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HomeMy WebLinkAboutTR-7721 James F. King, President Bob Ghnsio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ½ constructed ,//' Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7721 DATE: FEBRUARY 22, 2012 ISSUED TO: STEPHEN G. LATHAM PROPERTY ADDRESS: 845 ROGERS RD. SOUTHOLD SCTM#66-2-40 AUTHORIZATION Pursuant to the provisions of Chapter 275 and Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting in consideration of application fee in the sum of $250.00 paid by Stephen G. Latham and subject to tl Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and Wetland Permit to replace a storm-damaged timber bulkhead and 2' higher than existing and with a 17' return; replace 4'X4' platform and stairs; replenish beach with 400 cy. sand; install rip-rap ½ to I ton stone armor seaward of the bulkhead; and install a fence a minimum 10' landward of the bulkhead, with the Condition e buffer along the landward side of the bulkhead, and as depicted on the project plan received on February 8, 2012 and stamped approved on February 22, 2012. 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. TERMS AND CONDITIONS The Pennittee, Stephen G. Latham, residin~ at 60 Ro~ers Rd., Southold, NY as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period 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 thc 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. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Pcrmittee 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. James F. King, President Bob Ghosio, Jr., Vice~President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 February 22, 2012 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Stephen G. Latham P.O. Box 595 Southold, NY 11971 RE: 845 ROGERS RD., SOUTHOLD SCTM#66-2-40 Dear Mr. Latham: The Board of Town Trustees took the following action during its regular meeting held on Wed., February 22, 2012 regarding the above matter: WHEREAS, STEPHEN G. LATHAM applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, application dated December 21,2011, 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, 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 February 22, 2012, 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, and, 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, and, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees has found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees APPROVES the application of STEPHEN G. LATHAM to replace a storm-damaged timber bulkhead with 150' of vinyl sheathing and 2' higher than existing and with a 17' return; replace 4'X4' platform and stairs; replenish beach with 400 cy. sand; install rip-rap ~ to 1 ton stone armor seaward of the bulkhead; and install a fence a minimum 10' landward of the bulkhead, with the Condition of a 10' wide non-turf buffer along the landward side of the bulkhead, and as depicted on the project plan received on February 8, 2012 and stamped approved on February 22, 2012. 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, .~s .~Presid~ Jam~ King, Board of Trustees JFK/Ims James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated i ,,%!,-~ ~ ~ has been reviewed by this Board at the regular meeting of ,.5_~,,,~-t t ~ 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) __ ½ Constructed ($50.00) v/ Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., January 11,2012 the following recommendation was made: Moved by Doug Hardy, seconded by Derek Bossen, it was RESOLVED to SUPPORT the Wetland Permit application of STEPHEN G. LATHAM to replace, in-place, storm damaged timber bulkhead with 150' of vinyl sheathing and approx. 2' higher than present bulkhead; replace storm damaged 4'× 4' platform and stairs; replenish beach with 400 cy. sand; and install rip-rap ~ to 1 ton stone armor seaward of bulkhead. Located: 845 Rogers Rd., Southold. SCTM#66-2-40 The CAC Supports the application, however, recommends rip-rap rather than the proposed structure. Vote of Council: Ayes: All Motion Carried Jill M Dohetay, President Bob Ghosio, Jr. Vic,: President Jmnes F King Dave Bergen John Bredemeycl PO. Box 1179 Southold. NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: / /~/,/z._ /~ ?'