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HomeMy WebLinkAboutTR-7188 t Glenn Goldsmith,President �QF S�U�y Town Hall Annex Michael J.Domino,Vice-President ,`O� Old 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �0 �� Fax(631) 765-6641 �yCDUNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: /; 25 4X20 INSPECTED BY:' Co, ColdSrn��� V/ Ch. 275 . Ch. 111 INSPECTION SCHEDULE Pre-coristruction, haybale line/silt-boom/silt curtain 1St day of construction constructed Project complete, compliance inspection COMMENTS: OK Qoc C oar' 0.0-elc01'Ja ice. w9�\-7 oef,r I$8' e.�ec,deal v� it/NA? Uig► IA S aAye-A or\ ll iy l@ . CERTIFICATE OF COMPLIANCE: Glenn Goldsmith, President sa(/jti Town Hall Annex Michael J. Domino,Vice-President ,`O� ��� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III lx[ Southold, New York 11971 A. Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 1718C Date: June 25, 2020 THIS CERTIFIES that the replace in-place existing�8 P wooden groin with a 73' "Shore-Guard 425"vinyl sheathing groin-, the groin will be low-profile with the height not to exceed 12" above grade on the down-drift side; extend the existing groin 20' landward to prevent further erosion; install a±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1-2 ton stone armoring and rip rap base; and a total of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species (i.e. beachrag_ss bgybe!n) plantings; At 360 Park Avenue, Mattituck Suffolk County Tax Map#1000-123-8-28.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 29, 2009 pursuant to which Trustees Wetland Permit#7188 Dated September 23, 2009,was issued and Amended on November 14, 2018 and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the replace in-place existing 8 P wooden groin with a 73' "Shore Guard 425"vinyl sheathing_groin; the groin will be low-profile with the height not to exceed 12"above grade on the down-drift side; extend the existing groin 20' landward to prevent further erosion; install a±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1-2 ton stone armoring and rip rap base-, and a total of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species(i.e. beachrag ss bayberry) plantings. The certificate is issued to Michael Giacone owner of he aforesaid property. Authorized Signature Michael J.Domino,President O``�QF SOUTl Town Hall Annex John M.Bredemeyer III,Vice-President O 54375 Route 25 P.O.Box 1179 Glenn Goldsmith CA� Southold,New York 11971 A.Nicholas Krupski G p_Nc Telephone(631) 765-1892 Greg Williams ��� a COMM Fax(631) 765-6641 ,N� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 14, 2018 Jon Fabb Twin Fork Landscape Contracting, Inc. P.O. Box 460 Cutchogue, NY 11935 RE: MICHAEL GIACONE 360 PARK AVENUE EXTENSION, MATTITUCK SCTM# 1000-123-8-28.1 Dear Mr. Fabb: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, November 14, 2018: WHEREAS, Twin Fork Landscape Contracting, Inc., on behalf of MICHAEL GIACONE applied to the Southold Town Trustees for an Amendment to Wetland Permit#7188 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated October 1, 2018,,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 to be Consistent with the Local Waterfront Revitalization Program policy standards, 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, 2 NOW THEREFORE BE IT, RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#7188 to extend the existing groin 20' landward to prevent further erosion; install a ±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1-2 ton stone armoring and rip rap base; and a total of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species (i.e. beach grass, bayberry) plantings; and as depicted on the site plan prepared by TFLC Inc., dated September 24, 2018, and stamped approved on November 14, 2018. 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: None This is not a determination from any other agency. Sincerely, a Michael J. Domino, President Board of Trustees MJD/dd Michael J.Domino,President �O�OF SOUlyolo Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski �p� Telephone (631) 765-1892 Greg Williamsl�`,oU +N Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 15, 2018 John Fabb Twin Fork Landscape Contracting, Inc. P.O. Box 460 Cutchogue, NY 11935 RE: ENVIRONMENTAL DECLARATION OF SIGNIFICANCE PURSUANT TO NEW YORK STATE ENVIRONMENTAL QUALITY REVIEW ACT NYCCR PART 617 MICHAEL GIACONE 360 PARK AVENUE EXTENSION, MATTITUCK SCTM# 1000-123-8-28.1 Dear Mr. Fabb: The Southold Town Board of Trustees adopted the following Resolution at a meeting held on Wednesday, November 14, 2018: DESCRIPTION OF ACTION: Twin Forks Landscape Contracting, Inc. on behalf of MICHAEL GIACONE requests an Amendment to Wetland Permit#7188 to extend the existing groin 20' landward to prevent further erosion; install a ±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1-2 ton stone armoring and rip rap base; and a total of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species (i.e. beach grass, bayberry) plantings. Located: 360 Park Avenue Extension, Mattituck. SCTM# 1000-123-8-28.1 S.E.Q.R.A. NEGATIVE DECLARATION OF ENVIRONMENTAL SIGNIFICANCE: WHEREAS, on November 9, 2018 the Southold Town Board of Trustees found the application of MICHAEL GIACONE to be an Unlisted Action Negative Decision pursuant to SEQRA Rules and Regulations. A Short Environmental Assessment Form and a field inspection have been completed by the Board of Trustees; and it is hereby determined that it will not have a significant effect on the environment, and; I WHEREAS, the Southold Trustees are familiar with this project having visited the site on November 7, 2018 and having considered Twin Fork Landscape Contracting, Inc. plans for this project last dated September 24, 2018 showing the proposed revetment, landward groin extension, and stabilization, and; WHEREAS, in reviewing the project plans last dated September 24, 2018, it has been determined by the Southold Town Board of Trustees that all potentially significant environmental concerns have been addressed as noted herein: • No existing rocks or boulders are to be utilized, moved, or relocated on the beach. • Access to the site for construction will be by land only. • Vegetative, non-structural measures are not capable of stabilizing the erosion of the dune alone. • Protection of the toe of the dune using hardened structures including rock revetments is necessary. As time progresses, continued soil loss at the toe of the dune may lead to a complete loss of stability. A site inspection by the Southold Town Board of Trustees recognized severe erosion on this property and requested a stabilization/erosion control plan. THEREFORE, on account of the foregoing, the Southold Town Board of Trustees Approve and Authorize the preparation of a Notice of Negative Declaration pursuant to SEQRA for the aforementioned project. If you have any questions regarding the above, please contact this office. Very truly yours, s Michael J. Domino, President Board of Trustees 5 U RV EY Of: LOT 4 � P/O LOT 5 A5 SHOWN ON A CERTAIN SUBDIVISION MAP ENTITLED"MAP OF MARRATOOKA POINT' FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY MARCH 19, 1972 A5 MAP NO.331 e 51TUATE : MATTITUCK TOWN : 50UTHOLD 5UFFOLK COUNTY, NY s SURVEYED 09- 19-20 18 SUFFOLK COUNTY TAX # 1000 - 123 - 8 - 28. 1 CERTIFIED TO: CATHERINE GIACONE BARBER JAMES A. GIACONE JOSEPH J. GIACONE MICHAEL J. GIACONE DEEP hO�E NICHOLAS A. GIACONE PHILIP J. GIACONE DIANE GIACONE STEVER GARDINER'S ) CREEK FLOAT O -a "I1 rn ^ - NL W BOG O ASR U -BOG-- , oG - 0 10 1, o o R�GhP OF�, aT S (d roadway , it , 3 OG O �.gyp rn POLE ,� ` 0"0 ,• O o G I Itr r w �Fuv r" 6 5� pv5� CA? EN , Na F�p�N A\ ovG_ ,, F�zAME ,..BEACH'-' ` v2 C n .1c p/1EAN �P�E'l i ' 1 p MEAN LOW WATER LINE 1 OCT 2018 OZ p Scud old Tovin Board of Traslmzs CONIC 15 ,--GRE AT PEAY~ NOTES yy973 n "Unauthorized alteration or addition to o survey map be—rig a hcensed land surveyor's seal is a Area = 10,393 re Ft. JOHN C. E H LE RS, LAND 5 U RV EYO� ��� ���� violation of section 7209,sub—division 2,of the r, New York Slate Education Low" Area t 0.238 Acres G•E1-/< 'Only copies from the original of this survey Low water observed o�� �ip mmarked with an original of the land surveyors 09-20-18 3 30 PM (� to seal shall be considered to be valid true 6 EAST MAIN STREET N.Y.5, LIC. NO. 50202copies y 1 "Certifications indicated hereon signify that this �l / survey was prepared in accordance with the ex— RIVERH EAD, N.Y. 1 1901 OFFICE: G31 -3G9-8288 y t by the- he Code or Practice for Land Surveys adopted New York State Association of Professional p Land Surveyors Said certifications shall run only esurvey@opon line.net GRAPHIC SCALE I 30' rtlt ��l a"'cu to the person for whom the survey Is prepared, .,t and on his behalf to the title company,governmen— V� 502 lal agency and lending institution listed hereon.and Fp LAN to the ossignees of the lending Institution Certifico- 18-146 tions are not transferable to additional institutions Michael J. Domino,Presid, }' OFFat rC � i` Town Hall Annex John M. Bredemeyer III,Vice-Pr^sident Gym, 54375 Route 25 Glenn Goldsmith P.O.Box 1179 A.Nicholas Krupski 0 Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: V IVI8 W60 Completed in field by: Com. Go IJSMI Twin Forks Landscape Contracting, Inc. on behalf of MICHAEL GIACONE requests an Amendment to Wetland Permit:#7188 to extend the existing groin 20' landward to prevent further erosion; install a ±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1-2 ton stone armoring and rip rap base; and a total-of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species (i.e'. beach grass, bayberry) plantings. Located: 360 Park Avenue Extension, Mattituck. SCTM# 1000-123-8-28.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pools and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 J Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: ',r�1�p� G SIIS��r, i5 �XPDS�_.n1 . �;a1-• ���e. o-�o.�e.oc� �� a© lar��wo.c�1 a� aco,c� . S 1'c"»I A<- to 0�00coVe A O-A Cie eY�boSS , I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other W/ �c�7V��-"� VI/ l Aff- ................ � [TveLl (-rAbf�S-) V N 1 � rt T i _ 4 i i Aw �t C::7 t ��� �' *�� :. Fes+: � ,��� -, ��ro ,. ,, , ,� _� i �� f'�.. 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P : . ,�. i . . . . . . . . . . . . . . . . . . . . . . . . .I. - 3 _ ._. ,. I •:1 :: :::::Ston : . - i E1Stxn Beach i m �J.:.. i _ 4' -. i — I _ _- I i - iE ._—'�,__— _ E ?_I____.__.____._, ,_ Mi , E E 7 i.iY E ! i E i! :101 -. 50 Cubic Yards L- - i Clean Sand Backfill -- _ Proposed ' - Plantings etu n Groin IL Boulders P5�F-- - _ ii to Grade LI E OG— -,ILL L�L_ - - - 1 rr ! I = gr►-20 a1 l7 Err dpi i _ J Lion Revetment "t"Ieva Scale i =2 A. .46 roin h G xtensi" ont""'I" evarion Scale i"=io% ' } ! felti 0 �C J� rEE i _�- __ _ G 07 F za..1 wa7y - n I it It !{, + +! 76 °MMExistin 20 .y 96 Total E aProposed Extension pill if`C:I + Entire Area To �•I� i� � --� '! `,- '!� ', Be Re-vegetate i!� . o � ) Existing! sting Septic Syste 'tip , Clean Sandi Backfill 20' Proposed Groin Extension __4 1. -' ira r� Arm AIf1 t Ara Era 0 APPROVED BY r ! BOARD OF f RUSTEES TOWN OF SOUTHOLD r--- O ,E DATE 14' 2018 ' _ OCT 2018 771 MEAN L0`0/ 'y%iIA1TK UIP6.1 F_ ! k i �; .,r 1 . �r�,' A P NY ar Ftcol GOmIrN Trq atli m.&r 0 inc . Y f ILII ! t f R AkCox Lane , Cutchague I IVEP\ CREEr\- twinforldc@o tonline,net/6 i- -66 p 3 734 43 0 0 OFFICE LOCATION: �oF S® yQ MAILING ADDRESS: Town Hall Annex �� l0 P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) va Southold, NY 11971 aQ Telephone: 631 765-1938 lroutm LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry,'Assistant Town Planning Director LWRP Coordinator Date: November 14, 2018 Re: Local Waterfront Coastal Consistency Review for MICHAEL GIACONE SCTM# 1000-123-8-28.1 Twin Forks Landscape Contracting, Inc. on behalf of MICHAEL GIACONE requests an Amendment to Wetland Permit#7188 to extend the existing groin 20' landward to prevent further erosion; install a ±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1-2 ton stone armoring and rip rap base; and a total of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species (i.e. beach grass, bayberry) plantings. Located: 360 Park Avenue Extension, Mattituck. SCTM# 1000-123-8-28.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the Board considers the following: 1. Clarify the top elevation of the revetment. 2. The potential deflection of wave energy to the property to the east of the parcel should be assessed. 3. The replacement of the existing septic system shown on the plan with an A/I OWTS is strongly recommended to further Polices 5 and 6. Grant funding is available to cover the installation costs of the system through the http://Www.reclaimourwater.info/ website. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Peter Young,Chairman Q Town Hall,53095 Main Rd. Cn Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., November 7, 2018 the following recommendation was made: BARBER/GIACONE/STEVER to Amend Wetland Permit#7188 to extend the existing groin 20' landward to prevent further erosion to both protective dune and existing septic system. Project will include a proposed boulder revetment +/-20 If. extending from the southeast corner of residence to west side of groin. Proposed groin will be constructed of 1-2 ton armoring and rip rap base. Total of 50 cy. of clean sand fill will be required to replenish dune over septic system and entire dune will be revegetated with native species. Located: 360 Park Avenue Extension, Mattituck. SCTM#123-8-28.1 The CAC did not make an inspection, however reviewed the plans and Supports the application, as submitted. l; Michael J.Domino,Presidento� SU�fj/� Town Hall Annex John M.Bredemeyer III,Vice-President �� `Q 54375 Route 25 } P.O.Box 1179 Glenn Goldsmith �` Southold,New York 11971 A.Nicholas Krupski , c Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 14 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application _ Wetland Permit Application — �/Administrative Permit mendme Transfer/Extension Receive Application: Jb•�'!$ "! OCT _ 2018 Received Fee: $ �0 :itCompleted Application: Incomplete: - _- SEQRA Classification: Type I Type II Unl sted I NeRatiue Dec. ti positive Dec. Lead Agency Determination Date: _ Coordination:(date sent): _ �LWRP Consistency Asses;, e t Form Sent: CAC Referral Sent:_ /oa �g - LEGAL PROPERTY NAME: Date of Inspection: 11-7, Receipt of CAC Report: Catherine Giacone Barber Technical Review: James A. Giacone Public Hearing Held: / Joseph J Giacone Resolution: Michael J Giacone Nicholas A Giacone ' Philip J Giacone Owner(s)Legal Name of Property (as shown on Deed): _ Diane Giacone Stever, - Mailing Address: J 15 VK its i4e( _R-d Det ma-r 17 0 Phone Number: 45) —2,$ 1 —1(e Suffolk County Tax Map Number: 1000- Property Location: 3coo wv.. Atf VYT , �1wt, ° <<4sZ (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): ' AI 1 L"4US CAM CaH=6q7&-A5' I Mailing Address: Phone Number: , &10q Board of Trustees Application GENERAL DATA Land Area(in square feet): d 3q L T r---- Area Zoning: Previous use of property: - tom! At— - • - -- Intended use of property:-... ® A-L Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? 'Yes N0 Does the structure (s) on property have a valid Cprtificate of Occupancy? _Yes No Prior permits/approvals for site improvements: Agencyl/�7 �``'� Date L 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): _ 1000-123-8-28.1 PROJECT DESCIPTION: Request to extend existing groin 20' landward to prevent further erosion to both protective dune and existing septic system. Project will include a proposed boulder revetment+/-20 LFT extending from the South East corner of residence to West-side of groin. The proposed protective Groin will be constructed of 1-2 ton armoring and rip rap base as illustrated on plan provided. A total of 50 yds of clean sand fill will be required to replenish dune over septic system and entire dune will be re-vegetated with Native species (IE; Beach grass/Bayberry) plantings. l Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot:���3g77, SQ square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: - _ - feet Closest distance between nearest proposed structure and upland edge of wetlands: feet ` Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled?_ - _ 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:. GA—T— 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): 1000-123-8-28.1 PURPOSE OF PROPOSED OPERATIONS: Request to extend existing groin 20' landward to prevent further erosion to both protective dune and existing septic system. Project will include a proposed boulder revetment+/-20 LFT extending from the South East corner of residence to Westside of groin. The proposed protective Groin will be constructed of 1-2 ton armoring and rip rap base as illustrated on plan provided. A total of 50 yds of clean sand fill will be required to replenish dune.over septic system and entire dune will be re-vegetated with Native species (IE; Beach grass/Bayberry) plantings. 6I Z20 Appendix E Short Environmental Assessment Form Instructions for Comn9etlnp Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part l based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1--'Project and Sponsor Information ; Name of Action or Project: ; Project Location(describe,and attach a location map): Brief Description of Proposed'Action; dos";Pt7 ori Name of Applicant or Sponsor: - aa Telephone: 3 y Jt�bTWIN i� 6 W7,-Mail:.+-winfz)rk.LG I6 e. MO- Address: - Pd PA114+60 City/PO: State: Zip Code lure W&LC ._ [ra3s 1.Does the-proposed action only involve the legislative adoption of a plan,local law,ordinance, -NO _ YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that '000 R may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: Q 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? -, acres Af►wT 2,8W 54 R- c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? t acres 4. Check all land uses that occur on;adjoining and near the proposed action. E]Urban E3 Rural(non-agriculture) []Industrial ❑Commercial IVResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 r -.T 1000-123-8-28.1 Brief Description of Proposed Action: Request to extend existing groin 20' landward to prevent further erosion to both protective dune and existing septic system. Project will include a proposed boulder revetment+/-20 LI=T extending from the South East comer of residence to West side of groin. The proposed protective Groin will be constructed of 1-2 ton armoring and rip rap base as illustrated on plan provided. A total of 50 yds of clean sand fill will be required to replenish dune over septic system and entire dune will be re-vegetated with Native species (IE; Beach grass/Bayberry) plantings. 5. Is the proposed action, NO YES 'N/A a.A permitted use under the zoning regulations? 0 b.Consistent with the adopted comprehensive plan? El 1-1- 21,01 6. Is the proposed action consistent with the predominant character of the existing built or natural .NO - YES. landscape? D - 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify:'_ _ 3 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES a ITI b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: I ❑ ! i 10. Will the proposed-action connect to an-existing public/private water supply? - - NO- YES' If No,describe method for providing potable water: 11.W iII the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b. Is the proposed action located in an archeological sensitive area? �,J{• 13.a.Does any portion of the site of the proposed action,'or lands adjoining the proposed'action,contain NO- YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? EJ V� If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 44» 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply; ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional Wetland ❑Urban ❑Suburban 15.'Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? -- ❑ 16.Is the project site located in the 100 year flood plain? _ NO YES- 17.Will the proposed action create storm water discharge,'either from point or non-point sources? NO YES If Yes, ( T a.Will storm water discharges flow to adjacent properties? ❑NO [:]YES1=1 b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: [:]NO YES Page 2 of 4 ' 18. Does the propo'sed action include construction or other activities that result in the impoundment of -NO—' YES water or other liquids(e.g.retention pond,waste lagoon,dam)? ; If Yes,explain purpose and size: - 19.Has the ite of the proposed action or an adjoining property been the location of an active or closed -NO r YES solid waste management facility? If Yes,describe: D 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or :NO YES completed)for hazardous waste? If Yes,describe: AFFIRM THAT THE INFORMATION PROVIDED ABOVE7S TRUEAND-ACCURATE TO THE BEST OF MY KNOWLEDGEW .U&FJ N Applicant/sponsor name: f1 / Signature: — — Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the,following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have illy responses been reasonable considering the scale and context of the proposed action?" No,or Moderate 'small to large impact impact may may occur occur '1., Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? Ell 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? '' 4. Will the proposed action have an impact on the environmental characteristics that caused the D establishment of a Critical Environmental Area(CEA)? LI—�-J-J 5. -Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? _ 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ��j.� 3 _—reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? I- b.public/private wastewater treatment utilities? Q 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 ' No,or Moderate small to large i impact impact may may occur occur to. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? El 11. Will the proposed action create a hazard to environmental resources or human health? a Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-tern,long-term and l cumulative impacts. s f Check this box if you have determined,based on the information and analysis above,and any supporting documentation, - that the proposed action may result in one or more potentially large or significant adverse impacts and an Edenvironmental impact statement is required. 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 impact . Town of Southold-Board of Trustees Ia Name of Lead Agency Date Michael A a�9 i s a e l J. Domino, President - Print or Type Name f Res onsibl fficer in Lead Agency Title of Responsible Officer Signature of Respoi ible- fficer in-Le—id Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Sbuthbld's Cbdwoftthi 606ft,61[fiCeis and_dmjLjiJvees.,Th-q- cs-n hibits-conflicts of on the Theme pr i this forth is to-provide information which can alert the town of possibiedonflict.,;'Ofinterdst and-allow iti6take whatever action is neces9k toavoidscone. YOURNAME: (Last name,first name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance l Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do yowpersdfially-(dr throughydifr,6ompany,.s sibling;parent,'or pdase, -a rektionshipwith-any 6ffilier,&employee "Business interest"means-a business, esS, of theTowh of Southold? "Relationship"includes by,blood,i43rri oirbusli C, liess-interest. including a-partnership,to which the tov'm,offic'-e'r--or•c�mployeehlas,eyen-apartial ownership,6f(or,emplpyn fbX),a-corporaon in which the town oiflde_rortmployeiee'owris,morethbiq,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- icer or employee.Either check cribe,tlicjplationship b6tweenyourself(the applicailVagent/representative)and the town off Pek the up priatiAneA)thrbugh-D)Ano/or describejSpace the a6e provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): the owner of greater than 51/14_of the skitis of the corporate stock of the applicant (when the-applicant is-a coipbatl0n);, B)the e g-aUbrlbencrficial ownet,qf any interest-in a•non-corporate entity(when the applicant is nota C);an officer, I' the applicant or director,pailpqr,-or'dmp oyee& _D)the actual applicant. DESCRIPTION OF RELATIONSHIP � yof Submitted this d 2 0 Lo Signature Lj��tz—_, - Print Name—U-Min- ' 0 Form TS I MELANIE V BROWN Notary Public,State of Now York No.01 BR4908712 Qualified in Suffolk CountydV,;1 Commission Expires October 19, $p2Xd OZ :1 rus-r-Ee5• tWY-L AFFIDAVIT }'I 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 HISIHER KNOWLEDGE AND3BELiEF,AND THAT ALL WORD WILL BE DONE IN THE-MANNER SET FORTH IN,THIS APPIlICA'TION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.= THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTI3[OLD AND THE { Bt)ARD.OF TRUSTEES HARMLESS AND FREE FROM AN�TY AND'ALL DAMAGES AND CLAIMS.ARISING UNDER,OR BY VIRTUE,OF SAID PERMT-(S),IF' s' GRAFTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES;THEIR AGENT(S)OR_REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO " - INSPECT THE PREIAISES IN CONJUNCTION WITH THIS APPLICATION, • . INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEESTO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE_WITH ANY CONDITION OF ANY WETLAND 6R COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PEST. Signature of Property caner ignature of Property Own a SWORN TO BEFORE ME THIS DAY C}F =2� l SW . i n Notary Public V l _ JEREMIAH F MANNING Notary Public,State of New York Qualified in Albany County No.02MA4766991 commission Expires March 30,20, 3 • ••:>ip i `i.VGi,.i Vi ;iLi�7 4GG0 i11iI�./ '- +Gi 4i VSJ - �• ... .Yx>._ �mwe,,r_� � 'AUTHORIZATION (�Nlieeie:apglicant is not the owner}' I/We, ��A�VI�i�\Vl�l� �(1� �� ✓e� owners of the property identified as SCTM# 1000- �,�3„��'' , 1 in'the_tomm of -` D I ,New York,hereby authorizes r to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for thisro P Ply affo Property Own Signature, Property Owner's Si e 20 • SWbRN TO BEFORE ME THIS DAY OF --L l \Nn Notary Public \� 1 JEREMIAH F MANNING Notary Public,State of New York Qualified in Albany County No.02MA4766991 t" Commission Expires March 30,20-.:— y'''"q.'"'