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Home My WebLink AboutTR-5944 (2)Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0556C Date: July 19, 2010 THIS CERTIFIES that the removal of and replacing in-place existing bulkhead with two returns; a 10' non-turf buffer to be maintained along the bulkhead; the installation of two 6"x6" walers atop the upper waler of the existing bulkhead to function as a flood screen At 900 Rogers Road, Southold, New York Suffolk County Tax Map # 66-2-38 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 6/2/04 pursuant to which Trustees Wetland Permit # 5944 Dated 6/24/04 was issued and Amended on 1/20/10 and conforms to ali of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of and replacing in-place existing bulkhead with two returns; a 10' non-turf buffer to be maintained along the bulkhead; the installation of two 6"x6' walers atop the upper waler of the existing bulkhead to function as a flood screen The certificate is issued to THOMAS PETROSINO owner of the aforesaid property. A~orized Sig}nam~re Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971~0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE/~INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain Ist day of construction ~ constructed __ Project complete, compliance inspection. INSPECTED BY: COMMENTS: , %//// Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 January 20,2010 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Mr. Robert E. Herrmann En-Consultants, Inc. 1319 North Sea Road Southampton, NY 11968 RE: THOMAS PETROSINO 900 ROGERS ROAD, SOUTHOLD SCTM# 66-2-38 Dear Mr. Herrmann: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 20, 2010: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Wetland Permit #5944 to authorize the installation of (2) 6"x6" walers atop the upper waler of the existing bulkhead to function as a flood screen, and as depicted on the revised site plan prepared by En-Consultants, Inc. last dated January 8, 2010, and received on January 12, 2010. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, ll'M. Dohedy~~ ~'resident, Board of Trustees JMD:eac ROGERS ROAD NQNTLJRP BLPPBR N/F DALY, HOE-Y, & MCGRATH Ill APPR( 'ED BY ~OARD OI rRUSTEES TOWI~nOi~$OUTHOLD ? Al'OF BY,, PULKI'iBAP 1'0 FUNCTION AP "PLO01:2 SCt~N" POR I'HOMAP F'BfROSINO ON HIF'POPROMB CI~BK ANI2 E:~LITHOLP PAY, ExPLII'HOLP, ¢IJPPOLK CO,, NY ~BBTI OPI 12/10/09, I/8/10 James F. King, Jill M. Doherty Dave Bergen Bob Ghosio, Jr. John Bredemeyer P.O. Box 1179 Southold. NY 11971 Telephone(631)765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: En-Consultants, Inc. on behalf of THOMAS PETROSINO requests an Amendment to Permit #5944 to authorize the installation of (2) 6"X 6" walers atop the upper waler of the existing bulkhead to function as a flood screen. Located: 900 Rogers Rd., Southold. SCTM#66-2-38 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Modifications: Conditions: Present Were: '~llJKlng~- ' ~. Doherty/" /q~/~.~r'~Jt.o_ ~" D. Dzenkowski other Form filled out in the field by ,~J Mailed/Faxed to: Date: THOMAS PETROSINO~ 900 ROGERS ROAD, SOUTHOLD Figure 1. Looking northeast at +75' section of bulkhead to northeast of statrs to be topped wtth (2) 6 x 6 ale . Figure 2. LooMng southwest at +_75' section ~f bulkhead to northeast of stairs to be topped with (2) 6" x 6" walers. THOMAS PETROSINO~ 900 ROGERS ROAD~ SOUTHOLD Figure 3, Looking northwest atJhce of + 75' section of bulkhead to northeast of stairs to be topped with (2) 6" x 6" walers. Figure4. LooMng northwest at +_41' bulkhead return to be topped with (2) 6" x 6" waler,*. EN-CONSULTANTS, INC. ENVIRONMENTAL CONSULTING James King, C Board of Tmstee~ Town of Southo)d PO Box 1179 Southold, NY 1 ~19'7t- 1319 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 www. enconsultants.com January 11, 20t0 Re: Thomas Petrosino~ Wetlands Permit No. 5944 Dear Mr. King: As discussed, please find attached (3) copies of a project plan, last dated 8 January 2010, which has been revised