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HomeMy WebLinkAboutTR-5924 Albert J. Krupski,President ���F suuryo Town Hall James King,Vice-President 53095 Route 25 Artie Foster .If, P.O.Box 1179 Ken Poliwoda CA T Southold,New York 11971-0959 Peggy A. Dickerson • �O Telephone(631)765-1892 MUM Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 19, 2005 Mr. Miro Radovich 400 Budd's Pond Rd. Southold, NY 11971 RE: 400 BUDD'S POND RD., SOUTHOLD SCTM#56-5-18 Dear Mr. Radovich: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, October 19, 2005: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#5924 to replace the existing 110' bulkhead in-place and place 20 cy. of fill material behind bulkhead as backfill, and as depicted on the plan dated October 10, 2004. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, �n Albert J. Krupski, Jr. President,-Board of Trustees AJK:Ims James F. King, President ��of so�ryo 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 John Holzapfel '�0 ���y Telephone Fax(631631)76576 5-1892�0UNT1, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0103C Date 3/20/06 THIS CERTIFIES that the bulkhead At 400 Budd's Pond Rd. , Southold Suffolk County Tax Map # 56-5-18 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/26/04 pursuant to which Trustees Permit#5924 Dated 5/26/04 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 replacement of the existing bulkhead The certificate is issued to MIRO RADOVICH owner of the aforesaid property. Authorized Signa ure Albert J. Krupski,Presiden• a Town Hall James King,Vice-President ��FFU(I�'C 53095 Route 25 Artie Foster �� P.O. Box 1179 Ken Poliwoda Southold,New York 11971-0959 Peggy A. Dickerson Z Telephone(631) 765-1892 WOy �.ZC 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. hadoor h INSPECTION SCHEDULE Pre-construction, hay bale line t 5i day of construction % constructed Project complete, compliance inspection.3 ((1106 D Board Of Southold Town Trustees SOUTHOLD, NEW YORK h p lI PERMIT NO. .. S. /. 7 .... DATE: ...May..26,_. 2004 l y MIRO RADOVICH ISSUEDTO ..........._......................._....__._..................... zY a � .��#I�nri�tt#tnn x Pursuant to the provisions of Chapter 615 of the Laws of s the State of New York, 1893; and Chapter 404 of the Laws of the .� State of New York 1952; and the Southold Town Ordinance on- 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 .. May 26, 2004 250.00 6 ...L, and in consideration of the sum of f............................. paid by Miro Radovich s Southold N. Y. and subject to the Of ......................................._..._....___......._ 1 Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: y Wetland Permit to replace the existing bulkhead within 18" using . vinyl sheathing, with the condition that during construction, the pilings. are removed, the sheathing and the whalers are installed, and the pilings are re-installed, and all as depicted all in accordance with the detailed specifications as presented in the originating application. on the plan prepared by Mire Radovich Last dated June 28, 2004. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these Presents to F be subscribed by a majority of the said Board as of this date. o ;c m Peggy Dickerson Trustees TERMS and CONDMONS Miro Radovich Tlpe Pamittae residing at 400 Budd's Pond Rd. , Southold N. y, as part of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Hoard of Trustees and the Town of Southold are released from any and all damages, or daints for damages, of suits arising directly or indirectly as a result of any oiler. ation-performed pursuant to this pemut, and the said Permittee will, at his or her awn espease, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exdusion of the Band of Trustees of the Town-of Southold 2. That this Permit is valid for a period of `'4 elm which is ronsideml to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a tat" data. 3. Tbat this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that Auth- orization was originally obtained. 