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Home My WebLink AboutTR-7262Jill 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 $outhold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0549C Date: June 23, 2010 THIS CERTIFIES that the fixed 3'x8' ramp, fixed 3'x28' dock with a ladder and a pilling and pulley system at seaward end At 5800 Skunk Lane, Cutchogue, New York Suffolk County Tax Map # 138-2-25 Conforms to the applications for a Trustees Permit heretofore ~ed in this office Dated 1/26/10 pursuant to which Trustees Wetland Permit # 7262 Dated 3/17/10 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 fixed 3'x8' ramp, fixed 3'x28' dock with a ladder and a pilling and pulley system at seaward end The certificate is issued to MARTIN KOSMYNKA owner of the aforesaid property. ized S~gnature4/ Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredgmeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765.4641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: __ Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~ constructed Project complete, compliance inspection. CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemcyer 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 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 ½ constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NOt 7262 DATE: MARCH 17, 2010 ISSUED TO.- MARTIN KOSMYNKA PROPERTY ADDRESS: 5800 SKUNK LANE~ CUTCHOGUE SCTM# 138-2,25 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter ! 11 oftbe Town Code oftbe Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on March 17 2010, a~td in consideration-of application fee in the sum of $250.00 paid by Martin Kosmvnka and m~bject tO thc Terms and Conditions as stated in the Resolution, the Southold Town Board of TrUStees authorizes and permits the following: Wetland Permit to construct a dock consisting of a 3'x8' ramp and 3'x28' fixed dock with a ladder at the seaward end, and a piling and pulley system, with the condition that the proposed pile for the pulley system is not to be installed beyond the existing l;me~ of neighboring piles, and as depicted on the survey prepared by Kenneth H. Beckman, L.S., last dated April 2, 2010, and stamped approved on April 6, 2010. . IN WITNESS WHEREOF, 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. James F. King - Nay TERMS AND CONDITIONS The Permittee Martin Kosmgnka, residing at 1985 Pine Tree Road, Cutchoeue. New York as · part of the consideration for the issuance of the Permit does understand and proscribe 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 Pennittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Pennittee 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 removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 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 Brederaeyer Town HallAnnex 54375Ms~nRoad P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 March 17, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Martin Kosmynka 1985 Pine Tree Road Cutchogue, NY 11935 RE: 5800 SKUNK LANE, CUTCHOGUE SCTM# 138-2-25 Dear Mr. Kosmynka: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 17, 2010 regarding the above matter: WHEREAS, MARTIN KOSMYNKA 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 January.26, 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 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 March 17, 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 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 MARTIN KOSMYNKA to construct a dock consisting of a 3'x8' ramp and 3'x28' fixed dock with a ladder at the seaward end, and a piling and pulley system, with the condition that the proposed pile for the pulley system is not to be installed beyond the existing line of neighboring piles, and as depicted on the survey prepared by Kenneth H. Beckman, L.S., last dated April 2, 2010, and stamped approved on April 6, 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:S257.00 Very truly yours, //J~ll M. Doherty / ~President, Board of Trustees JMD/eac Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box t 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 77 TO: Please bo reviewed by th~s Board at tho re9ular mootin9 of ~ I ~ ~/O and your application has boon approved pendin9 tho eomplation of tho followin9 items chocked off below. ~_~ Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ Ist Day of COnstruction ($50.00) ¼ Constructed ($50.00) V/Final Inspection Fee ($50.00) I// 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: $ ~7~-~ BY: Jill M. Doherty, President 'Board of Trustees Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, 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: Ko. mvnk / Please be advised that your application dated ..