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HomeMy WebLinkAboutTR-6225 Albert J. Krupski, President i j . Town Hall James King, Vice-President ~gpFFO(,~c 53095 Route 25 Artie Foster ~~0 ¢j P.O. Box 1179 Ken Poliwoda ~ ~ Southold, New York 11971-0959 Peggy A. Dickerson ~ Z Telephone (631) 765-1892 Oy ~ Fax (631) 765-1366 ~?ol ~ Sao 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1ST day of construction 'h constructed t/ Project complete, compliance inspection. • James F. King, President ~,~oF sooryo Town Hall Jill M. Doherty, Vice-President ~ 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen G ~ • ~O Telephone (631) 765-1892 john Holzapfel ~y~~UNi'h~c~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2006 Mr. Robert Krudop 4650 Ole Jule Lane Mattituck, NY 11952 RE: 4650 OLE JULE LANE, MATTITUCK SCTM#122-4-34 Dear Mr. Krudop: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed, September 20, 2006: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #6225 to excavate bank to a1:3 slope, resultant 30 cy. of excavated material to be trucked off site to an approved location. Armor 95 linear ft. of slope with a 100 Ib. toe stone and max. of 10- 20 Ib. stone along the face of the slope. Plant inter-tidal marsh in the upper 1/3 tidal range and a buffer area landward of the tidal wetland boundary, and as depicted on the plan prepared by Robert Krudop dated June 19, 2006. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Ja es F. King President, Board of Trustees JFK:Ims ~7,~y z h~~ ~ ~ Q~ ~x ~ /cco-f 4Z-y -34 ~.~1,~,~ ~7Pr~ ~SU ~~s~ s~,~ ~ ~ fir. N ~ - 1~ M~~ . ,~J 1 t1-pny{2,~ ~~"+~1t~4 U~~(~ I~fGT~l. tiu \I~~ ~o c~+v~e~c -teex•s~~^f v.«~a,~.u~ \ ~ s+ 0~J °`PPwr 6-72 ~1wk~ ~ ~ SQnc'nU > ~I c N Y 9DSC ~ i ~ APPROV EU Aa ~'~N TERb/S ~cafoe-: ~ZY1H (l~V~ ` , ~ ~ ~ .yy Es--is-~^p~ ANU CONUI'I'IONB OB D3~ "~D ~6{U ~ I' d~ L'' PERMIT O.' 3 7 ~ ~OS+ \ ~ ~ ~l N r~fi ~enn Law W~4+ - le 3.,\e. (s 1 \ DATE ~ ~S' Q Mc14.1..dt- ~cc5~~n L,a.~(\ , ~ ~JI ~ ~ ~ ~ ~Y nag ~ I ti _ ~ 6 1~ ~o ,J C ~ ~J f'°` A i_;,. I pn ~ i,~• o,~ Use I~u.A ~ca.~r.r~ ~w"~'`~,rr0 1 2~ Q~~rtn ~-3U ~ ~ ~ ~ Ccr~v\ r~jion _ d~ ~ ~ rr~, az,~.l -4~ reck rc_ S\c~Z.- ~3 3 ~ ^°k - ~ ~~~9cGc'.`' --j:c U1Y"c r- 1=V S,~°~'-7 1~~~'1 ~ r IR? I ~TUGf: ScQ~e. 4~'~ `TJ..' ~ot'~l Vi¢w ~ ~,i^~~ ~ r~1,afo A° ~cbe~ Ct'o~V t 2~) ~ i k (fa~~ Olz"3~~)/ LTT7 V'NC~-~ ~ t y 15952 y 1 ~ ~l ~Q~ j~~ ~~ITI~Iil SIC>Ta / (NiL I IO IT.~Gn 4w~'T „ , ~ y~.v~ ~ ER.t..:~ i~ M0.~~~ _ . _ EK ;,sty ~ ~ ~~t ~v , ~ . Io2. anchor ~e[c\ ~j. exs~C.1,m ; /obi' 1 N Y B D 6 C 19ca.\ n!F'k,~S- Rs~S APPROVEii A~ :'ud TERb18 *}',~~5 R~cnq ~0'~^~' fJrCC~~ AND CONDIT10N3 ~~'y o3/YL/Ucxb Z. ~ ~ y' +l nai u-f o 1,~ Crn'i~ c~ 4~'b~[n, PERMIT I - ~ 3 a ~ @ 1,~J ` DwxB- ~t-o~~ ~3'Y~I~a t°j1~~"n~T'aYa~:~..,. ~b~ ~cw~s ~rTt~t;K IR ~~~Y ~ f'~ off' ~1~c~A\ rsana,~ . Y~,L,W Ili „ 12:' a~ Ges~~°'" MaTTI7!!G 1C 670- -~o cw~ra ~ r<<1S osew. ~~r s ' ~`JB~ 7~\ ~:f~l NEW YORK STATE DEPARTMENT~NVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-03142/00002 Au ust28,2006 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental August 27, 2011 Conservation L•aw TYPE OF PERMIT ~ New ? Renewal ? Modification ? Permit to Construct ? Permit to Operate ¦ Article 15, Title 5: Protection of Waters ? Article 17, Titles 7, 8: SPDES ? Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management ? Article 15, Title 15: Water Supply ? Article 19: Air Pollution Control ? Article 34: Coastal Erosion ? Article 15, Title 15: Water Transport ? Article 23, Title 27: Mined Land Management Reclamation ? Article 15, Title 15: Long Island Wells ? Article 36: Floodplain Management ? Article 24: Freshwater Wetlands ? Article 15, Title 27: Wild, Scenic and ? Articles 1, 3, 17, 19, 27, 37; 6NYCRR Recreational Rivers ¦ Article 25: Tidal Wetlands 380: Radiation Control ¦ 6NYCRR 608: Water Quality Certifica- ? Article 27, Title 7; 6NYCRR 360: lion Solid Waste Mana ement PERMIT ISSUED TO TELEPHONE NUMBER Robert H. Krudo (631) 298-7051 ADDRESS OF PERMITTEE 4650 Ole Jule Lane, Mattituck, NY 11952 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Krudo roe 4650 Ole Jule Lane, Mattituck COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold James Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Excavate bank to a 1:3 slope. Resultant 30 cubic yards of excavated material to be trucked off site to an approved location. Armor 95 linear feet of slope with a 100 Ib. toe stone and a maximum of 10-20 Ib. stone along the face of the slope. Plant intertidal marsh in the upper 1/3 tidal range and a buffer area landward of the tidal wetland boundary in accordance with the attached plans stamped NYSDEC approved on 8/28/06. