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TR-5807
James F. King,President �a S(](/�y Town Hall Jill M. Doherty,Vice-President `O� OCG 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson 41 41 Southold,New York 11971-0959 Dave Bergen N+ �C ti O Telephone(631) 765-1892 Bob Ghosio,Jr. O�y CDUFax(631) 765-6641 Nf'I,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0348C Date: Au¢ust 8, 2008 THIS CERTIFIES that the remove/replace in-place approximately 74' of timber bulkhead with vinyl bulkhead At 510 Bayberry Road, Cutchogue, New York Suffolk County Tax Map# 111-14-36.1 & 36.3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 08/22/03 pursuant to which Trustees Permit # 5807 Dated 09/24/03 was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the remove/replace in-place approximately 74' of timber bulkhead with vinyl bulkhead The certificate is issued to EUGENE & MARY ANN BOLTER owner of the aforesaid property. 0,0 , Authorized Signature Town Hall Albert J.Krupski,PresidentO��FF�I� O 53095 Route 25 James King,Vice-President C P.O.Box 1179 Artie Foster Southold,New York 11971-0959 Ken Poliwoda co Peggy A.Dickerson G Telephone(631)765-1892 • Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN INSPECTION.APPOINTMENT FOR A PRE-CONSTRUCTION O SO HALL BE CONS DERED A VIOLATION AND POSSIBLEREVOCAT ON OFT HE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction _ % constructed Project complete, compliance inspection. V 1 ,� .��. l .`.✓'.y , g�W L� .mow,.J' t...` ! "^} J \i X L 1r C lit Y �l !'IL 1,r�45 Yl TERMS and CONDITIONS The Permittee F,,gans n4ar�— ort $ellton er ring at 510 Bayberry Road, Cutnhogup N. Y., as parr of the consideration for the issuance of the Permit does understand end prescribe to the fol- lowing: 1. Tho the said Board of Trustees and the Tewn of Southold ate released from any and all damages, or daims for dsmq% of suits aching directly at indirectly as a result of any oper- adon performed pursuant to da puW4 and the said Pecmiebee will, at his or ler awn defend any sad all such sdts'hiidabd by abad patties, and the Odd Peradttx assume;fall 916ft with respect thereto, to rho complete exchsioa of the Board of Traseets of the Tow`of Saotioid 2. That this Perodt is v&W for a padod of 24_ scot whbh is comide ad to be die estimated time'required to complete the wodc involved, but should citemestimoss watnat, raison for an extension may, be made to the Board at a later dab. 3. Thu this Permit should be retained indefinitely, or'as long as the said Pranittee wMhea to maintain the structure orIproject involved, to provide evidence to anyone concerned flat amb- odzadon was originally obtaiad 4. That the work involved will be subject to the inspection and approval of die Hoed or its agents, and awn-cone iaooe with.the provisions of the originating application. may be ase for revocation of this Peart by resolution of the said Board. 5. Thu there will be no unreasonable interference with navigation as a result of the wads herein adt6orized. 6. That there shall be no interference with the tight of the public to pass and sapws sloag the beach between high and low water Quarks 7. That if future operations of the Town of SaMbpld require the removal aodh/ac Ateando" in the location of the work hercia aa1aed, or ifh in the ophtiae of die Bossu of 1 6 the, weak shall came untemoosble obstramon to free navigation, the said Permittee will be required, upon due notice, to remove or atter this work or project be& anted widtostt capas sit to the Town of Southold a. That the said Board will be notified by the Nominee a the masgistion.of da nods aath- oriued. 