�y;;�;;-.'r,t'„�K�':a i-��..>s'c� ^.-y�,3%:'T?,�' �;`'�'` ;","'7=:� >.nX"�+�.�><�r.;..,"."k _��� >rNN ;a;"�:�%�'.•"'%%,w -.�,,.,<«rs �:��;,p,r° ,s, �ai ..,.;�,,:,�ya:�°�.;7; 'Y:=zr, '�a,�;�`,�a�.�-w ri°^;,,,-�.f;� t�.�ff 'r,.r '°A�„,.i�,.�;s;�, ,;n,. ;,. ,�`.:;,.,�,,.�.s� ,.�,'�;` .�'',�';„�;:a�c •�r �(' >ff •,'� -�c`r'.`'' ; ''`�� �y3,(¢:.. �w=si;.:�� .".S�';5 ���a�,�'j.G..i;:��^"-'�,�}.`. „r3. "F ,,.j., rlsy f• � ;�:'.�.,:=e's^ �,s.W ?�mw,6.� ,,F g' ��� ....N�z �•, �Y._'T`/w<k.•,,, A�..�.�i,,.n-wY �y"•',f',.:�s, ,qo '�',,H�s<�;•q,;¢,..s sf`: `S” �4 1 'w �� e ydx, ��,.� tr, .j%�'° ,x .,a..�'�.." �•� �. ;�.ti s" ,,:nr $'':� v,.?^'i..,�,•%����.wN^ r �<4'''`F�.>-.,�,�,a'7'�1,r�3;^�f >`��'.�` .y .�'��* �., ��r�:s, •' •CtS ws"(S �;,r.��^ ^� �'.; yz ""a::: ,o'� k.. .>K'•'�ia�� !c',>���Y'' x�.��`.55 k �'rs s Board or Trusrees AFFIDAVIT - > b r - �� ✓Yj�,� � (r1 � � BEING DULY SWORN DEPOSES AND AFFIRMS'THAT HE/SHE IS THE APPLICANT FOR.THE°ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED. REIN 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 BOARDOF'TRIJSTEES: THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES CESS AND FREE FROM ANY AND ALLDAMAGES' , AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE ,. . TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING`'THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL IlYSI'ECTION. I FURTHER AUTRORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COWLIA.NCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF TI PERMIT. Agna of property Owner ignature f Property Owner { SWORN TO BEFORE IV E THIS d� DAY OF ,2a 3 � , v Notary Public —A M JEREMIAH F.MANNING Notary Public,State of New York Qualified in Albany County No.02MA4766991 Commission Expires March 30,M= 3 .. s ' :: r- < 1.nVGiiu Vi aA.ua s °. 'S n;Y AUOZA'TIOAI ffhere,the applicarit'is not the owner) = U .e, f owners of the property identified as SCTM# 10 00 (/ 11 in the town of New York,hereby authorizes 1'U• yorl&f n T�L A 4:'> '�Uvl N mak,, r •' .;--� . � ;� -; .� , INC. to act as my agent and handle all �s ' necessary work involved with the application process for permit(s)from the Southold Town Rt Board of Trustees for thisro P Ply , Property Owner's Signature Property Owner's Signature SWbRN TO BEFORE ME THIS DAY OF-u%r- r 2U Notary Public JEREMIAH F MANNING Notary Public,State of New York Qualified in Albany County ^ No.02MA4766991 Commission Expires March 30,20.x.. p£ ".W,�, -,e,;,.3%,;max` ;;g "="�.' �-.?z'r>;- �.�;�a�'z, �' ir.:�'., %;��'� »—.-z:�,.a r'Crc.'.`•i,,"<e;.^ .e'w,:„i.•-,c;n�'�`" a fir; ,-.� .z ,r. _ � ;7,'� "�•r�p;jy',� g"F.� x%� _ .3, F�•;q',*` .*�'':r r.�.e��`b". .�:�k�,� ",s,,, - "%tfir-; �'�,°°.i:;r ,w �%'�;': �'�:'%�:r�,'��'.• '.r�£"'r '` -��," `X',;�W '>���<; .fib' �:3'�.. _k' s�, '�•wa�.�,�s�`�; "/��n,�`,i':i;�t�f �; .,x r.f;.r a°'`*�,P �;,;a..��'��;,;3�..";��',`. ;�v,�;F ,�v��j�^' Yi'- �, � �� '.rz; '" ��,. ;- 'n.�""s�� ':' ;." 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' Board of Trustees Ot AFFIDAVIT BEING.DULY SWORN DEPOSES AND AFFIRMS THAT-HE/SITE IS THE API'LICANT.FQR'THI''A$OVE; DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ; ARKTRUE�TO T- 11E BEST OF HISMR"OWLEDGE AND BELIEF,-AND:T AT. ,4 AI:I;WORik,WILL BE DONE IN'THE MANNER SET'FORTH INS THIS APPLICATION OF TRUSTEES.. , AND AS MAY BE APPROVED BY THE SOUT]B[OLD TOWTT BOARD :.ptl THE APPLICANT AGREES TO HOLD THE TOWN OF SoMOLD'AND ESS AND FREE FROM ANY AND ALL DARES BOARD OF TRUSTEES HARML AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID'PERMIT(S); P .,rz GRANTED. IN COMPLETING THIS APPLICATION,I FIEREBY AUTIIORIZE THE ' TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUD G THE ; TO ENTER ONTO MY PROPERTY TO .CONSERVATION ADVISORYCOUNCIL, 3 :1 INSPECT THE PREMISES'IN CONJUNCTION WITHTAIS APPLICATION,, INCLUDING A FINAIL INSPECTION. I FURTHER'AUTHORZE 1'IEiE BOARD[3F TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUOR]Ao EREIaASO INgURE COMPLIANCE,WITH ANY CONDITION OF ANY WETLAND EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DUIEZINGTHE TERM OF THE'PERMIT. 3 • Si e f r erty Ovvner Si , rape Owner s SWORN TO BEFORE E PHIS �- DAY OF 20 M i NotaryPublic I - JEREMIAH F.MANNING Notary Public,State.of New York Qualified in Albany County No.02MA4766991 Commission Expires March 30,20�2D- F S d �a � S�"�'.", r.�j—^�, '�,Y:"' :�%"'��'"� ,.,r ;L,.�-r^r',�y^',y •�";,�-rs's a•`,,.9,:� <'.rylr�"p-� �'••»s,<,m*-r•59,'�`« 'y`eyr,,�:•��^�'�• '.q'`. ,a�.�: '",3� s w� krs,�r,,� ti� •/ n°�y,�v3�"'r"'�'� a����'. .: £��'�y'.�Y�4"'�.q'�"�`",Y'?5-'6'£"�','� �r���• 3 � ��5�r9:�,x', wsY N�,j:�Kf'" ,a�'' 'nNC�s �� •'^�zx.<,, �' ,,�7, 'x� m.�t;.�� o; p... � � a e� �a� '; r� ,.�,{ :v >*�w,.:�? .g �."mit°s „n; ': ° Fes:" ;'�``^ �' >, r' •�. :'4„r`;,.�� ^�"'J_ ,fir!:§� y.. �, ;�- � s. ;^�7"-" ,ks -a ;�,, ,«�.,, ,z„ ��^ ,�.';a�'•;n _.:^n"»�;; Fz�.z,a`.,�l'":� *'Srf %,`"'. �s'" r.. ,ax`.fi:a'.�; '.�s� '��. ,,,_k' r�.,y.<Aw "C��r �?�r,n ,�., y � � �."�'� ,fir"r w r.�„��f'.,; a, �jy,•, .:'$�`,,, �; �, _�._ o,,.,, ".T„' X,�� %i 3�, �'^� s � i5µ �'.� a;�i�.,,,f�u, �,3�i. 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",,, -,�'" �y" .g"�'�,.:...,..w. qaw sejldx.9 uolsslwwoo 46699LbdWZO'oN «' f4unoo AueglV ul pal;llenp NaoA nnaN 10 ejvjS'`ollgnd AeIoN JNINNVV :lHVIVOUSr �''C J•�' o, qn4 kelox oz L 14a.2Wa SIHl aWM104aU oz MUQAkS ' am mists s=aaur o 1410doad .rnl."uA s,za p adozd f •X3iadoad silpaoj saaisrul jo p.pog umoz pio nos a uioz�(s) juzrad aoj ssaooad uoijiaotjddt arj tRYA panjo�ut xzon�,Lz�ssaaau llgalpusq pug qua Am lo-e ol ; — sozuoWt,Xgazaq`-jzoA moo• r E` "Iounnol -000t IDS e paluopi adoid arR jo s zau&o `awl (.raunno alg IOU sY TUROgdde al.azaR&) �," �� •.:�x�"�dw�.�x, � � � $qtr, �r f Board of TruszeeS AFFIDAITTL BEING DUL'�'SWORN, DEPOSES AFFIRMS T' AT HEfSTIE IS THE APPLICANT FOR Ti3E¢.i;ABOYE DESCRIBED FE T(S) AND THAT ALL,STATEI'aUNTS COl'dT'AE�ED�EI�EIl� t' AJCY.tLr�' '.�'O`�' BESTS OF jt&HEIk 0W...��EDGE AND BEL, �i THAT - A.LL VO WILL'BE DONE EN`M I-VL41 l EIS SET•FOF'Tn IN TMS AATIOI� AND AS MAY BE APPS®VED BY s{�A7'�HOLD TOWN BOARD OF DS AS, THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE , BOARD OF TRUSTEES PIA ESS AND FREE FROM ANY AND ALL DAMAGES, AND CLAIMS ABISING UNDER OR BY VIRTUE OF SAID PEB.1 I'T�S�z� GRANTED. ITS COM LETING TATS APPLIC�ATIOi�1g I INCLUDING THEE TRUSTEES,THEIR AGENT(S)OR REPRESEI�T'TATIYESg Iii CONSERVATION ADVISORY COUNCILg TO ENTER ONTO M'PROPER'T'Y TO INSPECT TUE PREMISES IN CONJUNCTION WITH THIS AFFLIIi ATION9 INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE *OA OF `T'RUS'TEES TO ENTER ONTO My pROPERTY AND As REQ • , D TO INSURE COMPLIANCE-VVITU ANY CONDITION OF ANY WETLAND OR COIASTAL ,. EROSION PERMIT ISSUED BY THE BORED OF TRUSTEES DtRING THE TERM OF THE PEIIVIIT. ASignWoroperty Owner Signature of Property Owner SWORN TO BEFORE ME"LUIS —DAY OF ,20 j i q Notary Public s" "sig of New York Ailmni County ;�"Noi 02MA47669,9i i 9r rTii 01e6�Ex E ' 4 ' 3 f ��> - :.fir .F��•:•'•_'yS AUTHORIZATION z (Wheie'bee applicant is not the owner) I/LVe, owners of the property identified as SCT1IM#1 O0o- 3�ohgg&e Elf , in the town of New-York,hereby authorizes Uo ) b: to act as my agent and handlc all necessary work involved with the application process for perrnit(s)from the Southold Town Board of Trustee-s for thusperro • P Property O er°s Signature Property Owner's Signature ' SW6RN TO BEFORE ME THIS DAA OF-VI-& � 20 Notary Public JEREMIAH F MANNING Notary Public,State of Now York Qualified in Albany County No.02MAA768991 Commission Expires March 30,20" .T,;t>r�a.<�.;'$s�up°.;St��*�`,�"azr-"..»?5*.t"w',-`p"4e'r...'i,wp.,.'f.�1-,"ar.,`.^xr.x>�nr:�",§.g".,^?�z''!�-;"F..�.�'r'�,:=:.?ars:;.�>iya'�br,�°,".�"''�rr�:y;r�r:,,fi",r..�.°<:�'wt:�.,.na:'e,,^ms"".°,,'.a',?.u%u.?3,>,v.�,..»F?..r,.=�<w={�::�.'i.-;.,�k'.",Y'�..�.:�.1"3.'-::d,tKeatA�x.;+'.:�.u.:...,.;-»,r?b�t...�s�t.''."..'_,'�-..;.�,`.°.w�w',..',�.i.wi.^'..,.;en'.'...s..<`"h.. .-.-:.S.;.sm<.c"'.SM.'..�a,,Y;.,f.aa`[.'.k,'.boC�.�.,3"a?".:'.�µ....Z..'..:�>.'T.e�%-"z:s-�y..a,,' '}t1a.:�:a.�."-...�>>x-,;.,'�.:�.«,.fh:hC�'%'a.;",R.��'-r':�.gN✓i,';..�'.4�s'„,s>;:F'�,,ar..�,Lsy:`a;:.�,r,,.r.,.w�;�W�s;:7s'.y�,.'a:.'d,5"'-nW�'„„k„rrr4„ust,zWi,°a'^�atz��:,:„yv=e.1,1=:,ms-,;;xx..t.M:.';a..`rw..�yrw�-".:;tirWqy,r:f»;,u��,.;.a;,'p�.fi�a..,�ss,;F�e,N.'z"„.a;����`�`*'•u",��'?�a,..��;;-"i,jdfX,;4y<,Cy-"."s,a,F,r,<�'S�„�tF'`',k,.��'sk��.-.>",-.,'�/'; ;.�s�7:�" .7, 47 s:2, 1% y5, .,,�a�!M�. ,'c., !q`' -.,��}�e.f..�£.,,�'i�dx-qg.:d;.;�;�':z,�✓.:i,,,,,�J,,a, � f« gy'p i. Board o$ Trus'ceez a-Wwx.-<- � .....sa ^Yt� ➢ ` ' Q AFFIDAVITBEINJI—=----- fir DULY SW() RN DEPOSESA AFFIRMS TEAT I fS TE IS APPLICANT FOIA'I'II�'A�O DES � Iii { ).AI' TI ATA li, VE TS CONTAIII ED IE I OEI3CE AND BELIEF,AND THAT _ ALL � �.L BE DONE IN T'THE I'V:�ER SETFORTH AND I ��APPROVED Y'SHE SOUTHOL ` OWN BOA ()�'TRUSTEES.,,' THE APPLICANT AGREES TO HOLD THE TOS OF SOOLD AND TM $O Imo"��T'RITS TEES HA ESS AND 1 FRF FROM° ALLA S AND CLAIMS AS �i J�iDER OR BY VIRTUE OFSAID PERI 'T(S)9 `° `7" GRANTED. �0 LE`TING` IRS APPLICATION I HEREBY AIJ�HOR'ZE Tom' ' TRUSTEES,p�g� ypTHEIR $ � q AGENT(S)OR 7R PRES+EI�'�ry'�A,TI S,,7 CLUDIi �Gg�p'�g'� LYl,SEda tA'T11�➢21 ADVI�SORS COUNCIL,TO ENTER ONTO I+ T'R�. P RTYTO ��� i � �SAPT��AT�ON,. INSPECT THEPREMISES IN CONJT? ,F TION. gFURIR AUTHOR1ZETHE BOA dNCJVDAlB FINAL IN 9 TRUSTEES TO ENTER ONTO ICY PROPERTY AND AS REQUIRED'I O INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PEPAVHT ISSUED BY THE BOARD OF TRUSTEES DURING THE, TERM OF THE PERNU A o Signature of Property er Signature of Property Owner 4120_d SWORN TO BEFORE ME THIS_�-DAY OF-Ak 4") 3 i _ e Notary Fublic— JI FIEPAIA H F. MANNING 1 Notary Public,State oP r\lew Mork . i qualified in Albany County No.02M,A4766991 Commiamon ExFim3 Marob 00,20" i i " .,�c� - ��..-� .u+..ica.sAa va .t5aa.s.�a.cc� .ra�t�+�_-aa_.,ca a..avu -- .,�;.,P•r:>.,-w� 3�;,. _ "Kk MANk (Where the��Vlicmt is not the owner) I/We, Ge owners of the property identified as SCTM# 1000- ' ay�ln the town of �� New Fork,hereby authorizes t�act as my agent and handle all . .. necessary work involved with the application process for permit(s)£rorn the Southold Town' ; Board of Trustees for this property- Property Owner Signature Property Owner's Signature SW6RN TO BEFORE ME THIS —DAY OF t"q ��,% �i � 20 a ell M j Notary Public -- . JEREMIAH P MANNING ; Notary Public,State W4 NeW UK Qualified in Albany Cgunty No.02MA478f3999 Commission Expires MArch$0,2 i ""°l�%'� ." �'=s'" '"�F rs 4^}' -a.'R'.a";:F:,rc - ;�^m;.g^.s..,-:T.:o.....s p.,..:-;samrw•. 5,�:.. r•e ^s»�,.f'.•;;y,.,.�,�: a�,nr- �- `a};"",.:.� .g�'�';a;��. `� .e1� �. 9, •` t.-,.�:.•�" �"i .'�., t�"l �:�'� fr.µ,y.r,, cz;,�>.'=�,�vy.iw.,„ ^y�r �'�'��� •.�, �f.:r. `dSp. M:..^n4 �,>-.'6.,4n. �yk`.w;xa i,. /v n- r s• �. 7.,,byf°,:>''�^.�X> �r��;�,.,, ;u.>,f, s,cr .� .u. _ ;�'F•. „�" ';ti">�: .�3�'''::., r�.3�:Y. ;�,,,.. �;",•. „af= �;-.r.;ts,gvYn"� ;�z;�., .>t �'��,, �;.:Y�-'s � "��>'.�,a� a�."r rr�,?`> t �`�ti'm:�e ',.$j} it�'C .`f; � Y.4W $/.'. .f .X,; ".�t� �n+.rG�S �.�t ,)B6•�� .✓y'•�i��".L>�.'+� k r�,1,.,�}{'�s Y.:t �'.v .'.I'O'>t, E, ,i- .d�'.a,L�'&�. Y •.<g. '�'v�"Fera fi,;ik, .�, �^JY', "G '4' �. .,�� rre+ .Zi£•K,. .=.0 :F'-, a 'k.= -:�; ';�.wr• =,s.<,33 4a,g' f '�. ,�d'Y�;S,,•��,A*�z,..`�,•}"F�,:• 5�f-ir°-v� ,.��f?r" � f:�«"�.,��..�.a`".�.: �. e'.d.`�' a�a•"-�e'� r.��•"��'p.w_ ':, `. „r t„rF#. ._.,,,. •�s, "-' `�i°�• ��- �"• r.y � arm wf;,. �'sa.,. 4' ���w��%".��. �:,ii•4 w,'..34,..;s:i'w:+Hae._:Y.i.:,,.:.w4.sk..«, �.•��A�>,::s...s�:pt.«La.,�:.'°:w4»:F:.io-•E.�:x k�s%wt<:s..�>: „cz".'..,:....e.:.�.:,,�amw. .F"Z,X.��w,..<,,.'s"ia,«...<m««....r,.� µ.l��' ,'.;.� ,+.r«,N,_»,;..c� f Board of Trustees nf.Ya .•.�•••• r. :.y ,. a AFFID_ 1 TIWAB ��� -� ��d� ,�d`' BEING DULY SWORN R OVE DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT COIVTOAINED HERE N )DESCRIBED PERMIT(S)AND THAT ALL STATE ARE TRUE TO THE BEST OF))ISMER KNOWLEDGE AND BELIEF,AND THAT ' ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION a AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. . n THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTIIOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND AL I:�I)AIVIACES E AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S);IF" GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY,T o INSPECT THE-PREMISES IN CONJUNCTION WITHHORI HIS )THE BOARD OF INCLUDINING A FINAL INSPECTION. I FURTHER TRUSTEES TO ENTER ON'T'O MY PROPERTY AND AS REQUIRED TO INSURE LAND OR COASTAL COMPLIANCE WITH ANY CONDITIOo EROSION PERMIT ISSUED BY THE BOARD TRUSTEES DURING THE TERM ' OF THE PERMIT. j afore of a caner Signature of Property Owner E n v\ 2U SWORN TO BEFORE ME THIS a DAY OF y � P - --TvuNotary Public JEREMIAM F MANNING " j Notary Public,State of New York Qualified in Albany county No.02MA4766991 E Commission Expires March 30,20. . 