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Home My WebLink AboutTR-7271Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD CERTIFICATE OF COMPLIANCE # 0614C Date: December 6, 2010 THIS CERTIFIES that the renovation of existing bluff stairs and deck; for the existing fixed dock; and a 5' wide non-turf buffer area planted with native species to be maintained along the top of the bluff At 1445 Fleetwood Road, Cutchogue, New York Suffolk County Tax Map # 137-4-33.1 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 3/4/2010 pursuant to which Trustees Wetland Permit #7271 Dated 4/21/2010 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the renovation of existing bluff stairs and deck; for the existing fixed dock; and a 5' wide non-turf buffer area planted with native species to be maintained along the top of the bluff The certificate is issued to STANLEY MALON owner of the aforesaid property. 311tthorized Signaturdt Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer 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 DATE OF INSPECTION: i/'/' Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain st 1 day of construction ~ constructed Project complete, COmpliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: ~ ~"-~, COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC #: C10-44245 I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DECLARATION recorded in myoffice on1210612010 under Liber D00012645 and Page 164 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 1210612010 SUFFOLK COUNTY CLERK JUDITH A. PASCALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DECLARATION Number of Pages: 5 Receipt N~m~er : 10-0141210 District: 1000 Recorded: At: 12/o6/2OlO 02:40:41 P~ Page/Filing COE TP-584 Cert. Copies Received the Following Fees For Above Instrument Exempt Exempt $25.00 NO Handling $20.00 NO $5.00 NO NYS SRCHG $15.00 NO $0.00 NO Notation $0.00 NO $12.50 NO RPT $30.00 NO Fees Paid $107.50 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County LIBER: D00012645 PAGE: 164 Section: Block: Lot: 137.00 04.00 033.001 EXAMINED AND CHARGED AS FOLLOWS Number of pages This document will be public record. Please remove all Social Security Numbers prior to recording. Deed / Mortgage Instrument Deed / Mortgage Tax Stamp FEES Page / Filing Fee Handling TP-584 Notation LA-52 17 (County) EA-5217 (State) R.P.T.S .A. Comm. of Ed. Affidavit Certified Copy [.3~,_ NYS Surcharge Other 20. 00 5. 00 tO_ 15. 00 Sub Total Sub Total Grand Total Reco[ding / Filing Stamps IMortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec./Assit. or Spec./Add. TOT. MTG. TAX Dual Town __ Dual County Held for Appointment Transfer Tax Mansion Tax The property covered by this mortgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on 4 IDi ' Real Pr~ ~ Tax Se Age~ Verific 6 I 1000 13700 0400 033001 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: CF-l/J/>/, ~ ~ ~{ ~ n3~ 5z,V,&> / ~ ,,., page # of this ins[mment. fl- r'3 -tO Community Preservation Fund Consideration Amount $ CPF Tax Due $ Improved Vacant Land TD TD TD Mail to: Judith A. Pascale, Suffolk County Clerk Information 310 Center Drive, Riverhead, NY 11901 www. suffolkcountyny, gov/clerk Title # Suffolk County Recording & Endorsement Page This page forms part of the attached (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK. TO In the TOWN of '~'~'~ 0 k ~__ In the VILLAGE or HAMLET of ~'~ ,~ ~ (-~. O __ BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 12 0104 10/08kk (over) Declaration of Covenants THIS DECLARATION made this 17 day of November, 2010, by Mr. & Mrs. Stante~ Makro, residing at PO ~ 879, Cutchogue, NY t 1935, "DECLARANT(S)" ~'" hereinafter referred to as : WHEREAS, DECLARANT(S) is/are the owner(s) of certain real property located on 1445 Fleetwood Rcmel, Cutchogue, Town of Southotd, County of Suffolk, State of New York, described in the Suffolk County Tax Map as District 1000, Section 137, Block 4, Lot 33.1 which is more particularly bounded and described as set forth in Schedule "A' annexed hereto, hereinafter referred to as the Property; WHEREAS, the Property is situated on lands within the jurisdiction of the Board of Trustees of the Town of Southold (hereinafter the "Trustees") pursuant to Chapter 275 of the Town Code of the Town of Southold or its successor, and various activities conducted upon the property may thus be subject to the regulation and approval .of the Trustees prior to being conducted; WHEREAS, the DECLARANT(S) therefore made application to the Trustees for a permit pursuant to the Wetlands Law of the Town of Southold to undertake certain regulated activities; and WHEREAS, as a condition of the granting of a Wetlands Permit to