to depict a 10' wide nonturf buffer behind the easterly section of the bayfront bulkhead and a variable width (4' - 10') nonturf buffer behind the creekside bulkhead. Please also be advised that it came to my attention when designing the nonturf buffer that the previously approved deck behind the bayfront bulkhead was extended to the comer of the bulkhead when it was replaced pursuant to permit no. 5944. Therefore, we must request that the project description be amended as follows: Amend Permit 5944 to 1) authorize the installation of (2) 6" x 6" walers atop the upper waler of approximately t 17 linear feet of bulkhead to function as a "flood screen"; 2) establish a specific design for the nonturf buffer; and 3) legalize the + 12-foot extension of the previously existing 9.5' wide untreated deck previously approved to be replaced in-place, all as depicted on the project plan prepared by Eh-Consultants, Inc., last dated January 8, 2010." Please let me know if you have any questions or require any additional information. Robert E. Heg~smann Coastal Management Specialist Enclosures James F. King, Jill M. Dougherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 FAx (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD LETTER OF REQUEST FOR AN AMENDMENT DATE DECEMBER 11, 2009 OWNER ADDRESS AGENT THOMAS PETROSINO PHONE 516-248-0539 120 SALISBURY AVENUE, GARDEN CITY, NY 11530 EN-CONSULTANTS, INC. PHONE 631-283-6360 ADDRESS 1319 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 PROPERTY LOCATION 900 ROGERS ROAD, SOUTHOLD TAX MAP NO. 1000-66-2-38 5944 to l/We EN-CONSULTANTS, INC. request an Amendment to Permit # authorize the installation of (2) x 6" walers atop the upper waler of the existing bulkhead to function as a "flood screen", as notated on the project plan prepared by En-Consultants, Inc., last dated 12/10/09. f Signed By: _ COASTAL MGMT. SPECIALIST ~oard of Trustees Applicati¢ AUTHORIZATION (where the applicant is not the owner) (print owner of property) (mailing address) (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signat re~) County of Suffolk State of New York '~lO~V'~l/~t.$ ~,. ?t~. ']'"'~iP-..O.~ /J"d~' BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, 1 HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAYOF ,200 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the par~ of town officers and emt~lovees. The t~uroose of this form is to orovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: '"'T/4, ~ (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company, lfso, 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~'~he 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 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 Form TS 1 EN-CONSULTANTS, INC. ENVIRONMENTAL CONSULTING 1319 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 www. enconsultants.com December 10, 2009 James King, Chairman Board of Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 Re: Thomas Petrosino~ Wetlands Permit No. 5944 Dear Mr. King: The captioned permit, issued 24 June 2004, authorized the construction of a vinyl bulkhead in place of a previously existing timber bulkhead (copy of permit attached). Since the permitted work has been completed, the property has experienced occasional flood tides that have overtopped the portion of bulkheading located to the northeast of the deck, damaging or killing the vegetation planted behind it. As a solution to this problem, the applicant has proposed to bolt and spike two 6" x 6" walers atop the upper waler of the existing bulkhead to function as a "flood screen." The top of the proposed top waler would match the top elevation of the adjacent deck, which currently acts to prevent overtopping of the bulkhead in the southwesterly portion of the property. Therefore, we are enclosing herewith an application to administratively amend the permit to authorize this work, as depicted on the project plan prepared by Eh-Consultants, Inc., dated December 10, 2009. Also attached for your reference are current photographs of the site and a current survey prepared by Stanley J. Isaksen, last dated November 2, 2009. Respectfully yours, Robert E. Hemnann Coastal Management Specialist Enclosures Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line __ 1st day of construction ¼ constructed Project complete, compliance inspection. Board Of $outhold 'ToM Trustees SOUTHOLD, NEW YORK PERMIT NO...'S,~..