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Geor a W. Hammarth DMG Re ion 1 Head uarters Bld . #40 SUNY Ston Brook NY 11790-2356 AUTHORIZED SIGNAT/~~~4 DATE Page 1 of 4 Au ust 28, 2006 95.20-7 (11!03)-9d New York State Department of Environmental. Conservation r ~ ~ 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. 3g~031 02 X02. Regional Permit Administrator Permit Number ~ z7 a o 11 y~. ~~vl Expiration Date NOTE: This notice is NOT a permit Albert J. Krupski, Preb_ Q~O$UFFO(~CO • G Town Hall James King, Vice-President I~Z' y 53095 Route 25 Artie Foster o ~ P.O. Box 1179 Ken Poliwoda~„ ~ Southold, New York 11971-0959 Peggy A. Dickerson ~ ? `F ~Q aQt' Telephone (631) 765-1592 1 1~( ~ Fax (631) 766-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CEP ~ APPLICATION FOR AN AMENDMENT TO A PERMIT DATE -1 ~ ~~O OWNER '2~ PHOnN~ E ~i~( `7o j 7 c - ~x~~'~° ADDRESS Gee, 1"14~1~"UC.~t t~)`? ~~qSZ AGENT PHONE ADDRESS PROPERTY LOCATION CI~-~ ~e M ~ 1 ~~~jSZ~ TAX MAP NO. /CX~ (3 _ IZ2 -4 -3` f UWe~~.~ `~1 re~que~st~an~Amendment to Permit # ~ZZS ~ppP-~ °r~'-~-V~~~ 1 `b.~4 y7~'-r~~~ 1-~173ff o3~42ka~cZ. ~hr~d k L f ~ Xa C~~ ~o ~v~1. ososnl2n Vic. ~ 5a^ry1'~r~ s!'~~,.M r 7F^c.. ~ ~ ~tB-~rk-j ~~a~.. fC.L~.x~cr t~'" 12.5 I~ Q Terc u+a,....~ ',30 y„~rJs d Mc~in.,,~ ~u Fe,c~~:.e,~a, ~s1G/~+~v. Signed By: ~ ` 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 emp~yces The pylrpose of this form is to provide information which can alert the town ofpossible wnflic[s of interest and allow it to take whatever action i necessarv to avoid same. \ ~ ~ ~ YOUR NAME: ~C~c~ ~c~>QS+' (Last name, fu name, Middle initial, mless you are applying in the name of someone else or other entity, such as a company. If so, indicate theother person's or company's name J NAME OF APPLICATION: (Check ail that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the ac[iviry.) Do you personally (or through your company, spouse, sibling, patent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of t e 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/agenUrepresenta[ive) 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 alYthat apply): A) the owner of greater than 5% of the shares of the corporate stock of the epplicgnt (when the applicant is a corporation); B) the legal or beneficial owner of any interest in anon-corpomte entity (when the applicant is not a coiporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this d of,200~ Signature Print Name Form TS 1 Albert J. Krupski, President • ~ { • Town Hell James King, Vice-President ~SQFP~(/f'C 53095 Route 25 Artie Foster ~ P.O. Box 1179 Ken Poliwoda _ Southold, New York 11971-0959 Peggy A. Dickerson N Z Telephone (631) 766-1892 Oy ~ Fax (631) 765-1366 ~ Sao 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 ac day of construction / '/2 constructed V Project complete, compliance inspection. Albert J. Krupski, President ~~Of SDUlyO Town Hall James King, Vice-President ,`O l0 53095 Route 25 Artie Foster .IL .If, P.O. Box 1179 Ken Poliwoda ? T Southold, New York 11971-0959 Peggy A. Dickerson ~ ~ p ~ Telephone (631) 765-1892 ~lf'~Q~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 19, 2005 Mr. Robert Krudop 4650 Ole Jule Lane Mattituck, NY 11952 RE: 4650 OLE JUNE LANE, MATTITUCK SCTM# 122-04-34 Dear Mr. Krudop: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 19, 2005 regarding the above matter: WHEREAS, ROBERT KRUDOP applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated September 27, 2005, 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 October 19, 2005 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 standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, z • RESOLVED, that the Board of Trustees approve the application of ROBERT KRUDOP to construct a rock revetment to cover an area of 5.5'x125' and plant with Spartina patens and Spartina alterniflora to help control erosion along the bank, with the condition of planting a 10' non turf buffer, and all as depicted on the plans drawn by Robert Krudop 9/20/05. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) This is not a determination from any other agency. Fees: $50.00 Very truly yours, ~ ~ ~ Albert J. Krupski, Jr. President, Board of Trustees AJK/hkc ~,TM .!l . r.a~.. Board Of Southold Town Trustees " SOS-UTHOLD, NEW YORK PERMIT NO...~~)........ DATE: October.._1.9.,.2005 t~ ROBERT KRUDOP ISSUED TO . x Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of-the. x State of New York 1452; and the Southold Town Ordinance en- titled ."REGUI:ATING AND THE -PLACING. OF OBSTRUC71.S3NS , IN AND ON 70WN WATERS AND PUBLIC LANDS and--the REMOVAL OF SAND, GRAYEL•OR OTHER MATERI;4LS.F$.OM LANDS .UNDER TOWN WATERS;'. and in accordance with'the Resolution of The Board adopted at a meeting held on oct.I9 ' 2005 and in consideration of the sum of j 250.00 paid by t .............Robert Krudop........_................... e of Mattit°ck_ N. Y. and subject to +he . Terms and Conditions listed on the reverse :ide hereof, of Southold Town Trustees authorizez and permits the following: Wetland Permit to construct a rock revetment to cover an area 'f ~ of 5.5'x125' and plant with Spartina altexniflora and Spartina , patens to help control erosion along the bank, with the condi- tion of plantin 10' onturf g plans.. drawn by ~o~~~t ~Cru~o~.~~' ~j~ and all as depicted on th . afl in accordance w~ t e e a~ ~ Os~i ?fiwtions es presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees Ivere- by causes its Corporate Seal to be affixed, and these presents to be subscn'bad by a majority of the said Board .as of this defs. o~c~UFFO~co -.Q~-~'~~ - ~~7 z K oliwoda ~ o o -Arti ter (absent) - ' Trusieas { p• TERMS and' CONOfTIONS Robert Krudop Tkk Parti3ttee Mattituck t~siding at _ N. Y, ss j~atr of [he considetxdon for the tsmanae of the Permit don undersgmd rind pxsa#x to the foi- P: t. Tbst the aid Aoard of Trustees and the Iowa ttf Soudsdd ate relapsed from any and all damage; oe balms for damages, of sukc adsiog: dicocdy oe iadirec8y as a result of nay opa- adoa pedotnted.ptuataat~tl:~tb7s..~arwil: cad ih~ Nid Yemdttee wtll,, a bts or her own eipeasq ~ de&md any aced au such suia'haidated by tbird ~atdes, and the aid P~tae assupaes felt 1LWI1t~ with teapea tbeeeto, po-ehcnoomplete euloslon of the Board of Tmmes of the Tava of Southold 2. That this Peretk is gelid for a period of ?4 coos, avhtdr k tlOlastdabd to be the estimated time' eequired a complete the wodc ia~olved, but thoald drdausa~aca warrym, regoesc , for as a:tepsioa away be made to the Board at a IatCt dope 3. That this Permit should be retained indefinitely, or as tong as the eald Petmiaee wis6ea to' maintain the sttuttute or pmjea involved, to provide evidence m anyone eoaeetaed that anth- orhydoa was ocigiaailj abtaiaed, i 4. That the wodc iuvo(vod will tx wbjea co the inspatioa and appravat of the Bwrd a . its agents, and non~ompliaaae with the ptavisioas of the odgtaatiag applkadoq maybe pose f« tevocadoa of this Permit by tesoludon of the aid Board. 5. That there will be ao unteasoaable iaterEerena with mvigadoa as a result of tlx wodc btxdn authorized. 6. That there shalt 6e aw interfaeaa with the rigtu of the public W pass and repass alattg y. the beach between high and low water ancks. 7. Thu if future opetadoas of tlu Town of Southold tequlre the. removal atrdJor alatttiouc ; in the locadon of the wodc fierda tmthotdzed, or tf, in the opinion of t9ie.Boatd of Tnruea, the. wodc shall ease nareasooable obstnuxwa in free mvigatioo, the said tt~mo>iaa will 6e iequited, . ttpas tiuc soda, to reatove or alter this wodc or project herein cooed wlthom to the Town aE Southold. 6. That the said Board wLt tx aodfied by the Perniletee of the Cotapledon._of the worts anth- ndzed. f 9. That the 'Pbrnsitta wlll obaia all other permLs and eommti ~ taay be requhed RP' pletaeatal a this permit which tmy be subject to revoke u11On' faihtre to aasprin setae. Albert J. Krupaki, Preaident ~~OF S~UTyO Town Hall Jamea King, Vice-President ti~ l~ 53095 Route 25 Artie Foster .IL ~ P.O. Box 1179 Ken Poliwoda T Southold, New York 11971-0959 Peggy A. Dickerson ~ • ,O Telephone (631) 765-1892 ~ly~~~~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~ 0 ~ rT Y'vl ~.o~ Please be advised that your application dated / ~C~J has been reviewed by this Board at the regular meeting of f~~l ~l~ ~ 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. COMPUTATION OF PERMIT FEES: S(~ ~ jnJ~cc-l-w„1 ~\O~ TOTAL FEES DUE: $ ~O SIGNED: ~ ` ~ . PRESIDENT., BOARD OF TRUSTEES ~gpFFO(,~~, • ~~O OGy~ Telephone ~ Town Hall (631) 765-1892 _ W ~ 53095 Route 25 O ~ ~ P.O. Box 1179 O`' Southold, New York 11971-0959 of ~a CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., October 12, 2005, the following recommendation was made: Moved by Don Wilder, seconded by Jennifer Mannino, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of ROBERT KRUDOP to construct a rock revetment to cover an area of 5.5'X 125' and plant with Spartina Patens and Spartina Alterniflora to help control erosion along the bank. Located: 4650 Ole Jule Lane, Mattituck. SCTM#122-4-34 The CAC recommends Approval of the application with the Condition of a 20' non-turf buffer. Vote of Council: Ayes: All Motion Carried ~ i- . ~ ~ . ~ ~ ~~~C~ ~1-e. Vie, a.. _ t n~ II~S"~ 'fir` i C . ~ } 1l.. - F . 