from data obtained from others. Of11S. TOT�N� � � SUFFOLK OF SOUTHOLl� K COUNTY ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA77ON o h' ` 1 N. Y. ;ECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. �jY 1��� Bre 1000-115-11-09 PT AS PER SECTION 7209-SUBDIVISION 2. ALL CER77F/CA7IONS a SCALE.' ��=30� ON ARE VALID FOR 1NlS MAP AND COPIES THEREOF ONLY IF t Ij p X10 c� 2 O MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR iS®Y /i o JANUARY 3, 2007r- 3E SIGNATURE APPEARS HEREON. n SN Q00 � FEBRUARY 8, 2008 (f0' CONTOUR LINE) etions referenced to MARCH 4 N.G.G. V.D. ��! ,•(� 0- G n1 , 2008 (PROPOSED ADDITION & LATH -MONUMENT May 22, 2008 (SEPTIC CROSS SECTION) / Nov. I, 2010 (REVISIONS) FEB. 28, 2012 (lint) 9. JR BEDROOM MAX.) tiq 5' DEEP x 8' DIAMETER LEACHING POOLS �� erg'`` '� "krJ^y�,/ I N 1 0 / , / 7,000 GALLON SEPTIC TANK a� 00� / /COD o ,� WyC pr-LS d DRYWELL , � e• � e ?�• ST PSE � m �' ANK _ �(. B I o prop. dI&",%, .,. /� / 260' q $ i E& SPR , 10.6, I /ath 32' `��. 1�U�yS t0 69 g 75.3' g 1 M )4'F_ � TL FLAG ` � ? :_0 GE OF PY TLANDS AS DELINEATED BY ORU{ �A�dc>`� ' � u ?. FOX FEB. 08 f y O T CO VERA GE 035 sq.fl. UPLANDS 19/. /37035 = 6.5 % EXIST/NGl O o >94/37035 = 10.7% AFTER. CON TRUCTION N I c ST ?AIN RUNOFF COMPUTATIONS mI' �' r• <0- (A LL TA SOUSE 8 CONC. _ x.994 X 0.17 X. l; = 679 cull. to 3RA VEL ^,",'VEWA Y =3120 x M 0.17 x 0.4 =212 su.11.• Im r m� TEST HOLE DATA 891 cu,/!, I McDONALD GEOSCIENCE a �` 391 142.2 = 2/ VF _ � Qn 1 DECEMBER 29, SC ''h'OVlDE 4 L.P.s 8'0 x 6' DEEP OR EOUAL ( v2006 AREA TO TOP OF BANK. WITH SLOPE OF 101% * = 0' a � 1.5 6-1.01 rs 1 LP ^ 7� DARK BROWN SANDY LOAM oc rl rj' 15. BROWN SILTY SAND SM �1 EI R.0 EL. 8.6, ——— 23. . �;. . 5.20 = E� j!iI TER METER i _ — µA 21 PALE BROW FINE SAND SP I,Y t�� I � 1 0 3,►► EDGE OF PAyEMENT 8.5' 9 , MAR 2 8 2019 .4 app"W�U, OAD) 9 DP 14.5 S7 r ' PSE \ Y , a 3 WA 1ER 14.0' s tt,! 6 °c ---- -- EL. �P�r HSE r,}tJj r`_' t••ul•'\ EL 14.6, /ON pOI w ,ER IN STREET) F L14 fAlSyiED GRADE EZ/s �j ;fit - r. 4 ter' ARE/-L UpT PueuEL a /• W11 lALER� E SAND SP 5 ( IE! .ffi _ qui7! 5 Z'111tX i 'nye, �� E f2 S£P17� Off' e® rFOOL WA rANKqEAc c�, 1 ,pUSL �p LLIN GROW WATER III�I .r F C^ SEPTIC SYSTEM CROSS SECTION ! ,.F,AY 49618 "PiECONIC (631) 765-5020 FA�7' 765-1797 P.O. BOX 909 — AREAp39,078 SO, FT. TO TIE LINES SOUTHOLD, MY 1971 T 06-263 0 Michael J. Domino, President ;�° ��yF T Town Hall Annex John M. Bredemeyer, III, Vice-Presidenti4o 54375 Route 25 t y :, p r?h Glenn Goldsmith o ® P.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams `' y 'r Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ROBERT & MARYBETH POLKE c/o JEFFREY PATANJO Please be advised that your application dated March 28, 2019 has been reviewed by this Board at the regular meeting of May 15, 2019 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50 00) — (Silt boom) 1St Day of Construction ($50.00) % Constructed ($50.00) xx Final Inspection Fee ($50 00) Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ 50.00 P6- BY- Michael J. Domino, President Board of Trustees S�FFO(k Michael J. Domino, Pres Town Hall Annex 0�0 CCG John M Bredemeyer III, Vice-rresident 54375 Route 25 Glenn Goldsmith roP.O. Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams �'yh0® p� Telephone(631)765-1892 Fax(631)765-6641 axxr-� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: .5/S/)9 3 S'o Completed in field by: Jeffrey Patanjo on behalf of ROBERT & MARYBETH POLKE requests a Wetland Permit to stabilize the eroded bank with coir logs, rip-rap, and plantings; a total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be staked with oak stakes and planted; a total length of 80 lineal feet of rip-rap will be placed along the eroded bluff in areas shown on plans; rip-rap to have a stabilization fabric placed beneath and be installed in an interlocking fashion; all work to be landward of the normal mean high water line and no additional fill will be added to the site. Located: 1325 Lupton Point Road, Mattituck. SCTM# 1000-115-11-9 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: T+rA 4'7 Oc V✓AnA NJ I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: ✓ J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. 