~.?'~ ...... DATE: THOMAS PETROSINO ISSUED TO ........................................... : .......................................................................................... Pursuant to the provisions of Chapter 61~i of the Lews of the State of New York, 1893: end Chapter ~ of the L~ws of the · State of New York 19~12: and the Southeld Tov~n Ordlnence titled .'REgULaTING AND THE PLACING OF IN AND ON TOWN WATERS AND PUBLIC L~NDS end the REMOVAL OF SAND, GRAVEL OR OTHER IdATERIALS~FgC)M LANDS ·UNDER TOWN WATERS?. and in ac¢o~lance with ~the Resolution of The Board adopted et a meeting held on ..~.~?.~.,~.,.... .20.~.~...., end in consideration of the sum of $...;~.~.g.:.~g ....... paid by Thomas Petrosino Of .............. ,~.~(~.,~..~.O,~(~ ....................... r ................... N. Y. end subject to the Terms and Conditions ~isfed onthe reverse slde hereof, of Southold Town' Trustee,~' authorizes and permlh fha following: Wetlend Pexnti ~co remove ~nd replace (in-place) ~pprox. 252 linasr ft. of existing timber bulkhead (including 40' and ~' retume) with vinyl bulkhead ~nd backfill with approx. 100 cy. of dean sand till to be trucked in from an upland source, with the condition of a 1 O' non4uff buffer landward of the bulkhead, and all as depicted on the plan prepared by En-Consultants, Inc. last . dated June 29, 2004. all in acoordan~e wlfh the detai~l spec'd'icafions as presenfed in · fhe edglnafing appr~oafio~. IN WITNESS WHEREOF, The said Board Of Trusfees ~re- cause, Corporate. to be amxed, and these..j~eseuts I'o subscribed by ~'melority of the sald Board .as of this daf~. TERMS ~nd GONDI110NS Thomas Petrosir~o t~tdlag at 900 Rogers Rd., Southold . .~,, . N. ¥~ 'ti Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson To~vn Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 June 24,2004 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Robert E. Herrmann Eh-Consultants, Inc. 1319 North Sea Rd. Southampton, NY 11968 RE: THOMAS PETROSINO 900 ROGERS RD., SOUTHOLD SCTM#66-2-38 Dear Mr. Herrmann: The Board of Town Trustees took the following action during its regular meeting held on Thursday, June 24, 2004 regarding the above matter: WHEREAS, En-Consultants, Inc. on behalf of THOMAS PETROSINO applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 2, 2004, and, WHEREAS, said application was referred to the Southoid Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 24, 2004, 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, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 WHEREAS, the structure complies with the standards set forth in Chapter 97 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 approve the application of THOMAS PETROSINO to remove and replace (in-place) approx. 252 linear ft. of existing timber bulkhead (including 40' and 6' returns) with vinyl bulkhead and backfill with approx. 100 oy. of clean sand fill to be trucked in from an upland source, with the condition of a 10' non-turf buffer landward of the bulkhead, and all as depicted on the plan prepared by Eh-Consultants, Inc. last dated June 29, 2004. 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, Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims Telephone (631 ) 765-1892 To,sm Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, June 15, 2004, the following recommendation was made: Moved by Doris McGreevy, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of THOMAS PETROSlNO to remove and replace (in-place) approx. 252 linear ft. of existing timber bulkhead (including 40' and 6' returns) with vinyl bulkhead and backfill with approx. 