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HomeMy WebLinkAboutTR-5046 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 # 0782C Date August 3, 2012 THIS CERTIFIES that the 4'X 60 'catwalk with a new 4'X 15' extension, 4'X 8' dock extension in an "L" configuration, not to exceed an overall length of 12'; relocation of stairs to the southeast side of the dock; and two swim ladders, one 4' south from the northwest comer of the catwalk extension and one 4' east from the northwest comer of the new dock section At 1775 Indian Neck Lane, Peconic Suffolk County Tax Map #86-5-9.1 Conforms to the application for Trustees Permit heretofore filed in this office Dated 8/99 pursuant to which Trustees Wetland Permit #5046 was issued on 8/25/99 and Amended on 1/26/00 and on 1/18/12 and conforms to all of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for A 4'X 60' catwalk with a new 4'X 15' extension, 4'X 8' dock extension in an "L' configuration, not to exceed an overall length of 12'; relocation of stairs to the southeast side of the dock; and two swim ladders, one 4' south from the northwest comer of the catwalk extension and one 4' east from the northwest comer of the new dock section. The certificate is issued to DONNA WEXLER owner of the Aforesaid property. Authorized Signature James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-t 892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ¼ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: James F. King, President Bob Ghoeio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 TOW~N OF SOUTHOLD January 18,2012 Ms. Donna Wexler 1775 Indian Neck Lane Peconic, NY 11958 RE: 1775 INDIAN NECK LANE, PECONIC SCTM#86-5-9.1 Dear Ms. Wexler: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 18, 2012: WHEREAS, DONNA WEXLER applied to the Southold Town Trustees for an Amendment to Wetland Permit #5046 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated September 1,2011, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6, 6.3, 9 & 9.4 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: shorten the overall length of the proposed "L" addition to 12', and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, 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 for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, BE IT FURTHER, RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #5046 to add a 4'x15' extension to the existing catwalk; add a 4'x8' dock extension in an "L" configuration which is not to exceed an overall length of 12'; relocate the existing stairs to the southeast side of the dock; and add two swim ladders, one 4' south from the northwest corner of the catwalk extension and one 4' east from the northwest corner on the new dock section; and as depicted on the site plan prepared by David S. Corwin, PE, last dated February 16, 2012, and stamped approved on February 17, 2012. This is not a determination from any other agency. Fees: $326.00 Sincerely, m~esF. King ,'~ 'President, Board"of Trustees JFK:eac RICHMOND CREEK EXlSTING~&' x 6' ALW HAGSTROM SUFFOLK COUNTY MAP 25 GRID H-40 SCALE 1"=5000' OF SLOPE BOARD TOWN OF DATE /'/-d BY 1', ADD 4' WIDE BY 15' NEW DOCK SECTION IN LINE WITH EXISTING 60' CATWALK. ADD 4' WIDE BY 8' NEW ELL OOCK SECTION ON NORTHEAST SIDE OF CATWALK EXTENSION. THE ELL SECTION NOT TO EXCEED 12' IN LENGHT. RELOCATE EXISTING STNRS TO SOUTHEAST SIDE OF ELL DOCK. ADD TWO SWIM LADOERS: ONE 4' SOUTH FROM THE NORTHWEST CORNER OF THE CATWALK EXTENSION AND ONE 4' EAST FROM THE NORTHWEST CORNER ON THE NEW ELL DOCK. NEW PILES 6"¢ BY 20' CCA, NEW DIMENSIONAL LUMBER ACQ OR EQUAL TREATMENT, NEW DECK FIR TOWN OF SOUTHOLD PERMIT No. 5046 NYSCEC PERMIT No. 1-4738-01117/0..3 1625 INDIAN NECK LANE SCTM 1000-86-05-8.1 MARGARET HALLDEN 512 ASLAND AVENUE E~LD?V(N, NY 1)5~0 FEB 1 6 2012 SCTM 1000-86-05-9.1 DONNA IGLESIAS-WEXLER 1775 INDIAN NECK LANE EECONIC, NY 11958 SOUNDINGS FEET BELOW ALW DATUM ALW=O.O 1775 INDIAN NECK LANE 150' INDIAN NECK LANE PLAN VIEW SCALE 1"--50' 1925 INDIAN NECK LANE SCTM 1000-86-05-9,3 VIRGINIA SIC. A-PETERS 558 4th AVENUE ST JAMES, NY 11780 CATWALK EXTENSION RICHMOND CREEK PECONIC TOWN OF SOUTHOLO APPLICANT: DONNA IGLESIAS-WEXLER DRAWN BY: CORWIN SHEET 1 OF 2 AUGUST 7, 2011 EXISTING CATWALK PROPOSED EXTENSION ~ CO' I 15'. I ELL J2.2' 12.2, .~ ~ SWIM LADDER (2) 6"~, x 20' CCA PILE RELOCATED STAIRS 8' pENETRATION CROSSVIEW SCALE 1"=10' FEB 1 6 2012 CATWALK EXTENSION RICHMOND CREEK PECONIC TOWN OF SOUTHOLD APPLICANT: DONNA IGLESIAS-WEXLER DRAWN BY: CORWlN SHEET 2 OF 2 AUGUST 7, 2011 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 TO: DONNA WEXLER BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated September 1, 2011 has been reviewed by this Board at the regular meeting of January 18, 2012 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) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) XX Final Inspection Fee ($50.00) XX Dock Fees ($3.00 per sq. ft.) 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: Final Inspection Fee = $50.00 Fixed Dock = 4'x15'=60sq.ft. x $3.00 per sq.ft. = $180.00 Fixed Dock "L" = 4'x8' -- 32 sq.ft, x $3.00 per sq.ft. = $96.00 TOTAL FEES DUE: $ 326.00 \ BY: James F. King, President "'~ Board of Trustees James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemcyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: DONNA WEXLER Please be advised that your application dated September 1,2011 by this Board at the regular meeting of January 18, 2012 and your application has been approved pending the completion of the following items checked off below. XX Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ½ Constructed ($50.00) XX Final Inspection Fee ($50.00) XX Dock Fees ($3.00 per sq. ft.) 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: Final Inspection Fee - $50.00 Dock Fees - To Be Determined upon receipt of revised and approved plans TOTAL FEES DUE: $ 50.00 plus additional dock fees (to be determined) BY: James F. King, President Board of Trustees has been reviewed NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-01117 PERMIT Under the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To: DONNA I WEXLER 1775 1NDIAN NECK LN PECONIC, NY 11958 Facility: WEXLER PROPERTY 1775 INDIAN NECK LNISCTM# 1000-86-5-9.1 PECONIC, NY 11958 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Peconic Facility Principal Reference Point: NYTM-E: 714.067 NYTM-N: 4545.611 Latitude: 41°02'01.0'' Longitude: 72°27'12.5'' Project Location: Richmond Creek Authorized Activity: Constz:uct a catwalk extension, a platform, install a ladder and relocate stairs. All work must be in conformance with the attached plans stamped NYSDEC approved on 12/5/11. (JRP) Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-01117/0001 ! New Permit Effective Date: 12/6/2011 Expiration Date: 12/31/2016 Water Quality Certification - Under Section 401 - Clean Water Act Permit ID 1-4738-01117/00012 New Permit Effective Date: 12/6/2011 Expiration Date: 12/31/2016 Excavation & Fill in Navigable Waters - Under Article 15, Title 5 Permit ID 1-4738-01117/00013 New Permit Effective Date: 12/6/2011 Expiration Date: 12/31/2016 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, ail applicable regulations, and all conditions included as part of this permit. Permit Administrator: MARK CARRARA, Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY ~ STONY BROOKI50 CIRCLE RD STONY BROOK, NY 11790 -3409 Authorized Signature: , ..ff ~r..o.-~_ Date ~__.~/ ~v /ho ti Page 1 of 7 95-20-1 (11/03) -9d New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of the approved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Permit Number Expiration Date __ Regional Permit Administrator ROGER EVANS NOTE: This notice is NOT a permit New York State Department of Environmental Conservation Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 Phone: (631) 444-0352 Fax: (631) 444-0360 Website: www.dec.ny.,qov December 7, 2011 Joe Martens Commissioner Ms. Donna Wexler 1775 indian Neck Lane Peconic, NY 11958 Re: Permit No.: 1-4738-01117/00011 d~,,~ '8 2012 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Jacquetin~ R. Pasquini ,~.j/Env rc~rf'enta Ana yst ,/ JRP/Is · NEW YORK STATE DEPARTM~ OF ENVIRONMENTAL CONSERVA~I~ Facility DEC 1D 1-4738-01117 PERMIT Under the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To: DONNA I WEXLER 1775 INDIAN NECK LN PECONIC, NY 11958 Facility: WEXLER PROPERTY 1775 INDIAN NECK LNISCTM# 1000-86-5-9.1 PECONIC, NY 11958 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Pecomc Facility Principal Reference Point: NYTM-E: 714.067 NYTM-N: 4545.611 Latitude: 41°02'01.0'' Longitude: 72°27'12.5'' Project Location: Richmond Creek Authorized Activity: Construct a catwalk extension, a platform, install a ladder and relocate stairs. All work must be in conformance with the attached plans stamped NYSDEC approved on 12/5/11. (JR_P) Permit Authorizations ~, Tidal Wetlands - Under Article 25 Permit ID 1-4738-01117/00011 New Permit Effective Date: 12/6/2011 Expiration Date: 12/31/2016 Water Quality Certification - Under Section 401 - Clean Water Act Permit ID 1-4738-01117/00012 New Permit Effective Date: 12/6/2011 Excavation & Fill in Navigable Waters - Under Article 15, Title 5 Permit ID 1-4738-01117/00013 New Permit Effective Date: 12/6/2011 Expiration Date: 12/31/2016 Expiration Date: 12/31/2016 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: MARK CARRARA, Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY ~ STONY BROOK[50 CIRCLE RD STONYBROOK, NY 11790 -3409 Authorized Signature: Date~_M ~ /~oa Page 1 of 7 95-20-1 (11/03}-~1 New York State Department of Environmental Conservation NOTICE The. Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and eXtent of the apProved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown whe~n contacting the DEC. Permit Number Expiration Date Regional Permit Administrator ROGEh EVANS NOTE: This notice is NOT a permit :RESTRICTIVE COVENANT TO THE DEED ****************************************************************************** DECLARATION THIS DECLARATION, dated day of ,20 , is made by , (hereinafter the "Declarant"), whose address is WITNESSETH WHEREAS, the Declarant is the owner of certain real property located in the Town of , County of , State of New York, Tax Map # District , Section , Block , Lot(s) which real property is more particularly described in Exhibit A annexed hereto (hereinafter referred to as the "Property"); and "This covenant shall serve as notification that regulated wetlands are located on or near the properties of and his, her, their heirs, assigns or successors and is therefore subject to current environmental conservation laws regar~ting the conduct of regulated activities on such property." "Whereas, it is the responsibility of the owner of the property to obtain a current description of all regulated activities from the New York State Department of Environmental Conservation CNYSDEC") or its successor organization for the purpose of determining what is considered a regulated activity. Performance of any regulated activity will require prior approval by the NYSDEC or its successor. Regulated activities include, but are not limited to the erection of any structure(s); excavation; dredging; grading; filling; clearing of vegetation; and the application of chemicals." "The <describe restriction>" "The foregoing covenants shall run with the land and are binding on this owner and his heirs and assigns, forever" STATE OF NEW YORK ) )SS.: COUNTY OF ) On the day of in the year 20 , before me, the undersigned, a Notary Public in and for said state, personally appeared , personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the person or entity upon behalf of which the person acted, executed the instrument. NOTARY PUBLIC HAGSTROM SUFFOLK COUNTY MAP 25 GRID H-40 SCALE OF SLOPE 1625 INDIAN NECK LANE SCTM 1000-86-05-8.1 MARGARET HALl_DEN 512 A~LANO AVENUE BALDWIN, NY 11510 1 75' SCTM 1000-86-05-9.1 DONNA IGI.