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HomeMy WebLinkAboutTR-7639 f SO �*rj �ljyO Town Hall Annex 54375 Main Road P.O.Box 1179 Southold,New York 11971-0959 Vs 'nc0 i0� Telephone(631) 765-1892 lyC,oU ,� Fax(631) 765-6641 ARD OF TOWN TRUSTEES M5ViQ 155 UEP TOWN OF SOUTHOLD FICATE OF COMPLIANCE # 0749C Date May 14, 2012 THIS CERTIFIES that the replacement of 100' bulkhead with new navy style bulkhead in- place with vinyl sheathing and with two (2) 20' returns,backfilled with approx. 50 cy. clean fill from an upland source; and installation of a 10' wide non-turf buffer landward of new bulkhead At 845 Waters Edge Way, Southold Suffolk County Tax Map#88-5-63 Conforms to the application for Trustees Permit heretofore filed in this office Dated 9/1/11 pursuant to which Trustees Wetland Permit#7639 was issued on 9/21/11 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 replacement of 100' bulkhead with new navy style bulkhead in-place with vinyl sheathing and with two (2) 20 returns, backfilled with approx. 50 ccy. clean fill from an upland source; and installation of a 10' wide non-turf buffer landward of new bulkhead. The certificate is issued to BERNARD COSIMANO owner of the Aforesaid property. Authorized Signature 5 _ James F. King,President o�%lfF014,4, Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President �� Gy P.O. Box 1179 Dave Bergen Southold,NY 11971 On John Bredemeyer �� Telephone(631)765-1892 Michael J. Domino y�o1 ��� Fax(631),765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/2 constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: I I CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President so yo Town Hall Annex Bob Ghosio,Jr.,Vice-President h0 54375 Main Road P.O. Box 1179 James F. King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer0 Telephone(631) 765-1592 IOU ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction 'Y2 constructed �( Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES r SOUTHOLD,NEW YORK PERMIT NO. 7639 DATE: SEPTEMBER 21, 2011 ISSUED TO: BERNARD COSIMANO ( PROPERTY ADDRESS: 845 WATERS EDGE WAY, SOUTHOLD SCTM# 88-5-63 AUTHORIZATION Pursuant to the provisions of Chapter 275 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 September 21,2011, and in consideration of application fee in the sum of$250.00 paid by Bernard Cosimano 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 replace 100' of existing bulkhead with new navy style bulkhead,in-place and with vinyl sheathing,construct two (2) 20' returns, backfill with approximately 50 cubic yards clean fill from an upland source, and install a 10' wide non-turf buffer landward of the new bulkhead; and as depicted on the site plan prepared by Bernard Cosimano,received on September 1,2011, and stamped approved on September 21,2011; and also on the survey prepared on Peconic Surveyors, P.C., last dated September 19, 2011, and stamped approved on September 21 2011. 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. Jill M. Doherty — Absent su�NJ* o � � TERMS AND CONDITIONS The Permittee Bernard Cosimano,residing at 845 Waters Edges Way, 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 noncompliance 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 ofthe 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 so Town Hall Annex Bob Ghosio,Jr.,Vice-President Q 54375 Main Road P.O.Box 1179 James F. King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer Telephone(631) 765-1892 l`COU Fax(631) 765-6641 OO— BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 21, 2011 Mr. Ed Goodwin 22155 Route 48 Cutchogue, NY 11935 RE: BERNARD COSIMANO 845 WATERS EDGE WAY, SOUTHOLD SCTM# 88-5-63 Dear Mr. Goodwin: The Board of Town.Trustees took the following action during its regular meeting held on Wednesday, September 21, 2011 regarding the above matter: WHEREAS, Ed Goodwin on behalf of BERNARD COSIMANO 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 September 1, 2011, 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 September 21, 2011, 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 0 • 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 BERNARD COSIMANO to replace 1 00' of existing bulkhead with new navy style bulkhead, in-place and with vinyl sheathing, construct two (2) 20' retums, backfill with approximately 50 cubic yards clean fill from an upland source, and install a 10' wide non-turf buffer landward of the new bulkhead; and as depicted on the site plan prepared by Bernard Cosimano, received on September 1, 2011, and stamped approved on September 21, 2011; and also on the survey prepared on Peconic Surveyors, P.C., last dated September 19, 2011, and stamped approved on September 21, 2011. 