100 cy. of clean sand fill to be trucked in from an upland source. Located: 900 Rogers Rd., Southold. SCTM#66-2-38 The CAC recommends Approval of the application with the Condition the area seaward of the bulkhead is restored with wetland vegetation. Vote of Council: Ayes: All Motion Carried APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD ~OAD ? I~PbACIf. P . C 2CCg5; VIA 1' ?AR~L ) ~ .IMII' Off ~J THRU ~LtKHBAI? RBFL.,A£BMBNT ( CRBBK $1t2B) 5uti'ak Ceur~ Ifla~s~r~, Ma~ ?P I" ~ + ~C)OO' EN-CONSULTANTS lNG. 131g NORTH SEA RD. SOUTHAMPTON, N.Y. 11968 631-283-6360 \ \ \ \ \ ~6:0 FM# 7472 DATE FIE£D MARCH TM# 7000-066-02-038 GIJARANTE££) TO: THOMAS G PETROSIND HIPPODROME DRIVE S 60'20'40"W BLOCIK LOT 4 111.00' 550'- 2-STORY WOOD FRAME RESIDENCE GARAGE N 60'20'40"E WOOD PLATFORM & STEPS TO BEACH SEI×EDON BEACH '~l~ 24.6'- SLATE ~ WALK (PLOT A,) MAP SOUTHOLD, SUFFOLK LOT 5 IN BLOCK 6 OFBEIXEDON ESTATES SITUATE TOWN OF SOUTHOLD COUNTY, NEW YORK 135.71' SURVEYED FOR: THOMAS G. PETROSINO SURVEYED: 9 APRIL 2004 SCALE 1": 20' AREA : 8,827.88 S.F. OR 0.202 ACRES SURVEYED BY STANLEY J. ISAKSEN, ,IR, P.O. BOX 294 NEW SUFFOLK. N.Y. 11956 ~.~ ~ - ~_',]- ~.~ // ,~ NY~ Lic~No, 49273 04N1.313 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ,~,~Vetland Permit Application Waiver/Amendment/Changes ~,,l~Teceived Application: _l~Received Fee:* ,~,Completed Apl~lication 01 1 Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) . eAC Refe l Sent: - 6ate of nspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ,.l~blic Hearing Held: Resolution: Minor JU I - 2 S0uth01fl ]own Board 0f lrustees Name of ApplicantTHOMAS PETROSINO Address 120 SALISBURY AVENUE, GARDEN CITY, NY I 1530 Phone Number: 516-248-0539 Suffolk County Tax Map Number: 1000 - 66-2-38 Property Location: 900 ROGERS ROAD, SOUTHOLD (provide LILCO Pole #, distance to cross sweets, and location) AGENT: EN-CONSULTANTS, 1NC. (If applicable) Address: 1319 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Phone: 631-283-6360 of Trustees Applica~n Land Area (in square feet): 8,828 Area Zoning: R-40 GENERAL DATA Previous use of property: RESIDENTIAL. Intended use of property: NO CHANGE. 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.'? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): REMOVE & REPLACE (IN-PLACE) APPROXIMATELY 252 LINEAR FEET OF EXISTING TIMBER BULKHEAD (INCLUDING 40' AND 6' RETURNS) WITH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 100 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. of Trustees Applicat WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: MAINTAIN EXISTING EROSION CONTROL STRUCTURE. Area of wetlands on lot: 0 square feet Percent coverage of lot: N/A % Closest distance between nearest existing structure and upland edge of wetlands: N/A feet Closest distance between nearest proposed structure and upland edge of wetlands: N/A feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? 100 cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: APPROXIMATELY 100 CUBIC YARDS OF CLEAN SAND FILL WILL BE TRUCKED IN FROM AN UPLAND SOURCE AND DUMPED AND GRADED AS BACKFILL LANDWARD OF NEW BULKHEADING. 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): THE PROJECT ENTAILS THE ORDINARY AND ROUTINE MAINTENANCE OF AN EXISTING EROSION CONTROL STRUCTURE IN THE IN-PLACE REMOVAL AND REPLACEMENT OF AN EXISTING TIMBER BULKHEAD WITH A VINYL BULKHEAD. THE PROJECT WILL HAVE NO SIGNIFICANT ADVERSE LMPACT ON ADJACENT T1DAL WETLANDS OR TOWN WATERS. t4-18--4 (2/B7}--Texl t2 PROJECT I.D. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) FORM SEQR I APPLICANT/SPONSOR: I 2. PROJECT NAME THOMAS PETROSINO BY EN-CONSULTANTS, INC. I 3 PROJECT LOCATION: Munidpelity SOUTHOLD County SUFFOLK 4 PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc, or provide map) ~00 ROGERS ROAD, SOUTHOLD, SLTFFOLK COUNTY, SCTM #1000-06-2-38, MAP PROVTDED ~. ,s PROPOSED ACT . 