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Home My WebLink AboutTR-6581 . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction Y, constructed .L Project complete, compliance inspection. . . TERMS AND CONDITIONS The Permittee James Grace. residing at 190 Willow Terrace. Orient. NY, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of South old are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered 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 later date. 3. That 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 authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating 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 work 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/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 18, 2007 Mr. William J. Lohn Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932-2003 RE: JAMES GRACE 190 WILLOW TERRACE, ORIENT SCTM#26-2-7.1 Dear Mr. Lohn: The Board of Town Trustees took the following action during its regular meeting held on Wed., April 18, 2007 regarding the above matter: WHEREAS, Suffolk Environmental Consulting, Inc. on behalf of JAMES GRACE applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 12,2007, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 18, 2007, 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, 2 . . 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 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JAMES GRACE to remove the existing stone revetment and install approx. 106 linear ft. of new stone revetment along the situate shoreline to prevent further erosion, install a set of slate steps through the stone revetment to provide beach access, install an access ramp through the stone revetment for launching small craft, with the condition an 8' non-turf buffer is installed landward of the stone revetment and re-vegetated, and as depicted on the plans prepared by Suffolk Environmental Consulting, Inc. last dated April 24, 2007. 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, ~ 5<'2: Jam . King Pre dent, Board of T ustees JFKllms . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT Permit #6581 C Date: April 18, 2007 SCTM#26-2-6.1 Name of Applicant/Agent: Suffolk Environmental Consulting, Inc. Name of Permittee: James Grace Address of Permittee: 190 Willow Terrace Lane, Orient Property Located: 190 Willow Terrace Lane, Orient DESCRIPTION OF ACTIVITY: Coastal Erosion Permit to remove the existing stone revetment and install approx: 106 linear ft. of new stone revetment along the situate shoreline to prevent further erosion, install a set of slate steps through the stone revetment to provide beach access, install an access ramp through the stone revetment for launching small craft, with the condition an 8' non-turf buffer is installed landward of the stone revetment and re-vegetated. The Coastal Erosion Management Permit allows for the operations as indicated on the plans prepared by Suffolk Environmental Consulting, Inc. last dated April 24, 2007. Permit to construct and complete project will expire two years from the date the permit is signed. SPECIAL CONDITIONS: (apply if marked) _ Bluff restoration through a re-vegetation plan is a necessary special condition of this permit. _ A relocation agreement is attached hereto and is a necessary special condition of this permit. _ A maintenance agreement is attached with application and is a necessary special condition of this permit. James F. King, PresidenL c;r k Board of Trustees /--,. - ;/ . . Environmental Assessment Date: April 17, 2007 APR 1 8 2COl Two applications reviewed by: Heather Cusack Field Inspection date: April 11 , 2007 Proposed Action: JAMES GRACE requests a Wetland Permit & Coastal Erosion Permit to remove the existing stone revetment and install approx. 106 linear ft. of new stone revetment along the situate shoreline to prevent further erosion. Located: 190 Willow Terrace, Orient. SCTM#26-2-6.1 BARBARA DEFINA requests a Wetland Permit & Coastal Erosion Permit to remove the existing stone revetment and install approx. 