9. That the Petmitoee will obtain all other permits cad comma dust mer be stymp• - plemendi to this permit which may be subject to revoke upon failure to obtain same. • • Albert J.Krupski,President gOFFO(,�O� CQ Town Hall James King,Vice-President I'1' 53095 Route 25 Artie Foster O P.O.Box 1179 Ken Poliwoda W Southold,New York 11971-0959 Peggy A.Dickerson �.f 0`� Telephone(631) 765-1892 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 29, 2003 Mr. Rob Herrmann En-Consultants,Inc. 1329 North Sea Road Southampton,NY 11968 RE: SCTM#11-14-36.1 & 36.3 Eugene& Mary Ann Bolter SIO Bayberry Road Cutchogue, NY Dear Mr. Herrmann: The Board of Town Trustees took the following action during a Regular Meeting,held on September 24th, 2003 regarding the above matter. WHEREAS,En-Consultants,Inc, on behalf of EUGENE & MARY ANN BOLTER applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 22aa, 2003 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 September 24, 2003 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 . 2 • 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 approved a Wetland Permit for EUGENE&MARY ANN BOLTER to remove and replace in place approximately 74 linear feet of existing timber bulkhead with vinyl bulkhead and backfill with approximately 20 cubic yards of clean sand fill to be trucked in from an upland source. Temporarily remove during construction and replace(in kind, in place) existing deck,platform and dock a ten foot non-turf buffer be maintained. . 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. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of$5.00 per inspection(See attached schedule). FEES: $5.00 Very truly, ouyours, y Albert J. Krapski, Jr. - President, Board of Trustees AJK/cjc cc: DEC il�� +IisyllP+sN+tllr �+ IIbMre�a, :... Albert J.Krvpski,President �QS�FFQ��CO Town Hall James King,Vice-President � !i 53095 Main Road Hem y Smith P.O.Box 1179 Artie Foster w Southold,New York 11971 Ken I'oliwoda Oy �� Telephone(516) 765-1892 �a0 Fax(616)766-1823 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD To ., En-Consultants, Inc. on behalf of Eugene & Mary Ann Bolter Please be advised that your application, dated August 22, 2003 has been reviewed by this Board, at the regular meeting of =sept 34th, 9993 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 following fee must be paid within 90 days or re-application fees will be necessary. CO_MPUTATION. OF PERMIT FEES: One Inspection 05.00 TOTAL FEES DUE: $ 5.00 SIGNED: PRESIDEFT, BOARD OF TRUSTEES BY: 0f'p'WZ_0&.itt�l LERIz, BOARD OF TRUSTEES Albert J,)aupski, President • ! Town Hall James King,Vice-President OSVFI�(� 53095 Route 25 Ai 14e Foster �O� CO P.O.Box 1179 XePoliwoda a '� Southold, New York 11971-0959 PeW,A. Dickerson Telephone(631) 765-1892 Oy Fax(631)766-1366 �bpl � baa BOARD OF TOWN TRUSTEES TOWN OF SO=OLD YOU ARE REQUIREDTO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR'f0 COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHAL L 13E CONSIDER+:D A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. BOLTER INSPECTION SCHEDULE Pre-cons1ruct'ron, hay bale line . 1 It 0y of construction %c(wnsti ucted x Project (*mplete, compliance inspection. .3 - Y !1 Albert J.Krupski,President Town Hall James King,Vice-President p$� It C . 