£ STEPHEN G. LATHAM requests a Wetland Permit to replace, in-place, storm damaged timber bulkhead with 150' of vinyl sheathing and approx. 2' higher than present bulkhead; replace storm damaged 4'X 4' platform and stairs; replenish beach with 400 cy. sand; and install rip-rap V2 to 1 ton stone armor seaward of bulkhead. Located: 845 Rogers Rd., Southold. SCTM#66-2-40 ~.~e of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland ~haf Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: / Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Modifications: Conditions: Presp, jat Were: __/J. King B. Ghosio /'~. Bergen. d J. Bredemeye~ -B:-BZerTkOWS~i,?--,,% other Form filted %ien~ Mailed/Faxed to: Date: N .... I~ COUN3YOFSUFFOLK © I~I OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NYl1971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: From: Jim King, President Town of Southold Board of Trustees Mark Terry, Principal Planner LWRP Coordinator JAN l 8 2012 Date: January 18, 2012 Re: Proposed Wetland Permit for STEPHEN G. LATHAM SCTM#1000-66-2-40 Note: It is unclear who owns the parcel to the south (Figure 1) of the subject parcel (black arrow) where 400 c.y. of fill is proposed. It is recommended that the Board clarify this. Figure 1. 2004 Aerial Photo STEPHEN G. LATHAM requests a Wetland Permit to replace, in-place, storm damaged timber bulkhead with 150' of vinyl sheathing and approx. 2' higher than present bulkhead; replace storm damaged 4'X 4' platform and stairs; replenish beach with 400 cy. sand; and install rip-rap % to 1 ton stone armor seaward of bulkhead. Located: 845 Rogers Rd., Southold. SCTM#66-2-40 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 to replace, in-place, storm damaged timber bulkhead with 150' of vinyl sheathing and approx. 2' higher than present bulkhead; replace storm damaged 4'X 4' platform and stairs; replenish beach with 400 cy. sand and install rip-rap Y2 to 1 ton stone armor seaward of bulkhead CONSISTENT with the denoted following Policy Standards and therefore is CONSISTENT with the 'LWRP provided the following: 1. Note that site inspection indicates that storm water controls are not installed. The downspouts are not connected to drywells. It is recommended that the Board require. The installation of drywells to control runoff from the roof and prevent surface runoff from entering the water body and Rodgers Road. The property is sloped to both of these areas. 2. It is recommended that the trees northwest of the bulkhead be preserved. 3. The source and composition of fill material to beach used on the beach has not been identified. It is recommended that the material be identified 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 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only 9oastal Erosion Permit Application --~/etland Permit Application Administrative Permit Amendment/Transfer/Extension ~ece~vved Application:_j~_ --~'~eceived Fee:$ ~7ompleted Application __Incomplete SEQRA Classification: Type I Type I1 Unlisted Coordination:(date sent). ~-----~LWqRP Consistency Assessment Form ~.-,'4--!0-1111 _ ~CAC Referral Sent: ~ of Inspection: [ Receipt of CAC Repol'ti ' __Lead Agency Determination: Technical Review: ~lic Hearing Held: Resolution: ~ ' ' NameofApplicant ~7~ff/~'~A,/ (/~. Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: aD4/D~- X/~&~:~-_~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application Land Area (in square feet): Area Zoning: ~O_ ~ Previous use of property: Intended use of property: Covenants and Restrictions: GENERAL DATA Yes .)( No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals __Yes ,fit/ No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes ,/ No 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? /k/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Area of wetlands on lot: ~ .square feet Percent coverage of lot: ~ % Closest distance between nearest existing structure and upland edgeofwetlands: feet bO~-7'2.._A~t.)2>~ ~ -~w0A4~¢ ~ p ~06~h~-~> Closest distance between nearest proposed structure and upland edgeofwetlands: feet ~ F-TZ_.zl-t, Jl)~ .,+t~_.