£SIAS-WEXLER 1775 INDIAN NECK LANE PECONIC, NY 11958 1775 INDIAN NECK LANE 150' INDIAN NECK LANE ADD 4' WIDE I]Y 15' NE'~ DOCK SECTION IN UNE WITH EXISTING 60' CAlWALK. ADD 4' WIDE BY 12' NEW ELL OOCK SECTION ON SOUTHWEST SIDE OF CATWALK EXTENSION. RELOCATE STNRS TO SOUTHWEST SIDE OF DOCK. ADD TWO SWIMMING LADDERS AT NOR~F~T AND SOUTHWEST ENDS OF ELL SECTION. NEW PILES 6"e BY 20' CC.A. NEW DIMENSIONAL LUMBER ACO OR EQUAL TREATMENT. NEW DECK RE TOWN OF SOUTHOLD PERMIT No. 50~-6 NYSOEC PERMIT No. 1-4758-01117/0..3 1925 INDIAN NECK LANE $CTM 1000-86-08-9.5 VIRGINIA SICA-PETERS 358 ~.th AVENUE ST dAMES. NY 11780 CATWALK EXTENSION RICHMOND CREEK PECONIC TOWN OF SOUTHOLD APPLICANT: DONNA IGLEStAS-WEXLER DRAWN BY: CORWlN SHEET 1 OF 2 AUGUST 7, 2011 SOUNDINGS FEET BELOW ALW DATUM ALW=O.O PLAN VIEW SCALE 1"=50' EXIST1NG CATWALK CO' CROSSVIEW SCALE I"=10' PROPOSED EXTENSION 15' I---4'---, 6"e x 20' CCA PII..~ 8' PENETRATION · --sw~ ~.~D~ (2) RELOCATED STAIRS CATWALK EXTENSION RICHMOND CREEK PECONIC TOWN OF SOUTHOLD APPUCANT: DONNA IGLESIAS-WEXLER DRAWN BY: CORWIN SHEET 2 OF 2 AUGUST 7, 2011 Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., November 9, 2011, the following recommendation was made: DONNA WEXLER to Amend Wetland Permit #5046 to add a 4'X 15' extension to the existing catwalk; add a 4'X 12' dock in an "L" configuration; relocate stairs to southwest side of dock; and add two swim ladders at northeast and southwest ends of "L" section. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 The CAC did not make an inspection, therefore no recommendation was made. Jill M Dohelly, President Bob Ghosio, Jr, Vice-President James F, King Dave Bergen John Bredemeyer P.O. Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: [/-' ~1-' // DONNA WEXLER requests an Amendment to Wetland Permit #5046 to add a 4'X 15' extension to the existing catwalk; add a 4'X 12' dock in an "L" configuration; relocate stairs to southwest side of dock; add two swim ladders at northeast and southwest ends of "L" section. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 rea to be impacted: ter Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part/~ Town Code proposed work falls under: ~hapt.275 Chapt. 111 other Type of Application: Wetland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Form filled out in t,l~ld by Mailed/Faxed to: Date: 1~/7/2011 IMG 0921 IMG_0922 IMG 0924 DEPARTMENT OF THE ARMY NE%N YORK DISTRICT; CORPS OF ENGINEERS JACOB K. JAVITS FEDERAL BUILDING NEW YORK, N.Y. 102784)090 ALI$ 1 9 2011 REPLYTO ATfENTION OF: Regulatory Branch-Eastern Permits Section SUBJECT., Permit ~A~plication Number~ L xrh ~3 ~'~}- ~?-/O~o ~ - ineers has The New York District, U.S. Army Corps o= ~:ng , received a request for Department of the Army authorization for the following activity: ACTIVITY: Install a 4-foot wide by 15-foot long fixer% pier extension to an existing ~o-foot long by wide fixed pier; and, instal,],~ a 4-foo.,t .wide by foot long , , "L' st~pe-~~ The purpose of %h~s project is to achieve adequate water depths for recreational watercraft WATERWAY: Ricb_mond Creek off Little Peconic Bay LOCATION: Peconic, Town of Southold, Suffolk County, New York As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c) (3) (A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. In order for us to better serve you, please complete our Customer Service Survey located at: http://www.nan.usace.arm¥.mil/business/buslinks/regulat/index,Dhp?survev. PLEASE USE THE 18-CHARACTER.FILE NUMBER ON ALL CORRESPONDENCE AU6 1 9 2011 To allow for the timely processing of the subject application, ~your comments are requested within 20 days of the date of this letter. If you have any questions, please contact Mary Ann Miller, of my staff, at (917) 790-8516. Sincerely, C~ef,~aster Permits Section Enclosures 2 New York State APPLICATIONS TO · 1. NYS Department of Environmental Conservation .JOINT APPLICATION FOR~¢? - For Permits/Determinations to undertake activities affecting streams, waterways, waterbodies, wetlands, coastal areas and sources of water supply. You must separately apply for and obtain separate Permits/Determinations from each involved agency prior to proceeding with work. Please read ail instructions. Check all permits that apply: [] Stream Disturbance [] Coastar Erosion [] Excavation and Fill in Hanagement Navigable Waters [] Wild, Scenic and [] Docks, Floorings or Recreational Rivers Platf~orms ~r~ Water Supply [] Dams and Impoundment [] Long is[and Well Structures [] Aquatic Vegetation Control [] 401 Water Quality [] Aquatic Insect Control Certification [] Fish Control [] Freshwater Wetlands [] incidental Take of Endan- [] Tidal Wetlands gered/Threatened Species [] I am sending this application to this agency. 2. US Army Corps of Engineers Check all permits that apply: [] Section 404 Clean Water Act I--] Section 10 Rivers and' Harbors Act [] Nationwide Permit(s) - Identify Number(s): Preconstruction Notification - E3v/Du [] I am sending this application to this agency. 5. Name of Applicant (use full name) Appr~t must be: ~1 Owner ~"~ ~3'~-'~. ~'. ~"J~'O._TM E] Operator Hailing Address ~ Lessee Post Ice City, Telepho~daytime)~ Email 7. Contact/Agent Name Com~ Flailing Address Post Office City State Zip Code Telephone (daytime) Email 3, NYS Office of General Services Check all permits that apply: [] state Owned Lands Under Water [] Utility Easement (pipelines, conduits, cables, etc.) [] Docks, Moorings or Platforms US Army Corps of Engineers (USACE) [] I am sending this application to this agency. 4. NYS Depart- ment of State Check if this applies: [] Coastal Consistency [] I am sending For Aoencv Use Only DEC Application Number: this application to this a~enc~,. 3OINT APPLICATION FORM 09/10 6. Name of Facility or Property Owner (if different than Applicant) Mailing Address Post Office City State Zip Code Telephone (dayt. ime) Emall 8. Project / Facility Name J Property Tax Map Section / Block'/Lot Number Proj~ct'Location - Provide directions and distances to roads, bridges an(J bodies of waters: Street Address, if applicable Post Office City State Zip Code Town / Village / City County Name of USGS Quadrangle Map Stream/We,tar Body Noq)e . ~ Location Coordinates: Enter NY'rMS in kilometers, OR Latitude/Longitude NYTM-E NYTM-N J Latitude J Longitude USACE Number: Application Form Page I of 2 This is a 2 Page Application Both Pages Must be Completed QO[NT APPLICAT]'ON FORM - PAGE 2 OF Submit; this completed page as part of your Application. 9. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose. Attach additional page(s) if necessary. Include: description of current site conditions and how the site will be modified by the proposed project; structures and till materials to be installed; type and quantity of materials to be used (i.e., square f~ of coverage and cubic yds of fill material and/or structures below ordinary/mean high water) area of excavation or dredging, volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource imptacts; and where applicable, the phasing of activities. A~-rACH PLANS ON SEPARATE PAGES. Proposed Has Work Begun on Project? [] Yes /~No If Yes, explain. ~ · ~ Will Project Occupy Federal, State or Municipal Land? [] Yes ~' No If Yes, please specify. I10. List Previous Permit / Application Numbers (if any) and Dates: It 1. Will this projec~ require'additional Federal, State, or Loca~ Permits including zoning changes?. ~s ~-INo If yes, please list: 12. Signatures. If applicant is not the owner, both must sign the application. ! hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 21.0.45 of the Penal Law. Further, the applicant accepts full responsibility for ail damage, direct or Indirect, of whatever nature, and by whomever suffered, arising out of the protect described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said project. In addition, Federal Law, 18 U.S.C., Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies, or covers u or knowingly makes or uses a false, fictitious or fraudulent statement. Signature of Applicant Printed Name Title Date Signature of Owner Printed Name Title Date Printed Name Title Date DETERMZNATZON OF NO FERMZT REC~UZRED Agency ProJect Number has determined that No Permit Is required from this Agency for the project described In (Agency Name) this application. Agency Represantatlve: Name (printed) ~ ~tle Signature Date 3OZNT APPLICATION FORM 0g/10 ApPlication Form Page 2 of 2 New York State Department of Environmental Conservation PERMISSION TO INSPECT PROPERTY By signing this permission form for submission with an application for a permit(s) to the Department of Environmental Conservation ("DEC"), the signer consents to inspection by DEC staff of the project site or facility for wi/ich a permit is sought and, to the extent necessary, areas adjacent to the project site or facility. This consent allows DEC staffto enter upon and pass through such property in order to inspect the project site or facility, without prior notice, between the hours of 7:00 a.m. and 7:00 p.m., MondaY through Friday. If DEC staffshould wish to conduct an inspection at any other times, DEC staffwill so notify the applicant and will obtain a separate consent for such an inspection. Inspections may take place as part of the application review prior to a decision to grant or deny the permit(s) sought. By signing this consent form, the signer agrees that this consent remains in effect as long as the application is pending, and is effective regardless of whether the s~gner, applicant or an agent is present at the time of the inspection. In the evem that the project site or facility is posted with any form of"posted" or "keep out" notices, or fenced in with an Unlocked gate, this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further, agrees that during an inspection, DEC staff may, among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soils and vegetation (taking samples for analysis), and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s) sought by the application. Permission is granted for inspection of property located at the following address(es): By signing this form, I affirm under penalty of perjury that I am authorized to give consent to entry by DEC staff as described above. I understand that false statements made herein are punishable~as a Class A misdemeanor pursuant, to Section 210.45 of the Penal Law.