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HomeMy WebLinkAboutTR-7293 J Jill M.Doherty,President SOF S011 Town Hall Annex James F.King,Vice-President ,`O� Ol0 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 Bob Ghosio,Jr. G Q John Bredemeyer Telephone(631)765-1892 COU Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 21, 2010 '4" 4 fps O+ Ms. Linda Seccafico a—&e--,t �� �►j/l, LES Associates, Inc. , (� Hampton Atrium 6 I', Cd+'GYM 186 West Montauk Hwy., Suite D-4 �ZQ �� Hampton Bays, NY 11946 s D I S RE: KUBIAKITIBETT 185 WILLOW POINT RD., SOUTHOLD SCTM#56-5-25 Dear Ms. Seccafico: The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed., July 21, 2010: RESOLVED, that the Southold Town Board of Trustees APPROVES the request for a Transfer of Wetland Permit#7293 from Richard Kubiak to Jonathan S. Tibett, as issued on April 21, 2010. If you have any questions, please contact our office at(631) 765-1892. Sincer IY, PA' Jill M oherty President, Board of Trustees JMD:Ims I 0 0 Jill M.Doherty,President Of so Town Hall Annex James F. King,Vice-President ,`O� �� 54375 Main Road P.O.Box 1179 Dave Bergen Southold, New York 11971-0959 Bob Ghosio,Jr. G Q John Bredemeyer Telephone(631) 765-1892 �(�CO Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD July 21, 2010 Ms. Linda Seccafico LES Associates, Inc. Hampton Atrium 186 West Montauk Hwy., Suite D-4 Hampton Bays, NY 11946 RE: KUBIAKITIBETT 185 WILLOW POINT RD., SOUTHOLD SCTM#56-5-25 Dear Ms. Seccafico: The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed., July 21, 2010: RESOLVED, that the Southold Town Board of Trustees APPROVES the request for a Transfer of Wetland Permit#7293 from Richard Kubiak to Jonathan S. Tibett, as issued on April 21, 2010. If you have any questions, please contact our office at (631) 765-1892. Sincer ly, Jill M oherty President, Board of Trustees JMD:Ims pgpFFO(� Jill M.Doherty,President P.O.Box 1179 James F.King,Vice-President 'sF� Southold,NY 11971 Dave Bergen ti Telephone(631)765-1892 Bob Ghosio,Jr. Fax(631)765-6641 John Bredemeyer �yof * hyo Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: V, 1)' /0 LES Associates, Inc. on behalf of JONATHAN S. TIBETT requests a Transfer of Wetland Permit #7293 from Richard Kubiak to Jonathan S. Tibett, as issued on April 21, 2010. Located: 185 Willow Point Rd., Southold. SCTM#56-5-25 FLOATS? Type 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: 6j Modifications:_ �d / Z;i�- , Conditions: nt e: _J.King _J.Doherty_J. Bredemeyer_D. Bergen_ = Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: 0 0 ti�b�OguFF0t,e`�a� Jill M.Doherty,President G Town Hall,53095 Main Rd. James F.King,Vice-President P.O. Box 1179 Dave Bergen Qf, - Southold,NY 11971 Bob Ghosio,Jr. mTelephone(631)765-1892 John Bredeeyer dl 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 % constructed Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7293 DATE: APRIL 21,2010 ISSUED TO: RICHARD KUBIAK PROPERTY ADDRESS: 185 WILLOW POINT ROAD, SOUTHOLD SCTM#56-5-25 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 11 I of 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 AArri121,2010,and in consideration of application fee in the sum of$250.0 paid by Richard Kubiak 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 reconstruct the existing bulkhead using C-Loc vinyl sheathing and for the existing 6'x4.5' wood platform,with the conditions of the installation of a 12' to 15' non-turf buffer along the landward edge of the bulkhead, the installation of a silt boom during construction that will retain all suspended sediments within the immediate project area, the bulkhead is to be raised to the adjacent neighbors bulkhead height when reconstructed, and as depicted on the survey prepared by Peconic Surveyors, P.C., last elated April 27,2010,and stamped approved on June 11,2010. 