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A 18 `5.) 1 +$ •• �1 1B a M 12 a - -1T ® 7C 10 1]A(C) _ 19 14 15 p18 - IS 14 d lx p,T 12 n1A(a SEE TF„RCEONO. _ ,fi13•y\ .A S - ~ SEE SEC.NO. - n01-002.1 • 1x ze FOR PCL NO. • 1 ^ _u m IxxMUm '� LNIa SEE SEC.NO. a 19 • a s 1z3mme q^ u � 1 -Z----- -tZ I WTd15- I UNE �a , d MATCH --- UNE 'L 4a 4 - _ sF3 sEc.xo. eff aw,No.1a 4� +°- ^ - ts14 13 ° 12 K1 Tc 1101E A -- --a— —'•-- NOTICE COUNTY OF SUFFOLK C K 102 4° m SOUTHOLD SECTION NO ..�.- ...e .� �2) O E z ��� " — — �U\1 Real Property Tax Service Agency y ra�u. -r- r^r --� - r•� � Ca v •.NYI19M M n% p•twwngNpr NnrdRaNee ltE Z.� .• unt r1r• 114 1N°9L,RE '� 4artpANUNnmu rvN no4af[o -. _ ..._....� a.._..�-....._v�:;.�r•—� v �t N�..�o ,00a PNOPENn ruw f � , OFFICE LOCATION: OF SO �® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 G Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: May 13, 2019 Re: LWRP Coastal Consistency Review for ROBERT & MARYBETH POLKE SCTM#: 1000-115-11-9 Jeffrey Patanjo on behalf of ROBERT & MARYBETH POLKE requests a Wetland Permit to stabilize the eroded bank with coir logs, rip-rap, and plantings; a total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be staked with oak stakes and planted; a total length of 80 lineal feet of rip-rap will be placed along the eroded bluff in areas shown on plans; rip-rap to have a stabilization fabric placed beneath and be installed in an interlocking fashion; all work to be landward of the normal mean high water line and no additional fill will be added to the site. Located: 1325 Lupton Point Road, Mattituck. SCTM# 1000-115-11-9 The 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, the proposed action is recommended as 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 Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 8, 2019 the following recommendation was made: Moved by James Abbott, seconded by John Stein, it was RESOLVED to SUPPORT the application of ROBERT & MARYBETH POLKE for the stabilization of an eroded bank with coir logs, rip-rap and plantings. Total length of 268 If. of coir logs with three parallel rows staked with oak states and planted. Total length of 80 If. of rip-rap placed along eroded bluff. Rip-rap to have a stabilization fabric placed beneath and installed in an interlocking fashion. Located: 1325 Lupton Point Rd., Mattituck. SCTM#115-11-9 Inspected by: John Stein, James Abbott Vote of Council: Ayes: All Motion Carried ®f 30 Town Hall Annex Michael J.Domino,President �® John M.Bredemeyer III,Vice-President Oy 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski ® O Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 WS BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit MAR 2 2019 !' 6ieceiveeceived mendment/Transfer/Extension Application:Fee: $ Z56,60 Completed Application It,It.I Incomplete: / SEORA Classification: Type I Type II V Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency As essment Form Sent: CAC Referral Sent: ,2 Date of Inspection: .SSI Receipt of CAC Report: Technical Review: Public Hearing Held: •�s� Resolution: Owner(s)Legal Name of Property (as shown on Deed): jeo err-f e /,A arti 64h P®�OCt Mailing Address: 31 Eus+on Qat. Cyardey1 Ct+fj , ^JY 11530 Phone Number: S b- 9 1 7 - Y 3 4-7 Suffolk County Tax Map Number: 1000 - 1/5' - //-°9 Property Location: 13As Lupton poin-t Sire- 1t9e-&+to., m4 p (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): --J,-4gr<-c j Pa.