3 iS i fi P . y< ��, i.T1JGiLL Vi iitdr'f VGS"..r7 .Cij./i./��-'-`e-a 41V1 • •,t" :XX� �aS ��Y� {J i,ii Vt S.i li i ,} (Where the applicant is not the owner) ; I/We, PAI8��G01JQ> rr owners of the property identified as SCTM# 1000- 360 pA&K Air) 9.4 in the-town of New York,hereby authorizes ion&PhAn INC, to act as my agent and handle all necessary work involved with the application process for permits)from,the Southold Town Board of Trustees for this property. P e O er` ign tune Property Owner's Signature f" v " SWbRN TO BEFORE ME THIS DAY OF 20 , Notary Public .4,. JEREMIAH F.MANNINQ Aubllc,State of New York ualified in Albany County No.02MA4766991 Commission Expires March .K : „rY 99 "�',2''` ...�.�`�,.Krz�'""-,4• �;;a,�aT•'r `s<,� Aq:w ^- r�..°•;�:'` t. 4,ir :e%, �,os�r< <_,r s:�:; _� `�; ;ia. , '� Fn��z_ =✓f�` ,�� %r: - n ".+ ', g„y.-.., ' gy .,.�:d" `• r wk:Y.•z.« ,• p fN"i.'4`§.�:if� "` „e Y'F sFp' f K. ,w Y.g. �y...,h�. "'iw"•' .�, k ,”:k.;<,�...,ai-%' %"o-°r''D'�:v' r,,;" ``:,,33i ` +-�z.P% •-,�, 6,;;•, .xa. "'T • 'al N� < s�.(. _,s _ T,s''' ..ii.' 4rti..«�r.':,.,; uww.u"'..:.,;..x..:ik7`:.::w,.i+d.:iw..:.,.s:..i$«;a•."_:s..3: 1 ✓a `s"' �;:,.'..L,1 ia .v:xw..:�.sF..r .S.�.s. "�,s.z.b«.xt sw�8ssw s'"2.:iz� '•1 AFFIDAVIT 1 a , ,�� (� BEING DULL'SWORN' DEPOSES AND AFFIRMS TH AT{�HE/Spl IS THE�I'P�I7..I�Ci A�N.F,`7��T'O�7I��� I' dt' -q-dV DESCRIBED �9-R �tZ�i�A►' Il�T ALL STAT tATEYIEN S CO Ja.AIN9b �13i+I < - A ` $UE TO THE BEST OF I S/ I KNO ..,EDGE AND BELIE',A THAT ALL VOI3 �. E DONE Iii TBE 1 IA I SET FORTH IN T S A�PL�CAT'�Ol� _ AND AS Y BE APPS® D B THE SOUTHOLD TO ,13OA OF TI��S �Sv THE APPLICANT AGREES TO HOLD THE TOS OF SO OLD AND-T HE BOARD OF TRUSTEES I'IA I+SS Al' D F1�E+E FROM ANY AND,AI-L D1 OACES ' AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PE�Li 'I's(S), GRANTED. .fir COMPLETING TIES �APPL�I+�C+,�A7 ION �LI AUTHORIZE- UTHOR ZE'I'HE DING THE RUS�„ ES9 THEIR A`�4�'rl'f 9.(S) OR a•'PRF �.7 +1� 9, CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO Il'iSPECT T PREMISES IN WITH THIS APPL'CAT'ION7 INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOAR OF `I'I{IJSTEES TO ENTER ONTO'O My pROpERTy AND AS REQUIRED D TO INSURE COMPLIANCE NVITH ANY CONDITION OF ANY WETLAND OR COASTAL ? EROSION PERMIT'ISSUED BY THE BOARD OF TRUSTEES DURING THE TEF' OF THE PERIVHT. Com- -` Sij�at—�are of�Prop:5w-ner Signature of Property O-,veer SWORN TO BEFORE ME T141S OA YOF ,20 ' Y) 1 Notary ublic jER-EMIAH F.MANNING � ►Public,Mate of New York Q'01illed in Albany County, Igo.02MA4766991 3 ¢ 44Qr�Expires Larch 30,2�e F f 3 4 Pr AUTHORIZATION y .N (Where,the applicant is not the owner) 1/We, owners of the property identified as SCTM# 1000 6 d 'P�ob�,K� f1l �( in the town of . New York,hereby authorizes V.• lrleuo to act as my agent and handle all ` necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for thisro P PAY• , Property Owner's Signature Property Owner's Signature SwbRN TO BEFORE ME THISDAY OF20 \j No# Public �'Y JEREMIAH-F.MANNING Notary Public,State of New York Qualified in Albany County <y No.02MA4766991 - Commission Expires March 30,20-2,;L- 7 0,20 2 • f� , - aq. ,. ",.' "�•:?[�,s:,^.>^' .,.p:." "f's.�: q..%.j.."'_ $` .M:a ' '• ��' w;4✓s'. /.".� 4' .`.O^ ,.S',iyrq-'.<3; ~° '�R�'.•<;K'..�F,.% ::i. T' �s, ��r���� � �• sip . w ,, ,Y, ^ y ? _ k .'+� •Dr,_ .r s 4, C .. <z-.9f„ R�,,. ..,F,t d�+%` ,d as<! , ,la v �» '+`;{m°'v, r ," .:,,a'?5; :i /.n°' td3'• i*M tt� ."'i'�, r b x mow„ `. 1 <v•^ .. I'>�.>�, ,k • .. '":»,".<......a, ;.. ..,. ._..'�:i; ..:inn^:i,:;a ,.iz.�."�....,���z.' .:r�, �a',,:;.,, .:; .'<: .,:..`•' dn.'g.ffiz '- � Postal1 IVIA V! 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Paul Carey Cssidy Revocable Trust 123-8-27.0 c/o Paul Carey 6065 Bluff Heights Dr Cumming GA 30040 2.) Barabara Helies/Anthony Helies/Michael Insel 123-8-28.3 Brenda Helies 45 Shady Hill Rd Weston MA 02493 STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on tfle day of /V0(J0& ,2011, deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Cto 7"- kY that said Notices were mail o each of said persons by CERTIFIED MAIL/RE URN RECEIPT. i I Sworn to^bpfore me this Day of ty d V ,20 r Notary Public MEI ANTE V BROWN Notary Public,State of New Vb* No.01 BR4908712 Qualified In Suffolk County Commission Expires October 19, Michael J.Domino,President 4ti FF0�'�O� Town Hall Annex John M.Bredemeyer III,Vice-President GV_ 54375 Route 25 Glenn Goldsmith CIO P.O.Box 1179 A.Nicholas Krupski 0 ��ry Southold,NY 11971 Greg Williams ��0 app {Y 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 MICHAEL GIACONE COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING THIS FORM IS TO BE COMPLETED AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE 1, wy oAal*� �r , residing at/dba Sy0(OX being duly sworn, depose and say: That on the S-day of AUCv 40W, 2018, 1 personally posted the property known as 366 PAYWI PJXJAE� E05�T_ 75- by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,November L,4, 2018. Dated: 1i IN - (sign re) Sworn to before me this day of NUl/20 /5 MELANIE V BROWN Notary Public,State of New York No.01BR4908712 Qualified in Suffolk County�b�1 Notary Public Commission Expires October 19, v v a ® e O m m f 3 rl ® r9 Ill ..0 Certified Mail Fee in ® in Ln L in in Extra Services&Fees(checkb0"eddfae vs appropriate) 1-9 e ® � � ❑Retum Receipt(hardwpy) $ 0 ® C3 C3 ❑Return Receipt(electronlc) $ Postmark C3 ® I3 0 ❑Certified Mail Restricted Delivery $ Here ®.m® 0 E:3 ❑Adult Signature Required $ ® []Adult Signature Restricted Delivery$ E3 O 0 Postage rl o rl ra Er ® IT Ir O O ClTotal Postage and Fees ® $ ® Sent To'Br it 5 O ® E3 C3 SNo--------- -- - - c ------------------------------------------- V- 171-- � --tr or Box N� ---- ---------�----------- 7 - ------------------ ii ® ® p e • • • j IN Complete items 1,2,and 3. A. Signature I ■ Print your name and address on the reverse x 0 Adddredre A I so that we can return the card to you. ssee ` ' ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery I I or on the front if space permits. I 1. Article Addressed to: Is delivery address different from item 1? Q Yes PAU sIPOL 14CA f If YES,enter delivery address below: ❑No 45- �r(QyLdla tdelt _ l��' �n rn A- 02 II'�III'I I��I I�I Ill V I I I II V I I I III�I fI I I �I� 3.❑❑Adult Service 0 Registered Mall- I Adult Signature Restricted Delivery ❑Registered Matt Restricted 9590 9402 3607 7305 3557 49 13 Certified Mail® Delivery ❑Certified Mail Restricted Delivery ❑Rettmt Receipt for crianise ❑Collect on Delivery 11 Signature dCorrfirtnatlon7°° 2. Article Number(transfer from service label 0 Insured on Delivery Restricted Delivery ❑Signature Confirmation E ❑Insured Mail Restricted Delivery Restricted Delivery I (over$500) I. PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt o — m ® A © m Ir Er IT- C3 C3 C3 ° ri ® r l rl r%- 171- , 1� � :1( U ;:,,) (72 —0 .A —0 Certified Mad Fee V7 s. L1 u7 ® Ln Ln Extra Services&Fees(checkbox add lee as appropriate) ® ❑Return Receipt(hardcopy) $ • ® r 3 c3 ❑Return Receipt(electronic) $ Postmark • C3 C3 C3 ❑certified Mail Restricted Deanery $ Here C3 ® r3 t3 ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ C-3 O O Postage 1.9 o ® r-91 r9 g C3 ® O 0 Total Postage and Fees N --�- &Fri , e City t e.ZIP 4- ---- j in`1` a- CSA- :,, i r, „ •, • Ir 1 d-OMPLEYE MIS SEC TIQN I M Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery I I or on the front if space permits. j 1. Article Addressed to: D. Is delivery address different from Item t? 13Yes .1"D4 If YES,enter delivery address beloW: p No 12�V6c�-bll6 Gates 13L.V FF- Weir7hts IIIIIIiII IIII1111111I II II III IBI I IIII Illll II III 3. Service Type ❑RegisPriority Mall dMallress® ❑Atlutt Signature ❑Registered Mail*"' ❑AdultSignature Restricted Delivery ❑Registered Mail Restricted ❑Certified Mail® Dellvery 1 9590 9402 3607 7305 3557 25 ❑Certified Mail Restricted Delivery ❑Return Receipt for j ❑Collect on Delivery Merchandise I 2. Article Number(Transfer from Service labeg ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation"M I ❑Insured Mall ❑Signature Confirmation I ❑Insured nsurr d Ma 1 Restricted Delivery Restricted Delivery (ov �I00) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Retum Receipt _••� t NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: 3U 0 ?A'KIG � T' SCTM# YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to reguest a Permit from the Board of Trustees to: k WW46 wd,'rI 40a JFWAAX 0-76" 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: I OW . a2, — J" —20,,l 30 PAIC(4- 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: DATE: 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. CATHERINE GIACONE BARBER MICHAEL J. GIACONE JAMES A. GIACONE NICHOLAS A. GIACONE JOSEPH J. GIACONE PHILIP J. GIACONE PROPERTY OWNERS NAME: DIANE GIACONE STETTER MAILING ADDRESS: ?*11LIfCdi�eDnt 1.995 fflSHf0_IQcll2l.r&ar hj� 124s-rl PHONE #: 5t —/ AGENT: - V1J 1AJ*-1 A/C MAILING ADDRESS: P6 _WX 4A,00- PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience_ T I NOTICEIS,HEREBY GIVEN that a-,PARc�`Hearing will. be held by the Southold Town Board of . Trustees a't the Tortin 'Hall; 53095 Main Road, Southold, New Yorle, .concerning this property: OWNERS) 0F , RECORD: MICHAEL GIACONE;: SUB.J-ECT ,CSF PUBL'IC:.H-EARIN-G,: For-an Ar endment,to wetland Permit J71,818 to ex' tend the existing groin 20' landward- to -prevent further erosion.; install a ±20 linear foot b®ulder revetrnent ex' tending from the soufih easfi corner ®f, dwelling to, west side of gr®i„n 'consisfiing of 1 -2 tomstone armoring and rip rap base; and ,a total) bf Sor cubic yards'of,clean sand fill -to be added to replenish dune over septic system; and entire diar�e vuill be re-vegetatedifih native species (i.e,. beach ,agrass, ” . bayberry,) plantings. :-Lo'cated: 360. Park Avenue Extension, Mattituck. SUM# 1,000= 12:3-8-28.1 CTINi':E & DATE -OAF PUBLIC' HEAR'ING : : 1Nednsdas Noverber 14; 201 = at .or about 530P. M. If you` have an interest in .this.project, you are invited to.view the Town files) which are. available for inspection prior,to the day of the hearing during normal business days between , the hours of 8 -a.m. and' 4 p®rh. - BOARD OF TRUSTEES *.TOWN .OF SOUTHOL' D * (631). 765-1892- PROPERTY LOCATION: 360 Park A--- `:xt, Mattituck IVY 11952 TAX MAP 123-8-28.1 = - DF�P LEGAL PROPERTY NAME: h0 Li Catherine Giacone Barber (GgRDWN p\,S James A. Giacone CREEK Joseph J Giacone Michael J Giacone F1pAT Nicholas A Giacone Philip J Giacone ,+ Diane Giacone Stever AGENT:W.Jonathan Fabb, President Twin Fork Landscape Contracting, INC PO BOX 460 Cutchogue NY 11935 PH: 631-734-6643 NL -..BOG- • � ?ER -BOG-•- FLAG I 1' O fOt A4-GA•5Pa d Coad aY ++ f _ +` O� .. POLE + r + +-0-p ZZ i O O GJON— (v cr �pv� CA 4 w- W s, F�pN SIL �i + t �4 MNNIGH`NP 75.5�+ Z 0 MEAN LOW WATER UNE r0 _ ---GREAT PECONIC DAY--- ��' ,NUTILt: Uim Ht: AKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: MICHAEL GIACONE SUBJECT OF PUBLIC HEARING : For an Amendment to Wetland Permit #7188 to extend the existing groin 20' landward to prevent further erosion; install a ±20 linear foot boulder revetment extending from the south east corner of dwelling to west side of groin consisting of 1 -2 ton stone armoring and rip rap base; and a total of 50 cubic yards of clean sand fill to be added to replenish dune over septic system; and entire dune will be re-vegetated with native species (i.e. beach grass, bayberry) plantings. Located: 360 Park Avenue Extension, Mattituck. SCTM# 1000- 123-8-28.1 TIME 8t DATE OF PUBLIC HEARING : Wednesday, November 14, 2018 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1692 Town of Southold ILWZP CONSISTENCY-ASSESSN ENT 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 Southold Local Waterfront Revitalization Program. A proposed ,action will be_evaluated as to, its -.sianificarik beneficial and-adverse effects upon the coastal kea.Nwhich-includes all ofSouthold-Tawn).. 