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. ellp! o rer� r+e eY TERMS AND CONDITIONS The Permittee Richard Kubiak, residing at 185 Willow Point Road Southold New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of 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. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents,and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required,upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90) calendar days of issuance of this permit. 9. That the said Board will be notified by the Permittee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. Jill M. Doherty,President �QF sorry Town Hall Annex James F. King,Vice-President ,`�� �� 54375 Main Road Dave Bergen y P.O. Box 1179 T Southold, New York 11971-0959 Bob Ghosio,Jr. A '.2 John Bredemeyer �O Telephone(631) 765-1892 COUNTI, ` Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 21, 2010 Ms. Linda E. Seccafico LES Associates, Inc. Hampton Atrium 186 West Montauk Highway, Ste. D-4 Hampton Bays, NY 11946 RE: RICHARD KUBIAK 185 WILLOW POINT ROAD, SOUTHOLD SCTM# 56-5-25 Dear Ms. Seccafico: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 21, 2010 regarding the above matter: WHEREAS, LES Associates, Inc. on behalf of RICHARD KUBIAK 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 31, 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, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 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, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of RICHARD KUBIAK to reconstruct the existing bulkhead using C-Loc vinyl sheathing and for the existing 6'x4.5' wood platform, with the conditions of the installation of a 12' to 15' non-turf buffer along the landward edge of the bulkhead, the installation of a silt boom during construction that will retain all suspended sediments within the immediate project area, the bulkhead is to be raised to the adjacent neighbors bulkhead height when reconstructed, and as depicted on the survey prepared by Peconic Surveyors, P.C., last dated April 27, 2010, and stamped approved on June 11, 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, / A O � Jill . Dohertyb' President, Board of Trustees JMD/eac 0 0 Q��gOFFQ(,l.co Jill M.Doherty,President y Town Hall,53095 Main Rd. James F.King,Vice-PresidentP.O. Box It 79 Dave Bergen 10 -Southold,NY 11971 Bob Ghosio,Jr. . '�� Telephone(631)765-1892 John Bredemeyer �'� �'d Fax(631)765-6641 BOARD OF TOWN TRUSTEES I� TOWN OF SOUTHOLD TO: �i f�C��� Ku6i o k Please be advised that your application dated A 1 . O1 O has been reviewed by this Board at the regular meeting of (t r.,l l 1 and your application has been approved pending the compl tion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 15t Day of Construction ($50.00) z Constructed ($50.00) � ,Ih /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: $ S� BY: Jill M. Doherty, President Board of Trustees ��$ypFpl,fc Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O. Box 1179 Southold,NY 11971 Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., April 14, 2010, the following recommendation was made: Moved by Doug Hardy, seconded by Greta Schiller, it was RESOLVED to SUPPORT the Wetland Permit application of RICHARD KUBIAK to reconstruct the existing bulkhead using C-Loc vinyl sheathing. Located: 185 Willow Point Rd., Southold. SCTM#56-5-25 Inspected by: Doug Hardy The CAC Supports the application with the Condition of a 10' non-turf buffer along the landward side of the bulkhead. Vote of Council: Ayes: All Motion Carried � i� .. . ''do- ��+h• a _ w i ~ � '\��� S y f i V J, M r RlII \\ 'Cow y.. _.