9. 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SOLOMON IiYCOU'M'~~ Southold, NY 1111 Telephone: 631 765-1938 Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Town of Southold Board of Trustees _ _ i - ~,Y iii From: Mark Terry, Senior Environmental Planner ~ ~ t, LWRP Coordinator 4' r^~ oc i ~ Date: October 18, 2005 ` _ t__--- - Re: Request for Wetland Permit for Robert Krtldop SCTM# 122-4-34 ROBERT IQ2UDOP requests a Wetland Permit to construct a rock revetment to cover an area of 5.5'X 125' and plant with Spatting Patens and Spartina Alterniflora to help control erosion along the bank. Located: 4650 Ole Jule Lane, Mattituck. SCTM#122-4-34 The proposed action has been reviewed to Chapter 95, 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 generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided the following best management practice is applied; 1. To further suaaort the LWRP and the policies, assess the feasibility of the installation of a silt boom/turbidity screen to be employed during construction of the rock revetment to minimise turbidity in the water column. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. .1Hert J. Krupski, President ~~Of SOUTyO Town Hall James King, Vice-President l~ 53095 Route 2b Artie Foster JL # P.O. Box 1179 Ken Poliwoda T Southold, New York 11971-09b9 Peggy A. Dickerson ~ O ~ J ~ '.2` ~ Telephone (631) 765-1892 OIyCOU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Co~aastal Erosion Permit Application ,/V1'etland Permit Application _ Administrative Permit _AmendmenUTransf r/Extension iKeceived Application:~~ .Received Fee:$~ 1~ - ~Eompleted Application s Incomplete ~ ~ ~n ~S ~ ~J _SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(dateseut) q 1a7~~Y ec~ , ?LWRP Consistency A s ssment orm I C ~ cuW ~CACReferralSent:__~e7~~-_. Hate of Inspection: Sa:ah:%!tl Town Receipt of CAC Report: R~•,~d of Trustees Lead Agency Determination: _Technical Review: ,.Public Hearing Held: Resolution: LtrJQP? Name of Applicant ~~>~tT ~r, y ~o,p Address 4(d~C~ Ge, 3~~~ I• Ip{fr~UL /N~~~ ~1~1~- Phone Number:( ) ~`1~ /~'rj 7 Cell % "~~c~ Suffolk County Tax Map Number; 1000 - X22 - G~i -3~ Property Location: Y~SCy Ge- ~.~.e.. ~ 1 ~~rE.+cnj(, __~1ZOVide_~ILC4Pnle_#,_distance to-cross~treets, and location) AGENT: c~a!) ~ bS (If applicable) 'r I 1 I,, ~~,~n~ Address: ~(o~~ Gl.~ ~i v~-~ t ~Gl'CiTix~ Mc Phone: ~~7 „ ~ard of Trustees Applicat~ GENERAL DATA Land Area (in square feet): ;~.42~ ~ ~F. Area Zoning: ~e~~s~,-k,~~ Previous use of property: ~ar~~e.,~-~~o.~ Intended use of property: ~e~„~ ~k~d~ Prior permits/approvals for site improvements: ~b t^'s;-m++ a~a<sh ~ .~,,b , Agency Date T52~^~-G-~. ~ ~c.~se_k~oe.~ 2co~ ~No prior permits/approvals for site improvements. -~~s a~'1'"'^ Has any permit/approval ever been revoked or suspended by a governrnental agency? __~No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~ ~ -to'3°° n ( ~ .fit Icxal rr-~-~til.:e. t~c~~ ^ -~z, C~x>•e`r ova o.~e~ cn~ S• hy~x ZSw~, W r{'H P~ur~w.%~ ~ 1/1C1~ ~no~ ~Ek'~ens a.t~ S~lnq CII-h'n iy~r4. '~o fie,\p c~~~\1 e~t~,. o~~or~g~ -~~e- 1~~- c~ o• d~~ crngl le~,d~~~ •oard of Trustees Applicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: ~jz7secr~ Area of wetlands on lot: © square feet ~,~s cam G~Z- Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: ` ~ ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ('i feet o.~ 1„~„ v.,~v- ; Does the project involve e/xcavation or filling? No ? Yes Gnl y ko ~cc~''-a If yes, how much material will be excavated?cubic yards ~~~~.~1 ~ ~tr,~ ~U How much material will be filled? cubic yards a. 117c~L wa\\ . Depth of which material will be removed or deposited: G - Z~ feet Proposed slope throughout the area of operations: ~ C~c~n~ M/n~anner in which material will be removed or deposited: I ~~I~ L~ Mi~~ Ten- o. MSn~ 2xc~.a.-tcer~ ~ ~el~ re-` "lt ~ I~~C\\.7r~ ~4 ~ Zan f1Ci'ro A~~ II~~ ~ l til~~~ [h.1. ~ c tid n Qo 'RQ CC7~5~ C!\ . C~_ ~ (~+f' 3'~1 Statement of the effect, if ,and, on the wetlands anted tidal_waters of the town that may result-by _ - _ reason of such proposed operations (use attachments if appropriate): 1W~.1 ~(l.Ci I~IVCW `-~Z.~G1nM° 1-Y ll.Z~~, ~\(/.L~~ W~1` ~M.~U-C3, 0. r~va~~ n? _ P hV fYGf1Mo N~~ ~ard of Trustees Applicat~ COASTAL EROSION APPLICATION DATA Purposes of pro+po~sedf activity:~~u;~ ~ro~c, ~a,n,w,-~ ~s,~,11 w+k~ Are wetlands present/within 100 feet of the proposed activity? No ? Yes Does the project inv/olve excavation or filling? No ? Yes any ~G seF.utz. Via.. fv]CiC~ 11-r.