* Print Name and Title Signature Date *The signer of this form must be an individual or authorized representative of a legal entity that: ovms fee title and is in possession of the property identified above; maintains possesso~y interest in the property through a lease, rental agreement or other legally binding agreement; or is provided permission to act on behalf of an individual or legal entity possessing fee titie or other possessoo, interest in the property for the purpose of conseefiug to inspoetinn of such proporty. Permission to Inspect Property Application Supplement 12108 617.2D Appendix C State Environmental QUality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ~PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) : 1. APPLICANT/SPONSOR ' ' 2. PROJECT NAME 3. PROJECT LOCATION: 4. PRECISE LOCATION (Street address and mad intem~ctions, prominent landmarks, etc., or pro~i~e map) 5. PROPOSED ACTION IS: [] New [] Expansion 6. DESCRIBE PROJECT BRIEFLY: ,..~odification/alteration 7. AMOUNT OF LAND AFFECTED: Initially ~ acres Ultimately . acres 8. WILL~OPOSED ACTIO, I_O.,N C(~MPLY WITH EXISTING~ONING OR OTHER EXISTING LAND USE RESTRICTIONS') ~Yes Ia No If No, desc~be briefly ' 9. WHA~;~PRE~ENT LAND USE IN VICINITY OF PROJECT? r ,~ Residential [] Industrial [] Commercial Describe: [] Agriculture [] Park/Forest/Open Space ' []' Other 101 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM aNY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes ~o If Yes, list agency(s) name and pe~rniUapprovals: 11. Di._~.. y ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVALS? ..~Yes. [] No If Yes, list agency(s) name and permit/approvals: 12. At. RESULT OF PRoPosE[~ACTION WILL EXISTING'PERMIT/APPROVAL REQUIRE MODIFICATION? ._.__~ Yes ["~ No I CERTIFY~'HAT THE INFORMATION PROV DED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDG Signature: ~ 95-20-7 (12/98) New York State Department of Environmental Conservation Supplement to Joint Application Form STRUCTURAL ARCHAEOLOGICAL ASSESSMENT FORM (SAAF) PART 1 ;- APPLICANT COMPLETES APPLICANT INFORMATION 1. Applicant Name - 2. Applicant Address PROJECT INFORMATION 3. Project/Faci~ity Name 4. Project/Facility Location Is the proposed project adjacent to, or does it contain a building or structure listed in the State or National Register of Historic Places? Are there any buildings 'or structures 50 years old or older adjacent to or within the proposed project area? If the answer to question 5 and/or 6 is yes, provide the following information ~or each building and .structure (use attachments if necessary): a. Name of structure b. Location c. Type of structure (ex. house, outbuilding, barn, bridge, dam, ruins) d. Approximate age or date of construction 7. Might the proposed project have any impact (physical/visual) upon any buildings or structures listed in the State or National Register of Histodc Places or 50 years old or older? OS If yes, describe briefly (use attachments if necessary): APPLICANT SECTION CONTINUES ON REVERSE SIDE 12/98 , SAAF PART 2 -- DEPARTMENT OF ENVIRONMENTAL CONSERVATION (DEC) COMPLETES APPLt,CANT/PROJECT INFO,RMATION 1. Applicant Name ! ~'"~[T'~ ',.~~'~ 2. Project/Fac ty Name 3. DEC Number BUILDINGS AND STRUCTURES Might the proposed project have any impact (physical/visual) [] Yes upon any buildings or structures listed in the State or ~o National Register of Historic Places or 50 years old Or older? If yes, DEC must consult with the Office of Parks, Recreation and Historic Preservation (OPRHP). DEC must request a d~tern~ination of eligibility for the State Register of Historic Places and/or comments regarding project impact. Include information supptied by the applicant in response to questions 5, 6, 7 and 8 of Part 1 of this form. ARCHAEOLOGICAL SITES Does the proposed project area coincide with a circle, square i []Yes or stippled area on OPRHP's Statewide Archaeological .~q'o Inventory Map? Is the proposed project area outside of a circle or square, but one for which information has been provided (ex: documented repqrts of known sites) that suggests the area is archaeologically sensitive? If yes, what i~ the nature and source of information? OS Is the proposed project area apparently undisturbed? 9. Is the slope in the area characteristically less than 15% (unless on limestone/fl nt escarpments)? 10. Is the proposed project area characteristically moderately well or well drained? Will the proposed action include a physical disturbance of the project area? . ..eoS ~ [-I Yes ° I-INo ~"~es []No If the answers to 5, 7-10 are yes, an archeological Survey should be performed by the applicant. Provide the applicant with a copy of or the link to the State Historic Preservation Office Phase 1 Archaeological Report Format Requirements (08/05). If the answer to 5 is no, but answers to 6-10 are yes, DEC must consult with OPRHP before reouirino that the a.Dolicant perform.an archaeolooical survey, DEC SECTION CONTINUES ON REVERSE SIDE DEC - Division of Environmental Permits, Region One SUNY ~ Stony Brook 50 Circle Rd Stony Brook, NY 11790-3409 631 444 0365 Aug. 15, 2010 To Whom It May Concern, I would like to apply for a Modification to my dock permit #5046 in Southold Town. The modification will not substantially change the scope of the permitted actions. Therefore, the permit is modified to authorize: We request the removal of the stairs at the seaward end of the existing catwalk and construction ofa 4 fl. by 15 fi. extension to the catwalk and a 4 fi. by 12 fi. "L" section. The decking will be constructed of fir. The stringers and piling will be constructed of CCA treated lumber. All work regarding this modification shall be performed in accordance with the plans prepared by David Corwin on Aug. 7, 2011. The stairs will be reinstalled on the inside of the "L" section. Special conditions that are added to the permit as follows: The extension to the catwalk and "L" section may be supported by pilings having a maximum diameter of up to 8 inches. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. Enclosed please find: A copy of the survey with proposed modifications. A drawing of the extension of the proposed fixed dock. Richmond Creek soundings A copy of the Southold Town Trustees Dock Permit Many thanks for reviewing my request. Donna Wexler OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Ma/n Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: December 12, 2011 Re: Proposed Wetland Permit for DONNA WEXLER SCTM#1000-86-5-9.1 DONNA WEXLER requests an Amendment to Wetland Permit #5046 to add a 4'X 15' extension to the existing catwalk; add a 4'× 12' dock in an "L" configuration; relocate stairs to southwest side of dock; and add two swim ladders at northeast and southwest ends of "L" section. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with LWRP policy standards and therefore is INCONSISTENT with the LWRP. Richmond Creek is a Siqnificant Coastal Fish and Wildlife Habitat (SCFWH) and Critical Environmental Area. Any proposed action in a Critical Environmental Area may be subject to more stringent requirements such as denial of certain operations, and shortenin.q or reducinq the size of the structure pursuant to § 275-11 Construction and operation standards. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem. 6.3 Protect and restore tidal and freshwater wetlands. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other/ands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. § 275-11 Construction and operation standards. (7) Critical environmental areas. At the discretion of the Board of Trustees, any operations proposed in critical environmental areas (§ 275-2) may be subject to more stringent requirements than detailed in this section. Such requirements may include, but are not limited to, denial of certain operations, shortening or reducing the size of structures, and increasing the width of non-disturbance buffers. The proposed dock location will terminate in an area with water depth less than 2.3 feet. The use of a vessel (althouqh not identified) associated with the proposed dock could have potential adverse impacts to the public trust bottomland (hull restinq on bottom, prop dred.qin.q). It is recommended that the potential impacts to the public trust bottomland from a vessel be considerinq when reviewinq the proposed action. Policy 9-Provide for public access to, and recreational use of, coastal waters, public_lands, and public resources of the Town of Southold. The proposed action is private, noncommercial and will not support a pattern of development that enhances community character nor preserves "Public" access or public recreational activities. The extension of the existin.q dock will eliminate the public use of the underwater lands in the vicinity. Policy Standard-9.4 Assure public access to public trust lands and navigable waters. A. Provide free and substantially unobstructed passage along public trust shorelands. E. Provide access to, and reasonable recreational use of, navigable waters and public trust lands under water. 2. Permit limited obstruction of public use, including navigation, in navigable waters: 3. Obstruction of navigable waters and underwater lands is limited: b. to the minimum necessary for access to navigable waters. The minimum is determined by evaluating the following factors: (ii) the range of tidal water level fluctuation, The water depth within the proposed location of the dock terminus is shown as less than 2.3 feet which is limitinq for many types and sizes of vessels. (vi) whether or not alternative means to gain access are available. The applicant presently enioys access to Richmond Creek via an 60'+ existing dock structure. The extension of the dock is therefore not warranted. 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: Lori Hulse, Assistant Town Attorney 12/27/2889 19:82 6317652762 TOM QUARTY PAGE 81/81 Jill M. Dohcrty, Prcsidcnt Bob Ghosio, Jr. , Vice-President James F. King Dave Bergen John Bredmneyer Town Hall, 53095 Main Rd. P.O, Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of DONNA WEXLER COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING being duly sworn, depose and say: That on theo~'Jc.day of (D¢~'. ,201I, I personally posted the property known as 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 Wed~ November 16, 2011 on or about 6:00 PM. Dated: ', ~'~..{s_%~X,,....,.o._ k.~lx~%~ (signature) Sworn to before me this ..~ day of O0~ 20 ! t ~6"totary Public ~ DENNY BEDELL r, ../ ~blic, State of New Yo:k ' 01BE6099317 . :~d in Suffolk Count), ,..,,,-,, ¢' Cv.,..~s~on Expires Sept. 29, ,~.a~, t ,* Return Receipt Fee (E~dorsement Required) Restricted Delivery Fee (Endorsement Required} dLING OF NOTICE Address: 512 Ashland Ave., Baldwin, NY l l 510 358 4th Ave., St. James, NY 11780 1675 York Ave. - Apt 30K, NY. NY 10128 , being duly sworn, deposes and says that on the ~ day of_~ . ,20 [~, deponent mailed a tree copy of the Notice set fo~h in the Bo~d of Trustees Application, directed to each of the above n~ed persons at the ad~esses set opposite there respective nines; that the ad~esses set opposite the n~es of said persons ~e the ad&ess of said persons ~ sho~ on the c~ent assessment roll of the To~ of Southold; that shd Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (ce~ified) (registered) mail. ..