__ .r,. , .. � � ` ° �< �ffd : , , . . ¥ . . , \� \ < .k� : � 2 } < :ƒ . �� « > \ �\»�\ « ��» ���\ \� : ? ��% ~ \? d< \ \��\ � \ .. . . . � \ � d« %© � 2 . �"�y� .\ ��22 \» � \ �� \2 � \ T ����- ©�>�\ «: \ � ���\ ` / . \ � ��� \/ �\� . \���� va$\, % « �%<�» » , � � ���� �, , © o ■ q��{ / \�>; a ��� Jill M.Doherty,President p�pSUFF!$,�CO P.O. Box 1179 James F. King,Vice-President = Gd2 Southold,NY 11971 Dave Bergen ti Telephone(63 1)765-1892 Bob Ghosio,Jr. �. Fax(631)765-6641 John Bredemeyer !'r` Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: l , 1 41– / RICHARD KUBIAK requests a Wetland Permit to reconstruct the existing bulkhead using C-Loc vinyl sheathing. Located: 185 Willow Point Rd., Southold. SCTM#56-5-25 Type area to be impacted: ` JZSaltwater Wetland _Freshwater Wetland _Sound Ul ay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: J,L2 aapt.275 Chapt. 111 _other Type of Application: _VWetland coastal Erosion _Amendment —Administrative—Emergency_—Pre-Submission Violation Info needed: I� � �.'� ►ten � +�r�F ��r �G Modifications: Conditions: Present Were: VJ.King Doherty ld Bredemeyer Bergen_ B.Ghosio, V;�–D. Dzen—tM Ski j_,,/ other Form filled out in the fltt by Mailed/Faxed to: Date: NEW YORK STATE DEPARTM&OF ENVn20NMENTAL CONSERVATIO ' Facility DEC in 1-4738-03474 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: RICHARD KUBIAK KUBIAK PROPERTY 185 WILLOW POINTIDR 185 WILLOW POINT DR SOUTHOLD, NY 11971 SOUTHOLD, NY 11971 r 0 Facility Application Contact: LES ASSOCIATES IN4f HAMPTON ATRIUM 186 W MONTAUK HWY STE D-4 HAMPTON BAYS, NY 11946 �. (631) 728-5071 n Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Southold Facility Principal Reference Point: NYTM-E: 717.8 NYTM-N: 4550 Latitude: 41°04'19.6" Longitude: 72°24'27.3" Project Location: 185 Willow Point Drive Authorized Activity: In-place replacement of 132 linear feet of existing functional bulkheading and backfill. Replacement of existing or the construction of new bulkhead returns. Reconstruct existing, or construct new parallel capping boardwalk landward of bulkhead. All authorized activities shall be done in strict conformance with the attached plans stamped "NYSDEC Approved" on 1/27/10. (SAP 1-08-010) Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-03474/00002 New Permit Effective Date: 1/27/2010 Expiration Date: 1/26/2015 Water Quality Certification - Under Section 401 - Clean Water Act Permit ID 1-4738-03474/00003 New Permit Effective Date: 1/27/2010 Expiration Date: 1/26/2015 Page 1 of 6 i LOT NUMBERS REFER TO "MAP OF SUBDIVISION WILLOW POINT" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE N ON JUNE 16, 1966 AS FILE NO. 4652. SURVEY OF PROPERTY GrMLExISTWB IXGVArm , NEW B CO. A T ARSHAMOMA 0 UE 16' ;AES, 16'P/Lwes TOWN OF SO UTHOLD ,HW SUFFOLK COUNTY, N. Y. MS TM&E4 TING TO BE REMO 1000-56-05-25 '�/'''a' TE R=' ALW SCALE. 1'=20' • AEW 6'-6' MULERS MARCH 29, 2004 We 0EA0rAN. s unoBs W W 9000 vwn gcATmm April 4, 2005 12'L June 30, 2009 TYPICAL X-SECTION JULY 8, 2009 (revislahs) SCALE, l'- /0' FILL AS NEEDED TO MA/NTA/N NEDUO CANAL EQUAL HEIGHT AT BULKHEAD WOOD 40 cu. yards max PLATFORM RFL OATS EPO BE REMOVED AND LACEDRAAP DUE EAST FLOAT FLOAT 132.00 MHW 9 ML along bulkhead BDOO,�BULKHEAO 1 CHAIN LINK FENCE " rara fE FE 16 FLAG • r —AJ — .