4. That the work involved will be subject to the inspection and approvsl of the Board or its agents, and non-compliance with the provisions of the origimtng application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the wort herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/ter alterations in the location of the work herein autthodzed, or if, in the opinion of the Board of Trurstees, the_ work shall cause unreasonable obstruction to free navigation, the said Permittee will be requited, upon due notice, to remove or alter this work or project herein stated without espemes to the Town of Southold 8. That the said Board will be notified by the Permittee of the completion of the work auth- ori w& 9. That the Permittee will obtain all other Permits and consents thu may be required sup- plemental. to this permit which may be subject to revoke upon failure to obtain same. o�gUFFO(,�c Albert J. Krupski, President - - a�. QG Town Hall James King,Vice-President 't 53095 Route 25 Artie Foster O P.O. Box 1179 Ken Poliwoda x Southold, New York 11971-0959 Peggy A. Dickerson y.J�o aQ� Telephone(631) 765-1892 '� Jf Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 26, 2004 Mr. Miro Radovich 400 Budd's Pond Rd. Southold, NY 11971 RE: 400 BUDD'S POND RD., SOUTHOLD SCTM#56-5-18 Dear Mr. Radovich: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 26, 2004 regarding the above matter: WHEREAS, MIRO RADOVICH 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 April 26, 2004, 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 May 26, 2004, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, 2 • • WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of MIRO RADOVICH to replace the existing bulkhead within 18" using vinyl sheathing, with the condition that during construction, the pilings are removed, the sheathing and the whalers are installed, and the pilings are re-installed, and all as depicted on the plan prepared by Miro Radovich dated June 28, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims o�gUFFO(,��o Telephone w CD Town Hall Z 53095 Route 25 (631)765-1892 P.O.Box 1179 oy��1 � Sao Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, May 11, 2004, the following recommendation was made: Moved by William Cook, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of MIRO RADOVICH to replace the existing bulkhead within 18" using vinyl sheathing and pilings of CCA material. Located: 400 Budd's Pond Rd., Southold. SCTM#56-5-18 The CAC questions the street drain going through the bulkhead. Vote of Council: Ayes: All Motion Carried 0 a ♦ P � 4 � a 0 � q 7� , i'V �� P� ♦ 3 S I if elm i \a • ♦ a J I r I I I I I III y \� • 5 4 ! Sri aa�. I a!• °�.' ° I I III III � aA/ � � vrs-• f ij Pq/f '�' A la� l jjaaaa Is I 3R ° 1�1II8I! 18 � l i ! f y 0 4� � q3 ypI . aee liF � • 9 -� III# P lid F!!i! s gUFFO(,� Albert J. Krupski, President 0� C� Town Hall James King,Vice-President /'Z' 53095 Route 25 Artie Foster a ^� P.O.Box 1179 Ken Poliwoda W Southold,New York 11971.0959 Peggy A. Dickerson a�t� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ` j Q D(N has been reviewed by this Board at the regular meeting of Slab l Oy 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: �eu��d p1a n W Date ��la (Sy 042083 yo Received From J O m Address zoaY C - 3 w z Dollars$ O 0 a For 0 Cc �111iA z � 3 � r5 00 tL ~ ACCOUNT 2 DO HOW PAID AMr of i Q ACC VW GOSH .e-� DUE m AMi PAID CHECK aAA MONEY ORDER �/ OREQ CARD - k y �4 a �?Y.p r�s� �� � �ifr a "` �+ - � ' F 1 5 T� ��' r� � h��., •1 Y a r l ic s / APR 2 6 2C04 Dj 1 t+n f /® � 1 Southold Town I , � � t Board of Trustees • • MAILING ADDRESS: P.O. Box 1179 PLANNING BOARD MEMBERS QF souryo�o Southold, NY 11971 JERILYN B.WOODHOUSE Chair OFFICE LOCATION: y Town Hall Annex WILLIAM J.CREMERS H oc 54375 State Route 25 KENNETH L.EDWARDS l- �O (cor.Main Rd. &Youngs Ave.) MARTIN H. SIDOR Southold, NY GEORGE D.SOLOMON �'�COW Telephone: 631 765-193 S Fax: 631 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Town of Southold Board of Trustees _ From: Mark Terry, Senior Environmental Planner LWRP Coordinator 1 I OCT 18 2i05 M, Date: October 17, 2005 Re: Request for Wetland Permit for Miro Radovich SCTM#56-5-18 MIRO RADOVICH requests an Amendment to Permit#5924 to replace the existing 110' bulkhead in-place and place 20 cy. of fill material behind bulkhead as backfill. Located: 400 Budd's Pond Rd., Southold. SCTM#56-5-18 The reconstruction of the bulkhead, in-kind, is an exempt Minor Action and not subject to LWRP review pursuant to Chapter 95 of the Town of Southold Town Code. This review will address the backfilling of the bulkhead with 20 c. y. of clean fill. 