~ Does the project involve excavation or filling? No )C~ Yes If yes, how much material will be excavated? //~. cubic yards How much material will be filled? ×~ O cubic yards Depth of which material will be removed or deposited: -~ - (o feet Proposed slope throughout the area of operations: ~VE-L Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application COASTAL EROSION APPLICATION DATA Are wetlands present within 100 feet of the proposed activity? No fi( Yes Does the project involve excavation or filling? No / Yes If Yes, how much material will be excavated? How much material will be filled?~-fl/~-t3 g Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Brcdemeyer 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 STEPHEN G. LATHAM COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~'7~C~Pff~M oa,,z-//77J'O~residingat/dba d'd/~dd£1gf' ?ddATD., d'Ot?';,":z/6;.2 r> / /CZ '7/ I17~1 being duly sworn, depose and say: That on the ~" ~ay of d-~O ~-"~/'~/Z y~, 201g-, 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, January 18~ 2012 on or about 6:00 PM. Dated: Sworn to before me this 1%c' day~j/'a..,~ 20 Wa{r~- . Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK .~ o~¢e)/...z3 .M/V lifT/, being duly swom, deposes and says that on the '1..-3 dayof P~"5~a;~,~ ,20// ,deponentmailedatme copyoftheNotice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~t 7-t4c.,- ~ , ~ ¥ , that said Notices were mailed to each of said persons by CERTIFIED MAIL/I~ETURN RECEIPT. -~ " - '~ Swo ,r~Jo. before me this Day of')~ ~, 20 Notary Pub~2c 7011 1570 0001 2,895 0506 ~:o ~ · o'o'o [] eslpueqO~el,4 ~o~ ~leoelJ ~ Ile~l~l~ I'1 [!~ pe~nsul r'l pe~e~eu [] 'B °N [] 7011 1570 0001 8895 0513 · Complete items 1,2, and 3. Also complete item 4 ~f Restricted Delivery Is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. ArUcle Addressed to: p o_ 2. A?d~leNumber i 7011 1570 m Ps Form 3811, February 2004 B. Received b If YES, enter c [] Agent of Delivery Yes No 3' ~JM~I r-I E~Of~'Mall I=1 F~glsteed I~m Rec~pt foe M~ [] Insured Mail [] C.O.D. 0001 8895 0513 Domestic Retum Receipt 7011 1570 0001 8895 0476 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 Project Sponsor) 2. PROJECT NAME ~un~ SEQR 3.PROJECT LOCATION: 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide mad 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: 8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? DYes [] No If no, descdbe bdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~]Residential []industrial E~commercial [~Agriculture [Z]Park/Forest/OpenSpace r-~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~(es r~ No If yes, list agency name and permit / approval: 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r~Yes [~]No If yes, list agency name and permit / approval: I CERTIFY THAT THE~INFORMATION PROVIDED ABOV~.~ IS TRUE TO THE BEST OF MY KNOWLEDGE Signature " If the action i$ a Costal Area, and you are a s~te agency, complete the Coastal Assessment Form he. re proceeding with t~is assessment PART I! - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, can~dinate Ule review process and use the FULL EAF. I--] Yes I'~No B. V~LL ACTION RECEIVE COOR~NATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR~ PART 617.67 If No, e negative dedaratio~ may be r~pe~eded by another Involved agency. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Aeswem may be ha~'w~ffon, If legible) C1. ~ a~' quarry, surfa~ or grmmdwatef quality or quantity, noise levels, e~s~g traffic patfam, s~ld weste ixoduddon or disposal, potential for erosion, draleage or,oodi~g problems? Expla~ briefS. I C2. Aesth~{c, agdc~t~al, archae~og~ll, I~s~ofic, or ofhor natoral or o, lffl~ll reson~ess; or com~ or nalghb~onod character? Expfaib Ixtelly: I C3. Vegetation or fauna, fish, ~helir~h or w#dlife species, slg~l~ant habitats, or threatened or e~langemd species? Explain bdefly: C4. A eommunily'a existk~g plans or goals as o~lall¥ adopted, ~ a change I~ use or'lr~onslty of use of ~ or other naf~Jraf msonmes? F-xp~in bdefly: C5, Growth, subsequent development, of related activities