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, Bob Ghosio, r. Vice President, Board of Trustees BG/ec O�SUFFOI�-co • Jill M. Doherty,President Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Route 25,P.O. Box 1179 James F. King Southold,NY 11971 Dave Bergen Telephone(631)765-1892 John Bredemeyer d'� * �'� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: BERNARD COSIMANO Please be advised that your application dated September 1. 2011 has been reviewed by this Board at the regular meeting of September 21, 2011 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) 1 at Day of Construction ($50.00) 'h Constructed ($50.00) XX Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) XX The Permittee is required to provide evidence that the non-turf buffer condition of the 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. 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: Final Inspection Fee - $50.00 TOTAL FEES DUE: $ 50.00 c9�� BY: Bob Ghosio, Jr., Vice President Board of Trustees 9�a�lil �o�au> Fo�xC Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary T P.O. Box 1179 Southold,NY 11971 Telephone(631)765-1892 1 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., September 14, 2011, the following recommendation was made: Moved by Derek Bossen, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of BERNARD COSIMANO to replace 100' of existing bulkhead with new navy style bulkhead, in-place and with vinyl sheathing, construct two (2) 20' returns, backfill with approx. 50 cy. clean fill from an upland source, and install a 5' non-turf buffer landward of the new bulkhead. Located: 845 Waters Edge Way, Southold. SCTM#88-5-63 Inspected by: Derek Bossen The CAC Supports the application with the Condition of a 15' non-turf vegetated buffer along the landward side of the bulkhead. Vote of Council: Ayes: All Motion Carried OgUFFtI(� Jill M.Doherty,President �� COG P.O. Box 1179 Bob Ghosio,Jr.,Vice-President a S2 Southold,NY 11971 James F.King Telephone(631 765-1892 Dave Bergen Fax(631)765-6641 John Bredemeyer G d�0! '0 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: "L `{' II BERNARD COSIMANO requests a Wetland Permit to replace 100' of existing bulkhead with new navy style bulkhead, in-place and with vinyl sheathing, construct two (2) 20' returns, backfill with approx. 50 cy. clean fill from an upland source, and install a 5' non-turf buffer landward of the new bulkhead. Located: 845 Waters Edge Way, Southold. SCTM#88-5-63 Type of area to be impacted: L�altwater 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: Preseerlt Were: J Doherty " B. Ghosio _- J. King D. Bergen, J. Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: .Bernard Cosiman0 845 Waters Edge Way,Southold - •�SCTM#8&5-63 MWA i �z^ - ..., - .. _ .- .. *'moi.• . r r h Y 1 yrSb —re�ms�:. �. .,, aviHHl I _ �. ��.�. ;py,. ' c� j�'+��� �. , w '. `� a _ . r .. ,� I- �„ 'L'� - -�,- __ — _ _ . . � ..Y� �. � � � _ f. _ _ ... ..a.-.. M vw k:6 n.�� a y .}. tr _ �n.. _ � a �ti , R`.h �. w tii � �,4.,. 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Main Rd. &Youngs Ave.) Southold, NY 11971 CA Telephone: 631 765-1938 Fax: 631765-3136 o�yCOU�,N� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM 'i 15 To: Jill Doherty, President SEP 20?1 Town of Southold Board of Trustees ___ .._ ��wn Baird of Tes ro;te From: Mark Terry, Principal Planner - --- _ - LWRP Coordinator Date: September 8, 2011 Re: Proposed Wetland Permit for Bernard Cosimano SCTM# 1000-88-5-63 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 "B" which states: B. Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site, including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit; The proposed action is not located within the CEHA. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney pF (/j Jill M. Doherty,President SO19own Hall Annex�� yO Bob Ghosio,Jr.,Vice-President /�0 Ile P. Main Road P..O.O.Box 1179 James F. King Southold, New York 11971-0959 Dave Bergen G Q John Bredemeyer � i� Telephone (631) 765-1892 ?"e' UNT ' \ Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit Amendment/Trasf r/ x[ension _✓Received Application: I /Received Fee:$ .. mpleted Application - _Incomplete _SEQRA Classification: �- -- - Type I_Type IIUnlisted_ _Coordination:(date sent) - - - %o*T�nW� RP Consistency A .