53095 Route 25 Artie Foster �O P.O.Bos 1179 Ken Poliwoda a Southold,New York 11971-0959 Peggy A.Dickerson Telephone(631)765-1892 O� Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. r INSPECTION SCHEDULE _ Pre-construction, hay bale line 1m day of construction _ % constructed Project complete, compliance inspection. o� Town Hull. 53495 Main Road ' P.O. Box 1179 TelephoneO Southold. New.York I1971 r' (631) 765-1892 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, September 23, 2003, the following recommendation was made: Moved by Bob Ghosio, seconded by Tom Schlichter, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITON of the Wetland Permit application of EUGENE & MARY ANN BOLTER to remove and replace (in-place) approx. 74 linear ft. of existing timber bulkhead with vinyl bulkhead and backfill with approx. 20 cy. of clean sand fill to be trucked in from an upland source. Temporarily remove during construction and replace (in-kind/in-place) existing deck, platform, and dock. Located: 510 Bayberry Rd., Cutchogue. SCTM#111-14-36.1&36.3 The CAC recommend's Approval with the Condition of a 25' non-turf buffer. Vote of Council: Ayes: All Motion Carried 1329 North Sea Road Southampton, New York 11968 631-283-6360 31-283-6360 Fax: 631-283-6136 E-mail: con@pe Aix . EN-CONSULTANTS NV. www.enconsuItants.com ENVIRONMENTAL SERVICES August 19,2003 Town of Southold Board of Trustees Post Office Box 1179 Southold,New York 11971 Attim Lauren Standish Re: Eugene&Mary Ann Bolter 510 Bayberry Road, Cutchogue SCTM#1000-111-14-36.1 &36.3 Dear Ms.Standish: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Three(3)Wetland Permit Applications, (including Notice and Proof of Mailing to adjacent owners). 2. Three(3)Short Environmental Assessment Forms. 3. Three(3)copies of authorization&disclosure forms. 4. Three(3)work plans. 5. Three(3)copies of survey. 6. One(1)set of site photographs. 7. Application fee of$200.00. 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. Sinc ly, Robert .Herrmann Coastal Management Specialist E C E U hp E ,khs U D Enc. AUG 2 2 2003 Southold Town Board of Trustees MARY ANN&EUGENE BOLTER 510 BAYBERRY ROAD,CUTCHOGUE Figure 1. Looking east at northerly terminus offace of existing bulkhead and adjacent bulkhead to north. a Figure 2. Looking south at face of existing bulkhead from dock to be tempor 'yDu t v�&Epl8ce D Southold Town Board of Trustees is : . . . � • � s , ------------------ Vie -- a - z i �y f �I y tel; h -.o Y ti i:. Ar 1 F; s i • MARY ANN&EUGENE BOLTER:510 BAYBERRY ROAD,CUTCHOGUE Figure 5. Looking east at face of southerly 5-foot section of existing bulkhead ,gyp#W^ �bn r Figure 6. Looking west from upland over wood deck andJized platform to be removed and replaced a ♦ �!y 2N C S J�" 4 C 4 Op Q' McseShae �^'` I " O r C. F,n6)pH NLfN NASSAU POINT s v 2 C Wunnevrta *50• i and gp 30 P9(AG(B55 V NEfA POW) 49e h OP • /_—`M� 4t O/JtAOE IIOOr CONC.CHER / m CONC O nS SLATE� WALK �r ' cur IJOtes: 1) Purpose: Maintain ex.erosion cur' sn:ra� .� control structure Rn AME TORY ■ " y, 2) Datura:&W FRW �. 3) NeW sheathm to be vinyl; all tledprs to be CCA-treated 4) A{ppropmately 20 cubic yards of clean sad to be trucked in woo BX from an upland source for backfill STEP ma N" oMWMERQ 5) AN Intertdal vegetation t1ob Is ro�ov lJ Q' dishrbed or lost as a restdt of the SLATE sws my project will be replaced wa pantlrgs •WALLS of a a(12" O.C.) EOWNO E D 6) Existtrq fired platform ad dark will be tempaardy removed clrirq con5bi ctlon I / I i . 1.