� ^^ice _ _ _ — � - I I�i \ GQ, a POLE - LOT 23 I B _ �� y I Q)o a 1 f i I �" ZE r�*t / ut 0.6 -•I NEL pump A WALL y0 N8.3. EO N3.1 SNN b0 I ,p 21.0' �. 9.2 SHOWER FEE ELHSE. O.JE 2 �GARAGE N .nel. 9.7 ro s.1' finished floor ELS 21.0 CONC. an APPRO\'HD .4C PIi.2 T'F;R;L{g - 15.4' yn N AND CO?;;'i : )... UP m, o. r Y 3 21.9 WALL PEIiA til J. 03tt�� 5' su CL 9.4 PATE /"OZ 1 COBBLESTONE \\ V CA OIL W EL ' O 9� k N y 1 1 COSOLESTON FLOOD ZONE AEW 8) 1 r< FIRM 36103CO158 G ow FEL=79 .84, \ 20.16' c mp1'' Ry273 7 - 10 — ae. n t6 'yam /g5 0� _ - -- -- ---- _ � ' • 'yo y y B p01 NT ROAD �,5 WI LLOW 1451ti0- a Ta �EOF NETIV h5�ANT. MEP O��r ti o' O C � /'� AREA=17,918 SQ. FT. ELEVATIONS ARE REFERENCED TO N.G.V.D. 6� 8 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION 0ECONIC SU YORS, jgp/psyj OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW (631 765-5020 FAX (6 -1797 EXCEPT AS PER SEC710N 7209-SUBDIKSION 2. ALL CERTIFICATIONS P.O. BOX 909 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IFSAID 44AP OR 1230 TRAVELER STREET WH SE SIGNATUREI APPEARS HEREON.ESSED SEAL OF THE SURVEYOR SOUTHOLD, N. Y. 11971 104-123 J s 'Wy i0.' y ..xw o,•.. O s u T .S < ® `� � ate.• � ate' B ��t n+•m .r . mew•, d�!•v�Potl .0.� . aa+e+ � � � ' e e w a n .♦ ''-�3 � � dp �n s � • s � q Q d 1 f � d n mmR+ ...w ,� ra COIMTY OF SUFFOLI( Q '� SWTN0.0 unox xo uoncE p�kwaty im Suvke Igency __ bnhpNRIWY111111 • O"" O�- -y�R rW W ___ __ •...r n c�� m.m—� WeM1Ri w.n�w �� w.. LES ASSOCIA TES INC Permit Expediting HAMPTON ATRIUM 186 WEST MONTAUK HIGHWAY, STE D-4 .HAMPTON BAYS, NEW YORK 11946 LINDA E. SECCAFICO TEL 631 728-5071 JOSEPH T. SECCAFICO FAx 631 728-6707 June 17,2010 I, LJC j Town of Southold Trustees 1 --------- - ---- —� 4 53095 Main Road S �'�` I Southold,NY 11971 L..— ----- ' Attn:Elizabeth Cantrell 765-1892 Re: Trustees Permit#7293 for 185 Willow Point Road,Southold SCTM No. 1000-56-5-25 Dear Elizabeth: In compliance with your recommendations this letter is sent to formally request a transfer of Trustees Permit# 7293 from Dr.Richard Kubiak to Mr.Jonathan S.Tibett. Transfer fee payment of$50.00 payable to Town of Southold has been paid by check# 1553. Yours truly, 7 r Linda E. Seccafico f' CC:Jonathan S.Tibett Dr.Kubiak 0 LES ASSOCIA TEs INC Permit Expediting HAMPTON ATRIUM 186 WEST MONTAUK HIGHWAY, STE D-4 .HAMPTON BAYS, NEW YORK 11946 LINDA E. SECCAFICO TEL 631 728-5071 JOSEPH T. SECCAFICO FAx 631 728-6707 p ��od � June 17,2010 Town of Southold Trustees JUN 2 1 2010 53095 Main Road Southold,NY 11971 South old Town Attn:Elizabeth Cantrell Board of Trustees 765-1892 Re: Trustees Permit#7293 for 185 Willow Point Road,Southold SCTM No. 1000-56-5-25 DearElizabeth: Attached are checks from Mr.Jonathan S.Tibett that you requested for above captioned project to be applied as follows: 1.Ck# 1553 for$50.00 to be applied for transfer for permit#7293 from Dr.Kubiak to Jonathan S.Tibett 1 have enclosed letter requesting transfer of permit#7293 for your files. 