~~ ~,~ Sworn to before me this ~7 20// ~ Not~-y Public-- n~:~:v ~EDELL N , ' ,,e of New Yo~ ~": - ;] ,99317 Commission Exp~re~ bept. 29, ~ 3 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A DATE OWNER '"~'*,"",~ ~,~M,~ ~_ ~ PHONE ADDRESS k'~'rS7 '-X~&cx AGENT PHONE ADDRESS PROPERTY LOCATION TAXMAPNO. IS(, I/We '-k~C'~"Nxa ~',,~O~,~te~" , /request an Amendment to Permit # ~136/'~2 · ,._ \ Request for a Modification to Permit #5046 [ S0~,thholJ ~,,,n Board o~ ~'rustees I would like to apply for a Modification to my dock permit #5046 in $out~o]d Town. The modification will not substm~tia]Jy change the scope of the permitted actions. Therefore, the permit is modified to autho6ze: The request is to remove the stairs at the seaward end of the existing catwalk and construct a 4 ft. by 15 ft. extension to the catwalk and a 4 ft. by 12 ft. "L" section. The decking will be constructed of fir. The stringers and piling will be constructed of CCA treated lumber. The pilings are not to exceed 8" inches. All work regarding this modification shall be performed in accordance with the plans prepared by David Corwin on Aug.7, 201. The stairs will be reinstalled on the inside of the "L" section. The work will be performed in accordance with the Local Waterfront Revitalization Program. The structure will comply with the standards set forth in Chapter 275 of the Southold Town Code and The Wetland Ordinance. (We have a 16' x 4' aluminum boat) The project will not affect the health, safety, and general welfare of the people of the town. The construction of the dock will not result in the destruction of or prevent the growth of vegetated wetlands, sea grasses including eelgrass and widgeon grass or shellfish. The modification of the dock will not change the waterway or the environment. The modification to the dock will not unduly interfere with the public use of the waterways for swimming, boating, fishing, shell fishing, waterskiing and other water-dependent activities. The dock will not interfere with transit by the public along the public beaches or foreshore. The dock will not cause degradation of surface water quality and natural resources. The dock will not cause habitat fragmentation or loss of significant coastal fish and wildlife habitats. Many thanks for reviewing my request. Donna Wexler Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ,,~0 DATE: 8/25/99 ISSUED TO ..... ~QLAND E KAREN GRANT ...... Pursuant to the provisions o; Chapter 615 of the Laws of the State of New York, 1893: and Chapter 40~ of f~ ~ of the State of New ~ork 1952: end the So.hold Town Ordlnan~ en- tiffed "R~U~TING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC ~NDS and the RE~OVAL OF SAND, GRAVEL OR OTHER ~ATERIALS FROM LANDS UNDER TOWN WA~RS:" end in accordance w~th fha Resolution of The Board adopted af 19 .gg, and Jn consideration~of the sum of $ ]~0,0~ pa~d by En-Consultants lac., for ROLAND & KAREN..G~ANT .... of ..... P~.~0ic. N.Y. aad ~ubie~t ~o th~ Ysrm~ a.d C*ndi~}oas Ii,fed o. ihs rs~ris rids h~r~of, o~ Sou~hold Town Tru~a*a ~a~horize~ ~nd psrmi~ th~ fdl*wl.q: Wetland Permit to construct a fixed timber dock, consisting of a 4' X 74' fixed timber catwalk, a ~ X 14' ramp and a 6~ X Z0' float, subject to receiving new plans showing a 4' X 60' catwalk instead of a 4' X 74' catwalk/ all in accordance with the detailed specificafion~ as predated in the originating application. IH WITNESS WHEREOF, The smd Board of Trustees ~re- by causes i~ Corporate Seal to be eft?ed, and ~ese p~sen~ to be subscribed by a majori~ of the smd Board as of th~s daf=. NAY, . KE~NETII T~tees P.O, Bo~ 1179 Ne~, York (631) BOARD OF TOWN TOWN OF SOUI~OI,D March 17, 2010 Ms. Donna Wexler t775 Indian Neck Lane Peconic, NY 11958 RE: 177~ INDIAN NECK LANE, PECONIC $CTIN~6-S.e.1 Dear Ms. Wexlec. The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed.. Ma~h 17, 2010: RESOLVED, that Ihe Southold Town ~oard of TnJstees APPROVES ~he request for a Transfer of Permit f~:)46 from Roland and Karen Grant to Oore~ Wexlar aa issued on August 25, 1999, and Amended on Janua,/26, 2000. If you have any questions, 1~4ease contact our office at (63t) 765-1892. JMD:lms Board of Trustees Application County of Suffolk State of New York ~'~"~C~',~'",~_ k-~d)~ ,0_,N// 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, I 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 DAY OF f APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics emhibits conflicts of interest on ~he hart of town officers and emnlovees. The ourcos¢ of this form is to emvidc information which can alert the town of oossible conflicts of interest and allow it to take whatever action is ncc¢ssarv to avoid same, YOUR NAME: X'"J P-'-"P' ~'& 'W' · (Last name, first name~aiddle initial, unless you are applying in the name of somcon¢ 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 Vt,. Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or offcial map Planning Other (lf"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parenk or child) have a relationship with any officer or employee of the Town of Sonthold? "Relationship" includes by blood, n~arriage, or business interest- "Busines~ 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 shar~s. YES NO ~ If you answered "YES", complete the balance of thls 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/agcot/representative) and the town oft'leer or employee. Either check the appropriate line A) through D) and/or describe in the space prm/ided. 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 tbe applicont (when the applicant is a corporation); __B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, partner, or employee of the applicant; or __D) the actual applicant,. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this day of-. ~ 200 Signature ~'"~ ~ ~.-)~ ~ . Print Name k~'ffc,~',v.a~ ~...\L'4A ,,~,~,~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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. 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 Waterfi'ont Revitalization Program. A proposed action will be evaluated, as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3~ B. DESCRIPTION OF SITE AND PROPOSED ACTION scm# PROJECT NAME 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~ caeh answer must be explainid in detail~ listing both supporting and non- suooortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at thc T0wn/~}f ~o~o~d ' s webstte (southoldtown.northfork.net), the Board of Tmstees Officq!~T)~partment, all local libraries and the Town Clerk's office. The Application has been submitted to (check appropriate response): Tow..oara 7] P,.nin,..raT] ~uaa~gOep~. [-] ~.r~o~Tr.ste~ 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: · , , . Locationofaction: ['~- .]\--'~::~.,~-~, XSk,-~ ~ k9~¢_~',~ ~L1 !lq~) Site acreage: ~O, ~ 6&e_ . Present land use: ka.2h.c~maW-~J Present zoning classification: A_~ ~c~-~ If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code (). (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ No [] If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. [] Yes [--] No ~-~Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [-] Yes ~ No ~(~Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI - Policies Pages 6 through 7 for evaluation criteria ~ Yes ~'~ No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria ~ Yes [] NoN 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 ~ No J~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section IH - Policies; Pages 22 through 32 for evaluation criteria. Yes ~ No Not App~l~ble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes ~ No [~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Yes No !) Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section IH - Policies; Pages 38 through 46 for evaluation criteria. ~] Yeti No [~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES0 Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. Yes ~ No_~ Not Applicable At~ach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ¥cs ~ No ~ Not App.eablc ~ 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 Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section HI - Policies; Pages 65 through 68 for evaluation criteria. Yes D NO ~ Not Applicable PREPARED BY~~t~k~,~.~( TITLE ~3L~,,0_~,~ DATE Neighbors to be notified: Margaret Hallden Virginia Sica Julliana Zinger & Christian Robertson Tax'ap# 86.5-8.1 86.5-9.3 84.4-6.1 512 Ashland Ave., Baldwin, NY 11510 358 4th Ave., St. James, NY 11780 1675 York Ave. - Apt 30K, NY, NY 10128 SPRING LANE SPRING LANE LOT 683.59' SCPHS. Ret. # RI0-95-0068 # R10-01-0159 RIO - OI - Ol~B SANITARY SYSTEMS- POOL HSE. (/000 gal. SEPTIC TANK min. 4 deep 8'¢ leaching pool) BARN (lO009d. SEPTIC TANK I.¢ Tesl Boring 4 PJ~ LOAMY 6.5 CO,4~E 6RAVEL I0' HEAVY 6RAVEL 11.5 WHITE SAND PALE 16.5 ...... ORANGE SAND GR. WA TER ~est Boring ~ 4/2_/96 0 SANDY TOPSOIL LOAMY SAND SAND W/TH GRA ~EL GR. ~'A TER I1.'~ -- ORA V~L L 0 T NOS. ARE REFERENCED TO ' MINOR SUBDIVISION FOR PECONIC BAY GARDENS, INC.,FILED IN TIlE OFFICE OF THE SOUTHOLD TOWN CLERK. ELEVATIONS ARE REFERENCED TO N.O ~f Datum. AREA = 2.6069 Acres to tie l/nos I om lam/Ilar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF .ZUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RES/DEN~ES and will abide by the conditions sot forlh therein and o, 1 /he permit /o conslruct. FLOOD ZONE L/NFS FiRM 3E103C0162 AND ACTUAL FIELD INFORMA T/ON The locations of wefts end cesspools shown hereon ore /rom fioM observe/ions end or from dole ob/e/ned from others. - WETLANDS FLAG BY ROBERT E, HERRMAN ( EN - CONSULTdNTS, INC. ) ON MAY ?~ 1999 · .STKFORDOC~ SURVEY FOR ROLAND & KAREN GRANT A T PECONIC TO WN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 86- 05 - 9.1 Scale: 1" = 60' Mar. 16, 1995 APRIL 4, ~995 (revisions) April 6,1995 (revisions) M~y I~ J~95 (revisions) MAY 4~ 1995 (revisions) JAN. 16, 1996 ( slk hse & born ,' Her. II, /996 (foundofion Iocol/on) Apr// 3, 1996 ( Addil/ons] Dec. 20,/99~ (f/no/) MAY 14, 1999 ( JUNE 7, 2001 ( prop. qddillons) July 24~ 2001 (eddlllons) NOV. 4~ ~002 I Find ) ANY AL TERA TION OR ADDITION TO THIS SURVEY IS A VIOLA TION OF SECTION 7~09 OF THE NEW YORK STATE EDUCATION EXCEPT AS PER SECTION 7E09-SUBDIVISION ~. ALL CERTIFICATIONS HEREON ARE VALID FOR THI~ MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNA TORE APPEARS HEREON. ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'AL TERED BY MUST BE USED BY ANT AND ALL SURVEYORS UTILIZING A COPY OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS 'INSPECTED' AND "BROUGHT-TO-DATE' ARE NOT IN COMPLIANCE WITH THE LAW. MUTUAL BANK~ :'r ~'"-' -- 1 2011 Southhold Tov, r~ Bom'd of Trustees · (651) 765 - 502~~,~-1797 P.O. BOX 909 ~/ 1230 TRAVELER STREET SOUTHOLD~ N. Y. 11971 95-133 Jill M. Doherty, President James F. King, Vice-President DaveBergen Bob Ghosio, Jr. John B~demeyer 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 March 17,2010 Ms. Donna Wexler 1775 Indian Neck Lane Peconic, NY 11958 RE: 1775INDIAN NECK LANE, PECONIC SCTM#86-5-9.1 Dear Ms. Wexler: The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed., March 17, 2010: RESOLVED, that the Southold Town Board of Trustees APPROVES the request for a Transfer of Permit #5046 from Roland and Karen Grant to Donna Wexler as issued on August 25, 1999, and Amended on January 26, 2000. If you have any questions, please contact our office at (631) 765-1892. Since. rely, Jill I~. Doherty ~/ Pre§ident, Board of Trustees JMD:lms 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 Mamh 17, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Donna Wexler 1775 Indian Neck Lane Peconic, NY 11958 RE: 1775 INDIAN NECK LANE, PECONIC SCTM#86-5-9,1 Dear Ms. Wexler: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., Mamh 17, 2010: WHEREAS, DONNA WEXLER applied to the Southold Town Trustees for an Amendment to Wetland Permit #5046 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 27, 2010, 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 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, WHEREAS, the two (2) 8" dia. offshore pilings, in the location applied for, do not comply with the standards set forth in Chapter 275 of the Southold Town Code, and, WHERAS, the Board has determined that the two (2) 8" dia. offshore pilings, in the location applied for, will have a detrimental effect upon the health, safety and general welfare of the people of the town, and, NOW THEREFORE BE IT, RESOLVED, that for the foregoing reasons, and based upon the application's failure to meet the standards contained in Chapter 275 of the Town Code, that the Board of Trustees deems the proposed project to be Inconsistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, based on lack of water depth at the end of the dock, and, BE IT FURTHER, RESOLVED, that the Southold Town Board of Trustees DISAPPROVES WITHOUT PREJUDICE the application of DONNA WEXLER to include two (2) 8" dia. offshore pilings at the end of the existing dock, and as depicted on the on plans received on January 27, 2010. This is not a determination from any other agency. Sincerely, JMD:lms Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., March 10, 2010, the following recommendation was made: Moved by Doug Hardy, seconded by Audrey Horton, it was RESOLVED to NOT SUPPORT the application of DONNA WEXLER to Amend Permit #5046 to include two (2) 8" dia. offshore pilings. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 Inspected by: Doug Hardy The CAC does Not Support the application because of the lack of water depth at the end of the dock. Vote of Council: Ayes: All Motion Carried SCDHS. ReL # RI0-95-0068 # R10-01-0159 RIO - Of - 0159 SANITARY SYSTEMS- POOL HSE, (lO00 gal SEPTIC TANK min. 4 deep 8'¢ leaching pool/ BARN (/OOOgoL SEPTIC TANK & min. 12' deep 8'~ Ioochlng pool) I om [om//ior with lhe STANDARDS FOR APPROV/ AND CONSTRUCTION OF .SUBSURFACE SEE/AGE DISPOSAL SYSTEMS FOR SINGLE FAMILy RES/DI 'ES ond will ob/de by lhe condilions se( forlh lflerein ond ~ lbo perm// /o con$lruc/, FLOOD ZONE LINEs FIRM 3~/03C016B AND ACTUAL FJELD INFORMA T/ON Tho Iocolions ol wells and cesspools shown horeon ore /rom b~/d observolions and or from dote ob/o/ned from o/hers, \ bOT (~ SURVEY FOR ROLAND & KAREN GRANT A T PECONIC TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y, 1000 - 86 - 05 - 9.1 Scale: 1" = 60' Mar. 16, 1995 APRIL 4, 1995 (revisions) April 6~1995 (revisions) MoI I, IE~95 (revisions1 MA Y 4~ 1995 (revisions) JAN. 16, 1996 ( Mot. //~ /996 (/oundo//on /ocofion) Apr// $~ /996 (AddD/ons) Dec. 20,/996 (//no/) MAY 14, 1999 duly 24, 2001 (odd~I/oDd ~,~ dr#NJTON MUTUAL BANK, PECONIC {6311 765 - P.O. BOX 909 1230 TRAVELER STREET SOUTHOLD, N.Y. 11971 179; 95-130 Jill M. Dohe~ly, President James F. King, Vice-President Dave Bergen Bob Ghosio. Jr John Bredemcycr P.O, Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: DONNA WEXLER requests a Transfer of Permit #5046 from Roland and Karen Grant to Donna Wexler as issued on August 25, 1999 and Amended on January 26, 2000, and an Amendment to Permit #5046 to include two (2) 8" dia. offshore pilings. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 [~Oaltwf area to be impacted: ater Wetland Freshwater Wetland __Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: J~f~apt.275 111 other Chapt. Type of Application: C/Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were:~d~.King ~k~J.Doherty J~. Bredemeyer L//D. Bergen~'~ B.Ghosio, __ D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, Nzw York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 26, 2000 Karen & Roland Grant 1775 Indian Neck Lane P.O, Box 126 Peconic NY 11958 RE: SCTM #86-5-9.1 Dear Mr. & Mrs. Grant, The following action was taken by the Southold Town Board of Trustees at their Regular Meeting on January 26, 2000: RESOLVED, that the Southold Town Board of Trustees grant an Amendment to Permit #5046 to construct a 4' X 60' fixed catwalk with a stairway at the seaward end as recommended by DEC. However, this determination is not a determination from any other agency. If you have any questions, please call our office at 765-1892. Sincerely,- Albert J. Krupski, Jr. President, Board of Trustees AJK/djh Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ',,,~0 4'/6 DATE: ISSUED TO ROLAND & KAREN GRANT .... Pursuant fo fha provisions of Chapter 615 of the Laws of the State of New York, 1893: and C;hapfer 404 of the Laws of fha State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS end fha REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WA'fERS;" and in accordance with the Resolution of The Board adopted at 19 .99, and in consideration!of fha sum of $150.00 paid by En-Consultants Inc., for ROLAND & KAR.E~.GltA~ .... of P~qo~c. N.Y. and sub?ct to the Terms and Conditions listed on the reverse s~de hereof, of Soufhold Town Trustees authorizes and permits the following: Wetland Permit to construct a fixed timber dock, consisting of a 4' X 74' fixed timber catwalk, a 3' X 14' ramp and a 6' X 20' float, subject to receiving new plans showing a 4' X 60' catwalk instead of a 4' X 74' catwalk/ all in accordance with the detailed specifications as presented |n the originating application. IN WITNESS WHEREOF, The said Board of Trustees I~ere- by causes, ifs Corporate Seal fo be ~ff. ixed. and these I~.resen+s fo be subscribed by a majority of the smd Board as of th~s date. NAY, , KE['I N.ETI I Trustees ~. iI I / / OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ~d)DRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: MarkTerry, Principal Planner ~ LWRP Coordinator Date: March 16, 2010 Re: Proposed Wetland Permit for DONNA WEXLER SCTM#1000-86-5-9.1 DONNA W£XLER requests a Transfer of Permit #5046 from Roland and Karen Grant to Donna Wexler as issued on August 25, 1999 and Amended on January 26, 2000, and an Amendment to Permit #5046 to include two (2) 8" dia. offshore pilings. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 The information submitted to review the action is incomplete. To accomplish a Coastal Consistency Review pursuant to Chapter 268 of the Southold Town Code for the action the following information is required: 1. Water depth at the end of the dock in relation to the vessel dimensions. 2. The draft of the vessel. Cc: Lori Hulse, Assistant Town Attorney James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDMENT TO A WETLAND PERMIT DATE ADDRESS AGENT PHONE ADDRESS PROPERTY LOCATION ~~ TAX MAP NO, ~- 5- - (~, i Signed By: 'l,).~_e~.~',~,~ "~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Nanle: Address: - I STATE OF NEW YORK \/~r~. '~ ' , beigg duly sworn, deposes and says that on the - ~ k,k_ Xday of ~. ,20~ deponent mailed a true copy of the Notice set forth, in the Bo~d 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 [he Tgwn of Southold; that said Notices were mailed at the United States,Post Office at ~fl,~ , that said Notices were mailed to each of said persons vy (certified) ~egistered) mail. , .,,~.,~ ~A,/,,~ Sworn tO before me this Day of I { 20 No. O1L060700~ Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 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 DONNA WEXLER COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~a*:~'~'.,:c ~p_~'~ , residing at /dba ["'~'~.~-'-W-~_ c~^'~3~ ~,~,~_ being duly ~wom, d~ose and say: ~ That on the & ~ay of ~-~'~ , 2010,.I personallyposted the propmy ~own ~ by placing the Bo~d of Trustees official poster where it c~ easily be seen, ~d that I have checked to be s~e the poster has remained in place for ei~t days prior to the date of the public he~ng. Date of he~ng noted thereon to be held Wed.~ March 17~ 2010 on or about 6:00 PM. Dated: } '1~' ~0 (si~ature) Swom to before me this day of !, 20~IID Notary Publi~ I- - Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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. 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 Waterkont Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 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 detafl~ listing both supporting and non- suooortino facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ~ ~5~ q - PROJECT NAME bc~ q_~c(oo¥ ~; (~x~x [,:~v ¼ The Application has been submitted to (check appropriate response): TownBoard F~ Planning Board ~ Building Dept. ~ Board ofTrustees~ 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: Natm'e and extent of action: ~ ,~ Site acreage: c~x/;~ c~ , Present land use: /~/o ~) Present zoning classification: ~;~%~ If an application for the proposed action has been flied with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code (). (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [--] No ~] If yes, which state Or federal agency?. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. 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. ~--~'~es [-~ No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes ~ No .~. 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 7] No [] Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria ~-~ Yes [~ No.[~'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 ~ No !"~.[NotApplicablc 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 HI - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not ~icable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes ~ No~'Not Applicable 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 PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [~ Yes[~ No[~x/Not Applicable Attach additional sheets if necessary WORKING COAST POLI(~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations· See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. Yes mo [] Not Ap.,ieable '~.,~, Z.OL~ ,..L_?~,~_l.l - '- Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section IIl- Policies; Pages 57 through 62 for evaluation criteria. / Yes [] No ~-~ Not Applicable ' 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 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 [--~/Notnpplicable PREPARED BY L ~-~x"~xa_ · ~ TITLE (~) L~'x~L~'- DATE Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 $outhold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TI~USTEES TOWN OF SOUTHOLD January 26, 2000 Karen & Roland Grant 1775 Indian Neck Lane P.O. Box 126 Peconic NY 11958 RE: SCTM #86-5-9.1 Dear Mr. & Mrs. Grant, The following action was taken by the $outhold Town Board of Trustees at their Regular Meeting on January 26, 2000: RESOLVED, that the Southold Town Board of Trustees grant an Amendment to Permit #5046 to construct a 4' X 60' fixed catwalk with a stairway at the seaward end as recommended by DEC. However, this determination is not a determination from any other agency. If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh ~1 ~bert J. Krupski, President .