�I l.:; _ 003 and subsequenHy replaced(Ik/Ip) f T LLL 2) Property location: 510 bayberry Road. srxrAx r z+r� ! cutchoo e; Sam#1000-111-14-36,1 &363 8) Adjacent owners: I 1. Rust Fandy Patrership 2 Mc%ffm 1 fm.re• 2. PP,OPO5ftn 01"AP P.FP AAM f EN-CONSULTANTS INC. ( IN-PLAa) POP, WRY ANN ANP 1329 NORTH SEA RD. SUC4 NW 13OL9P, ON WUWWEfA PONR SOUTHAMPTON, N.Y. 11968 CU1'CHOCU, 5UPPOLK COUNTY, NY 631-283-6360 5H55T I OF 2 8/ Id/ 03 V � CC� V O V cc > Z x SIZ � Y y otS +I fl f x Z EN-f ONsn,TP„,-- V PVOP05EP f3LL"An ITR AaWNT x < IWPLAC�) FCV MAP.Y ANN ANI7 FU N� 1301.T ON WUNNDVEfA POW, CUTCH06T, SUFFOLK COUNTY, NY 51FF12 OF 2 8/ 18/ 03 Albert L Krupski,Presiden P.O. Box 1179 Town Hall James King,Vice-President SgfFQ(,r y 53095 Route 25 CQ Henry Smith �.1.� �� Southold,New York 11971-0959 Artie Foster $� Ken Poliwoda Telephone(631) 765-1892 p ! Fex(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastat Erosion Permit Application Wetland Permit Application ^Major _Minor _Waiver/Amendmen Changes _Received Application: Received Fee:$_ " Completed Application_ Incomplete �SEQRA Classification: Type I_Type 11 Unlisted _Coordmation:(date sent _CAC Referral Sent: 3 Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: _Technical Review:_ Public Hearing Held: �!XP Resolution: Name of ApplicantEUGENE&MARY ANN BOLTER Address 90 FOURTH STREET,GARDEN CITY,NY 11530 D Phone Number: 516-746-3770 2��3 Suffolk County Tax Map Number: 1000 - 111-14-36.1&36.3 sou m Town Property Location:510 BAYBERRY ROAD,CUTCHOGUE Boats of T gtn (provide LILCO Pole#, distance to cross streets, and location) AGENT:EN-CONSULTANTS,INC. (If applicable) Address: 1329 NORTH SEA ROAD,SOUTHAMPTON,NY 11968 Phone:631-283-6360 rd of Trustees Applic4lft GENERAL DATA Land Area(in square feet):+/-104,794 Area Zoning: Previous use of property:RESIDENTIAL Intended use of property:NO CHANGE. Prior permits/approvals for site improvements: Agency Date NYS DEC; 14738-00481/OW3 12-03-01 SOUTHOLD TRUSTEES;#5436 10-26-01 No prior permits/approvals for site improvements. Has any permitlapproval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: D E qTown U L11 AUb 2003 ou o u s Project Description(use attachments if necessary): REMOVE&REPLACE(IN-PLACE)APPROXIMATELY 74 LINEAR FEET OF EXISTING TIMBER BULKHEAD WITH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 20 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. TEMPORARILY REMOVE DURING CONSTRUCTION AND REPLACE(IN-KIND,IN-PLACE)EXISTING DECK,PLATFORM,AND DOCK. �rd of Trustees Applice% WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: TO MAINTAIN EXISTING EROSION CONTROL STRUCTURE. Area of wetlands on lot: 0 square feet Percent coverage of lot:N/A % Closest distance between nearest existing structure and upland edge of wetlands:N/A feet Closest distance between nearest proposed structure and upland edge of wetlands:N/A feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated?N/A cubic yards How much material will be filled? 20 cubic yards Depth of which material will be removed or deposited: N/A feet �o !WJ Proposed slope throughout the area of operations: N/A D C ILIManner in which material will be removed or deposited: AUG p p APPROXIMATELY 20 CUBIC YARD FILL WILL BE TRUCKED IN FROM SOURCE AND DUMPED AND GRADED FOR BACKFILL. Board of Trustees Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): THE PROJECT ENTAILS THE ORDINARY AND ROUTINE REPLACEMENT OF AN EXISTING BULKHEAD,WHICH WILL HAVE NO SIGNIFICANT ADVERSE IMPACT ON THE WETLANDS OR TIDAL WATERS OF THE TOWN. ANY ADJACENT INTERTIDAL MARSH VEGETATION DISTURBED AS A RESULT OF THE PROJECT WILL BE REPLANTED,AS PER PROJECT PLAN. 141"(2187)—TSA 2 —101 PROJECT I.D. NUMBER 617.21 S E Q R 