~ox'x~, ~;~. c~O/O has been reviewed by this Board at the regular meeting of tY'J~t-cJL) I ?, ~<9/O and your application has been approved pending the completion 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.)- Fee& 1~ '-~"~eCo~lr~eJ C~o,o "]>x~c--e"~~L Permit fees are now due. Please make check or money or, er payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 2'/5 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: $ ,~'C~°---° plu.5~ ~-~.~(T, ~,~,'~ BY: Jill M. Doherty, President Board of Trustees New York State Departm f Environmental Conservation Division of Environmental Permits SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 Telephone (631) 444-0403 Facsimile (031) ~-44-0300 Alexandef B. Grannis Commis=ioner January l5,2010 Mr. Martin Kosmynka 1985 Pine Tree Road Cutchogue, NY 11935 RE: 1-4738-03913/00001 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. 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. Environmental Analyst SLMls Enclosure '~NEW YORK STATE DEPARTMOOF ENVIRONMENTAL CONSERVATIO Facility DEC ID 1-4738-03913 pERMIT Under the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To: MARTIN KOSMYNKA 1985 PINE TREE RD CUTCHOGUE, NY 11935 Facility: KOSMYNKA PROPERTY 5800 SKUNK LN CUTCHOGUE, NY 11935 Facility Application Contact: ALPHA CONSULTING PO BOX 1602 R1VERHEAD, NY 11901 (631) 477-0444 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 713.596 NYTM-N: 4543.51 Latitude: 41000'53.3'' Longitude: 72027'35.3'' Authorized Activity: Construct dock consisting of a 3' x 8' ramp and 3' x 28' pier with a ladder at the seaward end. Install piling and pulley systm. All work must be done in accordance with the attached plans stamped "NYSDEC Approved" on January 15, 2010. Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-03913/00001 New Permit Effective Date: 1/15/2010 Expiration Date: 1/15/2015 Water Quality Certification - Under Section 401 - Clean Water Act Permit ID 1-4738-03913/00002 New Permit Effective Date: 1/15/2010 Expiration Date: 1/15/2015 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: GEORGE W HAMMARTH, Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY ~ STONY BROOKI50 CIRCLE RD STONY BROOK, NY~lJ,790 -3409 Authorized Signature: Page 1 of 6 CROSS SECTION [ L~,o~-~. 7~I ~ , ,~1 Prepared by: ALPHA I1~ CONSULTING Date: Scale: ~Y 95-20-1 (11/03) New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further infOrmation regarding the nature and extent of the apProved work and any Department conditions applied to the approval, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Permit Number Expiration Date Regional Permit Administrator NOTE: This notice is NOT a permit , ..,~' ~. 1. FIRM ZONE AE (EL. 8) ~' . 2. ELEVA~ONS SHO~ REFER ~ ~ TO MSL DA~M NGS, NOS [FOR~ERLY USO ~ 9S DA~M) ~E EXIS~ OF RI~ OF W~ Y AND/~ EASEMEN~ ~ RECORD IF AN~ NOT EHO~ ARE NOT GUARAN~ED, UNAUTHORIZ£D AL TERA TION OR ADDISON TO THIS SUR~-Y IS, A~. ~,fOLA 770N OF' SECtiON 7209 OF' THE NEW YORK STATE EDUCATION LAW. COPIES OF THtS SURVEY MAP NOT BEARING UTILITY Board of Town Trustees Town of Southold P.O. Box 1179, 53095 Main Road Southold, New York 11971 Re: Dock Permit for Marry Kosmynka Dear Members of the Board: My husband and I reside on Sterling Road in Cutchogue. This road runs perpendicular to Mud Creek. We support Marry Kosmynka's application for a dock on this creek. The DEC has already approved a permit, thereby confirming that such a dock is not detrimental to the environment. Thank you for your kind attention to this matter. Sincerely, Diane Hobbs March 15, 2010 To the trustees of $outhold: I own property in the neighborhood. I also have a fixed dock on the creek. I support Marty Kosmynka in his process to obtain a fixed dock. Sincerely,~ ~~ ~ 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 Thurs., February 18, 2010, the following recommendation was made: Moved by Peter Young, seconded by Doug Hardy, it was RESOLVED to SUPPORT the Wetland Permit application of MARTIN KOSMYNKA to construct a dock consisting of a 3'X 8' ramp and 3'X 28' fixed dock with a ladder at the seaward end, and a piling and pulley system. Located: 5800 Skunk Lane, Cutchogue. SCTM#138-2-25 Inspected by: Peter Young, Doug Hardy The CAC Supports a dock in this area, however, the project was not staked and there were concerns with the size of the lot, location, and navigability. Vote of Council: Ayes: All Motion Carried Jill M. Doherty. President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer 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: c/,t//P //~,?