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained-in detail',-1isting both supportinz and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall notbd.undeftaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# I ern ` t PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate-response): (a) Action undertaken directly by Town agency(e.g.capital El construction,planning activity,agency regulation,land transaction) (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: s. Nature and extent of action: il' *0UE<T b&-SCe( ?T76-P--J fir_ S(79- Location of action: N Site acreage: Present land use: �SID�i � Present zoning classification: 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: 71�/_- N f (b) Mailing address: eo 60Y _/ (49 y _ 6'V (c) Telephone number: Area Code( ). �.7. __ 7 3 q . _ & t4p qJ (d) Application number,if Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes Q No - If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. 11M VC-L V�COASTVOLICY; Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, ` preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. 0-Yes .0 No Q Not Applicable Attach additional sheets if necessary f Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria Yes,Fl No L� Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria .❑ Yes ❑ No [?rNot Applicable { F Attach additional-sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LVVRP Section III—Policies Pages S through 16 for evaluation criteria FlYes ❑ No of Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —PoIicies PrNo through 21 for evaluation criteria Yes Vot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. a a Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and 'improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes [] No Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 0 f F' J Yes FI' NoE?rNot Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. 0 YeO No u Not Applicable -- Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑,Yes ❑ No [Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. � ; ❑ Yes ❑ No U Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑,Yes ElNo evU Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No 2Not Applicable PREPARED BY _ .--. - -___-=-- _---- TITLE_ DATE Lj t \ Twin Fork Landscape Contracting, Inc. P.O. Box 460 Cutchogue, NY 11935 PH: 631-734-6643 FX: 631-734-8354 Email: twinforklc@optonline.net httpJ/www.twinforklandscapecontractincg.com September 28th, 2018 RE: SCTM# 1000-123-8-28.1 360 Park Ave Ext., Mattituck, NY 11952 RE: AMMENDMENT TO PERMIT#7188 To the Board of Trustees, Attached provides you with a completed wetland application with required documents, updated survey and site plan. At this time, we are requesting an amendmwt to permit #7188 dated September 23, 2009, copy attached. We are requesting to modify this permit by expand the groin structure 20' landward to further protect the property. Also include a revetment wall along SE corner of property to further protect partially exposed septic system. The plan also includes area of native species planting to further stabilize dune area. Attached provides new survey, application, site plan and project description to amend permit#7188 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghos±o, 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 1st day of construction ¼ constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7188 DATE: SEPTEMBER 23, 2009 ISSUED TO: MICHAEL GIACONE PROPERTY ADDRESS: 360 PARK AVENUE EXT.~ MATTITUCK SCTM# 123-8-28.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trnstees adopted at the meeting held on Seotem, ber,2,3e 2009, and in consideration of application fee in the sum of $250~00 paid by Michael Giacone and sdbject tO the Terms and conditions as Stated in the Resolution the Southoid Town Board of Trnstees authorizes and permits the following: Wetland Permit to replace, in-place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin; the groin Will be low-prof'de, with the height no to exceed 12" above grade on the down-drift side, and as depicted on the site plan prepared by Harold E. Gebhard, Architect, last dated October 7, 2009, and received on October 9, 2009. IN wITNEss WHEREOF, the said Board of Trnstees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Pennittee Michael Giacone, residing at 360 Park Avenue, Ext., Mattituck, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released fi.om 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. 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. 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. 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. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 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. That if future operations of the Town of Southold require the ~moval 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. That the said Board will be notified by the Permittee of the completion of the work authorized. 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. 2 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 September 23, 2009 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Clay Colefield Enviropermits, Inc. 12 Beecher Street Coram, NY 11727 RE: MICHAEL GIACONE 360 PARK AVENUE EXT., MATTITUCK SCTM# 123-8-28.1 Dear Mr. Colefield: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 23, 2009 regarding the above matter: WHEREAS, Enviropermits, Inc. on behalf of MICHAEL GIACONE 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 June 29, 2009, 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 September 23, 2009, 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 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 MICHAEL GIACONE to replace, in-place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin; the groin will be Iow-profile, with the height no to exceed 12" above grade on the down-drift side, and as depicted on the site plan prepared by Harold E. Gebhard, Architect, last dated October 7, 2009, and received on October 9, 2009. 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, m~es F. KinC~gg ~ President, Board of Trustees JFK/eac 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 Please be advised that your application dated ~T~ne_ o1,~., c~9 has been reviewed by this Board at the regular meeting of ~-~oD ~,,~l~e-~,~,, c,~::~e/ and your application has been approved pending the cor~letion of the- following items checked off below. Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $. BY: James F. King, President Board of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August21,2009 Mr. Clay Colefield Envimpermits, inc. 12 Beecher St. Coram, NY 11727 RE: Application of Michael Giacone 360 Park Ave., Mattituck SCTM#123-8-28.1 Dear Mr. Colefield: In regard to above-referenced application currently being reviewed by the Board of Trustees, we have arranged a joint inspection with Jay Tanskie, Coastal Processes and Facility Specialist with the NY Sea Grant Program, as discussed with the applicant at the hearing on Wed., August 19, 2009. The inspection date has been set for Wed., September 9, 2009 at 10:00 AM, if you or your client would like to be present. Feel free to contact our office if you have any questions. Very truly yours, n M. Standish, Secretarial Assistant Board of Trustees Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 15, 2009, the following recommendation was made: Moved by Peter Young, seconded by James Eckert, it was RESOLVED to NOT SUPPORT the Wetland Permit application of MICHAEL GIACONE to replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side. Located: 360 Park Ave. Ext., Mattituck. SCTM#123-8-28.1 Inspected by: James Eckert, Peter Young The CAC does Not Support the application and recommends complete removal of the groin. Vote of Council: Ayes: All Motion Carried James F. King. President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio. Jr. PO. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: MICHAEL GIACONE requests a Wetland Permit to replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side. Located: 360 Park Ave. Ext., Mattituck. SCTM#123-8-28.1 rea to be impacted: er Wetland Freshwater Wetland Sound Bay Dista~e of proposed work to edge of wetland Paj;tFof Town Code proposed work falls under:' ~'Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment ~Ad ministrative__Emergency Pre-Submission __Violation Info needed: /~_ ~, ._¢~1~,r~¢~ Conditions: D. Dzenkowski __J.Dohe~y __P.Dickerson other ergen__~.B.Ghosio, Form filled out in the field by Mailed/Faxed to: Date: Appfication By: Enviropermits Inc. 12 Beecher St., Core, m, NY, 11727 631-375-4534 by C. Colefietd SCTM# 1000-123~8~2B Datum = Mean Low Water Job Site: 360 Park Avenue EXT. Mattituck, NY 11952 Applicant: Michael J, Giacone 23 Westphal Drive Delmar, NY 12054 Machinery access by land and sea Photo's Taken 10/04/08 REV Photo Sheet .001 Appficafion By Env~mpexmits Inc 12 BeechexSt, Cot'am, NY. 11727 63 ! -375-453,:I by C Co/efield SCTM# 1000~123~8-2B Datum = Mean Low Water I Job Site: ~k Avenue EXT. Mattituck, NY 11952 Applicant: Michael J, Giacone 23 Westphal Drive Delmar, NY 12054 Machinery acc/ess by land and sea 1:1 ~ Photo's Taken 10/04/08 P~ Photo Sheet New York State Depa ent of Environmental Conservatton Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www.dec.state.ny.us Alexander B. Grannis Commissioner April 20, 2009 Michael J. Giacone 23 Westphal Drive Delmar, NY 12054 Re: Permit #1-4738-00429/00003 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at' the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Eugene~R. Zamojcin Environmental Analyst GRZ Enclosure 'DEC PERMIT NUMBER 1-4738-00429/00003 FACILITY/PROGRAM NUMBER(S) PERMIT Under the Environmental Conservation Law ~NSERVATION EFFECTIVE DATE 4~20~2009 EXPIRATION DATE(S) 4/19/2014 TYPE OF PERMIT · New D Renewal [] Modification [] Permit to Construct [] Permit to Operate [] Article 15, Title 5: Protection of Waters [3 Article 15, Title 15: Water Supply [] Article 15, Title 15: Water Transport [] Article 15, Title 15: Long Island Wells [] Article 15, Title 27: Wild, Scenic and Recreational Rivers · 6NYCRR 608: Water Quality Certifica- tion [] Article 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation [] Article 24: Freshwater Wetlands · Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 360: Solid Waste Mana~lement [] Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management [] Article 34; Coastal Erosion Management ~ Article 36: Floodplain Management D Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control PERMIT ISSUED TO ~ TELEPHONE NUMBER Michael J. Giacone I 518-439-7255 ADDRESS OF PERMITTER 23 Westphal Dr, Delmar, NY 12054 CONTACT PERSON FOR PERMI'CrED WORK I TELEPHONE NUMBER Enviropermits, Inc., 12 Beecher St, Coram, NY 11727 I 631-375-4534 NAME AND ADDRESS OF PROJECT/FACILITY Giacone Property, 360 Park Ave EXT, Mattituck, NY 11952 SCTM# 1000-123-8-28.1 COUNTY I TOWN I WATERCOURSE I NYTM COORDINATES Suffolk Southold Great Peconic Bay E: 709.9 N:4540.2 DESCRIPTION OF AUTHORIZED ACTIVITY: In-place removal and replacement of the existing jetty structure. All work shall be done in accordance with the attached plans prepared by Enviropermits, Inc., last revised on 3/20/2009 and stamped NYSDEC approved on 4/20/2009. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, ail applicable regulations, the General Conditions specified and any Special Conditions included as part of this ~rmit. DEPUTY PERMIT ADMINISTRATOR: ADDRESS Region 1 Headquarters SUNY Circle Road, (~ Stony Brook, Stony Brook, NY 11790 - 3409 Susan V. acktrman~ (GRZ) I 50 AUTHORIZ~ SIG ~T~RE~ I DATE 4/20/2009 Page 1 of 4 YORK STATE DEPARTMENT OF ENVIRONMENTAL C(~RVATION SPECIAL CONDITIONS 1. Storage of Equipment, Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 50 linear feet from the tidal wetland boundary. 2. Jetty Construction The authorized jetty shall not exceed 18" in height over the existing grade of the downdrifi beach and shall not extend seaward of apparent low water. 3. No Structures on Jetty No permanent structures shall be installed on the authorized jetty without first obtaining written Department approval (permit, modification, amendment). 4. No Construction Debris in Wetland or adjacent Area. 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 or protected buffer areas. 