107 linear ft. of new stone revetment along the situate shoreline to prevent further erosion. Located: 192 Willow Terrace, Orient. SCTM#26-2-7.1 Type of Application: Wetland and Coastal Erosion Area to be impacted: Peconic Bay Information needed: Long term maintenance program, proof of erosion. Review: I spoke with Eric Star, NYSDEC Environmental Program Specialist, Region 1, (444- 0405) regarding the interpretation of the Coastal Erosion Hazard Areas law. I have attached a copy of Chapter 111, Coastal Erosion Hazard Areas, and highlighted the areas that pertain to the evaluation and permitting of these proposals. The main points Eric made in my conversation with him were that in order to issue a permit as proposed: 1. There must be proof of erosion, evidence that the shoreline is unstable, and evaluation of the house being threatened; is the erosion from overland flooding or from the seaward edge? 2. Explore any reasonable alternatives (softer solutions to the size of the revetment) such as a berm on top of the bluff and establishment of a buffer/ plantings on the bluff face and between the bluff and the lawn, or design a revetment that included some fill and plantings in-between the rocks. . '- , :'- ... ? . . Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., April 11,2007, the following recommendation was made: JAMES GRACE to remove the existing stone revetment and install approx. 106 linear ft. of new stone revetment along the situate shoreline to prevent further erosion. Located: 190 Willow Terrace, Orient. SCTM#26-2-6.1 This application was inspected by Jack McGreevy and James Eckert and both members Support the application. Crace . . . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P. O. Box 11 79 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field InspectionlW orksession Report Date/Tirne: t-{-11-01 ::Jorr.e S &qc..e Su~f,\k. Env'ITh"",-,>+<<1 21..:,-)-(,. \ (0"..\", /+;."1, ~( - 1'10 u).I(<owTerr<lG2 Name of Applicant: Name of Agent: Type of area to be impacted: _Saltwater Wetland _Freshwater Wetland _Sound Front ]X Bay Front Distance of proposed work to edge of above: Part of Town C9de proposed work falls under: r;f-.. Chapt.~ JC Chapt. ~ _other Type ;7<:.APPlication: / Wetland ~oastal Erosion_Amendment _Administrative _Emergency Info needed: I, L C(c.J..,..., c{ 2 - <;~'-~ Lo.>+c.' ~,\A:....\ ['0 {, "'"' L\h<. lA"""j ~..... ( ...0 'dr-'\. W,o-v-' Modifications: Conditions: c-.. I'" P\oe...- 1~"1 --..t =f" .' ~~~ r;.- Present Were: JJ.King v{Doherty 5~ickersoV_D. Bergen Other: ./ Bob Ghosio, Jr. Mailed/Faxed to: Date: Comments of Environmental TeChnician:-J:( ve f:0 In '\h..... ~ le..50""" '-(,f'-+- ok1< e <;c" on r<:V-C-hc~~ \ c..~fe...".... ) Fe , . r.-c.5't<'>) s'h .,horc.I,,,,- hw,J__."n"", . C .oJ I ..e.Jbf,o, ~r"nfl"'" 11'\ ""'- '\l<\,,(' cD- fus Clf {,'<'0-t de'Y'C>nl'1-a.-\c..t 5;j,".,-000r,-t e('1)5'''' ~ "-.l<v~+ f(~Q,"""""'J o \~, (e ~k ~ "n 1h.... beG-<C)., ~ l. r+crt-) (2\ ~ ~ 1h... Go(;>:r,...\ <:..ro{,6'o--o l--\-t(2_",rJ. (,h..? ~ L...L . "l ,-'-- L. L?~-\-'"" w,1l, 6> *' I' +- e'>< ('\ ~rc.\ '" \'--"'""J<O..) ,. e .~"c.<' '..... "... . S ~ tv(' r ,("" 7 ~ . . I ~"'" \ Ii" &<-~ . L UV~- . . - . . GRACE PROPERTY Situate: Willow Terrace (ROW); Orient; Town of Southold. NY SCTM#: 1000 - 26 - 2 - 6.1 ~ l'" \1 · -......... "~ -', 4S\ \\ ori....ort"...~......~st o~ ............., .. ...~.. : ~ ~ ~ f I t 'IJ (ll4\!:':'.~......... ~':- \ 'IJ /".s , : .~;;-...........~ ~"g<; I _.... ~ ...-t'" I _-'"""" " K ........"" "'-to ./ ......... """'-- - -...... ......... Proposed Construction Access Route . . GRACE PROPERTY Situate: Willow Terrace (ROW); Orient; Town of Southold. NY SCTM#: 1000 - 26 - 2 - 6.1 Photo taken from the situate shoreline at the subject property facing east showing the stakes indicating the area of the proposed stone revetment. . 1 I r- I ~ ..c:>Z ---==::--_' I lis!~ ~~i1 "' 1 . . Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street, P.O. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson, M.S., President April 6, 2007 Mr. James King; President Southold Town Board of Trustees Town Hall P.O. Box 1179 Southold, NY 11971 Attn: Ms. Lauren Standish Re: Situate: SCTM #: GRACE Application 190 Willow Terrace; Orient Town of South old, New York 1000 - 26 - 2 - 6.1 Dear Mr. King, As you know, the above referenced matter was approved at the April 18lh, 2007 regular meeting of your Board. In order to finalize said approval, please find the following enclosed herewith: . Revised Stone Revetment Plan (four [4] copies) indicating the following: ~ , o Area to be planted with Cape American Beach Grass extending 8' landward of the proposed stone revetment. . Check in the amount of $50.00 to cover the final inspection fee. Kindly review the amended plans and forward the official permit directly to this office at your earliest opportunity. Thank you as always for your attention and consideration. Sincerely, ct(]~ WilliamJ. Lohn ~5)}r~-[[!1'-~!1 ;" \ H\\' APR 2 6 i007 , - i ih 1\ ;. ! I , ' u Enc!. Cc: J. Grace I .