~ MARTIN KOSMYNKA requests a Wetland Permit to construct a dock consisting of a 3'X 8' ramp and 3'X 28' fixed dock with a ladder at the seaward end, and a piling and pulley system. Located: 5800 Skunk Lane, Cutchogue. SCTM#138-2-25 T¥~of area to be impacted: ~'Saltwater Wetland Freshwater Wetland Sound '~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: ¢//Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: ~t-~.King ~/J"'.~.Doherty ~ Bredemeyer __ B.Ghosio, __ D. Dzenkowski ~.- other Form filled out in the field by Mailed/Faxed to: Date: D. Bergen__ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 August 23, 2006 Ms. Beth Pike 1125 Sterling Road Cutchogue, New York 11935 Re: 5800 SKUNK LANE, CUTCHOGUE SCTM# 138-2-25 Dear Ms. Pike: The Board of Trustees has inspected the above referenced property as per your request for a proposed docking facility. The Board found that thc size of thc parcel would not allow for thc proposed dock. They recommend thc placement of an onshore off shore stake or mooring in order to secure a boat in that location. Please contact this office if you have any further questions. Very Truly Yours, James F. King President, Board of Trustees JFK/hkc James F. King, President Jill M. Doherey, Vice-President Pe~A. Dickerson Dave BerEen / ~, ~ Holz~fel Town Halt 53095 Route 25 P.O. Box 1179 Sou%hold, New York 11971-0959 Telephone (631) 765-1892 F~x (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Name of Applicant: Name of Agent: Property Location: SCTM# & Street Brief Description of proposed action: Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Distance of proposed work to edge of above: Part of Town Code proposed work falls under: Chapt.97 Chapt. 37 other Type of Application: Info needed: Wetland __Coastal Erosion Emergency SoUnd Front Bay Front __Amendment __Administrative Conditions: '-Present Were: '~J.King~_ TDoherty-/P.Dickerson ~. Bergen~J.Holzapfel Other: Mailed/Faxed to: Date: B DWI N'S cREEK ( MUD CREEK} LOT AREA: PARCEL 1: 18,163 SQ. FT. = 0.417 ACRE PARCEL 2: UPLAND AREA: 36 SQFT.X SL DATUM VATIONS HEREON REFER TO APPRO M EALRE~ THE RESULT OF ACTUAL FIELD MEAS'U,,REMENTS NO SURFACE WATER EVIDENT WITHIN 300 ~F PARCEL STERLING ROAD SURVEY OF PART OF PLOT 125 AND DESCRIBED PROPERTY MAP OF NASSAU FARMS SITUA TE A T PECONIC OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING AJ)DRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees//,/ From: MarkTerry, Principal Planner ~ LWRP Coordinator- Date: February 18, 2010 Re: Proposed Wetland Permit for MARTIN KOSMYNKA SCTM#1000-138.-2-25 The action is located within Cutcho.que Harbor Wetlands; a Si.qnificant Fish and Wildlife Area and NYSDEC Critical Environmental Area. MARTIN KOSMYNKA requests a Wetland Permit to construct a dock consisting of a 3'× 8' ramp and 3'× 28' fixed dock with a ladder at the seaward end, and a piling and pulley system. Located: 5800 Skunk Lane, Cutchogue. SCTM#138-2-25 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; provided that the proposed action meets the policies and sub-policies, as outlined below. Policy 5. Protect and improve water quality and supply in the Town of Southold. The plans do not specify the use of pesticide treated wood materials (if any). It is recommended that in the event the dock is approved and to further the above policy, the Board prevent the use that the below stated materials including the used of chromated copper arsenate (CCA) treated wood in the construction of the structure pursuant to § 275-11. B,1 (f) Construction and operation standards below. (0 In order to prevent the release of metals and other contaminants into the wetlands and waters of Southold, the use of lumber treated with chromated copper arsenate (also known as "CCA"), creosote, penta products or homemade wood preservatives is prohibited for use in sheathing and decking. Preservatives of any type, including but not limited to those listed above cannot be applied to any bulkheads, retaining walls or revetments after installation. Encapsulated pilings or native non- chemically treated (untreated)/umber only should be used in sensitive areas. The deployment of a silt boom is not shown on the plan. It is further recommended that the Board require the installation of a silt boom (where and if practical) pursuant to § 275-11. (2) Construction and operation standards below. 