-7Q n 1 Mailing Address: P 0ts c 5-8 X 43 40 Ae." a N y 7 l 716 Phone Number: 6 3 I y •`� 3 3�- �11 " Board of Trustees Applica )n GENERAL DATA Land Area(in square feet): Area Zoning: S Previous use of property: (L S Intended use of property: R�e 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 ✓ 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): See C_k r k �2 S r t' 1325 UPTON POINT ROAD -MATTITUCK SCTM No. 1000-115-11-09 PROJECT DESCRIPTION Project includes the stabilization of an eroded bank with coir logs, rip-rap and plantings. A total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be staked with oak stakes and planted as described on plans or as recommended by Town of Southold Trustees. A total length of 80 lineal feet of rip-rap will be placed along the eroded bluff in areas shown on plans. Rip-rap to have a stabilization fabric placed beneath and be installed in an interlocking fashion. All work to be landward of the normal mean high water line and no additional fill will be added to the site. Board of Trustees Applica --' )n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: .S-et d 4-6e k,A Area of wetlands on lot: 2 3 4 square feet Percent coverage of lot: 6'.d. % 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? No V1 Yes If yes, how much material will be excavated? cubic yards How much material will be filled? L10 cubic yards Depth of which material will be removed or deposited: 3-5- feet Proposed slope throughout the area of operations: o - qs- Manner in which material will be removed or deposited: 'colt r e M ove AL w i-tfi 1anre4+ar6Q State- Statement taPtStatement 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): 't here wi t) he e, J•scfi••e ojFPec-t mn 4"e-t•1a.►CPs oltit -t• ed'Cdk-ho/► af- o4S-Cw a /.fie61 10aart1C- Ano C,ea2uteS Ifo st.,A antP Sedr MCh.'w.+ioq o4 Wot-tc/LS 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: 1325 Lupton Point Road-Mattituck Project Location(describe,and attach a location map): See attached locatip Brief Description of Proposed Action: Install 80 LF total of rip-rap bank stabilization and 268 LF total of coir log bank stabilization with plantings.All work is landward or the MHW line. Name of Applicant or Sponsor: Telephone: 516-297-8367 RObert&Marybeth Polke E-Mail: yb1129@aol.com Address: 31 Euston Road City/PO: State: Zip Code: Garden City �NY 111530 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 government Agency? NO YES If Yes,list agency(s)name and permit or approval:Town of Southold Trustees/NYSDEC ❑ 3. a. Total acreage of the site of the proposed action? 0.89 acres b.Total acreage to be physically disturbed? 0.06 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.89 acres 4. Check all land uses that occur on,are adjoining or near the proposed action: 5. ❑Urban ❑ Rural(non-agriculture) ❑ Industrial ❑ Commercial m Residential(suburban) ❑Forest ❑ Agriculture ❑ Aquatic ❑ Other(Specify): ❑Parkland Page 1 of 3 t l 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑✓ ❑ b. Consistent with the adopted comprehensive plan? ❑ ❑✓ El- NO NO YES 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? ❑ 0 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES Name:Deep Hole Creek,Name:Peconic Bay and Environs,Reason:Significant coastal fish&wildlife habitat, If Yes,identify: Reason:Protect public health,water,vegetation,&scenic beauty,Agency:Southold,Town of,Agency:Suffolk 1:1 ❑ Count.. NO YES 8. a. Will the proposed action result in a substantial increase in traffic above present levels? ❑✓ ❑ b. Are public transportation services available at or near the site of the proposed action? ❑✓ ❑ c. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed 10 ❑ action? 9. Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: F77 F1 11. Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the project site contain,or is it substantially contiguous to,a building,archaeological site,or district NO YES which is listed on the National or State Register of Historic Places,or that has been determined by the 10 E]Commissioner of the NYS Office of Parks,Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places? b.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑ ❑✓ archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? 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: Page 2 of 3 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: mShorelme ❑ Forest ❑Agricultural/grasslands ❑ Early mid-successional ❑Wetland ❑ Urban [Z] Suburban 15. Does the site of the proposed action contain any species of animal,or associated habitats, listed by the State or NO YES Federal government as threatened or endangered? ❑ ❑ 16. Is the project site located in the 100-year flood plan? 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? ❑ ❑ b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? ❑ If Yes, briefly describe: 18. Does the proposed action include construction or other activities that would result in the impoundment of water NO YES or other liquids(e g., retention pond,waste lagoon,dam)? If Yes,explain the purpose and size of the impoundment: ❑ ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NO YES 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 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spo Robert a beth Polk Date: ,¢/,9 ' /Z �/� l T Signature: �— Q�ile-Owners PRINT FORM Page 3 of 3 otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable c tering the scale and context of the proposed actio _ No,or Moderate small to large _ impact impact may may occur occUr 1, Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of landv 3. Will the proposed action impair the character or quality of the existing community? ice! 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Envirdnmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level oftraffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, I�1 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)? {� 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 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Bead 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. t Check this box if you have determined, based on the information and analysis above,and any supporting documentation, that the proposed action may result to one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees _ 5—/6 // / Name of Lead Agency Date( IIIeehaeI J. Domino President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Respo&poble Officer'in Lead Agency Signature of Preparer(if different fi•om Responsible Officer) �R�6�T Page 4 of 4 EAF Mapper Summar,; report Wednesday, March 13, 2019 8:55 PM Disclaimer: The EAF Mapper is a screening tool intended to assist ii project sponsors and reviewing agencies in preparing an environmental 'ry assessment form(EAF) Not all questions asked in the EAF are I In 0�-1000-'I C! �` il'f 540-a2`Ga:�a+UO answered by the EAF Mapper.Additional information on any EAF question can be obtained by consulting the EAF Workbooks Although 115,00-1200-7000 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 _ 1!150,0-,1206-'860 to obtain data not provided by the Mapper.Digital data is not a 41T500-1200-9 4 � substitute for agency determinations. 000-2000 �-0 �I 5Q 200-1 0000 '' _ - - — - : •- f - ;i, 1,15'00.;12440 F it ' ,P. i _ 1ti1 204-1 0 [r1544�'114Di27 G,t1< foo=6'0� ®.'a. Torcnto } 1„t_544: 200-13000 I- 111:15 = t�45V 6 0 300!1' ' 1 i t5{0-ifi 00=7t?0!�. T I ; I150 =1,I OE1r W41y, i„ _a�,= _� -�� :f- •'t. _r trar#�,.- 1'15 00-1100=600b -� - ;t ' r Ii550-i'fl0t7=5040 60, �1 -,rt-T� l7atiolt_ �•'� ? ®3st ' — — - - .11540:t 21)4 100 ^r, �. 