undertake such regulated activities, the Trustees required that a 5' wide ..along entire top of bluff, flaring to 9' to meet landward edge of deck "non- turf buffer" adjacent to and landward of. top of bluff. NOW, THEREFORE, the DECLARANT(S) do/does hereby covenant and agree as follows: 1) Upon the substantial completion of the aforementioned permitted activities there shall be estabhshed and subsequently maintained adiacent to top of bluff "non-turf buffer" as defined by Chapter 275 of the Town Code; and 2) These covenants shall run with the land and shall be binding on the DECLARANT(S), his/her/their heirs, assigns, purchasers, or successors in interest and may only be modified after a pubhc hearing and upon resolution of the Trustees. Stewart Title Insurance Company T~t~e r~o: 23-S~.2956 Schedule A Description ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, sip~!e, lying and being at Fleets Neck, near Cutchogun, Town of $outbold, County of Suffolk and State of New Yod~ and being bounded and described as follows: BEGINNING · 83.60 feet at a point on the easterly side of Fleetwood Road, which point is distant south of the northeast side of Flectwood Road, which point of beginning is the d/viszon hne of the plvm~scs hereto described and land now or formerly ofI, Uefer; RUNNING THENCE Along land now or formerly of Kiefer, North 85 degrces 57 minutes 20 seconds East, 270.00 feet; RUNNING THENCE South 5 degrees 31 minutes 40 seconds East, 59.50 feet; RUNNING THENCE South 85 degrees $7 minutes 20 sdconds West, 270.00 feet to the east side o£Fleetwood Road; RUNNING THENCE Along the east side of Fleetwood Road, North 5 degrees 31 minutes 40 seconds West, 59.50 feet to the point or place of Beginning. TOGETHER with all right, title and interest ofthe patty of the first pm't, in and to the land lying in the slree! in front of and adjoining said premises. IN WITNESS WHEREOF, the owner(s) has/have duly executed this instrument this day of November 17, 2010 , O~W. NER'S SIGNATURE ., OWNER'S SIGNATURE New York: SS: COUNTY Of On the undersigned, a Notary satisfactory evidence to be subscribed to the within he/she/they executed the same m behalf of which the individual(s) , in the year 20 , before me the in and for said State, personally appeared me or proved to me on the basis of whose name(s) is/are and acknowledged to me that or the persons on instrument. NOTARY PUBLIC Uniform Form Certificate of Acknowledgment .State of New/York County of~~ On the ~ day of ~r~.-c.;~_.~f in the year c.~ ib> before me, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity (les), and that by his/her/their signature (s) on the instrument, the individual (s), or the person upon behalf of which the individual (s) acted, executed the instrument · ~/'lqotary Public ' MARION E, CASKIE Notary .,Public, State of New Yor; r~o, 04CA6209394 Quallfl~ in Suffolk County Commission Expires 07/27/1;~ Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 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 Ist day of construction ½ constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7271 DATE: APRIL 21~ 2010 ISSUED TO: STANLEY MALON PROPERTY ADDRESS: 1445 FLEETWOOD ROAD~ CUTCHOGUE SCTM# 137-4-33.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 o£the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on April 21, 2010, and in consideration of app!icafion fee in the sum of $250.00 paid by Stanley Malon and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to renovate the existing bluff stairs and deck, and for the existing fixed dock, with the conditions of the installation of a 5' non-turf buffer area is to be planted and maintained with native species along the top of the bluff, the existing deck connected to the stairs is being reduced in size, and as depicted on the site plan . prepared by Creative Environmental Design, received on April 20, 2010, and stamped approved on April 21, 2010. IN WITNESS WI-IEREOF, the said Board of Trustees 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 Permittec Stanley Malon, residing at 1445 Fleetwood Road, Cutchogue, 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 from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period 6f 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 removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstmetion 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. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 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. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Brederneyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 April 21, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. David Cichanowicz Creative Environmental Design P.O. Box 160 Peconic, NY 11958 RE: STANLEY MALON 1445 FLEETWOOD ROAD, CUTCHOGUE SCTM# 137-4-33.1 Dear Mr. Cichanowicz: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 21, 2010 regarding the above matter: WHEREAS, Creative Environmental Design on behalf of STANLEY MALON applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 4, 2010, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: installation of a 5' non-turf buffer area is to be planted and maintained with native species along the top of the bluff, the existing deck connected to the stairs is being reduced in size, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on Apdl 21, 2010, 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of STANLEY MALON to renovate the existing bluff stairs and deck, and for the existing fixed dock, with the conditions of the installation of a 5' non-turf buffer area is to be planted and maintained with native species along the top of the bluff, the existing deck connected to the stairs is being reduced in size, and as depicted on the site plan prepared by Creative Environmental Design, received on April 20, 2010, and stamped approved on Apdl 21, 2010. 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, ji~M'. Doherty~ President, Board of Trustees JMD/eac lill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Gho$io, Jr. John Bredemeyer 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 TO: ~-~ I¢/ 0')O~[0 ~ Please be advised that your application dated fi'")tarcJ'~ ~. oT~O/O has been reViewed by this Board at the regular meeting of .~..' ~ o,dl, ,-2o/~ and yOur application has been approved pending the comPi'etlon 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) __ ~ Constructed ($50.00) V'/'Final Inspection Fee ($50.00) ~O~ q~fo __ 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: Jill M. Doherty, President Board of Trustees Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., April 14, 2010, the following recommendation was made: Moved by Audrey Horton, seconded by Peter Young, it was RESOLVED to SUPPORT the Wetland Permit application of STANLEY MALON to renovate the existing bluff stairs and deck and for the existing fixed dock. Located: 1445 Fleetwood Rd., Cutchogue. SCTM#137-4-33.1 Inspected by: Peter Young, Audrey Horton The CAC Supports the application with the Condition the disturbance to the bluff is minimized, and appropriate construction materials and engineered erosion control devices are used when constructing the stairs. Vote of Council: Ayes: All Motion Carried Jill M. Doherty, Presidcmt James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bmdemeyer P.O. Box 1179 Southold, NY 11971 Telephone ( 631 ) 765 - 1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ~/'" //"['/~ STANLEY MALON requests a Wetland Permit to renovate the existing bluff stairs and deck and for the existing fixed dock. Located: 1445 Fleetwood Rd., Cutchogue. SCTM#137-4-33.1 T~aOf area to be impacted: Itwater Wetland Freshwater Wetland Sound c-.-~ Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: b//Wetland __Coastal Erosion __Amendment Administrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: BP: eGsheon~ oW, ~ iDnzge n-~-o~/'/J~ sD~)i h e rt y ~redemeyer D?'~. Be;ge ~r~'~ Form filled out in the field by Mailed/Faxed to: Date: LIITTI~R 01~ NfIN"llt~I~IlI['N'~N-TIBA1[' 264 Lintofl Ave Dear Appli~ Co~n~km-im ~ ~ ' · Bri~ P. l~nai?n ~lllB 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 MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: MarkTerry, Principal Planner~ LWRP Coordinator' Date: April 19, 2010 Re: Request for Wetland Permit for STANLEY MALON SCTM#1000-137.-4-33.1 Creative Environmental Design on behalf of STANLEY MALON requests a Wetland Permit to renovate the existing bluff stairs and deck and for the existing fixed dock. Located: 1445 Fleetwood Rd., Cutchogue. SCTM#137-4-33.1 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 INCONSISTENT with the denoted following Policy Standards and therefore is INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The proposed 96 square foot deck located on the bluff is not a permissible action pursuant to: 275-11 Construction and operation standards. A. General. The following standards are required for all operations within the jurisdiction of the Trustees: (6) Decks and platforms. No decks or platforms shall be permitted on or near bluffs. Platforms associated with stairs may not be larger than 32 square feet. [Amended 10-11-2005 by L.L. No. 17-2005] Pursuant to Chapter 275, 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 Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __Coastal Erosion Permit Application 4~%Vetland Permit Application __ Administrative