6 DESCRIBE PROJECT BRIEFLY: ND 6 RETURNS) WITH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 100 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. Initially 8,828 S.F. ac~s Ultimately 8,828 S.F. acres DeS [] NO If NO, describe briefly [] Residential [] Industrial [] Commercial [] Agriculture [] Park ForesUOpen space [] Other STATE OR LOCAL)? [] Yes [] No If yes, list agency(s) and pemlit/approvels DEC, COE, DOS 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yea [] No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION VVILL EXISTING PERMIT/APPROVAL REQUIRE MOCIFICATION? ~---]Yes []No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ~,pplicanu~ponsor nam ROBERT E. HERRMANN, COASTAL MANAGEMENT SPECIALIST DATE J~[~E 2, 2004 Signature: "~__~ ~ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING l ll! R SEA RD. $01_ .I~"~TON. N.Y. 119t/8 being dui3' swom, depose and say: ~1~0 That on the I t~ day of ~6,200~, ,~ perso'nallyRosted the property known as by placing the B6ar~l of'Tmdte~s official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight d3ys prior t_o the~late of the_public hearing. Date of hearing noted thereon to be held"~"~l~, ~l.f~ ~, ~ . Dated: (signature)~ ' - Sxvom to before me this o,~ y'~ day o~-/~200 ~ N~'~a~ Public- ~ -- NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:THONLqSPETROS[NO SCTM~1000- 66-2-38 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to Permit from the Board of Trustees to: request a REMOVE & REPLACE (IN-PLACE) APPROXIMATELY 252 LINEAR FEET OF EXISTING T1MBER BULKHEAD (INCLUDING 40' AND 6' RETURNS) WITH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 100 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 900 ROGERS ROAD, SOUTHOLD 3. That the project which under Chapters 32, 37, or comment on:Yt~NE24,2004~7:00pm 765-1892 or in writing. is subject to Environmental Review 97 of the Town Code is open to public You may contact the Trustees Office at The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: PHONE #: THOMAS PETROSINO 120 SALISBURY AVENUE GARDEN CITY, NY 11530 516-248-0539 Enc.: Copy of sketch or plan showing proposal for your convenience. 5 Name: GRACE LEWIS PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 885 ROGERS ROAD SOUTHOLD, NY 11971 KATHRYN HOEY GENEVIEVE DALY 49 8TH STREET NEW ROCHELLE, NY 10801 HENRY LATHAM g45 ROGERS ROAD SOUTHOLD, NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK SUSANNA B. HERRMANN doing business atEN~ONSULTANTS, INC. 1319 NORTH SEA ROAD SOUTHAMPTON, NY 11968 , being duly sworn, deposes and says that on the 17TH day of 3U~5 .20 04 , 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 $OUTH~N , that said Notices were mailed to each of said persons by (certified) ~) mail. Sworn to before me this 17TH day o f 3UNE .2004 Notary P~blicO EN-CONSULTANTS INC. '~:' ^¢P~*,,.,~k Ioo c~ a~,., .~ r,t~ ~ b. ~ke~ ,. 1319 NORTH SEA RD. ~ ~l~ ~ ~ .~ ~ ~k~,ll SOUTHAMPTON, N.Y 11968 s;' ~ I***~ *~***"~ *~a' ~a 631-283-6360 ROGERS ROAD ~ ~, -IMKOF: Mairr~r ~lrq erc,~a cor~-d ~ruckre ~ CC~-~ EN-CONSULTANTS lNg. :~ ~, ~lem ~ ~,ll ~ ~ ~e~ ,. 1 319 NORTH SEA RD. ~c~ ~ ~ m ~m~nll SOUTHAMPTON, N ~ 11 ROGERS ROAD ... :. . . . ~ -. ..... .... ~0~ ~01~ ~ ' ~B,.I~CF PA~C~b) %rf'dk Co,~ I'l~s'c, rm Map 2f : + 5000' ~osrd of Trustees kpplic~tio~ County of Suffolk State of New York "~t~7 '~C"1'1~1~0 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SFIE IS TFIE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND TELkT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TI-IlS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY .a2Xl13 ,%LL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), I~ GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJLFNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF ~.3% 20 Ok/' of Trustees Application AUTHOIAI ZATION (where the applicant is not the owner) I, ~l(~pOri~4n~,~o~e~r ~T~O~ ;/¥0 residing at of property) (mailing addres&) ~,~ 7';O~rJ-~(_. ]l~)do hereby authorize ~- ~v~...ul.v-~TS, ( Agent to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 06/24/2004 14:52 F&~ 63128361 Albert J. Krupsld. President James King, Vice-Prenident Artie Foster Ken Poliwoda Peggy A. Dicker~on EN-CONSULTANT$,IN¢. 