'I rp ir(�ttGa _y _:.15eia r�J E)@'a attJs(cc ,` �Cfel ;tail #` Ct. ,tin,g � - � t ti�lnt ,, ��.:�rfis{11 4TIP NI . - u. ='v:x� ` w-- 1'15(?0-1'140-1 10001'i50G's }J:;td}j`seli,Ctiina[1 FP�9aF� P�4a0 r C„�ir;"�``' �I C': ,`n1tvi ic�z � r'i.11�E:Csrmin, '11500-1,104-'16000 1''15-b&--1 140- fr's'Eyri{Thailsnd),1fGS.G i 1 Calumbu-v ' +et ktcrgh :`-USC,?tl�iretk lrt ,` 11500-1'1'00=16001.1`1500=;t14 =1500.0 Vp£nStr thlaFt nteibutcrs snd�t e-GiS ` ism _..,f ',._ „` „ 1-=6IGREtv1EFf lkt�"F.,Ca usgm.munity 1,1560r120F1600 'cinnat3 + .'. u. s an dETI;Earl Chi a 41 i'^; { F 11 . 7 `t_ .�L..-,—.r.."'�`�'— _ iPart 1 /Question 7 [Critical Environmental Yes (Area] Part 1 /Question 7 [Critical Environmental Name:Deep Hole Creek, Name:Peconic Bay and Environs, Reason-Significant Area- Identify] ;coastal fish &wildlife habitat, Reason:Protect public health, water, vegetation, 4 :&scenic beauty, Agency:Southold, Town of, Agency:Suffolk County, Date:3-9- '90, Date:7-12-88 I Part 1 /Question 12a [National or State I No Register of Historic Places or State Eligible Sites] i Part 1 /Question 12b [Archeological Sites] IYes Part 1 /Question 13a [Wetlands or Other 'Yes- Digital mapping information on local and federal wetlands and { Regulated Waterbodies] iwaterbodies is known to be incomplete. Refer to EAF Workbook. !Part 1 /Question 15[Threatened or No Endangered Animal] iPart 1 /Question 16 [100 Year Flood Plain] IYes Part 1 /Question 20 [Remediation Site] !Yes Short Environmental Assessment Form - EAF Mapper Summary Report , `Board of Trustees Applicai, `'n AFFIDAVIT ,Po LV—, 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 Signature o '74c erty O ner SWORN TO BEFORE ME THIS DAY OF , 20 Pt Aha� ota Public i�ubl °S viii105 , 'IrtkJra 9 6o p • ,Board of Trustees Applicat "`'M AUTHORIZATION (Where the applicant is not the owner) I/We, AA Zt 'r I � e -�k AR L lL owners of the property identified as SCTM# 1000- 11T-- ► 1 -09 in the town of AA New York,hereby authorizes J{ �—Fre ti n a 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. I Property Owner's Signature Property(Owner's Signature SWORN TO BEFORE ME THIS DAY OF ��C , 20 17 hA(VJAV No y Au is A N IGMIliT NMN r Public;State of New York 0IMI5012405 ,QUa11fied in Orange County "1" �Xpfres June 15, 26W APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever action-is necessary to avoid same. YOUR NAME: (Last name,first name,toddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO +� If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the appliceint (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 t 's—� da r_ �W7 20� S ignatur Print Na Fotm TS 1i�ot_lcZ � 4bc, A•MINCHiNPtate of New York No. OIMISO12405 Oil`lsid in Orange Corin ; �O.T .ex;fre;;June 15'1�20 � f i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibit conflicts of interest on thean rt of town officers and employees Tile numose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: V p L IL rAA rM Z+ (Last name,first name,Middle ini ial,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,parcut,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,trtarringe,or business interest"Business interest"means a business, including a partnership,in which the town officer or employee las 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)andlor describe in the space provided The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 1l day of �2 20Z— Signature Print Name Form TS 1 rq> !`IibIIC;State O/New YorRelAg` No:.0iMI5Q ;*05Prubll " at, of•iV `r/I 4iQiAMWlit O range Count ` '•�N 1MI501 40° ? P June 15, 20 fibd lrt Orange Oxpfres June;l APPLICANT/AGENT +PRF,SENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics-prohibits conflicts of int rest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: POL-r4 01)fl ��%e e" (Last name,first nameMiddle initial,unless 1you 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 f 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,sililing,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee las 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 