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 the intent of the LWRP and the policies assess the protect area for the use of a floating turbidity screen silt/boom during re-construction of the structure to minimize 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. 11 // r; r l OCT 1 8 2005 LAND 6 RMAML'INC. 35180 Route 48•P.O.Box 608•Peconic,NY 11958 Office(631)734-6800•FAX(631)734-2318•Evening(631)765-2382 September 29, 2005 Lauren Standish iVF 21— Southold Town Bd. Of Trustees SEP 3 0 2110 Southold,NY 11971 Re: Permit#5914 E '.�7, --A- 7 —� Miro Radovich gaud of Trus?ces Dear Lauren, At the request of Mr. Radovich I am submitting a copy of the DEC permit and also a copy of the Trustees permit for replacing and constructing a new bulkhead. Mr. Radovich told me that he has spoken with you regarding an amendment to the Town permit in order to have both permits read the same,that the reconstruction of the bulkhead will be do done in place. Thank you for your assistance in obtaining this amendment. Very �e truly yours, I)// aAl C -� Marion G. Latham Office Manager Marine Construction•Dredging•Precast Cesspools•Gravel•Fill•Topsoil•Excavating and Land Development gpFFO(� • Town Hall Albert J.Krupski, President O�� �'QG 53095 Route 25 James King,Vice-President o`Z` P.O.Box 1179 Henry Smith Southold, New York 11971-0959 N Artie Foster T 1� • 'F Telephone 631) 92 Ken Poliwoda y�o! � �aO� Fax(631) 765-1366-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application ,.-Wetland Permit Application Major Waiver/Amendment/ han es /Re_ceived Application: y �aj •deceived Fee:$ /completed Application _Incomplete _SEQRA Classification: I Type I_Type II Unlisted APR 2 Coordination:(date sent) ,GCAC Referral Sent:jjAAWP Southold Town mate of Inspection: /1 to Board of Trustees _Receipt of CAC Report: _Lead Agency Determination: Technical Review: _ Public Hearing Held:--]SjaV4— Resolution: ,✓J (� Name of Applicant / tl Address is I ( �7 (—Phone Number:( ) G 3 Suffolk County Tax Map Number: 1000 - ©S —05—O�8 `y a Property Location: Lf 00 Gr (provi LILCO Poe #, distance to cros streets, and location) AGENT: (If applicable) Address: Phone: 0 licati• Board of Trustees App GENERAL DATA Land Area(in square feet): 0 Area Zoning: '��s �,6 Previous use of property: Intended use of property: Q E S cam' � � � d l Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): ReoL,4acM &-,�U C C)AJSik"cCT 'nA _ /,v ;Cf c, C • Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA__�� � Purpose of the proposed operations: f O(ACIEW rAJS lairiLCL�fc'� 0'Ji uLL Area of wetlands on lot: square feet Percent coverage of lot: A /o Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 2 6I Leo ii feet Does the project involve excavation or filling? No_—_�.—Yes if yes, how much material will be excavated?__cubic yards How much material will be filled? 11 � cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: (�" Manner in which material will be removed or deposited: FILL A_1 m e&;7- o 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): • 617.20 • SEQR PROJECT ID NUMBER 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) 2.PROJECT NAME 1.APPLICANT/SPONSOR p 1�2o r17U c f=PLAc���� O LK c�A ,cl 3.PROJECT LOCATION: Municipality 5 o uT oL county 5 c FFo�K 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map q-oo P"I)o's PPOA4 sot~-irgoo iuy, 5.IS PROPOSED ACTION: New Expansion 9 odification/alteration B.DESCRIBE PROJECT BRIEFLY: R r p L4.--&—m Fi>Js g rA LK (,il rkohJT of r1ff'oc.b a5,:4i T 1//'Al yL I pl' rz> C— Io. '/x " 'u0/ Lrx n XA t � /q, Tj gc 7 T $coc e s (o//xG11x¢/ 112 �SuS.� Yhe/, �F SAxi' w:LL F3c c�Sc� 70 Pesos/jam Tie FYcc /S T7N /✓ TCio 3u C/c 7.AMOUNT OF LAND AFFECTED: i�p acres Initially o acres Ultimately 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: - g.WfiAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) I' /`' Other (describe) Residential Industrial Commercial []Agriculture Park/Forest/Open Space 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ®Yes No If yes, list agency name and permit / approval: C G v N r / PMi y QE7�11.:r/Cs 11.DOES A Y ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes No If yes, list agency name and permit / approval: 12. AS A RES LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? aes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Date: Applicant / Sponsor Name 3 1a o Signature If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II- IMPACT ASSESSMENT o be com leted by Lead Agency) FDOES 