-orm o0CAC Referral Sent_ mate of Inspection:_ _Receipt of CAC Repor . _Lead Agency Determination: Technical Review: oPublic Hearing Held:_ 1 Resolution: Name of Applicant a e N cLQ d [ 05,'m awe' Address �j c?k*GQS £dele W a Lq /s��v Wk old /971 Phone Number:( Suffolk County Tax Map Number: 1000 -_ /-/V99-9 U- 5 - (03 Property Location: O 'er) (provide LILCO Pole #, distance to cross streets, and location) AGENT: Ed GOOdw )►J CIS %s MAk (If applicable) +� Address: ( � S Phone: 66/- 765 -L/&/ 7 0 � Bo41 of Trustees Application • 'GE/NERAL DATA Land Area (in square feet): Area Zoning: (� Previous use of property: RE S,a e n✓�'d�< Intended use of property: Covenants and Restrictions: Yes C, No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes _,)(__No If"Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: 1N S 44// S/ Nv,J dAi;/( ZC71- Project Description (use attachments if necessary): Ave- '-f) Skm LQaNe /oo' 6, Ykc)ud w-e11 oue2 yOyeoR �kl , n-mac W a,, + 4-o p t0. E ytaceme.l+ 4 N9,1 V ire q� nrfw� o� co, y,4,;, bdgK eG i t,;� loo'4,weae 44' d , w 6 je. CNC1S o � pRoPeR f� n,f i'b.QS gaW kt ad f Re��NS ,�R2 (�a � b�el��'�� 1 wi APek 5o CwM �/�d d-rdea,v-r1 40(A L).0/4-,d cam Bole of Trustees Application • WETLAND/TRUSTEE LANDS Ic APPLICATION DATA Purpose of the proposed operations: c O p Ro 7c+ kom? Area of wetlands on lot: square feet Percent coverage of lot: h Closest distance between nearest existing structure and upland edge of wetlands: O c feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? No _Yes If yes, how much material will be excavated? / DD cubic yards How much material will be filled? 1 5o ' cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 2)SC-4�ul0Z 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): pIorQ Bol of Trustees Application COASTAL EROSION APPLICATION DATA Purpose of proposed activity: 4 pRO-�dc> Ad " 2 Are wetlands esent within 100 feet of the proposed activity? No Yes Does the project invo a excavation or filling? No X s If Yes, how much material '11 be excavated? 100 (cubic yards) How much material will be fille . 6 d (cubic yards) n/� Manner in which material will be re oved o deposited: Q)CCA mJ r Z Ptom r od Aas Describe the nature and extent the environm tal impacts to the subject property or neighboring properties reaso ly anticipated res ting from implementation of the project as proposed, including erosio increase or adverse of is on natural protective features. (Use attachments if necessary) a�gyFFO(,� • Jill M. Doherty,President Town Hall,53095 Main Rd. Bob Ghosio,Jr. ,Vice-President P.O.Box 1179 James F. King S Southold,NY 11971 Dave Bergen Q �O~ Telephone(631)765-1892 John Bredemeyer 1 # Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD.- -- ----------------------------------------------------- In the Matter of the Application of r t1i i c�� BERNARD COSIMANO J i COUNTY OF SUFFOLK) STATE OF NEW YORK) — r AFFIDAVIT OF POSTING / residing at/dba 2 z �S� C 1h yL t being duly sworn, depose and say: That on the 9 day of 5-el�eAk , 2011, I personally posted the property known as �lq5 wgly[s eAjr U±1 �o�lL�ld iyY jtq-7/ 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 September 21, 2011 on or about 6:00 PM. Dated: 9llyl'/ (signature) f�Ct7 J,� Sworn to before me this UjU� �" J�4-day ofS�Pi -20(f Nkfffy Public LAUREN M.STANDISH Notary Public,State of New York No.01ST6164008 0ual�ied in Suffolk County Commission Expires April 9,20_5 • 617.20 • SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW j SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME e2N&Ad cas; r,gNa BtAkeod 3.PROJECT �L`OCATIO�N: 1 MunicipalityJovfJ/4 old County ,i -40( 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map �y S Li Alca er) S6 r✓ o 11 /17 5. IS PROPOSED ACTION: NewElExpans n l�7RNoodifcation/alteration n /� 6.DESCRIBE PROJECT BRIEFLY: R�IlC< /bo LJ,-,,e& ST 4k CkiLikke l ( ujA U 'Owl rV N+"I �pe coNS&ct il.' !qH pcteS CAJOWS d"me-_J (/4c Q� �en.c e ewl;r�e c0eey'A did 6AV ad 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? rnrn li Yes ❑ No If no,describe briefly: j 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) j Residential Industrial Commercial E]Agriculture Park/Forest/Open Space Other (describe) ef Si it 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ®Yes No If yes, list agency name and permit / approval: 11.DOES AILY_ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes No If yes, list agency name and permit / approval: 1ff2—. LAS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? sFi u'as No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor ^Name Date�3olll Signature �+i 60041—l ry 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. 11 Yes ❑✓ 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. Yes 21 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic patter,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood charade(?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife spades,significant habitats,or threatened 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,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short lens,cumulative,or other effects not Identified in Cl C5? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of a Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? if yes,explain briefly: Yes ❑✓ No 17 . IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If s e Iain: Yes ❑✓ No F_ PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: Foreach adverse effect identified above,determine whether it is substantial,large,important orotherwisesignificant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of oocumng;(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. ff question d of part g was checked yes,the determination of significance mustevaluate the potential impactof the proposed action on the environmental characteristics of the CFA. Check this box if you have Idem ied one or more potentially large or significant adverse impacts which MAY occur.Then proceed direclyto the FU EAF aml/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 necessary,the reasons supporting thih determination. Board of Trustees - - �� Name of Lead Agency Date Jill M. Doherty President Print or*Name of Responsible Officer in Lead Agency Tide of Responsible Officer Signature o Re a Officer in Lead Agency Signature of Preparer(if different from responsible officer Ahk Alk d� k Town of Sou old ® Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.all: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A �14t STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN tamec3 bon �cr —Cod CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION rTEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Pmject Parcels? (Include Total Area of all Parcels located within .LJ Ge this Project Retain All ch Ra Storin-Water Run-Off Generated by a Two(2')Inch Rainfall on Site? ❑ the Scope of Work for Proposed Construction) (S.F./Aces) (This item will include all runoff created by site x b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all — and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F./Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DFSCRIPTiON tPmNd.Addlmnm Popes nNeedad) Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and 19 R1 2�1a`e Ori'' L e�n 4-0) ?44- Slopes Controlling Surface Water Flow. e�J1 ,l vP 'Y 3 Does the Site Plan and/or Survey describe the erosion and sediment control practices that will be used to excontrol site erosion and storm water discharges. This El /J lQ to item must be maintained throughout the Entire q / Construction Period. etftos.-e ��(;J7� C,Qt d$d/'Q 4 Will this Project Require any Land Filling,Grading or ❑ / I 1 Excavation where there is a change to the Natural (out K k ekl Existing Grade Involving more than 200 Cubic Yards X of Material within any Parcel? j Will this Application Require Land Disturbing Activities ❑ Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the ❑ Site? Is this Project within the Trustees jurisdiction X General DEC SWPPP Reguiremenla: or Within One Hundred(100')feet of a Wetland or L Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes ❑ are pan of a larger common plan that will ultimately disturb one or more acres o/land, which Exceed Fifteen If 5)feet of Vertical Rise to including Construction activities involving sod disturbances of less man one(1)acre where One Hundred(100')Of Horizontal Distance? the DEC has determined that a SPDES permit is required for storm water discharges. (SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious ❑ for Storm Water Discharges from Construction activity-Permit No.GP-0.10-001.) Surfaces be Sloped to Direct Stomn-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, Elrequired,post-construction storm water management pracUces at will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Rightof-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?rants Item will NOT include the t„aNllauon or Driveway Aprons.) identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answerto Questions One through Nine fs Answered with a Check Mark 3,All SWPPPS that require the post-construction storm water management practice In a Be.antl the construction site disturbance Is between 5,000 S.F.81 Piers in nee, component shall be prepared by a qualified Design Professional Licensed in New Ymk a Storm-Water,Grading,Drainage d Erosion Control Plan is Required by the Town of that is knowledgeable In the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to issuance of Any Building Permit (NOTE: A Cnecl,Mark(4) and/or Answer for each Question a Required for a Complete Appfcarion) STATE OF NEW YORK, COUN711Y OF,.....S.�. .............SS That I, ..._ ....v. �W...4l.S.^..'...._........................being duly swom,deposes and says that he/she is the applicant for Permit, (Name of individual signing Dowment) Andthat he/she is the ...................... . ° .D4. !4........._................................................................................................. �. (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the mariner set forth in the application filed herewith. Sworn to beforey� 1s; .................. � .. ay of....... ,2 .�.� Notary Public: ........ ...... ..... .....OLEW (Signature o/Applicant) FORM - 06/10 Nmry No.01GL1879808 aFk OAMW In Wick GMM Commltltlim Expirtr DOD.8, I 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 morose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. 