2) Erosion control. Installation of an erosion control structure is necessary during any building, grading, landscaping or site work activity within Trustee jurisdiction. This struCture may include, but is not limited to, installation of a silt fence, hay bales, wood chip berm and silt booms. The placement of the erosion control structure(s) shall be determined by the Trustees or their designee. All intertidal construction and excavation requires the installation ora silt boom that will retain all suspended sediments within the immediate project area. Further, the applicant has not cleady demonstrated that the proposed project meets the following standards. It is recommended that the Board require the applicant to provide additional information to allow the Board to assess whether the dock will have any of the harmful effects. 6.3 Protect and restore tidal and freshwater wet/ands. Comply with statutory and regulatory requirements of the $outhold Town Board of Trustees laws and regulations for all Andros Patent and other /ands under their jurisdiction Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. (d) Review and approval of dock applications. Before issuing a permit for a dock structure, the Trustees shall consider whether the dock will have any of the following harmful effects: [1] [2] Whether the dock will impair navigation or be located in areas of high vessel traffic or vessel congestion; Whether the dock will unduly interfere with the public use of waterways for swimming, boating, fishing, shellfishing, waterskiing and other water- dependant activities; Whether the dock will unduly interfere with transit by the public along the public beaches or foreshore; Whether the dock will significantly impair the use or value of waterfront Property adjacent to or near the dock; Whether the dock will cause degradation of surface water quality and natural resources; Whether the dock will cause habitat fragmentation and loss of significant coastal fish and wildlife habitats; [7] Whether the dock will result in the destruction of or prevent the growth of vegetated wet/ands, seagrasses including eelgress (Zostera marina) and widgeon grass (Ruppia maritima) or she#fish; [8] Whether the dock will unduly restrict tidal flow or water circulation; [9] Whether the dock will be safe when constructed; [10] Whether the dock will adversely affect views, viewsheds and vistas important to the community; [11] Whether the cumulative impacts of a residential and commercial dock will change the waterway or the environment and whether alternate design, construction, and location of the dock will minimize cumulative impacts; and [12] Whether adequate facilities are available to boat owners and/or operators for fueling, discharge of waste and rubbish, electrical sen/ice and water sen/ice. 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 Huise, Assistant Town Attorney Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, 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 Office Use Only 7~oastal Erosion Permit Application __Wetland Permit Application Amendment/Transfer/Extension /"Received Application: I [ r~JO ~ I ~ ~4~eceived Fee:$ O~D~' ~-Completed Application I [~ [ t~ __Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent). ~EWRP Consistency Assessment Form ! ~--~AC Referral Sent: I .~Ot }tO ~__.~tte o f Inspection: __Receipt of CAC Report: __Lead Agency Determination: ~Teehnical Review: ~,,a~ublic Hearing Held: _.z.q.~_~ql I~ __Resolution: Admimsh'ative Permit Name of Applicant Address Suffolk County Tax Map Number: 1000- /:~ '-'~ ~'~-' Property Location: ~'-~ (provide LILCO Pole ~, dist~ce to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Applicati Land Area (in square feet): ~ea Zomg: ~0et 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 ~fior pe~it~approvals for site improvements. H~ ~y p~iffapprov~ ever been revoked or su~p~d~ by a ~v~ent~ agency? ~.< ~ No ~es Project Description (use attachments if necessary): ,ard of Trustees Applicati~ V~ETLANDfrRUSTEE LANDS APPLICATION DATA Purpose or~e proposed operations: ~0 C' (~ f~ .square feet cubic yards cubic yards Area of wetlands on lot: '~co 5' F Percent coverage of lot: /~ ~ ~ I'~ % Closest distance betweenpe~arest existing structure and upland edge of wetlands: / 1 r. feet Closest distance between ~oa~est proposed structure and upland edge of wetlands: ! j~ f'/ feet Does the project involve excavation or filling? C"// 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: feet Statement of the cffect, if any, on the wetlands and tidal waters of thc town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART '1 . PROJECT INFORMATION 1. APPLICANT / SPONSOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Pn~ject Sponsor) SEQR 3.PROJECT LOCATION: Municipelity q~_~ C T/)/~-~'' ~ 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide mad 51JS PROPOSED ACTION: [] New r--~Expaesion i----IMndifioalJon~atieratJon 16. DESCRIBE PROJECT BRIEFLY: Initially acres Ultimately acres 8. W1LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? r'~Yes [] No If no, descdbebriefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) C~Resideotial E~lndustrial CIcome, : i--lAg,ic.tiu,e I--IPark,Fo,..:,Ope. Spec. 10. DOES ACTION I.