~l ~s~.b+\ ~k„ . + / If Yes, how much material will be excavated? (cubic yards) f ct How much material will be filled? "f - (cubic yards) Manner\in which material w1ill be removed or deposited: (~lc~,{- Exccac*kty~ W t~~ CPS ~cr~ ~1 Vt~~~a - I~K~ ~>~K. ~ 1~'n-E MIFII Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of thep~roj(ect as proposed. (I7se attachme~n(ts i`f necessary) ~1`n.._ ~ cn~ !`'G'YIWG_, `1-<Y`J.(.SS ~.n~ ~ 1GVrC+ ~a-~-z- ti~1~. o, c can, CC~'~Ci~c~1 ~~c Ic~c_ 'tj r~ emu.-+v~a~¢, l~'KtiS+"~. ~ tie. . . PROJECT ID NUMBE~ 617'2() SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. AP ANT/SPONSOR 2. PROJECT NAME ~ Lro6lcr C¢n~rc~ 3.PROJECT LOCATppIOgN: 'yb~, Municipality I" `~cr`'Y~X~-~ County l~ 4. PRECISE LOCATION: Street Addessp~and Road Intersectiofns~,-~P-r~ominent landmar s etc -or provide map G.e.~ ~ 1- 1CH-~'t~~ 1/~ v / ~ ~ ~ 5. IS PROPOSED ACTION : New ~ Expansion ~ Modification /alteration 1 6. DESCRIBE PROJECT BRIEFLY: ~l^~ IcC~~ ~IVt'' T~ \ J~~r^. y GjryGc~ Via. b~k. ~ a d}~< 1~ Cr~.nc~l ~c~ ~w~~[J csss~~'(~ ~~r~\cn W~r~-- Q~ k~ ~~e~ -~tr~z. gal-r~,~c.~ Mcri>~z I . 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately - acres 8. W~IL1L~ PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? U? Yes ? No If no, describe briefly: 9. WH IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ~ Industrial ~ Commercial OAgriculture ~ Park /Forest /Open Space Other (describe) 10. GOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENC (Federal, State or Locap es ~No If yes, list agency name and permit /approval: G 11. DOES ANY PECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Ves ~o If yes, list agency name and permit /approval: 1I2~. 1A"S A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REpUIRE MODIFICATION? LJres No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor Name ~ Date: qJ I LI Signature If the ction is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT To be coin leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? -If yes, coordinate the review process and use the FULL EAF. Yes ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be supersedetl by another involved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C7. Existing air quality, sudace or groundwater quality or quantity, noise levels, existlng traffic pattern, solid waste production or disposal, potential for erosion, drainage or Flooding problems? Explain bdefly: C2. Aesthetic, agricultural, archaeological, hislodc, or other natural or cultural resources; or wmmunityor neighborhood charactae? Explain briefly: C3. Vegetation or fauna fish, shellfishor wildlife species, significant habitats, or threatened or endangered species? Explain bdefly: C4. A community's existing plans or goals as officially adopted, or a changein use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related acGVities likely to be induced by the proposed action? Explain briefly C6. Long term, short term, cumulative, or other effects not Identified in C1-C5? Explain briefly: C7. Other impacts mcludin than es in use of either quan[i or t e of ener 7 Ez lain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA ? If es, ez lain bdefl Yes ~ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: Yes ~ No PART III -DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identifed and adequately addressed. If question d of part ii was checked yes, the determination of signifcance must evaluate the potential impact of the proposed action on the environmental characteristics ofthe CEA. Check this box if you have identified one ormore potentially large or signifcant adverse impactswhich MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this box if you have detennmed, based on the information and analysis above and any supporting documentation, that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supponing thi determination. Name of Lead Agency Date riot or ype Name o Response a ecer In ea gency Title of Responsible Officer Signature o Responsible ecer In Lead Agency l9nature of Preparer (If di Brent from responsib e o ecer) ~gUFFO(,~ Albert J. Krupski, President CQG Town Hall James King, Vice-President 'y~ 53095 Route 25 Artie Foster H - P.O. Box 1179 Ken Poliwoda Z Southold, New York 11971-0959 Peggy A. Dickerson ~ ~ ~if~0 ~Q~ Telephone (631) 765-1892 1 ~ Fax (631) 765-3398~~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of -----~-~.~11~i>~-k~_c~d~p--------------------------- COUN'fY OFSUFFOLK) STATE OF NEW YORK) AFFIISAVIT OF POSTING I~?r~.