applicitnt/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2 da of AA^e 20_Lt Signature Print Name 04a Form TS 1 May 10, 2019 Town of Southold Trustees 'ii) Town Hall Annex Building t 1 E C r Q ,� E 54375 Rte. 25 1 . P.O. Box 1179 ��,� 1 + ?''l9 Southold, New York 11971 RE: 1325 UPTON POINT ROAD- MATTITUCK Southold Toiv i SCTM No. 1000-115-11-09 ° AFFIDAVITS Dear Trustees: Attached, please find affidavit of mailing and posting 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 trul urs, Ir J rey Patanjo P.O. Box 582 Bohemia, NY 11716 T. U.S. Postal Serviciet'. CERTIFIED MAILo o m M Domestib Mail Only L t � e s e (09 F IF � C M Certified Mall Fee M Cerhfled Mail FeeLn Ln d C3 $ O $ � EXtrB Services&FeeS(checkbox,edd fes as ep ne ' Extra Services&Fees(checkbox,add fe propdate) 4Here I ❑Return Receipt(hardcopy) $ n.l ❑Return Receipt(hardcopy) $ rUrU ❑Return Receipt(electronic) $ fy p stm rk 0 ❑Return Receipt(electronic) $ merk r3 ❑Certdled Mail Restricted Deliveryo�0 ❑Coddled Mail Restricted Delivery $ C] ❑Adult Signature Required $ ! ere C7 []Adult Signature Required $ ❑Adult Signature Restricted Delivery$ []Adult Signature Restricted Delivery$ C7 Postage {� C7 Postage m M $ -- -- - ----- Total Postage and CO ---- --- ----- �` � Total Postage and SCTM#1000-115-11-10 '� $ SCTM#1 -11-11 w $ entro Gambino, Michelle Sent To Esquirol,Susan F a 1450 Lupton Pt. Road o sifeeiandAPr."ivo 38531-elandSt Cl Sheet andApt No I r� r` Mattituck, NY 11952 ctiy State 2%P+4a San Diego, CA 92106 City,State,ZIP+4� Ir /e ru �cc rrl Certified Mall Fee Ln $ 0 ExtraServices&Fees(check box,add fee as appropda 0 ❑Return Receipt(hardcopy) $ ❑Return Receipt(electronic) $ 0 U �a ❑Certified Mail Restneted Delivery $ e 0 []Adult Signature Required $ 0 ❑Adult Signature Restricted Delivery$ O Postage cO Total Posenc-- - - - —— —-- �, r-1tage SCTM#1000-115-11-8 $ Tintle, Carrie cO Sent To O SVeefandApt IVc 1235LuptonPoint Rd. Mattituck, NY 11952 Ul y'State,21P+4' PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 ,Notary Public 1 t - PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: SCTM#1000-115-11-8 SCTM#1000-115-11-11 Tintle, Carrie I Esquirol,Susan F 12351-uptonPoint Rd. 38531-elandSt Mattituck, NY 11952 j San Diego, CA 92106 SCTM#1000-115-11-10 ; Gambino, Michelle 1450 Lupton Pt. Road Mattituck, NY 11952 STATE OF NEW YORK COUNTY OP-SUFFOLK Jeffrey Patanjo residing at PO Box 582,Bohemia,NY 11716 being duly sworn,deposes and says that ori the 7th day of May -120 19deponent mailed a•true copy of the Notice ` Sit forth in the Board of Trustees Application,directed to each of the above named, persons at the addresses set opposite there respective names;that the addresses set opposite the names.of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold;that said Notices were mailed at the United States Post Office at-=Bohemia ,.that said Notices re mai to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. g Sworn to before me this .7th _ Day of May ,20 19 FWARY YN S. HICKS C,STATE OF NEW YORK n No.01 H1636MB9 in Suffolk County NOpires October 10,2021 1 • Michael J.Domino,President O��SQfFO(,��oG Town Hall Annex John M.Bredemeyer III,Vice-President y 54375 Route 25 Glenn Goldsmith H z P.O.Box 1119 A.Nicholas Krupski Southold,NY 11971 Greg Williams ti p! Telephone(631)765-1892 Fax-(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ROBERT & MARYBETH POLKE COUNTY OF SUFFOLK STATE OP NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE j, Jeffrey Patanjo residing at/dba PO Box 582,Bohemia,NY 11716 being duly sworn, depose and say: That on the _7thday•of May , 2019 ,I personally posted the property known as 1325 Lupton Point Road,Southold SCTM# 1000-115-11-09 by placing the Board of Trustees official poster where it can easily be seen,and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing.Date of hearing noted thereon to be held Wednesday,May 