5. Notice of Commencement At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of, and understand all terms and conditions of, this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work. I DEC PERMIT NUMBER 1-4738-00429/00003 IPage 2 of 4 'Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnity 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, 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 prevision 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 ara 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 u pon the land s or inter[era 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 bythe Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized rapresentative 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 SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all 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 modity, supersede or rescind any order or determination previously issued by the Department or any of the terms, 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 or transfer granted 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); b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification ara to be submitted to: Regional Permit Administrator, SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modity, 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 terms 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 1-4738-00429/00003 Page 3 of 4 ~ YORK STATE DEPARTMENT OF ENVIRONMENTAL C RVATION ADDITIONAL GENERAL ~IDITIONS FOR ARTICLES 15 (TITLE $) 25, 34 AND 6NYCRR PART 608 (TIDAL WETLANDS) If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 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 or along the bed of a waterway or floodplain, deposits within any regulatory floodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 5. 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 been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation m ay require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration, If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Enviropermits, Inc., last revised on 3/20/2009 and stamped NYSDEC approved on 4/20/2009. DEC PERMIT NUMBER Page 4 of 4 1-4738-00429/00003 SITE PLaN NYSDE; Proposed Activities: 1. Replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side Summer address Mr. & Mrs. Helies / i / 440 Park Ave ext. Mattituck, NY 11952 45 Shady Hill Rd. ~ston, MA 02493 Existitlg residence Mr. & Mrs. Cassidy ~ ~ ~ X I: \Distance to opposite shoreline 270 Park Ave ext, ~ I ~ greater then 5 miles 6187 Buckskin Dr. Farmington, NY 14415 Job Site: Application By: 360 Park Avenue EXT. Enviropermits Inc. Mattituck, NY 11952 12 Beecher St., Coram, NY, 11727 Applicant 631-375-4534 Michael J, Giacone by C. Colefield 23 Westphal Drive Delmar, NY 12054 SCTM# 1000-123-8-2BA I Machinery access REV by and and sea Prepared 03/20/09 .003 Datum = Mean Low Water lin = 30fl. 0in. I Page 1 OF 3 PROJECT PLAN ONE // X. Summer address Mr. & Mrs. Helies 440 Park Ave ext. Ma.itu(k, NY 11952 Writer address 45 Shady Hill Rd. Summer address Mr. & Mrs. Cassidy 270 Park Ave ext. Mattituck. NY 11952 Writer address 125 Patience Place Lane Mooresville, NC 28117 Co-owned by Mr. & Mrs. Carey 6187 Buckskin Dr, Farmington, NY 14415 existing 60' wooden groin Proposed Activities: 1. Replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side NYSDEC ApHW & ApLW delineated by C. Colefield on 10/15/08 ApHW & ApLW delineated by C. Colefield on 12/06/08 Job Site: Application By: 360 Park Avenue EXT. Enviropermits ~nc. Mattituck, NY 11952 12 Beecher St., Applicant: Coram, NY, 11727 Michael J, Giacone 631-375-4534 23 Westphal Ddve by C. Colefield Delmar, NY 12054 SCTM# 1000-123-8-21~.1 Machinery access REV by land and sea Prepared 03/20/09 .003 Datum = Mean Low Water lin = 30fl. 0in. I 2 OF 3 I CROSSVIEW 6" X 6" upper wale 6" X 6" lower wale "Shore Guard 425" vinyl sheathing 10" X 10' pilings 8' o/c " ~ .. GREAT PECONIC BAY I I III I I II ~ .~-'---'~"--'-~73'---._.(._.__._~' ) OJdexjstJ~gpjjjt~g$ -'~ "~'~" ~ ' ~.~,,~ ApHW t, U U ~ BoEom ) ApLW is one foot ~low 10" X 1~ ff~/c ~h~aw~d end of the 1~" existin~ulkhead ~ ApHW & ApLW delineated by C. Colefield on 10/15/08 Job Site: Application By: 360 Park Avenue EXT. Enviropermits Inc. Mattituck, NY 11952 12 Beecher St,, Coral, NY, 11727 Applicant: 631-375-4534 Michael J, Giacone by C. Colefield 23 Westphal Drive Delmar, NY 12054 REV SCTM# 1000-123-8-21~.J Machinery access Prepared 03/20/09 .003 by land and sea Datum = Mean Low Water lin = 30ft, 0in. Pa~ 3 OF 3 1. Replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side NYSOEC NaD CoNDmoNs OF / Proposed Activities: ApHW & ApLW delineated by C. Colefield on 12/06/08 DAVID A. PATERSON GOVERNOR STATE OF NEW YORK DEPARTMENT OF STATE ONE COMMERCE PLAZA 99 WASHINGTON AVENUE ALBANY, NY 12231-0001 LORRAINE A, CORTI~S-VAZQUEZ SECRETARY OF STATE Mr. Clay Colefield Enviropermits Inc. 12 Beecher Street Coram, NY 11727 May 29, 2009 Re: F-2009-0121 U.S. Army Corps of Engineers/NY District Permit Application - Giacone - Replace existing 81' timber groin with 71' of low profile design with vinyl. Peconic Bay, Town of Southold, Suffolk County General Concurrence - Proposal Modified To Be Consistent Dear Mr. Colefield: The Department of State received your modified proposal for the above referenced proposal on May 13, 2009. The modified proposal is redeigned to be 7' less in length and of a Iow-profile design as illustrated on revised plans dated 3/20/09. The Department of State has determined that this proposed activity, which has been modified to be consistent with the New York Coastal Management Program, meets the Department's general consistency concurrence criteria. Therefore, further review of the proposed activity by the Department of State, and Department's concurrence with an individual consistency certification, are not required. This General Concurrence is without prejudice to and does not obviate the need to obtain all other applicable licenses, permits, other forms of authorization or approval that may be required pursuant to existing State statutes. When communicating with us regarding this matter, please contact Gary Haight at (518) 486-3047 (e-mail: gary2haight~dos.state.ny.us) and refer to our file #F-2009-0121. Sincerely, Supervisor'6f Consistency Review Office of Coastal, Local Government and Community Sustainability cc: COE/New York District - R. Tomer NYS DEC Region 1- J. Pavacic Town of Southold - H. Cusack WWW,OOS,STATE.NY US , E-MAIL:INFO~DOS.STATE,NY.US REPLYTO ATTENTION OF: Regulatory Branch-Eastern Permits Section DEPARTMENT OF THE ARMY NEW YORK DISTRICT, CORPS OF ENGINEERS JACOB K. JAVlTS FEDERAL BUILDING NEW YORK, N.Y. 10278-0090 SUBJECT: Application NO. NAN-2009-000183-1 by Michael J. Michael J. Giacone 23 Westphal Drive Delmar, New York 12054 Giacone Dear Mr. Giacone: On April 9, 2009, the New York District Corps of Engineers received a request for Department of the Army authorization to replace, in-place, an 81 linear foot deteriorated timber groin with a 73 linear foot low profile C-loc vinyl sheathing groin heighten nor more than 18-inches above the grade on the down drift side. The site is in Great Peconic Bay located in Mattituck, Town of Southold, Suffoik County, New York. Based on the information submitted to this office, and accomplishment of notification in accordance with the applicable federal requirements, our review of the project indicates that an individual permit is not required. It appears that the activities within the jurisdiction of this office could be accomplished under Department of the Army Nationwide General Permit Number 3. The nationwide permits are prescribed as an Issuance of Nationwide Permits in the Federal Register dated March 12, 2007 (FR Vol. 72, No. 47). The work may be performed without further authorization from this office provided the activity complies with the permit conditions listed in Section B, No. 3, Section C, any applicable New York District regional conditions, the following special condition(s), and any applicable regional conditions added by the State of New York, copies enclosed. 1) Special ~ The permlttee understands and agrees that, if future operations by the United States re~ulre the removal, relocatlon, or other alteration, of the structure or work herein authorized, or if, in the opinion of the Secretary of the Arm~ or his authorized representative, said structure or work shall cause unreasonable obstruction to the free navigation of the navlgable waters, the permlttee will be required, upon due notice frc~ the Corps of Engineers, to remove, relocate, or alter the structural work or obstructions caused thereby, without expense to the United States. No claim shall be made against the United States on account of any such removal or alteration. This determination covers only the work described in the submitted material. Any major changes in the project may require additional authorizations from the New York District. Care be taken so that construction materials, including debris, do not enter any waterway to become drift or pollution hazards. You are to contact the appropriate state and local government officials to ensure that the subject work is performed in compliance with their requirements. Please note that this nationwide permit (NWP) verification is based on a preliminary jurisdictional determination (JD). A preliminary JD is not appealable. If you wish, prior to commencement of the authorized work you may request an approved JD, which may be appealed, by contacting the New York District, U.S. Army Corps of Engineers for further instruction. To assist you in this decision and address any questions you may have on the differences between preliminary and approved jurisdictional determinations, please review U.S. Army Corps of Engineers Regulatory Guidance Letter No. 08-02, which can be found at: httD://www.usace.armv.mil/cw/cecwo/re~/r~ls/r~lO8_O2.pd~ This verification is valid for a period of two years from the date of this letter, unless the nationwide permit is modified, reissued, or revoked. This verification will remain valid for two years from the date of this letter if the activity complies with the terms of any subsequent modifications of the nationwide permit authorization. If the nationwide permits are suspended, revoked, or modified in such a way that the activity would no longer comply with the terms and conditions of a nationwide permit, and the proposed activity has commenced, or is under contract to commence, the permittee shall have 12 months from the date of such action to complete the activity. All of the existing NWPs are scheduled to be modified, reissued, or revoked March 18, 2012. It is incumbent upon you to remain informed of changes to the NWPs. We will issue a public notice when the NWPs are reissued. This authorization is conditional on the apDllcant's receipt of the required coastal zone management concurrence or waiver from the New York State DeDar~m-~t of State (NYSDOS). No work may be accomplished untll the re~ulred approval from NYSDOS has been obtained. Within 30 days of the completion of the activity authorized by this Dermlt and any mitigation required by this permit, you are to sign and submit the attached compliance certification form to this office. If any questions should arise concerning this matter, please contact Ms. Denise Butts, of my staff, at (917) 790-8513. Enclosures CC: Enviropermits Inc. 12 Beecher Street Coram, New York 11727 ~fge, ~aF se~eerSn Per, its Section NOTIFICATIO~TRATIVE AP~ PROCESS AND REQUEST FOR APPEAL i App icant: Michael J. Giacone File Number: NAN-2009-00183-EBU Date: ~t1~¥ 0 5 ~ Attached is: See Section Below INITIAL PROFFERED PERMIT (Standard Permit or Letter of Permission) A PROFFERED PERMIT (Standard Permit or Letter of Permission) B PERMIT DENIAL C APPROVED JURISDICTIONAL DETERMINATION D X PRELIMINARY JURISDICTIONAL DETERMINATION E sECTION i ~ The foll6wing ldentifiea yOur fights and 0Ptions regarding an administritive appeal 0fthe above decision, Additional info a"0h b, fo.,d a y V eVfan o, Tew/ W;/re, Or c rPsre ii h0"S at Pa" 331 A: INITIAL PROFFERED PERMIT: You may accept or object to the permit. · ACCEPT: If you received a Standard Perm/t, you may sign the permit document and retain it to the New York District Engineer for final authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to eppeal the permit, including its terms and conditions, and epproved jurisdictional determinations (.ID) associated with the permit. · OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request that the permit be modified accordingly. You must complete Section II of this form and return the form to thc New York Disthct Engineer. Your objections must be received by the New York District Engineer within 60 days of the date of this notice, or you will forfeit your right to appeal the permit in the future. Upon receipt of your letter, the New York District Engineer will evaluate your objections and may: (a) modify the permit to address all of your concerns, Co) modify the permit to address some of your objections, or (c) not modify the permit having determined that the permit should be issued as previous]y written. After evaluating your objections, the New York District Engineer will send you a proffered permit for your reconsideration, as indicated in Section B below. B: PROFFERED PERMIT: You may accept or appeal the permit. · ACCEPT: If you received a Standard perrmt, you may sign the permit document and return it to the New York Dislrict Engineer for final authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all fights to appeal the permit, including its te'nns and conditions, and approved jurisdictional determ/nafions associated with the permit. · APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions thereto, you may appeaI the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the North Atlantic Division Engineer, ATTN: CENAD-ET-O, Fort Hamilton Military Community, Building 301, General Lee Avenue, Brooklyn, NY 11252-6700. This form must be received by the Division Engineer within 60 days of the date of this notice. C: PERMIT DENIAL: You may appeal the danial of a permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the North Atlantic Division Engineer, ATTN: CENAD-ET-O, Fort Hamilton Military Community, Building 301, General Lee Avenue, Brooklyn, NY 11252-6700. This form must be received by the Division Engineer within 60 days of the date of this notice. D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new information. · ACCEPT: You do not need to notify the Corps to accept an approved ID. Failure to notify the Corps within 60 days of the date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved ID. · APPEAL: If you disagree with the approved ID, you may appeal the approved ID under the Corps of Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the division engineer. This form must be received by the North Atlantic Division Engineer within 60 days of the date of this notice with a copy furnished to the New York District Engineer. The'~''Predminary 3]3 is not appealable. If you wish, you may request an approved JD (which may be appealed), by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the Corps to reevaluate the .iD. SECT!ON II; REQ~ST FOR APPEAL Or OBJECTIONs TO AN INITIAL PRoFpERED PE~T REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or objections are addressed in the administrative record.) ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to clarify the administrative record. Neither the appellant nor the Corps may add n~v information or analyses to the record. However, you may provide additional information to ciatify the location of information that is already in the administrative record. CoNT ,cT FOR Qt ST oNs If you have questions regarding this decision end/or the appeal process you If you only have questions regarding the appeal process may contact: you may also contact: Richard L. Tomer Michael G. Vissichelli, Administrative Appeals Review U.S. Army Corps of Engineers, New York District Officer Jacob K. Javits Federal Building North Atlantic Division, U.S. Army Engineer Division New York, NY 10278-0090 Fort Hamilton Military Community (917) 790-8510 General Lee Avenue, Building 301 Brooklyn, NY 11252-6700 (718) 765-7163 E-mail: Mich ael.G.Vissichelli~usace.army.mil RIGHT OF ENTRY: Your s~gnature below grants the right ofenlxy to Corps of Engineers personnel, and any government consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day notice of any site investigation, and will have the opportunity to participate in all site investigations. Date: Telephone number: Signature of appellant or agent. SIT PLAI I Summer address Mr. & Mrs. Helles 440 Pank Ave ext. E×istiog ! · HAY 0 5 2009 Writer address Neighboring 45 Shady Hill Rd. structures Weston, MA 02493 Summer address Mr. & Mrs. Cassidy 270 Park Ave ext. Mattituck, NY 11952 Writer address 125 Patience Place Lane Mooresville, NC 28117 Co-owned by Mr. & Mrs. Carey 6187 Buckskin Dr. Farmington, NY 14415 Proposed Activities: 1. Replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side existing 78' .w. ooden'q?o'ih ........ '~." -I~ 3~'~' ~ .~..~ ~ I ~Distance to opposite shoreline ~' -'-' -._~ ~.._ ~ ~ greater then5miles Application By: Enviropermits Inc. 12 Beecher St., Coram, NY, 1¢727 63¢-375-4534 by C. Colefield Existing % '~"~ Neighboring '% structures Existing/ / existing 60' wooden groin Neighbbring structures ApHW & ApLW delineated by C. Colef~e!d on 10/15/08 ~ ApHW & ApLW delineated by C. Colefield on 12/06/08 Job Site: 360 Park Avenue EXT. Mattituck, NY 11952 SCTM# 1000-123-8-2B Datum = Mean Low Water Applicant: Michael J, Giacone 23 Westphal Drive Delmar, NY 12054 lin = 30ft. 0in. I Prepared 03/20/09 .003 I OF 3 ~ PROdECT PLAN ONE Summer address Mr. & Mrs. Helies 440 Park Ave ext. Matt,ack, NY 11952 . ,E, xi~n. fl Writer address F~e hDonn \: 45 Shady Hill Rd. stru~ures .~ ~ Proposed 73' in plane /-- ........... _~ ..... Weston, MA 02493 .~-.. ~ replacement of groin ./ ~ CI 2s'----~-~ .... /7 (~ . ,/~ .~'. ~ .._.. _ -"-"- -L_..a - Sum~r address 270 Pa~ Ave e~. Ma~i~, NY 11952 , Writer address existing 60 wo~en groin 125 Pa~n~ Pla~ Lane Mooresvil~, NC 28117 Co-owned by Mr. & Mm. Carey 6187 Bu~skin Dr. Farming~n, NY 1~15 Proposed Activities: 1. Replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side ApHW & ApLW delineated by C. Colefield on 10/15/08 ApHW & ApLW delineated by C. Colefield on 17-/06/08 Application By: Enviropermits Inc. 12 Beecher SL, Coram, NY, 11727 631-375-4534 by C. Colefield SOTM# 1000-123-8~2B Job Site: 360 Park Avenue EXT. Mattituck, NY 11952 Applicant: Michael J, Giacone 23 Westphal Drive Delmar, NY 12054 IMachinery access by rand and sea, Prepared 03/20/09 REV .003 6" X 6" upper wale 6" X 6" lower wale 10" X 10' pilings 8' o/c CR:OSSV!E -- ApHW -- ApLW Bottom Proposed Activities: 1. Replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-drift side residence ~?' GREAT PECONIC BAY u [I ~[J~8~ _ Bottom ~ A-pLW is one foot below - 10"X 10' pih%gs 8' o/c I the seaward 181. existing bulkhead ApHW & ApLW delineated by C. Colefield on 10/I 5/08 ApHW & ApLW delineated by C. Cotefield on 12/06/08 Application By: Enviropermits Inc. 12 Beecher St., Coram, NY, 11727 631-3 75-4534 by C. Colefield SCTM# 1000-123-8-2B Datum = Mc~2n I r~t,t ~AIo~. .J. ob Site: 360 Park Avenue EXT. Mattituck, NY 11952 Applicant: Michael J, Giacone 23 Westphal Drive Delmar, NY 12054 Prepared 03~20/09 RE~ .005 DAVID A. PATERSON GOVERNOR STATE OF NEW YORK DEPARTMENT OF STATE ONE COMMERCE PLAZA 99 WASHINGTON AVENUE ALBANY, NY 12231-0001 LORRAINE A. CORTI~S-VAZQUEZ SECRETARY OF STATE April 22, 2009 Clay Colefield Enviropermits, Inc. 12 Beecher Street · Coram, NY 11727 Re: F-2009-0121 - M. Giacone U.S. Army Corps of Engineers/New York District Permit Application. Proposed 75' groin replacement two wave breaks. Peconic Bay, Town of Southold, Suffolk County Received Consistency Certification - Request for Additional Information Dear Mr. Colefield: The Department of State (DOS) received your Federal Consistency Assessment Form and consistency certification and supporting information regarding the above referenced proposal. However, pursuant to 15 CFR Part 930.58, the following data and information is necessary to enable the Department of State to adequately assess the consistency of the proposed activity with the New York Coastal Management Program as expressed in the Town of Southold LWRP: The Waterfront Revitalization and Coastal Resources Act (Article 42 of the NYS Executive Law, 19 NYCRR Part 600) requires that activities proposed to be undertaken in the coastal area of a municipality with an approved Local Waterfront Revitalization Program (LWRP) be consistent with, and advance, the policies and purposes of the LWRP. The submitted Federal Consistency Assessment Form (FCAF) indicates that the proposed project will not affect or be located in, on or adjacent to a beach or dune. Based on the information submitted, it appears that the proposed project will take place in, on, and adjacent to a beach (C.2.f.). The submitted FCAF also indicated the proposal did not involve the construction or reconstruction of a flood or erosion control structure· Groins are considered to be a hard erosion control structure and the proposed reconstruction needs to be analyzed in regard to applicable local policies of the Town's state and federally approved (LWRP). Also see question C.4. of the FCAF. Lastly, section D. Of the FCAF asks that if any of the questions in Section C are answered "yes" then the applicant or agent will: (a) identify, by their policy numbers, which coastal policies are affected by the activity, (b) briefly assess the effects of the activity upon the policy; and © state how the activity is consistent with each policy. Adequate WWW.DOS·STATENY.US · E-MAIL;INFO~DOS.STATE.NY.US information assessing the effects of the proposed activity upon the affected policies, or how the activity is consistent with the policies is necessary. The stated purpose of the activity is "private use." No apparent obstruction to access exists at the site, nor in the vicinity. A groin structure is designed to trap sand and does not provide or enhance access in any way. It appears the proposed groin reconstruction and expansion will project seaward of the applicants property and encroach upon publicly owned underwater lands, there fore reducing the public ability to access the waters' surface and column. Identification the underwater land owner and their authorization to complete the work, or evidence that the applicant has authority to complete the proposed work without the owners authorization is requested. Detailed analysis of the littoral drift of sediment in the proposed project's area needs to be provided. In that analysis, particular attention needs to be given to the length of the proposed structure and it's effect on the natural transport of sediment. Also, please provide additional information as to the alternatives to replacing the existing structure that have been considered, and an explanation why those alternatives are not feasible. Please provide the information requested above to the Department of State within thirty days from the date of this letter. Pursuant to 15 CFR 930.64(d), if this necessary data and information is not provided, the Department of State may object to your consistency certification on the grounds of insufficient information. You and the Corps of Engineers will be notified of our decision when we have completed our review of this project for its consistency with the New York State Coastal Management Program. The Corps of Engineers cannot issue a permit for this project unless the Department of State concurs with your consistency certification. Please call me at (518) 486-3047 if you have any questions. C~ncer.~' ~ Coastal Resources Specialist CC: COE/New York District - G. Nieves NYS DEC/Region 1 - G. Hammarth Town ofSouthold - L. Standish ENVIR OPERMITS Inc. 12 Beecher Street, Coram, NY 11 72 7 Ceil 631-375-4534 Fax 631-698-0229 enviropermits~yahoo.com October 7, 2009 James F. King, President Southold Town Hall PO Box 1179 Southold, New York, 11971-0959 RE: SCTM #1000-123-8-2B1 Subject: Permit Application for Michael J, Giacone, 23 Westphal Drive, Delmar, NY 12054 Project Site: 360 Park Avenue EXT, Mattituck, NY 11953 Dear Ms. Cantrell: Enclosed please find three sets of revised project plans dated 10/07/09 and company check for fifty dollars. The revised plans now show "The groin will be low-profile, with the height not to exceed 12" height above grade on the down-drift side". Sincerely, Envir~permits/{nc. Clay Colefield, Marine Biologist Cc: M. Giacone CM# 7004 1160 0001 4519 33496 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner" LWRP Coordinator Date: July 16, 2009 Re: Proposed Wetland Permit for MICHAEL GIACONE SCTM#123-8-28.1 Enviropermits, Inc. on behalf of MICHAEL GIACONE requests a Wetland Permit to replace, in place an existing 81' wooden groin with a 73', "Shore-Guard 425" vinyl sheathing groin. The groin will be Iow- profile, with the height not to exceed 18" above grade on the down-drift side. Located: 360 Park Ave. Ext., Mattituck. SCTM#123-8-28.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the below Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney .~q3oastal Erosion Permit Application ~Wetland Permit Application A men dm en t/Tr ansfer/F.,xt~ejl s ion ~-"~eceiv~d Application: /'D~r'~ ,.~eceived Fee:$ r~ .'.~ ' ~...L;~mplet ed A ppl~c'at~n __Incomplete __SEQRA Classification: Type 1 Type II Unlisted__ Coordinafion:(date sent) 4,~AC Referral Sent: 'q ~ ~/15ate of Inspection: __Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~q~lic Hearing Held: Q, Resolution: Name of Applicant Michael J, Giacone Office Use Only Administrative Permit J Address 23 Westphal Drive, Delmar, NY Phone Number:( )~-/ff -NS q- 'L?