2.Ck# 1554 for$50.00 to be applied for advance final inspection fees. Yours truly, Linda E.Seccafico CC:Jonathan S.Tibett Dr.Kubiak LES ASSOCIA TES INC Permit Expediting HAMPTON ATRIUM 186 WEST MONTAUK HIGHWAY, STE D-4 .HAMPTON BAYS, NEW YORK 11946 LINDA E. SECCAFICO TEL 631 728-5071 JOSEPH T. SECCAFICO FAx 631 728-6707 April 30,2010 1 Town of Southold Trustees 53095 Main Road Southold,NY 11971 Attn:Elizabeth Cantrell 765-1892 Re: Revisions to survey for 185 Willow Point Road,Southold Dear Elizabeth: Attached are revised surveys from Peconic Surveyors with revision recommendations from Wednesday April 21,2101 agenda. The dock plans from contractor is not included due to the fact that Dr.Kubiak was applying for permit on behalf of the new owner,who will be hiring a dock contractor to completed job. Please advise me how to proceed with this project. Yours truly, c4" Linda E. o OFFICE LOCATION: OQF so MAILING MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 # Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Telephone: 631 765-1938 i Fax: 631 765-3136 OOUNTI LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President C Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator I "' Date: • mclRI 15, 2010 Re: Proposed Wetland Permit for RICHARD KUBIAK SCTM# 1000-56-5-25 The proposed action is not located within the Coastal Erosion Hazard Area. 1. LES Associates, Inc. on behalf of RICHARD KUBIAK requests a Wetland Permit to reconstruct the existing bulkhead using C-Loc vinyl sheathing. Located: 185 Willow Point Rd., Southold. SCTM#56-5-25 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 EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "GG" which states: GG. Within all Town creeks, replacement of existing bulkhead on the applicant's property in the same location with a silt curtain deployed prior to and during construction; Cc: Lori Hulse, Assistant Town Attorney Office Use Only Coastal Erosion Permit Application Wetland Permit Application _Administrative Penni[ t / _Amendment/Transfer xtension r Received Application: .3 1 I 10 ', I Received Fee:$ F, i ' MAR 3 ) 20'0 /Completed Application .313npN _Incomplete _SEQRA Classification: Seutlrrol;;It•, n i Type I_Type 11 Unlisted _ ^" of t,u _Coordination:(date sent) '— ICAC Referraof Sent �ate of Inspection: t _Receipt of CAC Report: _Lead Agency Determination: Technical Review: � lic Hearing Held: ' l Resolution: Name of Applicant Or /et c h4v `,/cit Lj1e lC r('� Address / if Wt l/U« /'nivj F Ac'del, Jvu {hG((f Phone Number:(63+) y-70 96 S_- 7eao Suffolk County Tax Map Number: 1000 - —6 — Property Location: /PS- of t 1d a./ /�t 11 f Pd 41 Sac c f h o l C/ (provide LILCO Pole#, distance to cross streets, and location) AGENT: AW4 - •- (If applicable) q Ab*= Address: r re e'*coa �i � Phone: (6 9 /) 7.2 .TUCeI�h r �rcr « /'6x ( 631 7a67a J Board of Trustees Application GENERAL DATA Land Area(in square feet): �7 �� — Area Zoning: Previous use of property: �c s We n 1` Intended use of property: Prior permits/approvals for site improvements: Agency Date J✓NS /7Ec peir}�, l- -� l- y 7.��'03Y�y�oom� No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende y a governmental agency? No Yes If yes,provide explanation: Project Description (use attachments if necessary): ✓� v f �'L�sGt aU c'Z • • Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: �eytlV, repf4Ce-We0+ a �xtsf-,� B��Ikhead Area of wetlands on lot: square feet Percent coverage of lot: () Closest distance between nearest existing structure and upland edge of wetlands: 53 feet 4 YT S Closest distance between nearest proposed structure and upland edge of wetlands: 6 feet Does the project involve excavation or filling? No &Yes If yes, how much material will be excavated? 410 cubic yards How much material will be filled? Yo cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Nig 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): 0 . 