15,2019. Dated: 05/07/2019 (si a e) Swornto before-me this 7th - I day of May 2019 MARILYN S.AHICKSNOTARY PUBLIC,STATftistration Nc.0tNotar bli , Qualified m SuffoCommission Ex,,iris O NUTILt: Ulm Ht: ARING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: ROBERT & MARYBETH POLKE SUBJECT OF PUBLIC HEARING : For a Wetland Permit to stabilize the eroded bank with coir logs, rip-rap, and plantings; a total length of 268 lineal feet of coir logs will be installed with three parallel rows which will be staked with oak stakes and planted; a total length of 80 lineal feet of rip-rap will be placed along the eroded bluff in areas shown on plans; rip-rap to have a stabilization fabric placed beneath and be installed in an interlocking fashion; all work to be landward of the normal mean high water line and no additional fill will be added to the site. Located: 1325 Lupton Point Road, Mattituck. SCTM# 1000-115-11 -9 TIME & DATE OF PUBLIC HEARING : Wednesday, May 15, 2019, — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 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 ' cant 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 favets. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall notbe 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 t. SCTM# 11 —__L1 PROJECT NAME 13 J'S L- jo n 19ovb, 2°w6 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: p Location of action: 13 a S L-p tan Po t n T 4--& t-,,c dL Site acreage: 0• V1 Present land use: Present zoning classification: 1295 . 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: Rote A (b) Mailing address: 31 C us-t"on 2� C>a rrC-e-n Ci.-4__ Ny_ -115-30 It (c) Telephone number: Area Code{ ) 6-14 - ;0-1-7 -S 3 6 7 (d) Application number,if any: /14 _ Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes Rr No❑ If yes,which state or federal agency? V-4`4 S t gc-- C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure, makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. QYes 0 No [-] Not Applicable ,,&4 Pro-twets w pen sn,-ee- iw 44— w.c'toit-ww., 4,&- reet4 e-r-D 61NOR 0 erec IA. fro sa I I G I s w 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 1:1No [ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable e tc 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 E?rYes ❑ 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 Q No ❑Not Applicable ro I t.CA eret-�d-tS Aj 4 i.L s .�,roSLe,� .� ¢ SttQt�+ltr�'fk to Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable Yrace Seat *?V t4r-� e- Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWP.P Section III — PoIicies Pages 32 through 34 for evaluation criteria. Yes ❑ No of Applicable Prate G4- J%c.L ^-t, c Fc G4 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. 1-1Yes 1-1No : s.Not Applicable Pr ols t ,no a Efte- T- o— 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 LVVRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YeO No U Not Applicable �rw.,,,4 kftj 40 e4Wc Attach additional sheets if necessary WORKING COAST POLIUkS Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section HI--Policies; Pages 47 through 56 for evaluation criteria. ❑Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L'VVRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑Yes ❑ No Not Applicable tj Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No Not Applicable �✓ 4 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 0 Not Applicable N A, PREPARED BY �- Pw a TITLE A DATE -2-- Z 7 1} t c - March 25, 2019 Town of Southold Trustees Town Hall Annex Building E 0 E V EDD 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 MAR 2 8 2019 RE: 1325 UPTON POINT ROAD-MATTITUCK Southold Town SUM No. 1000-115-11-09 1 Board of Trustees APPLICATION FOR PERMIT Dear Trustees: 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, A A Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716