~ /~ James King, Vice-President f0J~I'~ - Artie Foster · .~ · , ! KenPoliwoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1692 Fax (631) 765-1366 March 22, 2002 Mr. & Mrs. Roland Grant PO Box 126 Peconie, NY 11948 RE: 1775 Indian Neck Lane, Peconie, NY SCTM#86-5-9.1 Dear Mr. & Mrs. Grant: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 20, 2002. RI~SOLVED, that the Southold Town Board of Trustees grant the request for a Waiver to install four foot high fence across rear of property, N/E comer within Town Tmstee's jurisdiction per NYS Building Code, fence required to surround property containing swimming pool. This approval does not constitute approvals from any other agency. If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krup~ki, Jr. President, Board of Trustees AJK: ejc cc: DEC Building Department t/~c ,/,f F/ETLANDS FLAG BY ROBERT E. HERt~MIiN CONSUL T.4NT$~ INC. ) ON 1~4 Y 7, !.999 SURVEY FOR lmq,~ elmm, oe~. (x, tim str,,~c~. ~C~V.L #,~-209'/. 4e HOtm IN AI)mu~. CERTIFIED TO, ROLAND & KAREN GRANT ~o~A~~ GRANT KAREN GRANT A T PECONIC sour~ B~ Y ,~SrRA~cr TO WN OF SOUTHOLD Telephone (631) 765-1892 Tovm Hall. 53095 Main ~ P.O. Box 1179 Sou~bold. Hew Yo~k 11971 SOUTHOLD TO~FN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 18, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Scott Hilary, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Waiver Request of KAREN & ROLAND GRANT to install a 4' high fence across rear of property, n/e corner within Trustees jurisdiction, to surround property containing swimming pool. Located: 1775 Indian Neck Lane, Peconic. SCTM#86-5-9.1 Vote of Council: Ayes: All Motion Carried ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF V~TAL STATISTICS - . M.~qRIAGE OFFICER RECORDS ~NAGEMENT OFFICER FREEDOM OF INFORMATION OFFICE Town Hall, 53095 Main Road · P.O. Box 1179 Sou~hold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town CN~rk's Office (agency Freedom of Information.. Officer). One copy will be returned to you in response to your request, or as an interim response. SECTION I. TO:' (Department or Officer,, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: date. file title, tax map number, and any other pertinent information. / Mailing Address (if different from above): Telephone Number: '7~C/-~© Date: /¢-- g -- ~'Describe the record sought. If possible, supply APPROVED 5 2001 APPROVED WITH DELAY* [ ] DENIED*""' ~-,n~,o ~own Clerk F-~zabeth A. Neville Freedom of Information Officer 'D~,te f delayed or denied see reverse side for explanation. Albert J. Krupski, President James King, Vice-Presidew; Henry Smith .-M-tie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631~ 765-1366 Jtme _6, 2001 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. & Mrs. Roland Grant P.O. Box 126 Peconic, NY 11948 RE: 1775 Indian Neck Lane, Peconic SCTM#86-5-9.1 Dear Mr. & Mrs. Grant: The Southold To~vn Board of Trustees reviewed the survey dated Mai:ch 16, 1995 and last revised June 7, 200l and determined the proposed pool, pool cabana, and the addition to the dwelling, to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code. However, any activity ~vithin I00' of the Wetland line would require permits from this office. Tiffs determination is not a determir..ation from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40 - SUNY, Stony 6rook, NY 11790-2356 Phone: (631) ~.~.-0365 Fax: (631) '!n.n.-0360 Commissioner Roland & Karen Grant PO Box 126 Peconic, NY 11958 December 28, 1999 RE: 1-4738-011i7/00003 Dear Permituee: In conformance with. uhe requiremenus cf the Staue Uniform Procedures .~ct (Arcic!e 70, ECL) and ins implementing re?ulazisns L6NYCRR, Part 621) we are enclosing ';cur. cermiu. Please conditions carefu±x!~. If you are unable cc ccmclv wizh conditions, please ....... ~s .-_he Also enclosed is a permit sign which is uo be conspicuously posted at the project site and protected frcm the weather. Ver-y uruly yours. Jane~ Kolodziejski Agency Program Aide JJK:cg enclosure DEC PERMIT NUMEER 1-47'58-01117/00003 FACILITY/PROGRA~ NUMBER(S) STATE DEPARTMENT OF ENVIRONMENTAL CONOTION PERMIT Under the Environmental EFFECTIVE DATE Dece~er 28~ 1999 EXPIRATION DATE(S) December 31, 2002 TYPE OF PERMIT · New [] Renewal r~ Mollification [] Permit to Construct [] Permit to Operate I · [] [] [] Article 15, Title 5: Protection of Waters Article 15, Title 15: Water Supply Article 15, Title 15: Water Transport Article 15, Title 15: Long Island Wells Article 15, Title 27: WilD, Scenic and Recreational Rivers · 6NYCRR 608: Water Quality Certification Article 17, Titles 7, 8: SPDEB [] Article 19: Air Pollution Control [] Article 23, Tithe 27: Mine~ Land Reclamation [] Article 24: Freshwater Wet[ands · Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 560: Solid Waste Management Article 27, Title 9; 6NYCRR Article 34; Coas[a[ Erosion [] Article 36: Floodplain Articles 1, 5, 17, 19. 27, 37; 6NYCRR 380: Radiation Control PERMIT [SSbED TO TELEPHONE NUMBER Roland & Karen Grant (6313 ~34-7388 ADDRESS OF PERMITTEE PO Sox 126 Peconicr RY 11958 CONTACT PERSON FOR PERMITTED ~ORK EnConsuttants, Inc. 1329 North Sea Roadt Southampton NY 11968 TELEPHONE NUMBER (6313 283-6360 RAME AND ADDRESS OF PROJECT/FACILITY Brant Property 17'75 Indian Neck Lane LOCATION OF PROJECT/FACILITY Peconic COUNTY TOWN WATERCOURSE NYTM COORD INAFES ~uffolk Southo[d Richmond Creek DESCRIPTION OF AUTHORIZED ACTIVITY: plans prepared by EnConsuLtants, Inc., Last c~ated December 2, 1999 and stambed NYSDEC approved on December 28, 1999. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict combliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 33 and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara JJK BLdg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE Page December 28, 1999 NECK STATE OEPARTMENT OF ENVIRONMENTAL CONS~TION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee exprassly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, [ts representabves, employees, agents, and assigns for all claims, suits, actions, damages. and costs of even/name and description, arising out of or resulting from the peri,tree's undertaking of acbvities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Perrnittee's Contractom to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including ail special conditions while acting as the permitteers agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Enwronmenfal Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements anct rights-of-way that may De required to carry out the activities that are authorized by this permit. Item 0: 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. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representatwe may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection To the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be availab!e for ;nspection by the Department at al! times at the project site or facility. Failure to produce a copy of :he permit upon request by a Department representative is a violation of th*s permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for Dy the Department, issuance of this permit does not mod~fT, supersed~ cr rescind any order or determination previously issued by the Department or any of the terms, condit!ons or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written applicatic'~ to the Department for ~'eneWa~r moo,f:,cat~c:; Jr t~:;n.~fe, of this permit. St:ch application rnust JncJucle any forms Jr suppleroentaJ information the Department requires ,my renewal, modification or transfer granted by the Department must be m writing. The permittee must submit a renewal applicatior~ at least: a) 180 days before expiration of permits for State Pollutant Discha~:ge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Pacilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg ¢t-40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the dght to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or prows~ons of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new matedal information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMfT NUMBER PAGE 2 OF 4 1-4738-01117/00003 ADDITIONAL GENERAL CONDITIONS FOR Af. RTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 10. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. The State of New York shall in no case be liable for any damage or injuw to the structure or work here~n authorized which may be caused Dy or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any suci'~ damage. Granting of this permit does not relieve the applicant of the responsibility of obta~mng any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of Generai Services or local government which may be required. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other enwronmen[all? deleterious materials associated with the project. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leawng large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency [o cause damage to navigable channels or to the banks of awc, terway. There shall be no unreasonaole interference with navigation by the work herein authorized. If upon the expiration or revocation of tn~s permit, the project hereby authonzed has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any pod:ion of the uncompleted structure or fill and restore the site to its former condition. No claim sh~[I be mede against the State of New York on account of eny such removal or alteration. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302. 303. 306 and 307 of the Clean Water Act of 1977 (PL 95..217) provided that all of the conditions hsted here~n are met. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return [he top portion of the enclosed notification form certifying that they are fully aware of and understand a~ terms and conditions of this permit. Within 30 days of completion of project, the bottom port,on of the form must also De signed and returned, along with photographs of the completed work and, if required, a survey All activities authorized by this permit must be in strict conformance with the approved plans submitted Py the applicant or his agent as part of the permit application. Such approved plans were prepared by EnConsultants. inc.. last dated 12/2/99 and stamped NYSDEC approved c)n 12/28/99 DEC PERMITNUMSER PAGE 3 OF 4 1-4738-01117/00003 STATE DEPARTMENT OF ENV)RONMENTAL CONS~,TION SPECIAL CONDITIONS 3. 4. 