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 EUGENE&MARY ANN BOLTER BY EN-CONSULTANTS,INC. 3 PROJECT LOCATION: Municipality CUTCHOGUE county SUFFOLK 4 PRECISE LOCATION(Street address and road Intersections,Prominent landmanu,etc,or Provide map) 510 BAYBERRY ROAD,CUTCHOGUE,TOWN OF SOUTHOLD,SCTM#1000-111-14-36.1&36.3;MAP PROVIDED CkPROPOSEDAC New Expemlon ❑ Modiacetlonfalteratim 6 DESCRIBE PROJECT BRIEFLY: REMOVE&REPLACE(IN-PLACE)APPROXIMATELY 74 LINEAR FEET OF EXISTING TIMBER BULKHEAD WITH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 20 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. TEMPORARILY REMOVE DURING CONSTRUCTION AND REPLACE(IN-KIND,IN-PLACE) EXISTTNG DECK,PLATFORM,AND DOCK. 7. AMOUNT OF LAND AFFECTED Initially 2.4 areas Ultimately 2.4 apes S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ❑No N No.deseribe briefly 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ®Residential ❑Industrial ❑Commercial ❑Agriwaue ❑Park Forest/Opon space ❑Other Describe: no. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER gum E L STATE OR LOCAL)? D ®Yem ❑No If yes,list apancy(s)and penNUapprovals AUG 2 2 2003 DEC,COE 11. DOES ANY ASPECT OF THE ACTION HAVE CURRENTLY VALID PERMIT OR APPROVAL? Oyes ®No H yes, list agency name and permittapproval Southold Town Board of Trustees 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yea NNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicarwaponaor name ROBERT ,COASTAL MANAGEMENT SPECIALIST DATE AUGUST 19, 2003 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER Boa�f Trustees Application AUTHORIZATION (where the applicant is not the owner) I t^'S=ne I � residing at �) b " �� �e `20 - (print owner ofproperty) (mailing address oche , y '.1, do hereby authorize (Agent) 615 ( has -ly\cL to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 0127( a0-ner14 si, r AUG22 2003 D Foothold Tows Smrd of ThMm 8 B40 of Trustees Applicatior� fJAssAu County of guffbfk State of New York EING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SM IS THE APPLICANT FOR THE ABOVE DESCRIBED PERM[IT(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 120A3_ Notary Public FOR NE HFANFY NOTARY i'j," „ t'-1 York FORTUNE HEANEY �v r NOTARY PUBLIC,State of Now Volt Commies:,i1 No. 4923498 D AUG 2 2 2M Southold Town Board of Trustees APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide infommtion which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. 1 ,-, YOUR NAME: �o�f T_ f•uw p trpNN (Last name,fust now,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) W gTLA+V S Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest.'Business interest"mcans a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO x If you answered"YE",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agentkepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): _A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); - C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this t%—j,of -1 2003 Signature Print Name • • APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Etliice rohibita conflicts of nterest on the art of town officers and em to ees. The purpose of this form is torov de infoal on wh ch can alert the town of possible confl cta ofrmnterest_and allow_ it to take whatever action is necessary to avoid same. YOUR NAMBs Last name, first name, middle 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. ) NATURE OF APPLICATIONS (Check all that apply. ) Tax grievance Variance Change of sone AppS5gval of plat Exertlption from plat or official map Other (If "Other," name the activity. ) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee or the Town of Southold? "Relationship- includes ' by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO If you answered -YES,- complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the apace provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply) , A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation)t .. B) the legal or beneficial owner of any interest in a noncorporate 'entity (when the, applicant In not a cn officer, p�yti nn sa C) an officer, director, partner f h D applicantl or D) the actual applicant. AU( ? 2 DESCRIPTION OF RELATIONSIIIP ! 2003 Southold Town Submitb a a � of 199_ Signatur � Print name,-,- • ' (l�H�--r' __ r`71�� Albert J.Krupski,President p$uFFO( C • Town Hall James King,Vice-President ' � 53095 Route 25 Artie Foster P.O.Box 1179 Ken Poliwoda W Southold,New York 11971-0959 Peggy A.Dickerson � O�� Telephone(631) 765-1892 Fax(631)765-1366 w BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application jA ofOF SUFFOLK STATE OF NEW YORK) AFFIDAVIT OF POSTING 41&f'L EN-CONSULTANTS INC. 1329 NORTH SEA RD. SOUTHAMPTON, N.Y. 11968 being duly sworn, depose and say: 631 293 6369 fl- That 7 the /7 da of 7 200 ,I erso lly po ed the property known as 5/0 �Gyc, '✓2077 t " I'M, r,<.c by placing the Board of Truskees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in plac r e1 t days prior to the date of the public hearing. Date of hearing noted thereon to be held/ o� ' 3 !k d1� Dated: (signature) Swom to b fore me this day of (Y2 2003 tu AINSI�161 n�zyPam•SeiNYtd CmnitimR91i1 Wmili CIMYr11 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:EUGENE&MARY ANN13OLTER SCTM#1000- 111-14-36.1 &36.3 YOU ARE HEREBY GIVEN NOTICE: 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: REMOVE&REPLACE(IN-PLACE)APPROXIMATELY 74 LINEAR FEET OF EXISTING TIMBER BULKHEAD WITH VINYL BULKHEAD AND BACKFILL WITH APPROXIMATELY 20 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. TEMPORARILY REMOVE DURING CONSTRUCTION AND REPLACE(IN-KIND,IN-PLACE)EXISTING DECK,PLATFORM,AND DOCK. 2 . That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 510 BAYBERRY ROAD,CUTCHOGUE 3. That the project which is subject to Environmental Review under Chapters 32, 37 , or 97 of the Town Code is open to public comment on:SEPT.24,2003@7.00 pm 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 does not reference any other agency that might have to review same proposal . OWNERS NAME: EUGENE&MARYANN BOLTER MAILING ADDRESS: 90FOURTH STREET GARDEN CITY,NY 11530 PHONE # : 516-746-3770 Enc. : Copy of sketch or plan showing proposal for your convenience. 5 9 G A Y N W • � Ol R HaReSh41 .! BOO/,a arch nN�• � NASSAU ?� y POINT 4 IVY 3� � 7 Wunnaweta �i y and { ".. . W 59C ACa55 VlA 51D.kCf ` � PAM&Vl9NN VtfAPOW) apA 140. w kgk Bu�k�o ?! tor. :...'. •.{ " ova poo—se: Maudam ex.erosmn X g� E 2) Datum:AM r.o 3) New ehea$wll to be wn{I:A timber to be CCA-treated eo o 4) 4pror matel4 20 orbic LTd5 of * as -.MRam+ Q clew,%rd to be trucked m me gar d from am uplad Wce for backfill P _ 0 5) MAimtertidalvegetat�t1atK � 4r (4 dlS,U+bed or JoA a5 a result of the SLAIE Sl" Ta ct wdl be replaced W6 PLgn*5 Pe aterylbaCl2" O.C.) b) Tref d platform ad dock wdl be ad 65eya 4 replaced(k/ sroawme + W �) prR�+ylocaGon: 51013atcT4road, i Cutchape;5CfM#1000 III Ih'�b.l &�b.3i 8) AdJace�owners; I I � I. Rust Fandv,Patxiership I 2 M6heru I ,mee' 2. ME ,r,I cn f �I PG�NI�NTEN CONSULTANTS MC. 0F MA's'ANN M12EN-C NORTH SEA IN pp ON WUNWMfA rONP,SOUTHAMPTON,N.Y. 11968 U� 0M COUNTY. NY631 283 6360 B/ I8/ 02 v � n � � o2S � n � o z n � R)� co > Z V Q "Z S).