~._ OLV,_;~A. PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, ~t~'or E~¥es [] No If yes, list agency name and permit / appm~l: 11~S ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~NO If yes, list agency name and ~ / approval: 12. AS A ~LT OF PROPOSED ACTION WILL ~ISTING PERMIT/ ~PROVAL REQUIRE ~DIFICATION? ~es ~ No ' CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE :::' 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 Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. [~] Yes r~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. i--I [71No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answem may be hafldwdtten, if legible) Cl. 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 bdefly: C2. st et c, agricultural, archaeological, h~stodc, or other na ural or coltura resources; or commun ty or ne ghbo~hoed character? Exp a n briefly: C3. Vegetation or fauna, fish, ahellfish or wiidlile apacles~ signi6cent habitats, or threatsnsd or endange~ spaeiss? F~phain bhefl¥: ! I C5. Growth, subsequent developm;ntl oi ~i;ted activities likely t(~'[; i'~l[~ced by the proposed action? Explain bdefly: C6. Long term, shod term, cumulative, Or other effect;-~ identified in CI-C~;~ Explai~ b-fiefl~y'i c7. Other impacts lincl'udin~l chanties in use 0~ ;ith~r ({uanti~ or t;/pe of ene~/? Expl~'i'n bri~fi;/: IRON MEN,~TAL AREA ICEAt? IIf )'es, explain briefly/: Yes [.~No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENT AL ADVERSE ENVIRONMENTAL IMPACTS? If )~es explain: i-IrT-1 NoI PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadverseeffectidenti~edab~ve~determinewhetheritissubstantia~~Iarge~imp~rtant~r~therwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. ud3an 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 sufficJent 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 la~ge or significant edveme 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 suppoding documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees Name of Lead Agency Jill M. Dohert¥ Print.or Type Name of Resl3onsib[e Officer in Lead Agency //~ Signature of Responsible Officer ~ad Agency Date President Title of Responsible Officer Signature of Preparer (If different from responsible officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Nan~e: Address: ct- ~rm 3811, February 2004 Dorr~-tic Return Receipt 219 0229 says that on the 0 ~m~w~l opy of tho Notice · [] R~tum Receipt for Merchandise ~ aboYe narD_cd [] C.O.D, ~ addresses set q (F_.Jd~a ~) OYes shown on the current led at the Unit~ States Post ~each of said persons by DEBORAH H. VANDUZER Note? ~bli~ ~of~r~ N0. 01VA61861~? Qualified in Suffdk County Commissio~ Expires Apd128, 2012 Jill M. Dohcrty, President James lc. King, Vice-President Dave Bergen Bob Ghosio, 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of MARTIN KOSMYNKA COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, f~p/fia?//~ )~°~t~y/at~,~residing at/dba / being duly sworn, depose and say: That on the~,~) day of ,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. February 24~ 2010 on or about 6:00 PM. (signature) Swom to before me this day of -~r~ 20010 blic DEBORAH H.¥ANDUZ~ Notar~ Pul~i b~ate ot New Yo~ No. ~'V~186177 Qua4ified in Suffolk Coun~ Commissiofl Expires April 28, 20].2 ~oard of Trustees Applica~n County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE S~gnature SWORN TO BEFORE ME THIS Nota~ Public CONNIE D. BUNCH Nota~ Public.State of New No. 01BU618§0§0 Qualified in Suffolk Commission Expires April 14, APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Tho Town of Southold's Code of Ethics omhibits conflicts of interest on the oart of town Officers and cmalovees. The ourooee of this form is to umvide information which can alert the town of oossiblo conflicts of interest and allow it to take whatever action is neeessarv to avoid same~. (Last name, first name, roiddle initial, unlass you are applying in the name of someone else or other untiVj, 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 pint