5. Any debds or excess matedal from construction)of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. The storage of construction equipment and materials shall be confined to within the prOJect work site and or upland areas greater than 75 linear feet from the tidal wetland boundary. Dock or timber catwalk shall not exceed 4 feet in width and shall be a minimum of 3~ feet above grade* over tidal wetland areas (* as measured from ground to bottom of dock si~eathing). The use of wood treated with pentachlorophenol in the construction of structures that will be in contact with tidal waters is strictly prohibited. No dredging, excavating or other alteration of shoreline or underwater areas ~s authorized by th~s permit, ncr shall issuance of this permit be construed to suggest that the Department wdl issue a permit for such act~wbes m the future. No permanent structures may be installed on dock/catwalk without first obtaining written Department approval (permit, modification, or amendment). Docks/catwalks may not (a) extend laterally beyond properly lines, (b) be placed so that docked I~oats extend over adjacent property line, (c) interfere with navigation, (d) interfere with other landowners riparian dghts. No ramp or float is authodzd with this permit, nor will the Department issua a permit for such activities in the future. OEC PERMIT NUMBER PAGE 4 of 4 1-4738-01117/00003 ~IO~MON~ C~K ~ (V~pl~ o ~1~0') 1329 NOR] H SOUTH~'~PTO~,L N.Y_. 516-283-6260 i PI~OPO~U CA1W~K POR P. OI.ANO ~, I~N ~P. AN~ ON IqCHMONI~ ?~CONIC, ~POLK CO,. NY Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ,,,,~0 DATE: 8/25/99 ISSUED TO ........ ~QLAND..~...KAREN GRANT ......... Pursuant fo the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:" and in accordance with the Resolution of The Board adopted at a meeting held on ...~-~.5-99... 19 .99, and in consideration of the sum of $150.00 ..... pMd by En-Consultants Inc., for ROLAND & KAR.EN..Gi~AN2U ..... of ..... peconic N.Y. and subject fo the Terms ~d""Condlfions listed'on the reverse side hereof, of Soufhold Town Trustees authorizes and permits the following: Wetland Permit to construct a fixed timber dock, consisting of a 4' X 74' fixed timber catwalk, a 3' X 14' ramp and a 6' X 20' float, subject to receiving new plans showing a 4' X 60' catwalk instead of a 4' X 74' catwalk/ all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal fo be affixed, and these presents fo be subscribed by a maiorlfy of the smd Board as of this date. NAY . KEI~NETH PC~I.I-WCID~ '- Trustees Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 26, 199 En-Consultants Inc. Rob Herrmann 1329 North Sea Road Southampton NY 11968 Re: ROLAND & KAREN GRANT $CTM #86-5-9.1 Dear Rob, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on August 25, 1999, regarding the above matter: WHEREAS, ROLAND & KAREN GRANT, applied to the $outhold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 6, 1999 and, WHEREAS, said application was referred to the Southold 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 August 25, 1999, 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, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 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 approves the application of ROLAND & KAREN GRANT to construct a fixed timber dock, consisting of a 4' X 74' fixed timber catwalk, a 3' X 14' ramp and a 6' X 20' float to be secured by (2) 8" in diameter pilings., subject to receiving new plans showing a 4' X 60' catwalk instead of a 4' X 74' catwalk. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: Catwalk: 4' X 30' = 120' X $3 = $360 ramp: 3' X 14' = 42' X $3 = $126 float: 6' X 20' = 120' X $3 = $360 TOTAL DUE: $846 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC Dept. of State ACE EN- CONSULTANTS '::':/ii:,-i-:::. ENVIRONMENTAL SERVICES 1329 North Sea Road So~Jthampton. NewYork 11968 516-283-6360 Fax: 516-283-6136 E-mail: encon @ peconic.net August 27, 1999 Janet Kolodziejski Division of Environmental Permits NYSDEC SUNY, Building 40 Stony Brook, NY 11790-2356 RE: ROLAND AND KAREN GRANT~ #1-4738-01117/00001 Dear Ms. Kolodziejski: Based on their field inspection of the subject property and the testimony offered during the public hearing on the application held 25 August 1999, the Town of Southold Board of Trustees has issued a wetlands permit for a smaller dock than that originally proposed. Specifically, the length of the proposed four foot wide catwalk was shortened from 74' to 60', resulting in a reduction of the dock's seaward extension beyond the edge of tidal wetlands to 34'. Attached herewith are (4) copies of a project plan revised accordingly. Therefore, I respectfully request that the Department staff coordinate their review with the Southold Trustees, with the hope that a similar permit can be issued by the State. We expect receipt of a Letter of Permission from the U.S. Aa'my Corps of Engineers shortly. Please feel free to contact me directly should you have any questions regarding the modified plan. Respectfully yotlrs, Robert E Hemh~ann Coastal Management Specialist Attachments cc: Chris Affsten, BMHP, NYSDEC Albert Krupski, Chairman, Southold Board of Trustees ./ James Haggerty, USCOE, #1999-09760-L2 Vance Barr, NYSDOS, #99-666 Roland and Karen Grant & % 2o' FI-~A 'l' .,,~ 4.. PdCHMON[2 (WIDTH ~' +__1~0') tlDi l~ !, u I,; :' . AU~ 3 0 1999 .',LW:Ed§e of[ D~pth Mar~h o' (ALW) o'-o" 3 5' (seaward 2' - 0" ~d of float) ~%lk I-b~Vm ~ 29 I" ~ ~:000' [N-CONSULIANTSINC. 1379 NORTH SEA RD. SOUTHAP~PTON, N.~ 11968 516-283-6360 PROPO~I~P POCK POR ROLANP KA~N ~iBqxll' ON IqCHMONIP O~I~K, Pl~COkllC, ~PPOLK dO,, NY '~-II~fl C_~ I 7121/99 RIG~MON~) CI~BK (WlgFH ~' ~1~0') 5dTdk Hav~ro. ~ 29 I" '~ ~000' ALWq~lge of Depth o' (.~w) 0'-o" end of float) EN-CONSUUANTS INC. 1329 NORTH SEA RD. SOUTHAMPTON, N.Y. 11968 516-283-6360 PROFOS~O ~OCK POR ROLANP Al,Il) KAI~N ~P. FC, IT ON IqCHMONi7 ¢I~K, PI~COHIC, 5LIPPOtK C0,, NY 5H~I~F I OP I 7/21/~2~) RIO'IMONP CI~BK t 2, 4, Distance from I Water ,~LW.,'Ed§~ of I l)~t~ end of float) I EN-CONSUUANTSIN~ 1329 NORTH SEA RD. SOUTHAMPTON, NX 11968 516-283-6360 KAt~N dF-ANT ON F. ICHMOMO CI~K, ?~CONIC, FIJPPOI. K C0,, NY ~q~tl OF' I 7121/ ~ 8/2~1~q Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone ~516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: fJZ& h w Please be advised that your application, dated ~ --~--~ has been reviewed by this Board, at the regular meeting of ~---~ '~ and the following action was taken: (~) Application Approved (see below) (__) Application Denied (see below) (__.) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The fees will be necessary. following fee must be paid within 90 days or re-application COMPUTATION OF PERMIT FEES: TOTAL SIGNED: BY: FEES DUE: PRESIDENT, BOARD OF TRUSTEES CLkRK, B~D- OF TROsTE~s 4/98 Eastern Permits Section DEPARTMENT OF THE ARMY NEW YORK DISTRACT, CORPS OF ENGINEERS JACOB K. JAVlTS FEDERAL BUILDING NEW YORK, N.Y. 10278-0090 August 19, 1999 SUBJECT: Application No. 1999-09760-L2 by Roland and Karen Grant To Whom It May Concern: The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Roland and Karen Grant P.O. Box 126 Peconic, NY 11958 ACTIVITY: Install a 4 foot by 74 foot fixed timber pier raised a minimum of 4 feet above the grade of wetlands vegetation, a 3 foot by 14 foot walk-ramp and a 6 foot by 20 foot float secured to two 8- inch diameter pilings. The purpose of this project is to provide an adequate mooring facility for the applicants' vessel(s). WATERWAY: LOCATION: Richmond Creek, Little Peconic Bay Peconic, Town of Southold, Suffolk County, As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 30? (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c) (3) (A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of date of this letter. the Enclosures Sincerely, c~ee~,W~asH~eggr~ Permits Srty~/~ ~ection 5- _ EN-CONSULMNTS INC. 1329 NORTH S~A SOUTHA~PTON, PROPOSI~P POCK POI~ I~OLANP Al,Il) 61~f ON lelCHMONP Ct~f~K, Pt~CONIC, ~PPObK CO,, NY Off I 7/:21/g~) Telephone (516) 765-18q~. Town Hall. 5309.5 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Thursday, August 12, 1999, the following recommendation was made: Moved by Scott Hilary, seconded by Richard Smith, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A STIPULATION of the Wetla?d Permit Application of ROLAND & KAREN GRANT 86-5- 9.1 to construct a fixed timber dock, consisting ora 4'X 74' fixed timber catwalk; YX 14' ramp; and a 6'X 20' float to be secured by (2) 8" diameter pilings. 1775 Indian Neck Lane, Peconic The CAC recommends Approval with the stipulation that there be no disturbance on the vegetation during construction. The CAC also expressed concerns about the structure being excessive and having an impact on the navigation of the channel. Vote of Council: Ayes: All Motion Carried CONSULTANTS, INC. ENVIRONMENTAL SERVICES 1329 North Sea Road Southampton, New York 11968 516-283-6360 Fax: 516-283-6136 E-mail: encon @peconic.net August 3, 1999 Town of Southold Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Diane Herbert Re: Roland & Karen Grant 1775 Indian Neck Lane, Peconic SCTM #1000-86-5-9.1 Dear Ms. Herbert: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 3. 4. 5. 6. 7. Three (3) Wetland Permit Applications, ( including Notice and Proof of Mailing to adjacent owners). Three (3) Short Environmental Assessment Forms. Three (3) copies of authorization & disclosure forms. Three (3) work plans. Three (3) copies of survey. One (1) set of site photographs. Application fee of $150.00 wetlands. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Sin , ~.l Coastal Management Specialist /khs Enc. Albert J. Krups!d, President James King, Vice-President Henry Smith Arfie Foster Ken Po[iwoda Town Hall 53095 Route 25 P.O. Box 1179 $outhold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOa. RD OF TOWN TRUSTEES TOWN OF SOUTHOLD LETTER OF REQUEST FOR A WAIVER DATE :LDDRESS 9,©. ~o-rc AGENT .4~DDRESS PROPERTY LOCATION TAX MAP NO. PHONE request a Waiver to SignedBy: :~O-;%.O..,W'X ~ ~/'~',,'r~ Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliweda 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 I, K~ ~. ~QJ~- , residing at ~5 being duly sworn, depose and say: That on the ~wq day of~k;xG-~, 200~, I personally posted the property known as %q~ ~O~Mx) ~ L~.)~O~%C_~ 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 oi~the , public hearing. D~te of he~ar~ng noted thereon to be Dated: ( signature ) Sworn to bef~o~re n~e this ~%~ day of~Y~ 200-L_ Notar~ Public LYNDA M. BOHN NOTARY PUBLIC, State of Ne~ No. 01 BO6020932 Qualified In Suffolk Cou~ Term Expires March 8, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: ~ Address: STATE OF NEW YORK COUNTY OF SUFFOLK . ~O.~__~ C~l~q~- , residing at ~-~-IS ~*aOl~.x,3 }.3C~C~ fv~CO~ ~¢~ ~,.~ ~/ , being duly sworn, deposes and says that on the '~Jo'rq day of ~ p.C'~.',/ , 200'2, 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 ~z~-colq lC [ ~ x( , that said Notices were mailed to each of said persons by (certified) (registered) mail. Swo omfto~b:=~.~ me this Dayo '</- . ,20 t~ Public ~CE M. ~LKINS ~ ~i~ June ;~ NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN 'OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request Pc---n. i~ from the Board of Trustees to: 2. That the property which is the subject of Environmental Review is located adjacent to your propert¥~nd is described as follows: 3. That the project which is subject to Environmental Review dnder Chapters 32, 37, or 97 of %he Town Code is open to public cpmment on: %!