1 r— i YOUR NAME: E U l7df� (Last name,first name,ipiddle initial,unless you are applying to the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance 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-corporate 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 Submitted this 30 day of /?y4 200 T Signature li�rseet.� Print Name Form TS 1 Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. 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. i 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 si 'ficant 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" 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 supporting and non- supporting onsu ortin 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# 41—�30 PROJECT NAMEb�� The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license,certification: f�1 Nature and extent of action: r� 1/J h5 idC iN F'/�/4 /1 66 wke,— Location of action: L-AAM" 'f le (,Ja� Site acreage: / i y A<-E, Present land use: A es'd eu k'r4 Present zoning classification: Re S,d•,-� ��a 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: g e Q Na 2d C^ OS.`/n a AJ e) (b) Mailing address: Q i� Li dl+1 tf c,6 e lvCx q � 44 std /y4 091 I (c) Telephone number: Area Code ( ) (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ No❑ If yes,which state or federal agency? 71).4e,C C. Evaluate the project to the following policies by analyzing how the project will further support or j 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. IN Yes ❑ No ❑ Not Applicable QV/1�tT� L(7�1�iftGGc��o�J `f'htt �' (IJ � I( 'C3lvIlA,^Ct OCl2 C Ua�.it L.,,. e Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III—Policies Pages 3 through 6 for evaluation criteria 11 Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable ✓, N Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria rN Yes ❑ No ❑ Not Applicable n PRO lw-4 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 I Yes ❑ No ❑Not Applicable ��l S O e �S %C — _ E N � i 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 Apple • 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 I 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. LA Yes ❑ No ❑ Not Applicable C �Z r►�t�� c�P�o�e b�r,��,� �o {mss., n7 ! o L -5�211y�ue1 �IN a�e/2� i 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. I N 41 No ❑ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES • Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable I I 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. It Yes ❑ No ❑ Not Applicable to �elck 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 I Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes ❑ No ❑ Not Applicable i PREPARED BY TITLE DATE Boa: of Trustees Application • AUTHORIZATION (where the applicant is not the owner) I, 6(frC N a r2<,( irl u vo residing at d q 5 lv o 4.e5 edfe- L✓G t„ (print owner of property) (mailing address) 1 do hereby authorize / (Agent) odtt .jto apply for permit(s) from the Southold Board of Town Trustees on my behalf. lei (Owner's signature) j CGL BERT I.SCOTT,J . Not Public, State of New Y rik alified in Suffolk Coun No.01SC472508 Term Expires May 31, APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of SII this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. r— if YOUR NAME: E (Last name,first name,rfiiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) � NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance 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/agenUrepresentative)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 j (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 3 0 day of 4, uy 200 Signature <mlv t. Print Name Form TSI � �yS 0, ISS Cdy wal BpQjaz� Cos-;Ma Ne) 3ok-kolc( �Y, 1071 -� —_ 2Cff x 6" TCS' CI AMPal l„ xt2 � � = JUS�g 6�,�ej e r 2" LAYI.OG ( 2) 8 " x 8' 11VPI.�5 -f-:- 1a►" I7[;A�JMAN W1'AINING Wl S Ali i ,A - ,9TF�SF s cs F io '9 y � foo. / / 0 O A,. ,a 10 Goo o 4k, s laoa TveF g�FFr:>< / D% 0 1 � p� N 5• o � 9 '0 FC39j0N/C SURVEY OF PROPERTY A TBA YVIEW TOWN OF SOUTHOLD �-F rr'OVED r SUFFOLK COUNTY, N. Y. ,RD OF Tfct Scale 1_ 05 30 3 ';'vN OF SOUTH:rI_ Sept. 19, 2011 aJ LOT NUMBERS ARE REFERENCED TO "MAP OF BAY HAVEN' FILED IN THE SUFFOLK COUNTY ��� Q�'v{ifs CLERK'S OFFICE JAN. 22, 1959 AS MAP NO. r, - r� 2910 '°�� f\i AREA = 17,360 sq.11. to lie lines ; I ANY ALTERATION ON ADDITION TO TNS SURVEY IS A VIOLATION OF SECTION 7209 OF THE AEW YORK STATE EDUCATION LAW EXCEPT AS PER SECTION 7209-SWDMSIW 2. ALL CERTIFICA TOC , 49618 HEREON ARE VALID FOR TMS MAP AMD COPIES THEREOF ONLY 14D U F SAD MAP OR COPIES SEAR THE dIW RESSED SEAL OF THE ECONIC S YOBS, P.C. SURVEYOR WHOSE SIGNATURE APPEARS WAEOM (631) 765 - 5020 FX (631) 765 - 1797 P.O. BOX 909 1230 TRAVELER SOUTHOLD, . 11971