likely to be Induced by lhe proposed action? Explain briefly: C6. Long lerm, short term, cumulative, or other eIfects not ide~tified in Cl-C57 Explain bdefly: IA'ILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAU~iIED THE ESTABLISHMENT OF A CRITICAL / I E. 18 THERE, OR I$ THERE LIKELY TO BEr CONTROVERSY RELA'I~D TO POTEN'RAL ADVE. R~E ENVIRONMENTAL IMPACTS? If ~es expla~: PARTIII. Dc~INATIONoFSI<~,RCANCE('ro beor~ofeted by ~ge,~) . INSTRUC11ONS: F~rusch~dve~see~ectidenti~edabeve~de~erminewbe~herit~ss~bstaofia~'~a~~s~n~nL Each effe~ should be assessed in connection with its (a) setang (i.e. urban or mini); ~b) prof~blaty of o~utring; (c) dura~on; (d.) krevemb#ity; (e) geograph~ s~3e; ond (f) magnitude. If necussa~/, add attachmonts or reference supposing materials. Eusum Ihet axplona~ms cgmlain yes. the delmmlnallon of slgnlt~ence must evaluate the pofeoflallmpact oflfle proposed ~ on the emlronme~al dmmc~erlstlcs of the CEA. WILL NOT result le any slg~ticant adve~e end, mmv'gal Impacts AND provide, m aff. achmeflts as nasessa~/, the masorts suppofllng ~ dete~nlnation. Board of Trustees Name of Lead Agency Pd~ or Type Name of Responsible Officer Intel Agency Slg I~ore po slble OFmer in Lead Age~;~f' President Date TIUe of Responsible Officer Signalum of Preparer (If different from mspons/ble o~cer) Town of old Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM  PROPERTY LOCATIOH: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A /~,~ ~ ~ ~ ~ STO~-WATER, G~DING, D~INAGE ~D ER~ION CO~ROL P~N DIstdct 5~tion Bilk ~ CERTIFIED BY A DESIGN PROFESSION~ IN THE ~ATE OF N~ YO~ SCOPE OF WO~ - PROPOS~ CON~U~ON l'l'~ ~ / WO~ ~S~S~ ] Yes No a. W~t ~ the Total ~a of the Pmj~t Pa~ls? I ~ll ~is Project Re,in NI S~-Wat~ Rum~ (Include To~l ~a of all Pa~ls I~t~ ~ the S~pe of Wo~ for Pm~d Consign) /~/(S.F. I ~) ~ ~ ~ ~l ~iS item will i~lude all mn~ff cmat~ by s~Gen~ated by a Two (2") Inch ~in~ll ~ Site?~ ~ b. What ~ the Total Ama of La~ Clea~ng ~ c~aring an~or c~s~caon ac~fi~ as well ~ all and/or Gmu~ Dis~an~ ~r the proposed ~ ~ ~ Site Impmvemen~ a~d the ~anent cma~on of ~ns~ion a~?~ impewious su~s.) (s.F.~) 2 D~S ~e Site Plan and/or Su~ey Sh~ NI ~ PRO~E B~ PRO~ D~ON {~e~.~ DminageS~r~lndi~tingSize&L~t~n?Thb ~ [ [ item shall include a~l Pm~ Grade C~nges and ~/~0 ~ ~ ~ ~ ~ SIo~s ~ntmlling Sudace Water FI~. ~~ ~/~ ¢/~ ~;~ 3 ~es~eSitePtanandlorSu~eyde~ee~~ ~ and s~im~t ~ntrol pmc~ces ~at will ~ u~d to ~ c~ol site erosion and sto~ ~ter discharge. ~is ~ ~ ~ ~~ ~ itemmustbemaintainedthroughout~Enfire Cons~cfion Ped~. ~/~ ~ ~0 ~;~ 4 Will ~is P~je~ Require any Land Filling, Gmdingor Excava~on where there is a change ~ ~e NaOmi [ [ ~ ~ ~ ~ ~ ~ ~ ~. / ~ Existing Grade Involving m~e than 200 Cubic Ya~s~ --~ ~(--~/~~/~ / ~ ~ ~ of Uatedal within any Panel? 5 Will ~is A~li~tion R~uire Land Disturbing A~vi~es ~ ~ ~~ P~% Encompassing an Area in Excess of Five Thou~nd~ ~ (5,000 S.F.) Square Feet of Ground Su~ace? 6 Is there a Natural Water Course Running ~mugh the ~ Site? Is ~is Project within ~e Trustees jurisdiction General DEC SWPPP Requiremen~: or within One Hundred (100') feet of a We~and or I~turban~s of one (1) or ~ ~res; indud~ dis~n~s of less ~an one acm ~at ~7Will there be Site preparation on ~sfing Grade Slo~s ~ 2+ ~e SWPPP shall des~ t~ e~n and s~en{ ~nt~ ~s a~ ~em 9 ~11 ~is Project R~uire ~e Pla~ent of Martial r~ui~. ~st~n~n s~ ~ter ~nag~nt p~s ~at ~ ~ u~ a~or Removal of Vege~tion and/or ~e ~s~c~n of any [ [ ~/ ~s/m~ to ~uce the ~n/s ~ s~ ~t~ d~a~es and ~ assure Item Within the Town Right,f-Way or R~d Sh~lder STATE OF NEW YO~, .o cou~ or ....k.~/.:~4.'.~. ......... ss ~]la[ l, ....~Z ................. ~ ............................................ ... ~m~ ~uly sworn, deposes ~d s~ys ~zt he/she is ~c zpplic~[ [or Pe~h ~d ~at heshe is ~e ....... ~5.~.~:..