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 ILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? IfNo,anegative claration may be superseded by another involved agency. Yes No OULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) Cl. Existing it rerosion,drainage uality,surface or groundwater problems?o Explainfzz: noise levels,existing traffic pattern,solid waste production or disposal, potentia ooding C2. Aesthetic,agricultural,archaeological,historic,or other natura orcuu or community or neighlarhood character?Explain briefly: significant habitats,or threatened or endangered species?Explain brefly: C3. Vegetation or fauna,fish,shellfish or wildlife species, f use of land or other natural resources?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change in use or intensity o C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including.changes in use of either quantity or type of ene 7 Ex lain bri fl : D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If ves,explain brie . Yes No E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex in: Yes No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether itis substantial,large,important orotherwie significant. Each effect should be assessed in connection with its(a)setting add attachments or refen or lrenbcepsupporting materialrobability of s. Ensure that explanations contain geographic scope;and(f)magnitude. If necessary, sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impactof the proposed action on the environmental characteristics of the CE4. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur.Then pro:so ctly to the FUL EAF and/or prepare a positive deGaration. Check this box if you have determined,based on the information and analysts above and any supporting documentation,trposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the upporting thi determination. Date Name of Lead Agency not or ype erne o esponsib a xxir m e gency Title of Responsible Officer ignature o Responslb a (filer in Lead Agency Signature o reparer(If tlifferent rom responsible officer) NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES TOWN OF SOUTHOLD In the matter of applicant: o eA )O tz/ YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Boardof Trustees to: � FPL,aGc 'Jt� tK1�Y4 � C� �Sc � 7� 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: p) St--AA C y?c, 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: 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: o///c - 9 . ..n � MAILING ADDRESS L Enc: Copy of sketch or plan showing proposal for your convenience. r �OSQFFOII�'CO Town Hall Albert J. Krupski,President G 53095 Route 25 James King,Vice-President =� y� P.O.Box 1179 Artie Foster Southold,New York 11971-0959 Ken Poliwoda p Telephone(631) 765-1892 Peggy A.Dickerson y t Fax(631) 765-1366 �ol � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------- In the Matter of the Application of mt�-- axc h------------------------------ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING ' 6w nl I� L� I, 4111�0 '��1� 1x; i�lCIt_, residing at �tOC' �,��bVS �0L�7 K6 L-h being duly sworn, depose and say: That on the I day of 2004,,I personally posted the property known as '�OOo NG�D rl� 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 pnsor6to the date 1f the public hearing. Date of hearing noted thereon to be held u t abet Dated: 6CE fi (4ignature) Sworn to before me this day of tlny' 200 C otary Public DEBORAH Nalary S ale wY** No. Ot MC5073323 Oualifled In Vings Cow* OwNwasion wraa Pib•A zaa. • • Board of Trustees Applicati County of Suffolk State of New York A�le 66 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 AND ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION 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 APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, PERNUT(S), IF THEIR AGED. IN ENT(S ORETING BS 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 OFeFl 120_0� Notary Public DEBORAH R.McCRAY NotaYNo* 01M 50 3 2w`kMk oualified in Kinggs C°unb 1 cwwniswon Ev'res feu ?+►. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics rohibits conflicts of interest on the art of town officers and a to ees.The u action i this form is to rovide information which—can" an alert the town of ssible conflicts of interest and allow,it to take whatever action is necessa tom,_o avoid same. YOUR NAME: (Last name,first name,noddle initial,unless you a, P mdirate the othece o If so someone else or other entity,such as a company. 