~,~- Suffolk County Tax Map Number: 1000 - 123-8-2b Property Location: 360 Park Avenue EX'r. Mattituck, NY t 1952 (provide LILCO Pole #, distance to cross streets, and location) AGENT: Enviropermits Inc., C Colefleld (If applicable) Address: 12 Beecher Street, COMA, NY 11727 Phone: 631-375-4534 ~Board ' ~' of Trustees Application Land Area (in square feet): 42000 sr Area Zoning: Rosidontial Previous use of property: Residential Intended use of property: Residential GENERAL DATA Prior permits/approvals for site improvements: DEC ACOE Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen, ded by a governmental agency? ~tr No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 1. Replace, in place an existing 81' wooden groin withe 73', "Shore-Guard 425" vinyl sheathing groin, The groin will be Iow-profile, with the height not to exceed 18" above grade on the down-ddtt side Area of wetlands on lot: ~00 sg. ~. square feet Percent coverage of lot: 2% % Closest distance between nearest existing structure and upland edge of wetlands: sv feet Closest distance between nearest proposed structure and upland edge of wetlands: sv feet Does the project involve excavation or filling? ¥ No Yes lfyes, how much material will be excavated? NA cubic yards How much material will be filled? N^ cubic yards Depth of which material will be removed or deposited: N^ feet Proposed slope throughout the area of operations: NA Manner in which material will be removed or deposited: 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): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Prevent fudher coastal erosion Are wetlands present within 100 feet of the proposed activity? No ~/ Yes Does the project involve excavation or filling? ~ No Yes If Yes, how much material will be excavated? ua (cubic yards) How much material will be filled? N^ (cubic yards) Manner in which material will be removed or deposited: ~3&/.~-o;,, Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Thoro will be no environmental impacts bg the replacement of this structure (groin). The §rein will act to stabilize the eroding beach sand by controlling sediment transport, The captured sand is needed to maintain wetland communities which stable at this time. PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR 2 PROJECT NAME Michael J, Giacone Park Avenue Project 3.PROJECT LOCATION: Town of Southord Suffolk Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 360 Park Avenue EXT, Mattituck, NY 11953 5. IS PROPOSED ACTION: r~ New ~ Expansion ~Modification / alteration SEQR 6. DESCRIBE PROJECT BRIEFLY: Proposed Activities: 1. Replace, in place an existing 75' wooden groin with a 75, 425 C-loc vinyl sheathing groin. 2. Place 2 cys. of clean fill.. 7. AMOUNT OF LAND AFFECTED: Initially 1/10th acres Ultimately 1/10th acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) r~Residentia, []Industrial [~Commercia, r--]Agriculture [~ Park / Forest / Open Space [--'"]Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or Local) 7'lYes [] No If yes. list agency name and permit / approval: ACOEs, DOS & Town of Southold 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? --]Yes r~No If yes. list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I Yes P-INo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor .~e .En,virop~mit~c. 12 Beecher St., Coram, NY 11727 Date: I il'la.¥ ~g Signature f//~.~ 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 (To be completed by Lead A~lenc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAr. E~Yes E~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. 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 or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I C2. Aesthetic, agricultural, amhaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. I Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered sp~ci'~S? 'Explain briefly: I C4 A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development or ielat;d activities iikely to be induced by the proposed action? Explain briefly: ? ExPlain bdefiy: c6. Long term shodterm cumulabve or other effects not ~denflfied ~n 01 C5 I C7. Other impacts lincludin~l chanties in use of either quanti~/or ~pe of ener~l;/? Explain briefly/: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEA)? fir yes, explain briefly: [~Yes [-"1 No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? lf),es explain: [-"1 Yes r--1 No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. 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. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed acfio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) ENVIR OPERMITS Inc. 12 Beecher Street, Coram, NY 11727 Cell 631-375-4534 Fax 631-698-0229 enviropermits~¥ahoo.com July 15, 2009 James F. King, President Southold Town Hall PO Box 1179 Southold, New York, 11971-0959 RE: SCTM #1000-123-8-2B1 Subject: Permit Application for Michael J, Giacone, 23 Westphal Drive, Delmar, NY 12054 Project Site: 360 Park Avenue EXT, Mattituck, NY 11953 Clerk of Town Trustees: Please find the Certified Mail Receipts, (proof of the mailing the Public notices) for the adjoining neighbors. Notices were sent to their summer and winter addresses. Sinc~rel/.~ Envirop,e~its Inc. Clay Colefield, Marine Biologist Cc: M. Giacone Shore line Bulkheading CM# 7008 1830 0004 1060 8866 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Mr. & Mrs. Cassidy 270 Park Ave ext. Mattituck, NY 11952 Mr. & Mrs. Cassidy 125 Patience Place Lane Mooresville, NC 28117 Mr. & Mrs. Carey 6187 Buckskin Dr. Farrnington, NY 14415 STATE OF NEW YORK COUNTY OF SUFFOLK Ad~ Mr. & Mrs. Helies 440 Park Ave ext. i ~ Mattituck, NY 11952 (~ o~.~4 ~ tt~ ¥ t i 7 ~ ~ , being duly sworn, deposes and says that on the 4~'~ day of 3-~1¥ ,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 there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Co .. a-'~x /o'/~ ¢7:~"/ , that said Notices were mailed to each of said persons by (certified) (registered) mail. Mr. & Mm. Helies 45 Shady Hill Rd. Weston, MA 02493 ~ Fee CasSidy ~ }~f;_K/Q~_"5 ........ 270 pafl~ Ave e~2 .................... 't , Sworn to ~'efore me this Dayof ~ Notary Public State:of:blear York No. OITR61~ffi Qualified in SM~I~ Commission Expi~s 10/~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 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 MICHAEL J. GIACONE COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, /~[~3 ~[//~'~, residing at/dba being duly sworn, depose and say: That on the 3 day of ~ ]( ,200 , I personally poste, dtthe property known as _ .3 'tt, e..,,:r-. /fid, Z_ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of heating noted thereon to be held Wed. July 22~ 2009 on or about 6:.0~.P~. Dated: 7//~/t57 ~r'~d//~ ~e) Sworn to before me this r~~~ay of'T'~l'1 200~ ~._~tary Public TAMMY A. BULl iVANT Notary Public - State of New York NO. 01BU6041214 Qualified in Gmmm County My Comml~lm Expires Board of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE't~T~HE 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, l HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR Sig~ture SWORN TO BEFORE ME THIS /J DAY OF ff')~'L/J ,2oo ? rAMMY A. BULUVANT ~qotary Public - State o~ New York No. 01BU6041214 Qualified In Greene County My Commlsslo~ Expires M~ch 27, ~oard of Trustees Applicati~ ' ~' ], Michael J, Giacone (print owner of property) AUTHORIZATION (where the applicant is not the owner) residing at. 23 westphal Drive, Delmar, NY (mailing address) do hereby authorize Enviropermits Inc., C.Colefield (Agent) to apply for permit(s) from the Southold Board ofTo.wn Tru~e~on my behalf. / ~o~vnerWs)~l~n~e: 323 Edelweiss Rd. West Islip, N.Y. 11795 (631)661-2169 LETTER OF AUTHORIZATION , authorize Clayton Colefield, agent for, ENVIRONM..ENTAL PERMIT/PROCESSING COR~. to secure all Governmental peTts n%sa~.~my waterfront pro. lect. S ignature:/~¢¢ ¢ :~ ~--~--~ Address of proposed waterfront project: Home Phone Work Phone Fax Number APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The purpose of this tbrm is to provide intbrmation which can aler[ the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first nme, middle initial, unless yofi are applying in the name of someone el~ or other enti~, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Olher (If"Other", name the activily.) Do you personally (or through your co~npany, 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 ~ lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the To~t~?outhold ~J'J' Title or position of that person Describe the relationship between yourself(the applicant/ageni/representative) trod 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); ~) an officer, director, partner, or employee of the applicant; or _~/~3) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Signature {'-~f~ - _ ~ PrintNam~- - (./ (~/~'e~, ~[,* APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Drohibits conflicts of interest on the hart of town officem and employees. Th~ purpose of this form is to ~rovide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, middle initial, u~16ss you are ~pplying in thc name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Tmstce Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planalng 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 ~,g//4 Title or position of tha~ person fl//1 Describe the relationship between yourself(the applicant/agenffrepresentative) 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): L>/I A) the owcer of greater than 5 ~ of the shares of the corporate stock ofthe applicant ].}/4 (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entit~ (when the fl ,ri- applicant is not a corporation); z, C) an officer, director, parmer, or employce of the applicant; or ~/~D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants lbr 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 inchtding BuiMing Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local 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). 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 LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# I ~ ~ ~ ,,~ i~> The Application has been submitted to (check appropriate response): TownBoard [] Planning Dept. [-~ Building Dept. [~ BoardofTrustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: Present land use: ~'~c, Present zoning classification: If an application tbr the proposed action has been filed with the Town of Southold agency, the following info~ation shall be provided: (a) Name of applicant: ~,'a~ (b) Mailing address: (c) Telephone number: Area Code (). (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No [] If yes, which state or federal agency? DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [] No [~Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~ Yes ~-~ No ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~-~ Yes [] No [~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria [xr-~ Yes [] No ~ Not Applicable Ai/ach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ~ Yes [] No [~NotApplicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. [-~ Yes [] No [~ Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~-~ Yes ~ No ~' Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes [] No'~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~ Yes~ No ~-~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section Ill - Policies; Pages 47 through 56 for evaluation criteria. [] Yes [] No ~Not Applicable A~ach additional sheets if aecessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section lll- Policies; Pages 57 through 62 for evaluation criteria. [~Yes [] No~NotApplicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. [-~ Yes [-~ No ~ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes [] No [~ Not Applicable Created on 5/25/05 11.'20 AM ENVIROPERMITS Inc. 12 Beecher Street, Coram, NY 11727 Cell 631-3 75-4534 Fax 631-698-0229 enviropermits~,yahoo.com June 25, 2009 ~ James F. King, President ~ J Southold Town Halt ~ : ; ~ 'i ~- 'i .... ~ ~ PO Box 1179 L__ ~,~': a'i 'Tri,']t es a Southold, New York, 11971-0959 RE: SCTM #1000-123-8-2B1 New Permit Application for Michael J, Giacone, 23 Westphal Drive, Delmar, NY 12054 Project Site: 360 Park Avenue EXT, Mattituck, NY 11953 Clerk of Town Trustees: Please find a completed permit application package, (three copies). Mr. Giacone is applying for permission to replace his existing wooden jetty. A fully and detailed description is appended to the permit application package. The installation of the new jetty will commence once the permit is granted and will take no longer than two weeks; weather permitting. The old wooden jetty will be removed by a backhoe and stored in a roll-off container till transported to an approved land fill site. No excavation or fill will be needed to install the new vinyl wood jetty. The neighboring properties were observed to have new and old jetties. Due to the high velocity of the littoral drift, no vegetated tidal wetlands were observed at or near the project site. Bottom sampling concluded that shellfish and algae beds were not present at or near the project area. Reinstallation of the jetty will provide needed protection of the minor sand dunes and the vegetated wetland species observed behind those dunes. Sincerel3~, ~ Enviro!6ern~t~ I~c~ J Clay Colefield, ~rine Biologist Cc: M. Giacone Shore line Bull{heading CM# 7008 1830 0004 1058 1602