~O~ O~ You may contact the Trustees Office at 76~-1892 Or in w~iting. The above refe=enced proposal is under review cf the Boar~ of Trustees of the To%~1 Of Southo~d and does not reference any other agen~ that might have to review same proposal. Eno.: Copy of sketch or plan showing proposal for your convenience. Albert J. Krupski, President James King, Vice*President Henry Smith Artie Foster Ken Poliwoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD LETTER OF REQUEST FOR AN AMENDME! Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18q2 Fax (5!.6) 765-1823 DATE I/JO/CO ADDRESS ~).C), ~:)C)X ~ ~_-(o i AGENT ~k,~ C) b"~ ~c; PHONE ADDRESS PROPERTY LOCATION ~"]~ j~k) Ok~,,.~ '}x.~--C-\C.- TAXMAPNO. %(0- z~ ,q. ~ lJWe gOk-b,~g ~-..~k~K~,3 ~k]~request an Amendment to Permit # c~ CD ~ ~ C4)_~q~-r~CT /~ q~ ~g0' ~c~C*D C,a,''tb3/kL-z-. ,,.,.)Ct-~A ~ <o'r0,~e_v.,'~V Signed By: .~..M2A~ C~ ~C~ Albert J. Krupski. President John Holzapfel. Vice President Jim King Mardn H. Garrell Peter Wenczel Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicati~ 7Wetland Permit Application ~ Grandfather Permit Application Waiver/Amendraent~ ~Rec~ived Application: 7Received Fee:$ l~' _A~ompleted Application~___ Incomplete SEQRA Classification: Type I__.Type II Unlisted Coordina<ion:(date~ ~AC Referral Sent: w-'Date of Inspection: __Receipt of CAC Report: Lead Agency Determination: Technical Review: ~ublic Hearing Held:~ Resolution: Name of Applicant Address Roland & Karen Grant Post Office Box 126 Peconic. NY i194~ Phone Number:(516) 734-7388 Suffolk County Tax Map Number: 1000 86-5-9.1 Property Location: d~3- Indian Neck Lane, Peconic (provide LILCO Pole ~, distance to cross streets, and location) AGENT: En-Consultants, Inc. (If applicable) 1329 North Sea Road Address: SouthampEon, NY 11968 Phone: 516-283-6360 FAX#: 516-283-6136 of Trustees Applicati~ GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: ±113,556 R-40 Residential No Change Prior permits/approvals for site improvements: Agency Date X 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): Consuruct a fixed timber dock, consisting of a 4' x 74' fixed uimber catwalk; 3' x 14' ramp; and a 6' x 20' float to be secured by (2) 8" diameter pilings. of Trustees Applicati~ WETLAND/TRUSTEE LANDS A~PLICATION DATA Purpose of the proposed operations: To provide ~rlvate dockage of owner's crafs. Area of wetlands on lot: ±3,250 square feet Percent coverage of lot: ±3 % Closest distance between nearest existing structure and upland edge of wetlands: ±142 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet catwalk Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? How much material will be filled? n/a n/a cubic yards cubic yards Proposed slope throughout the area of operations: Depth of which material will be removed or deposited: n/a feet n/a Manner in which material will be removed or deposited: n/a statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attacb_ments if appropriate): Except for the temporary disturbance to the tidal marsh area caused by installation of tile dock, the project should cause no impacts to the wetlands or town waters. T~le Gock will De constructed in similar fashion to other existing docks on Richmond Creek. 14-16-4 (2/87}--Text 12 PROJECT I.D NUMBER I 61 7.21 I Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEQR 1 . APPLICANT/SPONSOR ROLAND & KAR~N GRANT I 2. PROJECT NAME I BY EN-CONSULTANTS, INC. 3. PROJECT LOCATION: Municipality SOUTHOLD County SUFFOLK 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., oi' provide map) 1775 INDIAN NECK LANE, PECONIC, TOWN OF SOUTHOLD, SCTM #1000-86-5-9.1; MAP PROVIDED 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: CONSTRUCT A FIXED TIMBER DOCK, CONSISTING OF A 4' X 74' FIXED TIMBER CATWALK; 3' X 14' RAMP: AND A 6' ~ 20' FLOAT TO BE SECLIP. ED BY (2) 8" DIAMETER PILINGS. 7. AMOUNT OF LAND AFFECTED: Initially 2.61 acres Ultimately 2.61 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [X~ Yes LJ No If No. describe bi'lofty 9. WHAT IS PRESENT LAND USE IN VlCfNITY OF PROJECT? [] Residential [] Iodustdal [] Commercial [] Agriculture [] Park/Forest/Open space [] Other STATE OR LOCAL)? IX] Yes LJ No If yes. fist agency(s) and permit/approvals DEC, COE, DOS 11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~__JYes [] No If yes. list agency name and p~rmit/approval E~Yes []NO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the Coastal Area, and you are a state ago j j Fon to t§e Coastal Assessment Form before proceeding with this {assessment Albert J. Krupski, President James King, Vice-President Henry Smith ,an-tie Foster Ken Poliwoda Town Hail 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOW/WTRUSTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POS_TING I, ~ ~ , r~at 1329 ,, .,,, o--,.):. .... -,t~ ~a SOIJIF~,~?~(;N, N.Y. 11968 516-233-6360 being duly sworn, depose and say: That on the {~ day of ~ - , 199~, Z personally posted the property known as {~3~ f~Pt~ ~~ ~/~ by placing the Board of Trustees off~cial ~oster where it can easily be seen, and that I have checked to be sure the poster has remained ~n place for seven days prior to the date of ~he of hearing noted thereon to be held~ public hearing. (date Dated: ( signa%u~ ~-~ ~ Sworn to befo/r~e me this ~%~-day of C~C~&199~ NO.~ Public ., NOTICE TO .~]DJACENT PROPERTY OWNER BOARD OF TRUSTEE$~ TOWN OF SOUTHOLD In the matter of Roland & Karen Grant SCTM~1000- 86-5-9.1 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to req~es~ a Permit from the Board of Trustees to: Construct a fixed timber dock, consisting of a 4' x 74' fixed timDer catwalK; 3' x 14' ramp; and a 6' x 20' float to be secured by (2) 8" diameter pilings. 2. That the property which is the subject Environmental Review is located adjacent to your propert~ and .is described as follows: 1775 Indian Neck Lane, Feconlc 3. That the property which is subject to Environmental Review under Chapters 32,37,or 97 of the Town Code is open to public comment. You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and dose not reference any other adjacent that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: Roland & Karen Gran~ P.O. Box 126 Peconic, NY 11958 PHONE $: 516-734-7388 Enc.: Copy of sketch or plan showing proposal for your convenience. Name: S amu e 1 & Virginia Peters Andrew & Margaret Hallden PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 81 Short H~lls Avenue Short Hills, NJ 07078 512 Ashland Avenue Baldwin, NY 11510 STATE OF NEW YORK COUNTY OF SUFFOLK doing business En-Consultants, inc. Robert E. Herrmann ., r~ at 1329 North Sea Road .Southampton , being duly sworn, deposes and says that on the 4th day of August ,19 99 , deponent mailed a true copy of the Notice se= forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; tha~ the addresses set opposite the names of said persona 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 were mailed to each of mail. .. Southampton , t~at said Notices Sworn to ~efore me Chis .. ~~'\ Notary ~ Notary Publl~Bmm m' N,ff. Yod~ I[ ~15,,P~%~ Comm[~lofl No. 801~1 . CounU# 6 Z 385 219 992 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided, Do not use for International Mail (See reverse} St[eet & her P ice Slate. ZIP Ccde Po,lage $ · Cedmfied Fee ~ ~0 Special Dolive~ Fee Restfid~ Delive~ Fee ~ Return Receipt Showing to ~ ~om & Dale Delive~d / ' ~ ~ US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See reverse) AUTHORIZATION (Agenu) to apply for permiu(s) from the Souuhold Bcard of Town Trusuee$ ~~((O'~ner' s s~gnau'~re on my behalf. CounTy of Suffolk State of New York ~OLA~40 ~fl,f_~QA~4/- ~ %~3k(ti~Q L. ~ BEING DULY ~O~ DEPOSES ~ AFFI~S ~T HE/S~ IS ~E ~PLIC~ FOR ~ ~O~ DESCRIB~ P~IT(S) ~ ~T ALL STA~S CO~ ~IN ~ ~.UE ~ ~ BEST OF HtS/H~ ~O~GE ~ B~I~, ~ ~T ~L WO~ WILL BE DONE IN ~E ~ SET FOR~ IN 'kafS ~PLiCATION ~ AS ~Y BE APPRO~ BY ~ SOUT~O~ TO~ BO~ OF ~E ~LIC~ AG~ES TO HO~ ~ TO~ OF SOU'i~O~ ~ ~ TO~ ~us~s ~ESS ~ ~E ~OM ~ ~ ~L D~ES ~ C~MS ~ISING ~ OR BY VIR~ OF SAID P~IT(S), IF G~T~. IN CO~.iPLETII:G ~iS ~PLiCATiON, i ~Y Ab~ORiZE ~ ~USTEES, ~EZR AG~[S) OR ~P~E~ATI~S(S), TO ~T~ 0~O ~ Signature s,ORI; TO B ...... :~E TH. iS DAY OF / APPL[(~ANT TRANSACTIONAL DISCLOSURE FOEH Tile Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town o[ftcers and employees. The purpose of tbia form is to provide information which can alert tile town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. ~Last name~ ~lrat name, midOl.lc 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.) NATURR OF APPLICATION: (Check ali that apply.) Tax grievance Variance Changs of zone Approval of plat ' . Exemption from pIat or o~ficial map Other (If "Other," name the activity.) ~O~ Do you personally (or through your company, ~poune, sibling, parent, or cblZd) have a relatloneblp with nny officer or employee of tile Town of Southold? "Relationship" ln~ludee by blood, marriage, or business interest. "Business interest" means a bu.ineee, tncludinq a partnership, ill which tile town officer or employee ha, even a partial owner,hip nE (or employment by) a corporation in which the town officer ur employee own, mote than 5% of bite YES ~/ NO If you answered 'YES," complete bite balance of this form and ,late and nigh where indicated. ,ame of person empIoyed by the Town of ~outhold ~C~C ~0~ Title or position of that person ~ Q~ ~ Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the appropriate line A) throuuh D) and/or describe in tbs space provided. The parent, town officer or employee or his or her spouse, siblinG, or child is (check all that appiy)~ the owner of Greater than 5% of the shares of the corporate stock of tile applicant (when the applicant is a corporstion)t nonuotpoua~e'en~i~y (wl~en ~he appliuan~ ia no~ a corporation) ~ applicant ~ or D) the actual applicant. DESCRIPTION OF RELATIONSHIP ekc- e - k. ' · ,'~ ~ ,~,. ,,, ~ ' ,/x~ e~J ,~,r _.- .- - .... ~ 0~ ~ CERT~IED TO' ROLAND & KAREN GRANT A T PECONIC KAREN GR~NT SOUTH B~Y ~BSTRACT 1NC. P~ULING BANK ~~~ ~' TOWN OF SOUTHOLD ~. SUFFOLK COUNTK N K ~ ~o~ - a6 - o5 - 9. ~ -~ M~. 16, 1995 s~ND A~ 4, ~ ( revis~ns ) WITH A~ril 6~/995 (revisions) GRA VEL LOT NOS. ARE REFERENCED TO ' MINOR SU~DIVISION FOR T~ ~T~D TO~ ~E~, ~A~ A~ ~F~NCED TO ~G ~ ~. I0' SAND& FF_AVY 11.5 WHJ TE SAND IR' ' PALE 16.5 ...... ORANGE SAND 11.5t .... SAND ~TH ERA VEL GR. WA TER GR. IVA 7'ER Mqy I, 1995 (revisions) MA Y 4, /995 (revisions) JAM 16, 1396 ; rt,~ '~.~ ~ barn .' t am lorn/liar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF 2UBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES end will ob/de by the conditions seI forth therein end on the permit to construct. The locations o/ wells and cesspools shown hereon ore from field observolions ~tREA = 26069 Acres to tie lines Mar. II, 1996 (/oundollOn local/on) April 3, 1996 (Add/lions) Dec. 20,1996 (line/) MAY 14, 1999 ANY ~.TeR~ T~N OR AOOmON TO T~S SURVEY ~ ~C~ ~ ~ r~ ~ Y~ sr~ EX.PT ~$ ~ ~C~ ~~ ~. ~ON A~ V~ F~ T~ ~ ~ C~$ SAD MAP ~ C~S ~ T~ ~ ~L ~T~LY TO ~Y ~ ~ LAW ~ ~ ~T~R ~$ ~. ~ ~ (516) 765 - 5020 P.O. BOX 909 IZ30 TRAVELER STREET SOUTHOLD, M Y. 119 7/ NO. 49618