Permit Amendment/Transfer/Extension ~Rece~vved Application: ,~1~/10 ~_Received Fee:$ ~%---O °~ -~_Completed Applic~tion~lj~ __Incomplete __SEQRA Classification: Type l~Type II Unlisted Coordination:(date sent). ~,LWRP Consistency Assessment Form q/OLIlO CAC Referral Sent: j~ate of Inspection: ~Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~l~ublic Hearing Held: Resolution: Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 Name of Applicant Address Suffolk County Tax Map Number: 1000- I'B'-7 - ~-~ - ~>..I Property Location: ~_~ ~*n ~. t4~ ~oV ~- (provide LILCO Pole ~, ~t~ce to cross s~eets, ~d location) (If applicable) Address: 3~ [~70 Phone:G3l - '7~,q- 7q2-:5 ~rd of Trustees Applicati, Land Area (in square feet): Area Zoning: ~(-~ . Previous use of property: "~ Intended use of Property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Yes ~'"/No Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend, gal by a governmental agency? ~' No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~5 rd of Trustees Applicati¢ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: MI ~ square feet Percent coverage of lot: ~o/~, % 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? X~No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet 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): of Trustees Applicati COASTAL EROSION APPLICATION DATA Proposes of proposed activity: Are wetlands present within 1 O0 feet of the proposed activity?. No v'"/Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting fi.om implementation of the project as proposed. (Use attachments if necessary) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME County SEQR 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: Municipal~ 4. PRECISE LOCATION: Street Addess and Road intersections, Prominent landmarks etc -or orovide mad ,.is PR°POSE° ACTION: [] N.. []Expan, on I i,ea,on/ai ra,on PROJECT iEFLY: 7. AMOUNT OF LAND AFFECTED: Initially , OJ~:> acres Ultimately '~ ~ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~Yes [] No If no, describe bdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) E~esidential ~]lndustdal [--']Commercial [~]Agriculture ~] Park / Forest / Open Space E~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~;es r~ No If yes, list agency name and permit / approval: 11. DOES ANYYYA~[A PECT Of THE ACTION HAVE a CURRENTLY VALID PERMIT OR APPROVAL? ]Yes ~1% If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E~es [~]No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST_ OF MY KNOWLEDGE Signature ¢---'~-~--~ ) ~ ~ ~s 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 Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. 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 handwdflen, 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 flceding problems? Explain briefly: C2. Aesthetic, agficultsral, amhaeolo§ical, historic, or other natural or cultsral msourc~e; or community or neighborhood characteff/' Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threataned or endangered species? Explain briefly: 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, subseguent development, or ralatsd acti~ties likely to be indcced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effems not identified in C1-C57 Explain briefly: C7. Other imcacts lificlu0ifi~l chanties in use of either ~uantit~ or h/pe of ener[t~? Ex¢lain briefly: D. WILL THE PROJECT HAVE AN iMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA/CEAI? {If )'es, explain briefl)': [-I Yes I No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL iMPACTS? if PART Ill - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therwisesigni~cent~ 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 i m pact 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 FAF 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 actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessaPJ, the reasons supporting thi! determination. Name of L~ad Agency Print j)r Type Name ~)f ResporisTifie Offic.~ r in Lea~l Agency l~n~ture Df Respdm~51~ OfficerTead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredcmeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 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 STANLEY MALON COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING being duly sworn, depose and say: That on theC~ay of ~lo-q~x. ,2010, I personally posted the property known as 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 Wed, April 21~ 2010 on or about 6:00 PM. Dated: (signature) Sworn to before me this /iTt ~lay ot~./'201~/O y Public LAUREN M. STANDISH Notary Public, State of New York No. 01ST6164008 Qua flied n Suffolk County - Commission [xp res April 9, ~0~/~ PROOF OF ]VL~II,ING OF NOTICE A'I~ACH CERTIFIED 1VL~IL RECEIPTS n this box ° ~,t-J, _~"~ , being duly s~'om, deposes and says that on thc day of ', 20 , deponent mailed a true copy of the Notice set forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite 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 ~ e,, t_.