- ,,-- "Suuiho!d lu"" B(l?oro at Tru~t€r ~ . t . . OFFICE WCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAIliNG ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, L WRP Coordinator Principal Planner ~ APR 1 2 2007 Date: April II, 2007 Re: Town of Southold Wetland Permit for James Grace SCTM# 1000-26-2-6.1 JAMES GRACE requests a Wetland Permit & Coastal Erosion Permit to remove the existing stone revetment and install approx. 106 linear ft. of new stone revetment along the situate shoreline to prevent further erosion. Located: 190 Willow Terrace, Orient. SCTM#26-2-6.l The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the following Policy Standards and therefore is CONSISTENT with the LWRP. To further sub-policy 4.1; it is recommended that the applicant incorporate "practical vegetation methods" in the design of the structure. Policv Standards 4.1 Minimize losses of human life and structures from flooding and erosion hazards. The following management measures to minimize losses of human life and structures from flooding and erosion hazards are suggested: D. Use hard structural erosion protection measures for control of erosion only where: . . . . 4. Construction of a hard structure is the onlv practical design consideration and is essential to protecting the principal use. 5. The proposed hard structural erosion protection measures are: a. limited to the minimum scale necessary b. based on sound engineering practices 6. Practical vegetative methods have been included in the proiect design and implementation. 7. Adequate mitigation is provided and maintained to ensure that there is no adverse impact to adjacent property or to natural coastal processes and natural resources and, if undertaken by a private property owner, does not incur significant direct or indirect public costs. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Please contact me at (631) 765-1938 if you have any questions regarding the above. - t James King, President Jill Doherty, Vice President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (631) 765-1892 Fax (631) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use only Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application Waiver/Amendment/Changes V" Received Application: 31 f' ,..-Received Fee: $ '\\)/ ~ __Completed Application~jlJ-/~~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date sent) ___CAC Referral Sent: 3/ I '-flU) ,......J}ate of Inspection: '-III! (07 Receipt of CAC Report: Lead Agency Determination: Technical Review: rPublic Hearing Held: qll 't107 R lu i n: P -- x X '\I\v:n ~\ i ~ i-, ;,J <".r',i I Name of Applicant James Grace Address: 36 Bacon Road St. James, NY 11780 Phone Number (631) 862-8070 Suffolk County Tax Map Number: 1000 - 26 - 2 - 6.1 Property Location: 190 Willow Terrace; Orient; Town of Southold (provide LILCO Pole #, distance to cross streets, and location) AGENT: Suffolk Environmental Consulting, Inc. Address: P.O. Box 2003 Bridgehampton, NY 11932 Phone Number: (631) 537-5160 Fax:#(631) 537-5291 # ~qS ~\)'l 3\~ · l' ,. B~d of Trustees App lcatlon GENERAL DATA Land Area (in square feet) 16,330 SF Area Zoning: R-40 Previous use of property: Single family residential Intended use of property: Same as above Prior permits/approvals for site improvements: Agency Date NYSDEC Southold Trustees No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary) Applicant proposes to remove the existing stone revetment and install approximately 106 linear feet of new stone revetment along the situate shoreline to prevent further erosion. Please note that said revetment will be installed above the high water mark. Please see the submitted Stone Revetment Plan for further details. 2 - ~ . . Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Applicant proposes to remove the existinq stone revetment and install approximately 106 linear feet of new stone revetment alonq the situate shoreline to prevent further erosion. Please note that said revetment will be installed above the hiqh water mark. Please see the submitted Stone Revetment Plan for further details. Area of wetlands on lot: 0 (high water mark) square feet Percent coverage of lot: N/A % Closest distance between nearest existing structure and upland edge of wetlands: 47'f (existing wood deck) feet Closest distance between nearest proposed structure and upland edge of wetlands:S'f feet Does the project involve excavation or filling: x No Yes If yes, how much material will be excavated? N/A cubic yards N/A cubic yards How much material will be filled? Depth of which material will be removed or deposited: N/A Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Situate wetland degredation will be minimized by use of siltation fencing and hay bails during installation of the stone revetment. 