0 Board of Trustees Application COASTAL EROSION APPLICATION DATA fUl r ) Purposes of proposed activity: fie i /r-e bla c e m e n t of e- s+/r y Are wetlands present within 100 feet of the proposed activity? __ZNo Yes Does the project involve excavation or filling? No VveYes If Yes, how much material will be excavated? 4I (cubic yards) How much material will be filled? L/O (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Board of Trustees Application County of Suffolk State of New York Qy rtc�' rd ��ubry �C 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 P PE TY TO INSPECT THE PREMISES IN CONJUNCTION WITH RE I F APPLICATION. Signature SWORN TO BEFORE ME THIS !L' DAY OF 200 MOROI OIAN''fn-W n" W,%,y VARC,$tare of N��Yollt h!:�"'V v'1X� 1 ��/IQ V�/U-r�x�✓ ^No.88J8048'S cJ�l b�L(1L .amtzwm F D N taoN ry Public r 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 form is to Provide information which can alert the town orpossible conflicts of interest and allow it to take whatever action is necessary to avoid same. Amdatesr Inc // T& YOURNAME: D r- �r �s vL'� /��u w t�w C� .�6'JI��foruar�, �� (Last name,first name,middle initial,unless you are applying m t n e o Mr��� i sip- V4 someone else or other entity,such as a company.If so,indicatethe o ,'V 11946 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 (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corpomte 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 COUNTY OFSubmitted this day of 6 hop 9 renuwtp — Signature SUBSCRI O RN TO BEFQRE ME Print Name 7HI8 ST%)Ay0F 7 flESOOAH GIANNE^INAN'EP! No.4031043 Sra! Na ,r+vpn, c.4036043.6uf:: Jry A/21• � ^pinYscwnExplre4JuySO4Q(— 1] 0 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ['u hrs do residing at ��5� 0",(/11, 61At (print owner of property) (mailing address) Auxlata&Inc. A&ium SG u 4 C, l J N do hereby authorize w ft- tsx D'+ CAB 9�' 11946 L�sllrc- �• Sec•c_a c to apply for permit(s) from the 7os�n� rt Sc«� CO Southold Board r tees on my behalf. (Owner's s gnature) STATE OF . .........,.. COUNTY OF SUSSC E O-RN TO BEFORE ME �� � """"'"' ""^,••°^ • THIS� MORM GIAMIETTI.iMNiEA! Notary PUNC,Stale of New YA y� No.4x!6043-£uHotk C 9glmi6ewn Fxp4psJu'y 5,�,Za/D i m+rARYPUBLIC • o�811FF0(,�c • Jill M. Doherty,President Town Hall,53095 Main Rd. James F. King,Vice-President P.O. Box 1179 Dave Bergen '� Southold,NY 11971 Bob Ghosio,Jr. �Ol y ��� Telephone(631)765-1892 John Bredemeyer T Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of RICHARD KUBIAK COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, l eA- ,u' d// 0b ii/C , residing at/dba W , /�Ou/ being duly sworn, depose and say: That on the t I day of �1�'r r 1 , 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: (+ature) Sworn to before me this A 13`Iay of-�28e,,;20/6 rotary Public DIANE M.BARTH Notary Public,ftle at Now Yak No.018A5051655 QuaW In Suffolk Camty Term ExpIros FROM ru tic ru w: Ln Postage $ M p , Certified Fee '+-= ' O i Poslrpprk Return Receipt Fee Here 1'3 (Endorsement Required) - ;y Restricted Delivery Fee ;„�,�,�:', MAILING OF NOTICE O (Endorsement Required) ) y„y,s TIFIED MAIL RECEIPTS N Total Postage 8 Fees 0 tr M Address: PS Form rt August .t. SccRc,c,_1,,mr1ns�1,1c ns SOUTHOLD NY 11971 $0.44 Zone-1 First-Class Letter 0.90 oz. Expected Delivery: Sat 04/10/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70090820000035128126 Customer Postage -$5.54 Subtotal : $0.00 ROCKVILLE CENTRE NY $0.44 11570 Zone-1 First-Class Letter n qn 17 . '-x� �� > t l°u✓ residing at ✓ being duly sworn, deposes and says that on the day of 20 10, deponent mailed a