- � \I lU 03 +I j /p O ENIXONSULTANTS INC. n SCI 631-2t3-6360 MOP05W nUA19 MACEWW IN-PLAM FOV MAW ANN ANP ftaNF POLTM ON WUNNMfA PONR CU'fCHOGUF, 9FFOLK COUNTY, NY 9-Hf 2 OF 2 8/ 18/ 03 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: HELEN RUST FAMILY PARTNERSHIP 2600 DOUGLAS ROAD,SUITE 604 C/O REGISTER&COMPANY PA MIAMI,FL 33134 JOANNE McSHERRY P.O.BOX 1300 CUTCHOGUE NY 11935 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERT E.HERRMANN doing business atEN-CONSULTANTS,INC. 1329 NORTH SEA ROAD SOUTHAMPTON,NY 11968 being duly sworn, deposes and says that on the 20 TH day of AUGUST .20 03 , 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 addressesset opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) ,_ ) mail. Sworn efore me t2oo_� E C E V E day � U� D . - I Notary Publi6 Southold Town Board of Lustees Q�iYAtMp O�iMY1111h1y S S S (Domestic .A CON N I. rt i113C0 i A L Postage s 0.37 (NIT ID: 0968 oMPT Gk-, g ea 2.30 Return L 1.75 Poskralk Rea rise Clvk: KF048M C3 FU TOW PostageIkee $ 4.42 08/20/03 v -,'11 Helen Rust Family Partnership C/o Register&Company PA :; pix 2600 Douglas Road, Suite 604 iWin. Miami,FL 33134 � e. cc cc yy*��� y Ay � yy 6 v U90 Postage It 0.37 URT ID: 0968 `. 9 Certified Fee 2.30 PoStnwk Return Replpl F�e 1.75 ' (Eridonartien(RequlNene np) ��F*W" Cle►k: Kf048M Edi rowpostagsaFess $ 4.42 08/20/03 Q a To JoAnne McSherry 8iriii,Apt No P.O. Box 1300 "P°Box No. Cutchogue,NY 11935 city iui:,a-P -. TOPOGRAPHICAL SURVEY OF PROPERTY SITUATED AT NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-111 - 14-36. 1 1000- 111 - 14-36.3 SCALE 1 "=30' OCT. 8, 1991 FEB. 12, 1992 (ADDED PROPOSED DECK & POOL) JUNE 19, 2001 UPDATE SURVEY AREA = 104,794.34 sq. ft. l'a m ales) 2.4058 acres10 SyY S S 63'34'10" E , II�� 22 pp F� 30.44' D 6 C L5 0 1'1 LS 5 89' .00, E N 7g•21'ZO � 60.00' D 6s� WUNNEWETA POND by .. 1 �. � I max 11��11 WUNNEWETA POND Southold Town � 1 J h el � i, _ �• , W ,n N 30'09'17" W gd © j ©"°' •� /, 61.08' 13.69' R a� © I " �' , i i P •_ I C' / \ 9 ,3.3306f ////// II N 30'19'26".E 4 3i • N 5 '17" 5317" W � I • • •� ,• tl �* / �b06` III s�q�%� _)C•s • I !$ 1 •o= . �•� S 43034'06" E b4�� IV. Q °"" •• I j 31.50' 0�i' ro® I 1 Qo K2 a / r.. mNa n: I '05N 79' " E 63•p1' �� © d t tl .. 43 %- ��•� = lb 'hb ,r ax © max iANYT Hausc 4 t e2N A R uTb. y / " 143.39, NSA` �\ weer ❑ �"� ik ears ,u _ Sea• I - .A6• 73.,`� AMYLS N _1A rc up I D ie 7-r5315 r']�b�ryi'',/ �, � \72`�� � � v smr!cr r+l� I.�e' �� xtVj• xo F-�I '91T. �-1 4f'r I a."Ip W 0A \\ N 86.29'44" W wsz 1 I to rn a 1 11A I M \ f N 86'56'10" W 4°°rrm�" "'� 1y) n wmmaxI� 'Ml 4M 301.92' ACTUAL ' W \ Z\\ MON� .vae, 308.00' DEED 1 w�•\ ' WUNNEWEITA POND \\ N/0/F McSHERRY S Wuu�ulN.�1pN��A�ori ', Eaul�`AlloM UM. 11E NE\lrikr STA1E awo OF Do MMEY�"Ovines; NOTES: tan m_ W= a mL Mom 1. ADDITIONAL WETLANDS, IF ANY, ARE NOT SHOWN. 2. ADDITIONAL UNDERGROUND STRUCTURES, IF ANY, ARE NOT SHOWN. Wy m lw A=%=w w m tY 3. WETLANDS LINE INSPECTED BY SOUTHOLD TOWN TRUSTEES SEPT. 26, 1991. 15 PMVJM ® � w tiar 19�f801mG THE 006L[NC¢ (if gY1pF�T OF WAYS �,ZT Al1E NOTacoft.ANIFID. Franresn N rcwsoln¢ ne userlAt FOR Joseph A. Ingegno ��FaNA ' Fz�9� Land Surveyor orAN seven — gAmissism — sae Pbm — cantrac6w, Loran ���S��CA DSJPa� PHONE (631)727-2090 Fax'(831)727-1727 OFFICES LOCAM AT M MG AOARFSS . N.Y.S. Uc. No. 49668 1390 ROVM AYLWUEPAS Bax 1851, R6flMM, Nm, Yerk 11901 Rtwaroa. N!u j'aAr tiol—O9E.5,