3 ~ ~ard of Trustees APPlicati~ COASTAL EROSION APPLICATION DATA Purpose of Proposed Activity: Applicant proposes to remove the existing stone revetment and install approximately 106 linear feet of new stone revetment along the situate shoreline to prevent further erosion. Please note that said revetment will be installed above the high water mark. Please see the submitted Stone Revetment Plan for further details. Are wetlands present within 75 feet of the proposed activity? No x Yes If Yes, how much material will be excavated? 0 yards) (cubic How much material will be filled? o (cubic yards) Manner in which material will be removed or deposited: The stones used to construct the revetment will be deposited with a standard backhoe. Describe the nature and extent of the environmental impacts reasonably anticipated resulting from the implementation of the project as proposed. (Use attachments if necessary) The proposed stone revetment will be constructed above the high water mark, and silt fencing with staked hay bales will be utilized during construction. In addition, several stone revetments have existed in the surrounding area for years without any discernable impact to Orient Harbor. Further, the proposed stone revetment will prevent further erosion, thereby preventing upland soils from entering the Harbor. 4 . . 14-16-4 (9/95)-Text 12 l:ROJECT I.D. NUMBER 617.20 I Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only SEQR PART 1- PROJECT INFORMATION (To be comnleted bv Aoolicant or Proiect soonsor) 1. APPLICANT/SPONSOR [2. PROJECT NAME Suffolk Environmental Consulting, Inc. GRACE 3. PROJECT LOCATION: Municipality Southold County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc. or provide map) 190 Willow Terrace; Orient; Town of Southold, NY (SCTM#: 1000 - 26 - 2 - 6.1) 5. IS PROPOSED ACTION: 121 New D EXDansion o Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to install approximately 106' of stone revetment along the situate shoreline to prevent further erosion of the nronertv. 7. AMOUNT OF LAND EFFECTED: Initiallv < 0.02 acres Ultimatelv < 0.02 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 121 Ves o No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? I2IResidential Dlndustrial DCommercial DAgriculture DParklForesUOpen space DOther Describe: Single family residential dwellings with related appurtenances. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR UL TIMATEL Y FROM ANY OTHER GOVERNMENT AGENCY (FEDERAL, STATE OR LOCAL)? 121 Yes DNa If yes, list agency(s) and permit/approvals NYSDEC II. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes DNa If yes, list agency(s) and permit/approvals 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? DYes 121 No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Willi ' ~" - Suffolk Environmental Consultin~. Inc. Date: 3n!2007 a f/ [7- ."\ ) Signature: '<:::::> /' If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART 11- ENVIRONMENTAL ASSESS To be com leted b A enc A. DOES ACTION EXCEED ANY TYP I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. o Yes 0 No 8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. o Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archeological, historical or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitat, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or change in use or intensity of use of land or natural resources? Explain briefly: 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-C5? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. Will THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? OYes ONo D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? DYes D No If yes, explain briefly 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 othelWise 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 identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. D Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. D Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: - Name of Lead Agency Print or Type Name of Responsible Officer Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different From responsible officer) Date . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of -----~-~~--~-~~---------------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING r:l9w c.u A ~d..(.W . residing at SUFFOLK ENVIRONMENTAL CONSULTING, INC. p.o. BOX 2003 BRIDGEHAMPTON, NY 11932-2003 being duly sworn, depose and say: ~ That on the ~ 6 "(lay of ~ , 2001, r personally posted the property known as c:&-~ by placing the Board of Trustees official poster where it can easily be seen, and that r 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 (1 )eJ, 4or: I \~, 02-00 7 , I On Or Dloo.....