~ ,residing at t{(,~U q(~~_ ~juf};{ ~~f_[/4 $'Z being duly sworn, depose and say: That on the $~day of C3oF~6s , 2005, I personally~ ppo~sted the property known as by placing the Board of Trustees of icial 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 ~dJs~ tic 'A'1(J~4 l .~(1n,5" ~n 9~ a (acxc~t ~'Zb ~J Dated: (signature) Swom to before met is day ofjl-I 1_ 200 V(;Nfie( otary Public BONNIEI.DOROSIO NMary Publ'w, State Of NewYMk No. O1D06095328, Suffolk unq Term Expirea July 1, 20 } PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Ada -4.13,7 w,l1r., I,..,Is~ c.wF ~ ~4vc 14za, ~k.+-V~r~ 1i9s2. tz~_~-3s r PG 63cx 723 , McM~.F.,~ JJ4' JIUSZ. ~ ~ ~ ~ r J1ccF4tk~rlc- Vl II~SZ ~ r `f !moo r,IaS.l,, I,n ~ M1 w?iar',~r 1 ~ ~ Mu-~~-l~~ ~w Ir9s-~ ~ Poatege s 0.37 INIT iD: 0971 cenined Fae 0 2.30 ~ Retum Recelpl Fee 1..~ Posenenc (Entloraement Requlretl) O Realdcted DBIWery Fee Clerk: KKOAt0 `p (Endorsement Required) rl TOtel Postage a Fees ~ 4'42 09/27/Q1 'n ~mg at ~SU ~ >s Nh ~ IIRS Z ent o o ~t1~ro~,___~!!! s________.__„__________________________ _duly sworn, deposes and says that on the „POeo><NC. y-~ lye, ~y2q _ ,deponent mailed a true copy of the Notice F,tj ~ ,ion, directed to each of the above named respective names; that the addresses set e names o sar persons aze a address of said persons as shown on the current assessment roll of t e Town of Southold; that said Notices were mailed at the United States Post Office at ~,l ~ ,that said Notices were mailed to each of said persons by (certified) (registered) mail. t i ~ Sworn to bef re e this Day of~~ 20 U , _ _ ' No Public BONNIE J. DOROSKI Notary Public, State OJ NewM~tt No. O1D06095328, Suffolk ~poaty Term Expires July 1, 20 S,j, j„~ Board of Trustees Application County of Suffolk State of New York e~rt' ~~IZCI BEING DULY SWORN DEPOSES AND AFFIRMS T HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/I~R 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 CONJiJNCTION WITH REVIEW OF THIS APPLICATION. Signatu e SWORN TO BEFORE ME THIS a ~ DAY OF 52 p~ . ,20 ~ S \ Nary ~ 16iR Notary Public ~ ^~~Y0.1~a'O°~ • Board of Trustees Application County of Suffolk State of New York ~ ~ BEING DULY SWORN DEPOSES AND AFFIRMS T. AT HE/SHI: IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/fIDR 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 T`S APPL TION. Signature SWORN TO BEFORE ME THIS Z DAY OF S e p f • ,20 ~ ur~u~ e.scwou MolwyPuMk.~yol grwAMlc Notary Public ~~~~,0~!Iy~ Commlasbn Epiirea MaY 6.79+~C'f~ l~ . , APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of tows tifficers and emolovees The purpose of rhi form is to provide information which can alert the town ofpossible conflicts of interns[ and allow it to take whatever action is necessary to avoid same. ~ l 9 ~ YOUR NAME: f1C-VC~G.o ~cb~.S"t' ~ (Last name, first name, idle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: {Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town.of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the [own 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 [hat person - Describe [he relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check [he 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 wrporation); - B)the legal or beneficial owner of any interest in anon-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~da of~i200? Signature ~fr(.,1` ~ Print Name 'tyoba,-F Kcvcl,0 Form TS 1 Town of Southold • • saa{sn~1 p="oy u pn2S 1;'r~G°c~ LWRP CONSISTENCY ASSESSME FO - A. INSTRUCTIONS r'~~ 5000 ! Z ~ 1. All applicants for permits* including Town of Southold a~~~teies, skgli gtstnlilete tktl~~~C;AF for proposed actions that aze subject to the Town of Southold Waterfront Cok~sis'tenc'y Rsuiew?,a1u. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the prepazer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Townl. 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standazds 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#~ PROJECT NAME 4~SC~ G1e~-.~~ Gro~~t~. Cc~.-~-~,\ The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial-assistance-(e.g: grant; loan; subsidy) _ _ _ _ _ (c) Permit, approval, license, certification: Nature and extent of action: t e~ ~ c anc 1 mac. l,v.l ~ ~k>e.\ PYx\c ~e c# -lE, S- ~ n^e_ G-1 N,.A k,.- r~w-~ e l Location of action: `KoS~ ae. ~,j,e (s ~c,-lr~,-~.,~c Vic. r Site acreage: e (dJ~ cr,. Present land use: Present zoning classification: ~~~4e,-ang,l 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Kctse.3'~' K~~c~ (b) Mailing address: ~KnS~ U,e. ~i~,o_ L-r~ ~~c,-H-E,`~uc.