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 Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5"/ of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): _A)the owner of greater than 5%of the shares of the corporate stock of the 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 A day o 2(!0 Signature Print Name "v PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: Name: /rr12- PSoLi A 0 zs'o 6'pbA Po AID 2d. Tokn wAer M1� STATE OF NEW YORK Postal Service COUNTY OF SUFFOLK sr CERTIFIED MAIL RECEIPT r` � 1141 MItOnE Er (Domestic Mail Only:No insurance coverage Provided) r` -MI .. e ti s 1! rij 1 c t() day of M rA& m Postage $ m Postage $ 0.37 UNIT ID: 0971 CoMfied Fee j5 set forth in the Board of Tn o o cemned Fee v. -- .rr O persons at the addresses set o geWM Reoiept Fee O Return Redep Fee ; 1 Poa mark (Endoreement Required) (Endorsement Required) _ Hara opposite the names of said ResMc ed De ha y Fee C3 Reatrkted DeI very FM CZP k:: KF9CWM assessment roll of the Tow o (Endors 2 Regwred) o (Endorsement Rego red) Office at r-R Total Postage&Fees ,$ ra Total Postage 8 Fees $ 4 t 04/24/04 (certified) (registered)mai m m O a�ntjjo r` '� .� ...� C3 ...............................--- c sa Now a2. city,° :5��'.. :rr rr 'Ir - 2002 See R,everse for instructions Sworn to before me this Day of Mt42C 20 0 Notary Public DEBORAH A.MCCRAY Notary ryNobol Zbflt MOS073323 Qualified in Kings Countrallirr Commission Expires Feb. PoND N OAD r—' I j =30 iuAc�E P< < a L- Y „ 2 si o2y I4owsE McK^ S i✓o. boo �l 7 � �Snw pEcK I pLF o✓cR �/ NruJ 5 '1flRE G+.pR� ViIJ�L She�thina CC4Soe o NK td -s- ® cw5j,c As or' SRu17 T° �grLoo xi-a"w lb r' f .cQ 0.�t +£lLc r� I •Dr. 1 NYSDEC t K (o�� APPROVED AS PER TERMS � ';rQ AND CONDITIO'rN-Sys OF PERMIT NO. I � lU� X �.E]� Pi c�'N i A E E T E NOTC'• �0 DwE�CrINLsA2 flL� RFCoJE2y NEfDtD � � /� O (ADD V Y V ( g � psi o 9tx2c) rPrLr06r I. 00ca r �X �FlZF2 K� Cou u �x F� i �K7�v . I.RR eoSccl .L>cF7 :2 :s-Fo:PyouSm U N I T e • �' Pjoop Qa- 4.6"IKpD o - ) � SNHKrN UoLrS i i / / �l/YI&A� C� r yti wf} Q TFIAi l�]' IC Qc"�4ktRE o Q"h i� YA�915 r xlZr i j- r2'=riE RoD - NYSDEC �t !r^ ` APPROVE_. .�, PER TERMS 314CT ALVAN%2t� RC �/ Z� ME-pvr �,oc) �^� /Y I'ER P C INPLAC t AND CONDITIONS OF PERMIT NO, (-��38-0333�1DDeel ✓ VAvra -3111vil0s � Ar u ��,, II qq Norc: Igo �REDt���� rtu�j 0o ,ecIA :OA; Y� Fi �, 6) uT oL. �o� DEP%q o F PENk R.A r,o rJ iRo RAbDVIC � NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE -03332/00001 March 16, 2005 ! FACILITY/PROGRAM NUMBER(S) At EXPIRATION DATES) PERMIT Under the Environmental March 16, 2010 Conservation Law 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: tion Solid t----- "-- � PERMIT ISSUED TO TELEPHONE NUMBER Miro Radovich C j ) (631) 765-9121 ADDRESS OF PERMITTEE 400 Budds Pond Road, Southold, NY 11971 - CONTACT PERSON FOR PERMITTED WORK, L--_'. __, "` TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Radovich property, 400 Budds Pond Road, Southold SCTM#1000-056-05-018 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Budds Pond DESCRIPTION OF AUTHORIZED ACTIVITY: Reconstruct 110' of bulkhead in place and place 20 cubic yards fill material behind bulkhead as backfill. All work must be done in accordance with the attached plans stamped NYSDEC approved on 3/16105. 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 specked (see page 2&3)and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark Carrara CKW) Re ion 1 Headquarters, Bldg.#40, SUNY, Stonv Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE Page 1 of 4 March 16, 2005 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Any debris or excess material 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. 2. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 50 linear feet from the tidal wetland boundary. 3. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 4. All fill shall consist of"clean" sand, gravel, or soil (not asphalt,flyash, broken concrete or demolition debris). 5. All peripheral berms, cofferdams, rock revetments, seawalls, gabions, bulkheads etc.shall be completed prior to placement of any fill material behind such structures. 