true copy of the Notice set forth in the Boar 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 rill of the�Town of Southold; that said Notices were mailed at the United States Post Office at C�'}�Gti 111ty” e/what said Notices were mailed to each of said persons by (certified) (registered) mail Sworn to before me this Day of TI 120 y Notary Public Wo p 3N3 ttExMW11,a013 617.20 SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 •R,RQ,)E T INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/ .. :r�; 2. PROJECT NAME 3.PROJECT W119y6 Municipality ��Iqf/v%d County � 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc or provide map I SSS wy /4 SGU4/1G/ d 5.IS PROPOSED ACTION: ❑ New ❑Expansion ficaflon/alterations � s�lri 6.DESCRIBE PROJECT BRIEFLY: 7.AMOUNT OF LAND AFFECTED: Initially/I'1/S acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHA S PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) esidential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY.tFederal, State or Local) es ❑No If yes, list agency name and permit / approval: 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r-1 Yes El 0 If yes, list agency name and permit / approval: 12. AS AOF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? RES ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART 11- 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 EAR ❑Yes © No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.64 If No,a negative dedaradw may be superseded by another Involved agency. ❑Yes a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,If legible) C1. Existing ab quality,surface or groundwater quality or quantity.noise levels.existing sales pattern.solid waste production or disposal, potential for erosion,drainage or(boding problems? Explain briefly: No C2. Aesthetic,agricultural.archaeological,historic,or other natural or ouWxal resources;or commuMly or neighborhood character?Explain briefly: No C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: No C4. A community's existing pians or goals as officially adopted,or a change In use or Intensify of use of land or other natural resources?Explain briefly: No C5. Growth,subsequent development,or related acgWes likely to be Induced by she proposed action?Explain briefly: No C6. Long term,short term,cumulative,or other effects not Identified in CI-CS? Explain briefly: No C7. Ot her Innds.Ndud' changes In use ofesher quantitya of a ain brie : D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEAR Of s,a lain briefl : MYes O No --—7 E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If s e lain: Yes a No F� PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: Foreach adverse effect Identified above,determine whertiverit Is substantial,large,important.orothenvisesignificant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)hreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient dela6 to show that all relevant adverse impala have been Identified and adequately addressed. If question d otparte was chedwd yes,the determination ofsignificanoe mustevaluate the potential impadofthe proposed action on the environmental charactedsticaoftheCEA Check this box Ifyou have identified one or more polentiallylarge orslgniflcans adverse Impacts which MAYoocur.Then pmceeddladlyto tine FU EAF and/or prepare a possive dedarstlon. Check this box If you have determined,based on the intomhallon and analysis above and any supportingdocumentation,that the proposed.acft WILL NOT result In any significant adverse environmental impacts AND provide,on attachments as necessary,she reasons supporting sol determination. - Board of Trustees Name of Lead Agency Date Jill M. ohertY President not or Type Name of Responsible Officer in Lead Agency Tite of Responsible Officer Signature sponsib a car n lea Agency Signature of Preparer(If different from responsible officer) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of 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). 