~ &,: 3op'" /P- (signature) Dated: Aroc- rt, ?o::J1 Sworn to before me this If"day of AWl 2007 N~ ~ Matthew D. Ivans Notary Public of New York No. 011V6053859 Qualified in Suffolk County Commission Expires January 22, 2011 ~ . Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street, P.O. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson. M.S., President April 6, 2007 Mr. James King; President Southold Town Board of Trustees Town Hall P.O. Box 1179 Southold, NY 11971 APR - 9 ;:D7 Re: Situate: GRACE Property 190 Willow Terrace; Orient Town of South old, New York 1000 - 26 - 2 - 6.1 SCTM #: Dear Mr. King, As you know, the above referenced matter has been scheduled for the April 18th, 2007 regular meeting of your Board. Therefore, in accordance with Town Code please find the following enclosed herewith: · Signed and Notarized Affidavit of Posting; · Copy of the Notice to Adjacent Property Owner; · Original Certified Mail Receipts and copies of the same. Kindly add these items to your records. The green signature cards will be delivered the night of the hearing. If you have any questions, or require additional information, please don't hesitate to contact me. Thank you as always for your attention and consideration. Sincerely, WilliamJ. Loho Encl. Cc: J. Grace ~ PROOF OF MAILING OF ATTACH CERTIFIED MAIL . NOTICE RECEIPTS Name: Address: Kenneth Dalauch P.O. Box 2443 Aquebogue, NY 11931-2443 Kathleen Becker Kimet c/o Entrust Capitol, Inc. 717 Fifth Avenue - Floor 25 New York, NY 10022 Peter W. Werden P.O. Box 278 Orient, NY 11957-0278 Ms. Barbara Defina P.O. Box 413 Orient, NY 11957 STATE OF NEW YORK COUNTY OF NEW YORK William J. Lohn , residing at 2322 Main St.; Newman Village Suite E; P.O. Box 2003; Bridgehampton, NY 11932 , being duly sworn deposes and says that on the day of , 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Bridgehampton ,that said Notices were mailed to each of said persons by (c 'ed) (registered) mail. Sworn to day of 61/.1 Public Matthew Divans Notmv PLbi,L ,'i'~i;\n, York No. 01 iV6l,: O'_'aldie(] in SUi/Oit, -!UntJl Cun-iflkSlon Expires JanUaf} 22, 20P 6 ~TICE TO ADJACENT . PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: James Grace SCTM# 1000- 26 - 2 - 6.1 YOU ARE HEREBY GIVEN NOTICE: 1. That is the intention of the undersigned to request a Permit from the Board of Trustees to: Applicant proposes install approximately 106 linear feet of new stone revetment along the situate shoreline to prevent further erosion. Please note that said revetment will be installed above the high water mark. Please see the submitted Stone Revetment Plan for further details. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 190 Willow Terrace; Orient; Town of Southold, NY 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment. 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: MAILING ADDRESS: James Grace 36 Bacon Road St. James, NY 11780 PHONE # (631) 862-8070 Ene.: Copy of sketch or plan showing proposal for your convenience. 5 U.S. Postal Serv , CERTIFIED M _" RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) ..J] r'- ru .... Ul .... IT"" IT"" 00IEf,ITJ/.\' 14%'1 Postage $ Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees $ 04/05/2007 ..J] CJ CJ CJ CJ CJ .... CJ 02 - .',.0 PoStmark Here ..J] ~ ent 0 i.Ks."Jl-.-b<,-,<,<-~~- r'- ~:t:::-;m'P.o..m1b:m4i3uu.m'h.----mmmUhmmm" 'Cit.Y:-stai8:ZI~._n_-.----_--_....--_--n__--_n__.._..nn_n_n__u_nnn.hn____ rn <lJ ru .... Ul .... IT"" IT"" 8EF Hf1t.lG2tl Postage $ ..J] CJ o Return Receipt Fee Cl (Endorsement Required) o Restricted Delivery Fee o (Endorsement Required) .... CJ Certified Fee Ff:-l/?~~"", Here 1 .," / 9.32 \.\,;:)/ 04/05/2007 Total Postage & Fees $ ..J] ~ Sent 0 r~ W. WUou,_IrI f'- sfiiiSi"ifiifNo.;hunnuhhn---nuhnnnn----nnnu._____n...__unu_hu__ o,PO Box No. 'P.()" ~c" 8-,8' CitY:-stai9:Zip.;.4.-~(J---nn--uh__n--n-hn.n--u_.-nn--d--nn--h_nn.uh__ "i\e.n> . E I f'-...._..... ~ ..J] CJ rn .... Ul .... IT"" IT"" U8>ostal Service", C!ftTIFIED MAIL. RECEIPT (Domestic Man Only; No Insurance Coverage Provfded) ~~ Wl~~J:, Postage $ $0.63 Certified Fee $2.40 Retum Receipt Fee $1.85 (Endorsement Requlrecl) RestrictedDeJ!'JeryFee $0.00 (Endorsement Required) Total Postage & Fees $ $4.88 ..J] CJ CJ CJ 02,;, '.POstmarn He.. CJ CJ .... CJ 04/0512007 ..J] CJ Sent 0 ~ ;g;n,;;("Aii{ ~...."th{9.:.~~--...-...""_....._...___...__...._""...__ ~7:i..;;+l-Q.,.~~-'J!;..