(C, ~ W't ~1~1SZ (c) Telephone number: Area Code ( ) („'3~- ~C1~6-7C~"7 cell (d) Application number, if any: (0`3\ - ~~-~17~(0 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? ~G ~ C. Evaluate the project to the following policies by analyzing how the project wilt 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 -~-P~ol/icies Pages 3 through 6 for evaluation criteria ? Yes ? No I~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality aad protect scenic resources throughout the Town of Southold. See LWRP Section III -Policies Pages 6 through 7 for evaluation criteria Yes ? No ? Not Applicable cx~ va ~ w~ ezfc..d c nw.v i~d ~5•n~ ueao~~ ~ 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 S through 16 for evaluation criteria Yes ? No Not Applicable L ` 1 1 -n. iDW~ l~i~ ~'Or,1R]y i`Nlll a~~$i 'r1rC. t!_I'~i`+~-f~ ~IV'~Cn Tu tr05tcn, r.-~o-c\ wl~~~e. tea. ~w7~~wc8 °S ^~a., ~%.'S4,.n.. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Poli es Pages 16 throug 21 for evaluation criteria Yes ? No Not Applicable 1oe.~G~.. w~l~ rnnihr~ ~Ib dts+urbo,~ ea-o ,icn Ccrk~.,~. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III -Policies; Pages 22 through 32 for evaluation criteria. ? ? Y s No Not Applicable ~ t~ ..J >e>SF~ lkc.. ~ a,,,. c~-~-ell, N91A 1U~~ v..` ~ ~ 1~ y 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 env' nmental 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 III -Policies; Pages 38 through 46 for evaluation criteria. ? Ye~ No Not Applicable Attach additional sheets if necessary s ~ WORKING COAST POLICIES 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 U Not Applicable Attach additional sheets if necessary Policy il. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town water .See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? No u Not Applicable Attach additional sheets if necessary Policy 12. Protect agric itural !ands in the Town of Southold. See LWRP Section III -Policies; Pages 62 through 65 for eval tion criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 13. Promote ap opriate use and development of energy and mineral resources. See LWRP Section III -Policies; ges 65 through 68 for evaluation criteria. ? Yes ? No Not Applicable PREPARED BY~CX~Q,1~T ~C~)Ur,.o TITLE DATE ~ James F. King, President ~~oF souryo Town Hall Jill M. Doherty, Vice-President ~ 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson * ~ Southold, New York 11971-0959 Dave Bergen G Q ~ ~O Telephone (631) 765-1892 John Holzapfel 0~~~~OM'I,Nc~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 20, 2006 Mr. Robert Krudop 4650 Ole Jule Lane Mattituck, NY 11952 RE: 4650 OLE JULE LANE, MATTITUCK SCTM#122-4-34 Dear Mr. Krudop: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed, September 20, 2006: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #6225 to excavate bank to a1:3 slope, resultant 30 cy. of excavated material to be trucked off site to an approved location. Armor 95 linear ft. of slope with a 100 Ib. toe stone and max. of 10- 20 Ib. stone along the face of the slope. Plant inter-tidal marsh in the upper 1/3 tidal range and a buffer area landward of the tidal wetland boundary, and as depicted on the plan prepared by Robert Krudop dated June 19, 2006. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Oti I~~ Ja es F. King President, Board of Trustees JFK:Ims ~'6 ~ ?n ~ ~ T c J ~ ~ T ti fig{+, ~ ~ ~~/9 ~ H ~ 6 ``n a ~ -'S' ~ ~ ~ r z ~ ~ ~ ~ 5 ~ AS ~ .8 ~ "ter ~ r~~,r„r~~ ~ M~~..~ ~c ' ~ ~ !f ~ ~ ~ C~SSe i y ~ ~ 1,~ d d J ~'J' i 5.~ ~ ~ E r~ ~ ~~r~2 ~ x ~ J ~ R; O ~ 7 II~~ t 4 E.. p U ~ M ~ ~ 0 ~ O 2 a d ~ Z~y p ~i. Q U H ~ y A a F ~R ~ aid ~ ~ _ - u ~ u~ I T ~ - a ~ _ _ _ > _ _ ~ y ~ I ~J ~ ~ k 6 6 ~ ~ N - ~R Y ~ ~ . ~ ~ , f ~ ~ C. ~ ~ . o /4`%7y d `~oT U j ~ W w Oo E'Gl~ 1 V~z Z ~ I 6 0 ' t~ = i ~ ~z.. a~a * ~ z P, .r H ~ ~ ~ ie ~c v ~ ~ ~ N ~.1- 0 ~ ~ r w ~ ~ ~ SS ~ ~ ' ~ ~ n ~ ~d ,s ~ 00 d NEW YORK STATE DEPARTMENT~NVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1738-03142/00002 Au ust 28, 2006 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental August 27, 2011 Conservation Law TYPE OF PERMIT ~ New ? Renewal ? Modification ? Permit to Construct ? Permit to O erate ¦ Article 15, Title 5: Protection of Waters ? Article 17, Titles 7, 8: SPDES ? Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management ? Article 15, Title 15: Water Supply ? Article 19: Air Pollution Control ? Article 34: Coastal Erosion ? Article 15, Title 15: Water Transport ? Article 23, Title 27: Mined Land Management Reclamation ? Article 15, Title 15: Long Island Wells ? Article 36: Floodplain Management ? Article 24: Freshwater Wetlands ? Article 15, Title 27: Wild, Scenic and ? Articles 1, 3, 17, 19, 27, 37; 6NYCRR Recreational Rivers ¦ Article 25: Tidal Wetlands 380: Radiation Control ¦ 6NYCRR 608: Water Quality Certifica- ? Article 27, Title 7; 6NYCRR 360: tion Solid Waste Mana ement PERMIT ISSUED TO TELEPHONE NUMBER Robert H. Krudo (631) 298-7051 ADDRESS OF PERMITTEE 4650 Ole Jule Lane, Mattituck, NY 11952 CONTACT PERSON FOR PERMITTED WORK ~ ~ ~ TELEPHONE NUMBER NAME AND ADDRESS OF PROJECTlFACILITY Krudo roe , 4650 Ole Jule Lane, Mattituck COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold James Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Excavate bank to a 1:3 slope. Resultant 30 cubic yards of excavated material to be trucked off site to an approved ' location. Armor 95 linear feet of slope with a 100 Ib. toe stone and a maximum of 10-20 Ib. stone along the face of the slope. Plant intertidal marsh in the upper 1/3 tidal range and a buffer area landward of the tidal wetland boundary in accordance with the attached plans stamped NYSDEC approved on 8/28/06. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Geor a W. Hammarth DMG {~~Re ion 1 Head uarters Bld . #40 SONY Ston Brook NY 11790-2356 AUTHORIZED SIGNAT/~" DATE Page 1 of 4 Au ust28 2006 95.20-1 (11/03)-9d New York State Department of Environmental Conservation 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 tQ the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting-the DEC. 3g,03~ ~ Regional Permit Administrator Permit Number - p Expiration Date NOTE: This notice is NOT a permit Albert J. Krupski, President. ~Q$UFFQ~~.C James King, Vice-President hQ~ Town Hall Artie Foster ~ 5309b Route 2b Ken Poliwoda ~ Z P.O. Box 1179 Southold, New York 11971-0959 Peggy A. Dickerson ~ ~ .tC y~~ a0~ Telephone (631)766-1892 l~( Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SEp 5 2006 APPLICATION FOR AN AMENDMENT Td A PERMIT DATE _I ~ OWNER ~ PHONE oC"i~ 705 7 C - ADDRESS Cie, ~ MQ-~~k~ ~yJ I~~ISZ AGENT PHONE ADDRESS PROPERTY LOCATION ~Ko~j ~ e ~n M ~ ~ ~/'//~3SZ~ TAX MAP NO. rCx~ d _ ~Z__Z_~ _~•f ~e ~ ~ request an Amendment to Permit #~~S ~ ~ V,~_~. ~y7a-r~~ -Y# 1-U7'3f~ o3f42~~Z., _ ~cak-.~5~ eseslc+. w1.~c rt~c 5a~vti,re s4~ 7G'e, c~; ~ ~x.lup. c~- Cd5' I~ A ll ~ ''rr ~Ca a ~p+nc r.X ~ i~ 1' 305 ~ M~.J'~u~ vu \'E.(~~K.¢~°F~m. 'S1F,Qd w`r$. 17rrFw`.1 ~a rJpk.~ , v Signed By: Town of Southold ~ 1 LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that aze subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other irtformation used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the prepazer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects u on the coastal area which mcludes all of Southold Town . 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standazds and conditions contained in the consistency review law. Thus each answer must be ex lained in detail listin both su ortin and non- suaaortine 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# PROJECT NAME ~ ~ ' o ~ f~~,,,,4,, ~,v The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees 1. Category of Town of Southold agency action (check appropriate7esponse): (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) Penni approval, license, certification: ? Nature and extent of/a~ction: d ~-+W~e,.n>au-~- ~tm-.nf~ ~oZZ~ cc,.,. 1n ~U~'C R~¢s r r[ . ~ APPLICANT/AGENT/REPRESEN'T'ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town btficers and emp~gvees. The o~rpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessarv to avoid same. \ ~ ~ ~ YOUR NAME: ~e-c{)nC~ ~.dnns~ (Last name, f name,~niddle initial, unless you are applying in fhe name of someone else or other entity, such as a company. If so, indicate thi:other person's or company's name.) NAME OFAPPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other', name the activity.) Do you personally (or through your company, spouse, sibling, patent, or child) have a relationship with any officer or employee of the Town of Southold? "Relazionship" includes by blood, rgarriage, or business interest "Business interesP' 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 otlicer or employee owns more than 5% of t e 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 appiicant/agentlrepresenta[ive) 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 t}iat 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 (whbn the - applicant is not a corporation); C) an ofFcer, director, partner, or employee of the applicant; or D) the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this dip oL_200~ Signature. ,r' ~ Print Name ~ Form TS 1