006 Town Hall 53095 Rout~ 25 P,O. Box 1t79 Southold, New York 11971-0959 Telephone (631i 7611-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In thc Matter of thc Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) JUt'~ 2 ~ £u04 Southold Town Board of Trustees AFFIDAVIT OF POSTING lalg SEA ~IJ~I~I~ON. ~.Y, 11,968 being duly sworn, depose and say: b . That on the I~ day of ~va6,200~,~ perso~nally~ost~.the property known as by placing thc BDard of Tndtees official poster where it can easily be seen, and that I have checked to be sine the poster has remained in place_..for eight d~ys priorio theAla, te of the public hearing. Date of hearing noted thereon to be held ~ ..... ' . Dated: Sworn to before me this Not a~y Public~ ~ - Henry Latham 845 Rogers Road Southold, NY 1971 poi 06/24/2004 14:54 FAX 63~28~61; EN-CONSULTANTS,INC, 008 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTE~.$, TOWN OF HOUTHOLD In the n%atter of applicant:~O~4A~TK~NO -qCTM~i 0 00- 66-2-38 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a ~ermit from the Board of Trustees to: REMOVE & REFLACE (IN-PLAC~ APPROXIMATELY 252 LINEAR Ft~T OF EXISTING TLMBI~R BULKItF..AD (INCLUDINO 40' AND 6' P.L~RNS) WiTH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 100 CUBIC YARDS OF CLF..AN SAND FILL TO BI~ TRUC',Cl~r~ IN FROM AN UPLAND SOURCE. 2. That the property which is the subject of Environmental Review-is located adjacent to your proper~y and is described as follows: 900 ROC~RS ROAD, SOUTHOLD 3. That the project which is subject to Environmental Review under Chapters 32, 37, Or 97 of the Town Code is open tO public co~en~ on:~UN~24~20~?:~m You r~ay contact the Trus=ees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of $outhol~ and does not reference any other age~oy that migh~ have to review same proposal. OWNERS NAME: T~OMAS PET~OS~O MAILING ADDBES$: 120 SALISBURY O~ CI~, ~ 11530 PHONE ~; ~l~8~539 Eno.: Copy of ske=ch or ~lan showing proposal for your convenience. 06/24/2004 14:54 FAX 63128361 EN-CONSULTANTS,INC, 009 Name: GRACE LEW~S PROOF OF MAILING OF NOTICE ATTACH C~RTIFI~D ~AIL R~CEIPTS Address: 885 ROG'ERS ROAD SOUTHOLD, NY 11~/1 KATI~YN FIOEY OENEVIEVE DALY 49 8TI-{ STREET NEW ROCHELLE, NY 10801 I-I~Y LATHAM 845 ROGERS ROAD SOUTHOLD, NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK SUSANNAB. HERRMANN 1319 NORTH SF, A ROAD SO~N, NY 11~68 doing business at~N410. NSULTANTS,~C. · being duly sworn, deposes and says that on the 17TH day of R3N~ ,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 addre$$es 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 SOUTHAN~FFON , that said Notices were mailed to each of said persons by ~/(~) mail. (certified) Sworn to before me this 17T~ day o f R3N~ ,2o~4 APPLICANT TRANSACTIONAL DISCLOSOR~ FORH The Town of Southold'a Code of Ethics prohibits conflicts o, interest on the part of town officers and employees. Th,. purpose of this form is to provide Information which ca.. alert the town of possible conflicts of interest and allow .St to take whatever action is necessary to avoid same. (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If au, indicate the other person's or company's name.) NATURE OF APPLICATION~ (Check ali that apply.) Tax grievance Variance Change of zone A~p~oval of plat , {If "Other,. name the activity.) oYnermh~p of (or employment by} a corporation ~n which If you answered 'YES,' complete the balance of this form and date and s~gn where indicated. Name of person employed by the Towa of Soutbold Title or position of that peraon Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the appropriate line A) through D) a~d/or describe in the space provided. parent, or child is (check all that apply)l is a corporation); B} 5he legal or beneficial owner of any interest in a noncorporate'entity (when the applicant is not a corporation)~ .. C) an nfficar, director, partner, or employee of the applicant~ or D) tbs actual applicant. DESCRIPTION OF R~LATIONSHIP