~ , that said Notices were mailed to each of said persons by (certified) (registered) mail. ~~~ Sworn to before,me this ,bTL ~- Dayof ~ ,20/cg Notary Public LAgREN M. STANDISH Notary Pubtic State of New York · ~ 31ST6164008 ~ ~,; ~ ( ~' ed in Suffolk ilCOqU~ Ce,nm~:' ,~ EmiresA~nl /u Z[ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 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. 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" 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~ listine both suooortim, and non- suooorfin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# /OOO /~ 7- q ~'33, / PRO,H~CT NAM~ ~..~73~-d/~ e7 ~~ The App~cafion has been submi~ed to (check appropriate respome): TownBoard ~ Plann~gBoard~ Build~gDept. ~ BoardofT~tees ~ 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 a~ign: Site acreage: Present land use: Location of action: Present zoning classification: 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: Co) 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 [] NoN Ifyes, which state or fedemlagency?_ 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. 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 - Pol)eies Pages 3 through 6 for evaluation criteria ~ Yes ~ No[~7(EX_i 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 Pajges 8 through 16 for evaluation criteria ~ Yes ~ No[-~' ' Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southoid. See LWRP Section III - Policies Pages 16 th~h 21 for evaluation criteria ~ Yes ~ No ~ Not 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. Yes No ~/Not App~l~ble 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 Atlach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section Ill - 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 llI- Policies; Pages 38 through 46 for evaluation criteria. [--] Yes~ No [--~/Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ 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 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 [] No [--~/Not Applicable Attach additional sheets if necessary Policy 13. Promote a~ppropriate use and development of energy and mineral resources. See LWRP Section III - Policies;~ages 65 through 68 for evaluation criteria. ~ Yes [] Nor-~l~l Not Applicable of Trustees ApplicatiOn County of Suffolk State of New York ~ Ctr~14~oo ~tcz~ 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 H/S/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF ~ION. Signature ~ ~ SWORN TO BEFORE ME THIS DAY OF c/Y~at~tq 20/0 Notary Public LAUREN M. STANDtSN Notary Public, State of New Yor~ No. 01ST6164008 Qualified n Suffolk County Commission Expires April 9 AUTHORIZATION (where the applicant is not the owner) residing at ~ ~ ~T~U~9~ (mailing address) do hereby authorize C~,~- (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ' (~ner' s signature 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the tyart of town 0fficem and emnlovees. The oumose of this form is to omvide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is ~oid same. (Last name, first name, x,niddle initial, u~less you are applying in the name of ~omeone else or other entity, such as a company. If so, indicate, the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (lC'Other", name thc 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 blobd, marriage, or buginess interest "Buslnes~ interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (o~' employment by) a corporation in which the town officer or employee owns more than :5% of the shams. YES NO ~ lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or Child is (check all that apply): A) the owner of greater than 5% of the shams of the corporate stock of the applicant (when the applicant is a corporation); __.B) the legal or 'beneficial ownqr of any interest in a non-corporste entity (when the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitt~ o~--~ Print Name SURVEY OF DESCRIBED PROPERTY SITUATED AT FLEETS NECK, TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C.T.M. NO. 1000- 137-4-35. 1 AREA = 16,060 SQ. FT. ¢ !LE NO. T5684 SCALE: REVISED: 12,/50/98 (PROP. 2nd STY. ADDITION /"-30' DATE: / :./27/98 ADDED) - SUC,¢E$SO? ,'0 PROFESS 0~,'4: LAND SURVEYORS )5~7-47P3 ( 516 )878-0120 N. Y.S. L tC. NO. 049287 1/ ../ i APR 2 0 2010 APPROVED BY COARD OF TRUSTEES TOWN OF $OUTHOLD- _: 6C ~/-,,~ 'I