6. Prior to any construction or removal of bulkheads and other shoreline stabilization structures all backfill shall be excavated landward of the bulkhead and retained so as not to enter the waterway,tidal wetland or protected buffer area. 7. There shall be no discharge of runoff or other effluent over or through any bulkhead or shoreline stabilization structure or into any tidal wetland or adjacent area. 8. Bulkhead must be installed in same location as pre-existing bulkhead. DEC PERMIT NUMBER PAGE 2 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24,25 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 1. 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,obstrudions,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 extentand in such time and manneras the Departmentof 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. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or resultfrom 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 such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other Permission,consent or approval from the U.S.Army Corps of Engineers,U.S.Coast Guard,New York State Office of General Services or local government which may be required. I. 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 environmentally deleterious materials associated with the project Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a ten d a ncy to cause damage to navigable channels or to the banks of a waterway. There shall be no unreasonable interference with navigation by the work herein authorized. If upon the expiration or revocation of this permit, the project hereby authorized has not bean completed, the of applicant shall,without expense to the State,_and-tosuch-extent and-in sudf$nle and manner as-t"T— Department ay restore the site o(i sonservation formerr condition.require,Noc aim shall be remove madeagainst n or any ton of the st the State of Yo rK orn a u re or fill and such removal or alteration. 9 ccount of an If granted under 6NYCRR Part 608,the NYS Department of Environmer�l_Concan,_ no r�tw ce rtifies that the subject project w;p_n01 centraver effluentttmifa lonsorotherlimitationsorstandards under Sectj&ns_-W1-307, 303, 306 and 307 of the Clean Water Act of 1977(PL 95_217)provided that all of the conditions li_ ad herein are met. At least 48 hours prior to commencement of the project,the permittee and contractor shall sign a n cil retum the top oortion of the enclosed notification form certifying that they are fully aware of and understand a 11 tE rms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form rust also be 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 su b rnitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by: Mina Radovich dated 10/10/04 and stamped NYSID EC-- approved on 3/16/05. ERMIT N UMBER 38-03R 39/nnnni PAGE 3 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives,employees,and agents("DEC")for all claims,suits, actions,and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with,or operation and maintenance of,the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors 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 all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental 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 and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: 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 representative may order the work suspended pursuant to ECL.71-0301 and SAPA401(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 available for inspection by the Department at ail times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit." General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any - order or-determination previously_issued-by_the_Department or an)voftheterms, conditions or-requirements_contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, -modification o Ara-nsfergranted by-the Department must be in writing___ The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System(SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities(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#40, Stony Brook NY 11790-2356 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify,suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terns or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions,relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions,orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-03332/00001 A 0 and �� Fb j S Booth W b, 0 00 S 30° 20'00"E rN� Inn; 0 2SO 00. 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