~..i~. ........................................................................................................................ O~er ~or representative of~e Ore, er or O~ers, ~d is duly au~omed m peffo~ or bare ~ffo~ed O~e sfid ~rk ~d to m~e ~d file ~is applica~on; that ~1 smtemenu con,ned in ~s applimfion ~e ~e to fl~e best of his hmwledge m~d ~liefi ~d ~at ~e work MIl ~ peffo~ed in ~e mm~ner set fo~ in fl~e application filed heremfl~. Sworn to, before me ~s; day of '/ ~'~~~~/~ ............... ................... .............. ,0..../ o eubfi : ..................... ........... .............................. FORM - 06/10 eard of Trustees Applicati~ AUT~ORI ZA~ION (where the applicant is not the owner) (print owner of property) residing at 1~) (mailing address do hereby authorize ( Agent ) to apply for permit(s) from the Southold Board of Town Trustees on my behalf~ ~ ~ ~ (~ner's signature) ~~ /~ ~/~ Board of Trustees Application County of Suffolk State of New York ~_~t-~_4:);? ~,~) ~ L ~/77~ 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. 1N COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION. ,.~ / .//Signature SWORN TO BEFORE ME THIS / 9 - DAY OF _,20 / / N APPLICANT/AGENTfREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics urohiblts eonffets of interest on the tmrt of town 6ffcers and employees. The ma'nose of this form is to provide information which can alert the town of nossible conflicts of h~t~st and allow it to take whatever action is neeessarv to avoid same. -(~s~ame, fa'st na~, ~iddle initial, un ess you are applying m me name 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 ,~ Varianco 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 lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Tow~n of Soothold ~--~'cO ,,7~'7"-~ Z_ ~.77f ~,~ tv* __ Title0rpositionofthatperson '~/q-~.~-~-/.f / / ~Oi-/~' /)F.g°4/:yLT-I~M / Describe the relationship between youraelf (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 (cheek all that apply): __~,) the owner of greater than 5% of the shams of the corporate stock of the applicant (when the applicant is a corporation); __.B) the legal or beneficial own~ of any interest in a non-corporate entity (when the applicant is not a corporation); C) an officer, director, partoe?, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP ,~ ~-T ,'~s ,~,y ~M ,_,, . ~,- Submitted this .~.cd.a'Y o~/~tf~'~f/~-2'I~z O// PrintName ~<:d~ ~'~. g/4 ?'7~,~l~t Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfi'ont Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listinl~ both supporting and non- suooortin~ 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 SCT #/ - - ,-,4:5 The Application has been submitted to (check appropriate response): own Board ~-] Planning Board [] Building Dept. ~ Board of Trustees T Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Site acreage:. Present land use: ~-/E)'~A:=,~7'7 ~ Present zoning classification: ~ - ~ If an application for the proposed action has been tiled with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (c) Telephone number: Area Code ( ) ~ ~ / - 7~,.or-- ~ c~ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [~7] No ~] If yes, which state or federal agency? /~--x~_. C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria Yes [-~ No ~2] Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes [] No [--~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria Yes ~ No ~-~ Not Applicable a//77- o7-- 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 ~Yes [] NO [] Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Ap~ble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No~ot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Yes No NotApplicahle 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. ~ Ye~ No [] Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [--] Yes [-~ No~/NotApplicable 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 Southoid. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~] Yes [-~ No~NotApplieable 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 TITLE ~K.~ DATE APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE ~'~ ~ '~ ~o/~ NOTES; 1. ELEVATIONS REF}~R TO HIGH WATER ELEVATION 2. LOT AREA: 12,000 S.F. / 0.275 ACRES BULKHEAD PERMIT PLANS ~_: PROPOSED PLAN DATE: ~'.ILX MA~ .~0. 1000-68-0~'-40 1 OF 2 TypICAL SECTION - STAIRS 1. ELEVATIONS REFER TO HIGH WATER ELEVATION 2. LOT AREA: 12,000 S.F, / 0.275 ACRES BULKa~IEAD PERMIT PLANE PROPOSEB SECTION ~: TAX MAP NO. 1000-66-02-40 2 OF