~-1.13...._.m...m.....m....on---..m u.e. . II-'- N fI1' - ,;)<('f3 rn <lJ ru .... Ul .... IT"" IT"" U.S. Postal Service,,, CERTIFIED MAIL" RECEIPT (Domestic Man Only: No Insurance Coverage ProvIded) ,-dl'f'HF-- ~~ \~o.r 1 '"i' \, _. ". " $0.4- Po_ $ 0932 Q2 . I'OO1m"'" Here ..n CJ CJ t:J Retum ReceIpt Fee (Endorsement Required) o Resbicted Delivery Fee o (Endorsement Required) .... CJ CertifIed Fee , OttioSi2007 Total Postage & Fees $ ..J] R ~;~k~:;~~::~~--.."------"...--h.h"------.. CitY.S;;;;;Zi~.m---on..~"-.....?J?---mon".."......on.m....m (J"i\e.n>kJy I/1S1. OC)..,~ on... . NOTICE . TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: James Grace SCTM# 1000- 26 - 2 - 6.1 YOU ARE HEREBY GIVEN NOTICE: 1. That is the intention of the undersigned to request a Permit from the Board of Trustees to: Applicant proposes to remove the existing stone revetment and install approximately 106 linear feet of new stone revetment along the situate shoreline to prevent further erosion. Please note that said revetment will be installed above the high water mark. Please see the submitted Stone Revetment Plan for further details. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 190 Willow Terrace; Orient; Town of Southold, NY 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment. 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: MAILING ADDRESS: James Grace 36 Bacon Road St. James, NY 11780 PHONE # (631) 862-8070 Ene.: Copy of sketch or plan showing proposal for your convenience. 5 . . Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits' including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. · Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of South old 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 Town). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the L WRP policy standards and conditions. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. A copy ofthe LWRP is available in the following places: online at the Town of South old'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# 26 ---L - 6.1 The Application has been submitted to (check appropriate response): Town Board D Planning Dept. D Building Dept. D Board of Trustees ~ 1. Category of Town of South old agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) D D ~ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: ADDllcant DrODoses to remove the exlstlna stone revetment and Install aDDroxlmatelv 106 linear feet of new stone revetment alona the situate shoreline to Drevent further erosion. Please note that sold revetment will be Installed above the hlah water mark. Please see the submitted Stone Revetment Plan for further details. . . Location of action: 190 Willow Terrace: Orient: Town of South old Site acreage: 0.375 acre ;, Present land use: residential Present zoning classification: R-40 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: James Grace (b) Mailing address: 36 Bacon Road St. James. NY 11780 (c) Telephone number: Area Code ( 631) 862-8070 (d) Application number, if any: N/A Will the action he directly undertaken, require funding, or approval by a state or federal agency? Yes [8J No D [fyes, which state or federal agency? NYSDEC DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances commnnity character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See L WRP Section TII - Policies; Page 2 for evaluation criteria. ~ Yes 0 No 0 Not Applicable Subiect oroposal is consistent with the policy in that the sitina and utilization of the imoroved erosion - control facilities (i.e. stone revetmentJ will maintain the character of the surroundina neiahborhood . which currently consists of other similarly imoroved lots with similar accessory structures (i.e. stone revetments to the north and south alona Orient HarborJ. In addition. subiect parcel will be in harmony with this" ".beneficial use of a coastal location"." in that the subiect waterfront lot will be enhanced and imoroved by the installation of the proposed stone revetment in order to control erosion alona the situate shoreline. The instant proposal will also "".minimize the adverse effecfs of developmenf" in that proposed construction above the hiah water mark and utilization of siltation tencina and hay bales will reduce the impact caused by the proiect. Accordinaly. we teel that the instant proposal complies with Policy 1. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of South old. See L WRP Section ITI - Policies Pages 3 through 6 for evaluation criteria DYes 0 No ~ Not Applicable Policy 2 is not applicable in that subiect lot and the surroundina neiahborhood cannot be deemed a substantial historic and/or archaeoloaical resources. Attach additional sheets if necessary . . Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Policies Pages 5 through 7 for evaluation criteria ~ Yes D No D Not Applicable Subiect orooosal will not adverselv imoact the visual aualitv ot the surroundina area in that the orooosal is to install a stone revetment alona the situate shoreline of the subiect oarcel. The surroundina area is currentlv comorised of orooerties imoroved with similar aoourtenances Ii.e. stone revetments I of similar size and scooe. Scenic resources. assumedlv views of Orient Harbor. are not at risk because the orooosed revetment will not block anv views of said resource. In addition, there is an existina stone revetment on the adiacent orooertv that has been in olace for vears without neaativelv imoactina uoon the scenic resources of this section of waterfront. Therefore, we feel that the instant mooosal comolies with Policv 3. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See L WRP Section III - Policies Pages 8 through 16 for evaluation criteria ~ Yes D No D Not Applicable Subiect orooosal will fullv comolv with this Policv in that the orooosed stone revetment is soecificallv desianed to minimize and/or orevent loss of life, structures and natural resources from floodina and erosion. In addition. the orooosed construction above the hiah water mark, rather than construction within the area of normal tide fluctuations, will helo to "manaae naviaatlon infrastrucfure to limit adverse impacts on coasfal processes" bv drasticallv reducina the amount of siltation caused bv the oroiect and therebv Iimitina imoacts to the naviaation of Orient Harbor. Therefore, we feel that the instant orooosal comolies with Policv 4. Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See L WRP Section III - Policies Pages 16 through 21 for evaluation criteria DYes D No ~ Not Applicable Policv 5 is not aoolicable to this orooosal in that it will have no effect to the water aualitv/suoolv within the surroundina area. 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 L WRP Section III - Policies; Pages 22 through 32 for evaluation criteria ~ Yes D No D Not Applicable Subiect orooosal will maintain the aualitv of the surroundina ecosvstem in that the orooosal is to simolv install a stone revetment. Stone revetments in and of themselves have not been shown to adverselv imoact aauatic ecosvstems. The orooosed stone revetment will orevent anv further erosion to the orooertv, therebv oreventina anv uoland soils from enterina Orient Harbor. The choice to construct above the hiah water mark, as aooose to construction within the area of normal tidal fluctuations, will further "protect and restore ecoloaical aualify..." bv Iimitina the amount of siltation caused bv the instant orooosal. Therefore. we feel that the moomal fullv comolies with Policv 6. Attach additional sheets if necessary . . Policy 7. Protect and improve air quality in the Town of South old. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria DYes 0 No ~ Not Applicable Policy 7 is not applicable to this Proposal in that the Proposal is simply to replace an existina timber bulkhead thereon. and which will not result in any torm of adyerse effects to air aualitV. Accordinaly. this proposal is not applicable with this policy. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes 0 No ~ Not Applicable Policy 8 is not applicable to this proposal in that the Proposal does not inyolye disposal and/or transportation of solid waste. hazardous waste. taxic pollutants. or petroleum products. Attach additional sheets if necessary 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 South old. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria DYes 0 No ~ Not Applicable Policy 91 is not applicable to this proposal in that the Proposal is not situated within a property containina. or hayina the potential to contain. public access to coastal waters. public lands and/or public resources within the Town of Southold. Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent nses and promote siting of new water-dependence uses in suitable locations. See L WRP Section III - Policies; Pages 47 through 56 for evaluation criteria DYes 0 No ~ Not Applicable Policy 10 is not applicable to this proposal in that the proposal does not inyolye a water-dependent use ILe. marina. aauaculture. etc...1. Attach additional sheets if necessary . . Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town Waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria DYes 0 No [gJ Not Applicable Policy 11 is not aoolicable to this orooosal in that the oroomal does not involve any form of marine resource manaaement (i.e. commercial fisheries. recreational fisheries. aauaculture. etc...1. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages 62 through 65 for evaluation criteria. DYes 0 No [gJ Not Applicable Policy 12 is not aoolicable to this orooosal in that the orooosal does not involve aariculturallands (i.e. the conversion of farmland. the establishment and/or maintenance of new coastal aaricultural oroduction. etc...J Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See L WRP Section III - Policies; Pages 65 through 68 for evaluation criteria. DYes 0 No [gJ Not Applicable Policv 13 is not aoolicable to this orooosal in that the orooosal does not involve the conservation of eneray resources on a commercial level and/or the oromotion of alternative eneray sources. orooer maintenance of fuel storaae facilities and/or the extraction of mineral extraction Attach additional sheets if necessary . . Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street, P.O. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Bruce Anderson, M.S., President Fax: (631) 537-5291 March 1, 2007 Mr. James King, President Board of Trustees Town Hall P.O. Box 1179 Southold, NY 11971 Re: Situate: SCfM #: GRACE Property 190 Willow Terrace; Orient Town of Southold, New York 1000-26-2-6.1 Dear Mr. King, This Firm represents the owner of the property referenced above, who wishes to acquire all required regulatory approvals in order to install a stone revetment thereon. Accordingly, approval from your Board is required. Kindly note that the proposed stone revetment will be installed above the high water mark. Please find enclosed herewith for your review: (1) Town of Southold Trustees Wetlands Permit Application (original and three [3] copies); (2) Short Environmental Assessment Form (original and three [3] copies); (3) Local Waterfront Revitalization Program Consistency Assessment Form (four [4] copies); (4) Photographs of subject property (two [2] sets); (5) Location Map for reference (four [4] copies); (6) Stone Revetment Plan prepared by this Firm and dated January 12, 2007, (four [4] copies); (7) Check made payable to the Town of Southold in the amount of $250.00 covering the requisite application fee. ~ . . By way of this correspondence, and on behalf of our client, I request that you commence review of this application and schedule for the next available meeting of your Board for discussion and subsequent permit issuance. Should you have any questions regarding this matter, or require additional information, please feel free to contact this office at any time. Thank you as always for your attention and courtesy. Sincerely, ~ WilliamJ. Lohn Encl. Cc: J. Grace T . . Suffolk Environmental Consulting, Inc. Newman Village, Suite E, 2322 Main Street, P.O. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson, M.S., President March 14, 2007 Ms. Lauren Standish Board of Trustees Town Hall p.o. Box 1179 Southold, NY 11971 MAR c Re: Situate: SCfM #: GRACE Application 190 Willow Terrace; Orient Town of Southold, New York 1000 - 26 - 2 - 6.1 Dear Ms. Standish, As requested, please find enclosed herewith a check in the amount of $250.00 to cover the additional Coastal Erosion Permit Application Fee. Amended plans showing the Coastal Erosion Hazard Line will follow shortly. Should you have any questions regarding this matter, or require additional information, please don't hesitate to contact me. Thank you as always for your attention and consideration. Sincerely, William J. Lohn Encl. Cc: J. Grace . . . OWNER'S ENDORSEMENT (TO BE SIGNED IF APPLICANT IS NOT OWNER) STATE OF NEW YORK) COUNTY OF SUFFOLK) 55: James N. Grace being duly sworn, deposes and says; I reside at 36 Bacon Road.; St. Tames, NY 11780 In the County of Suffolk and the state of New York, and I am the (owner in fee) (officer of the Corporation which is owner in fee) of the premises described in the foregoing application and that I have authorized Suffolk Environmental Consulting, Inc. to make the foregoing application as described herein. ~)J..- Signature If Corporation, name of corporation and Officer Officer's Title B~re me, this ~ day of Jt:vnI.lVJ .200"7 uM(l~ Notary Public MARK C MAGUIRE NOTARY PUBLIC: State of NY No. 4827232 Qualified in Nassau County rerm Expires April 30, 20JP -ct f 1" · Boar 0 Trustees App lcatlon County of Suffolk State of New York Wi11iam J. Lohn BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVE(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE 'REM'SES 'N CONJONE"ON W"H RE~A"L]CA']ON' Signature SWORN BEFORE ME THIS ~liC (1), DAY OF ~20 07 ~ Matthew 0, Ivans Notary Public of New York No. 011V6053859 Qualified in Suffolk County Commission Expires January 22, 20 I) 7