Mooring Exemption from plat or official map Planning Other (lf"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? "Relittioaship" includes by blood, marriage, or business interest- "Business interest'~ means a business, including a partnership, in which the town officer or employee has~e2~n'a'~ar tial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5°/~5'~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 6r 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 spac~ provided. Tbe town officer or employee or his or her spouse, sibling, parent, o~ child is (check all that apply): A) the owner of greater than 5% of the shares of the corporate stock of the applic*n~. (when the applicant is a corporation); __B) the legal or beneficial own~ of any interest in a non-corporate entit}, (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 Signature PrintName To~n of Southoid LWRP CONSISTENCY ASSESSMENT FORM I~STRUCTIONS 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, e~ch answer must be explained in detail~ li~tino, both supporting and non- suooortin~ fact& 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 PROJECT NAME ~7e90 5//~' (;/c /d Ziq! C' Cc;)~P/Cyc. L' The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board ~ 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) Co) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Natureandextentofacfion: ~. o/,j,.~dTlaC,,tL f~ I")oc[d CcA2~/c)7-/l..'d-' COIL-- ,/of- Lo~ation of action: Site acreage: Present land use: Present zoning classification: /$~4 ~-,' ~- f~ ~'~ ~ / 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: t~/~ (c) Telephone number: Area Code ~)~ 7fl~/ - /7/~' ~''q (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? federalagency. 0~"~ ~3F /? ~/'No [--] If yes, whic slam. or ? ~ / Yes 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 Southoid. See LWRP Section~ III - Pol~ies Pages 3 through 6 for evaluation criteria Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section IH - Policies Pages 6 through 7 for evaluation criteria Yes [] No Not App.cable 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 HI - Policies Pa. ges 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 Southold. See LWRP Section HI - Policies Pages 16 throu.~gh 21 for evaluation criteria I I Yes[ I No I I 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. Attach additional sheets if necessary Policy ?. Protect and improve air quali~y 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.~ee LWRP Section HI - Policies; Pages 34 through 38 for evaluation criteria. II Yes ] I No I I 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 Ill - Policies; Pages 38 through 46 for evaluation criteria. ~ Ye~ No otApplicable Attach additional sheets if necessary · WOI~KING COAST POLICII~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. Se~ LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. 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 HI - 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 65 through 68 for evaluation criteria. [ lYes t I Nol I Not Applicable PREPARED BY~ ..J~ TITLE Address _04'3740 Dollars 09/05/2008 i4:37 6312984214 GOGGTNS AND PALUHBO PAGE 83 ~;URVE¥ OF PARt'OF ~L~T ~25 & ~ART OF LOT11~ MAP OF NA SSA U F~ RM9 $1TUA TE A T ~ $&RD Or: TRUSTEF-5 C~ a.5~ - ~ .... ,' ,__ BAY AVENUE , j ~ N OF SOUTHOLD ....... (.49.5'J ~ ~. ~ , %:'-.~~ NO7 5g 50 CER~ED TO~ ~ ~ CHRIS'NE KOSM~KA ~ ~ ~ S~WART ~TLE INSURANCE CO. ~ ~ ' . THE EXIS~NCE OF RIGH~ OF WA Y AND/OR EASEMENTS OF RECORD IF AN~ NOT SHOWN ARE NOT GUARANTEED. 0+1~ UNAU~ORIZED AL ~RA ~ON OR ADDITION TO ~/S SURLY IS A ~OLA ~ON OF SEC~ON 7209 OF ~E NEW YORK STA~ 0+20 EDUCA ~ON LA · ~ -2.7' COP/ES OF THIS SURVEY MAP NOT BEARING THE LAND SUR~YOR'S INKED SEAL OR EMBOSSEDTo BE A VALIDSEAL TRuESHALLcop KNOT BE CONSIDERED ~ ALDEN,s GUARAN~ES INDICA~D HEREON SHALL RUN (~OP CREEK~ ONLY TO ~E PERSON FOR ~OM ~E SURLY 1. FIRM ZONE AE (EL. IS PREPARED, AND ON HIS BEHALF TO ~E COMPAN~ GO~RNMENTAL AGENCY AND ~ ~ 2, ELEVATIONS SHO~ REFEF TO MSL DA~M NGS, NOS LENDING INS~ON LIS~D HEREON, AND ~ ~ (F~MERLY USC TO ~E ASSIGNEES OF ~E LENDING INSTI- GS DATUM) TU~ON, GUARAN~ES ARE NOT ~ANSFERABLE. SURVEY OF: DESCRIBED PROPERTY SITUATED IN: PECONIC TOWN OF: SOUTHOLD SUFFOLK COUNTY, DATE: 9/8/08 DIST. S.C.T.M. NO. 1000 NEW YORK JOB NO. B08-11756 SCALE: SEC. BLK. LOT 138 02 025 I"= 10' KENNETH H. BECKMAN, L.S. Surveying and Land Planning 1814 Middle Country Road Suite D Ridge, N.Y. 11961 (631) 345-9427 FAX (631) 345-9429 ADD PULLEY POLE 4/2/2010 REV. DOCK 3/18/2010 B08-11922 ADD PROPOSED DOCK 2/11/2010 BO8-11922