3. If any question in Section C on this form is answered "yes", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the 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# 56 -5_- 12 -5 The Application has been submitted to(check appropriate response): Town Board 0 Planning Dept. 0 Building Dept. 0 Board of Trustees Ell 1. 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 actygn: / e Location of action: Site acreage: /7 Present land use: 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: c t 4xior A kc, 6lei-L (b) Mailing address: S O,U o� �01 nt �0 a SOt-04\ol Q b 4 1 (c) Telephone number: Area Code�30 5 �Lof SASSGr"fid 'S 7J,+-SG� � (d) Application number, if any: Will the action be ' ectly 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 E] 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-Poli es Pages 3 through 6 for evaluation criteria © Yes 0 No 12r 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 M Yes D No 2Not 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—Policies7Pa 8 through 16 for evaluation criteria El Yes Not Applicable Attach 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 E] Yes E 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 evaluatio criteria. R Yes D No-NNot 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 ETNot 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 El 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. nn ❑ YeAD 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.. Se WRP 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 Town7wat rs. SeeLWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes 1:1No ot 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 foreval tion criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 13. Promote !Not ropriate use and development of energy and mineral resources. See LWRP Section III—Policies; es 65 through 68 for evaluation criteria. ❑ Yes ❑ No Applicable Created on 512510511:20 AM LOT NUMBERS REFER TO "MAP OF SUBDIVISION WILLOW POINT" FILED IN THE SUFFOLK COUNTY CLERKS OFFICE N ON JUNE 16, 1966 AS FILE NO. 4652. SURVEY OF PROPERTY � VA� 2-W - AT ARSHAMOMA0UE TOWN OF SO UTHOLD w H SUFFOLK COUNTY, MY E=TM&CATHM To BE ROW 1000-56-05-25 044-ALL. TE RMS, ALW -' It� SCALK 1'--20' eer oEwowN• t uttoLu AVW s'-6• WHALERS MARCH 29, 2004 NEW aoc soM vwtt srFATlsws April 4, 2005 It'Lo""S June 30, 2009 TYPICAL X1 SECTION JULY,8, 2009 (re vislohs) SCALES r- /O' rjl March 5, 2010 (Iba/s rwmv�LO DUO CANAL March A 2d0 lCwMkoffland r AS NEEDED TO MAINTAIN APRIL 27, 2010 (additions) AL HEIGHT AT BULKHEAD w000 cu,yords mar LPLA 7MRM DUEEAST OR 132.00` AYR' LI ML•W along D REPAIR OF CHAIN L94K FZNCE T 1U.IOF.�O NOW MAKhEAO ELECTRIC FE .0 TO BE RAISED FE !L eta COMECnaN / .CENT NEIGHBORS 1.5'E Y lD HEIGHT. x I 5' N t� N T U R F B. U F P E R. , - ...,.. • FLAG POLE � y 4 I sw LOT 23 O o, ii V_ i O —' wow dab pump WALL B'S ��00 u tJF so 9.2 W 00..R FE _ EL Z STM FR- 14SE. 0.3T i N 8 GARAGE ry 9• 9.1• finished boor e1. x ELS 21.0 LAG TO, I 21.9. 3AU, AN TIBETT 1 vi q 9A NTAL HOME LOANS x Y NATIONAL TITLE INSURANCE'ly E RBOR T/TL F- dGFNCv_ 9! 1 C�Es R (v./