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Home My WebLink AboutTR-7766 James F. King,President r3F soory Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O �� 54375 Main Road Dave BergenP.O. Box 1179 A Southold,New York 11971-0959 John Bredemeyer co Michael J. Domino '.20 �� Telephone(631) 765-1892 (yco ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0826C Date: December 11, 2012 THIS CERTIFIES that the repair of an existing 3'x40' catwalk replacement of 3'x7' stairs from bulkhead to dock and replace damaged 3'x3.5' stairs from dock to beach• with the conditions of the use of either non-treated lumber or thru-flow material on deckin • and access stairs to beach on each side of the dock At_1.265 Shore Drive Greenport New York Suffolk County Tax Map#47-2-26.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 22. 2012 pursuant to which Trustees Wetland Permit#7766 Dated April 18. 2012, was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the repair of an existing 3'x40' catwalk replacement of 3'x7' stairs from bulkhead to dock and replace damaged 3'x3.5' stairs from dock to beach; with the conditions of the use of either non-treated lumber or thru-flow material on deckin • and access stairs to beach on each side of the dock. The certificate is issued to JOHN& MARIE SHACK owners of the aforesaid property. Authorized Signa ure Jill M. Doherty,President QF souryo Town Hall Annex James F.King,Vice-President �O 54375 Main Road Dave Bergen P.O.Box 1179 Southold,New York 11971-0959 Bob Ghosio,Jr. d+ ae John Bredemeyer '.�l �� Telephone(631) 765-1892 A� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE 9F INSPECTION: I D /-'�- Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction %: constructed Project complete, compliance inspection. INSPECTED BY: `JtTI� COMMENTS: AJ I iaz oJowlt . CERTIFICATE OF COMPLIANCE: James F. King, President Bob Ghosio, 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. 7766 DATE: APRIL 18, 2012 ISSUED TO: JOHN & MARIE SHACK PROPERTY ADDRESS: 1265 SHORE DRIVE, GREENPORT SCTM# 47-2-26.1 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 April 18, 2012, and in consideration of application fee in the sum of $250.00 paid by John & Marie Shack 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 repair an existing 3'x40' catwalk, replace 3'x7' stairs from bulkhead to dock and replace damaged 3'x3.5' stairs from dock to beach; with the conditions of the use of either non-treated lumber or thru-flow material on the decking; and access stairs to beach on each side of the dock; and as depicted on the site plan prepared by John B. Kirmish Jr., last dated March 15, 2012, and stamped approved on April 18, 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 Permittee John & Marie Shack, residing at 1265 Shore Drive, Greenport, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for dmnages, 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 txmy be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 April 18, 2012 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD John & Marie Shack 1265 Shore Drive Greenport, NY 11944 RE: 1265 SHORE DRIVE, GREENPORT SCTM# 47-2-26.1 Dear Mr. & Mrs. Shack: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 18, 2012 regarding the above matter: WHEREAS, JOHN & MARIE SHACK 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 22, 2012, 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 18, 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, 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 JOHN & MARIE SHACK to repair an existing 3'x40' catwalk, replace 3'x7' stairs from bulkhead to dock and replace damaged 3'x3.5' stairs from dock to beach; with the conditions of the use of either non-treated lumber or thru-flow material on the decking; and access stairs to beach on each side of the dock; and as depicted on the site plan prepared by John B. Kirmish Jr., last dated March 15, 2012, and stamped approved on April 18, 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, m~esF. Kin~' ,~ President, Board of Trustees JFK/eac 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 tO: JOHN & MARIE SHACK Please be advised that your application dated March 22, 2012 has been reviewed by this Board at the regular meeting of April 18, 2012 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) __ Ist Day of Construction ($50.00) __ ¼ Constructed ($50.00) XX Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) __ 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 7,), 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 (63 I) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., April 11, 2012 the following recommendation was made: Moved by Jack McGreevy, seconded by John Stein, it was RESOLVED to SUPPORT the Wetland Permit application of JOHN & MARIE SHACK to repair an existing 3'X 40' catwalk, replace 3'X 7' stairs from bulkhead to dock and replace damaged 3'X 3.5' stairs from dock to beach. Located: 1265 Shore Dr., Greenport. SCTM#47-2-26.1 Inspected by: Doug Hardy, Jack McGreevy The CAC Supports the application with the Condition appropriate materials are used and there is a provision for public access along the beach. Vote of Council: Ayes: Jack McGreevy, John Stein, Audrey Horton, Peter Young, William McDermott. Nay: Doug Hardy Motion Carried James F King, President Bob Ghosio. Jr, Vice-President Dave Bergen P.O Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report JOHN & MARIE SHACK request a Wetland Permit to repair an existing 3'X 40' catwalk, replace 3'X 7' stairs from bulkhead to dock and replace damaged 3'X 3.5' stairs from dock to beach. Located: 1265 Shore Dr., Greenport. SCTM#47-2-26.1 Typ/of area to be impacted: _~;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: Presept Were: ~J. King l B. Ghosio '-'~. BredemeyeL ~YMichael Domino ~/D. Bergen, D. Dzenkowski Form filled out in the field by ~ Mailed/Faxed to: Date: ~er r.' John B. Klrmlsh Jr. 15955 Main Road, Mattituck, NY 11952 ~ Phone/Fax (631) 298-1956 March 15,2012 Service proposal for: John & Marie Shack 1265 Shore Drive Greenport NY Service description as follows: (DOCK REPAIR) 1. Remove existing decking, deteriorated support beams and headers 2. Prep. & Install new treated 4x6 headers attached to existing pilings and fastened with galvanized 5/8" thru bolts. 3.Install (3)new 4x6 treated support beams a~tached to new headers. 4.Install new 2x6 Doug ~r decking using Stainless steel screws. ptions: or "Thru Flow" decking material, Add approx. $2,800 to estimate. * Fo-~.2~" x 5.5" docksid~ composite decking, Add $2,600 to estimate. Total estimate for above item ........................................... $4,975 *Any additional carpentry work to be $60 per man hour. Payment schedule as follows: to be determined. star~ date:to be determined at acceptance of service proposal. completion date: 3-5 days Page 1 of 2 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees APR 1 2 2012 From: Mark Terry, Principal Planner LWRP Coordinator Date: April 11, 2012 Re: Proposed Wetland Permit for JOHN & MARIE SHACK SCTM#1000-47-2-26.1 JOHN & MARIE SHACK request a Wetland Permit to repair an existing 3'X 40' catwalk, replace 3'X 7' stairs from bulkhead to dock and replace damaged 3'× 3.5' stairs from dock to beach. Located: 1265 Shore Dr., Greenport. SCTM#47-2-26.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is 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 (inplace), 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 and shoreline erosion control structures (including, but not limited to, groins, jetties, bulkheads, filled piers) located within Great Peconic Bay, Cutchogue Harbor, Little Peconic Bay, Hog Neck Bay, Noyack Bay, Southold Bay, Shelter Island Sound, Pipes Cove, Orient Harbor, Gardiners Bay, Long Island Sound, Fishers Island Sound and Block Island Sound (excluding all creeks); 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 Coastal Erosion Permit Application ~Vetland Permit Application Administrative Permit Amendment/Transfer/Extension ,.~Rece~vved Application:. ~!~o% ~ ~) · ~'Received Fee:$ r~'~ -~n~ompleted Appl]~ation~ Incomplete SEQRA Classification: Type I Type II Unlisted ~ ~t:m~. ,~ Coordination:(date sent)_ '-~LWRP Consistency Asqessment Form ~CAC Referral Sent: .°.~1',~)~{~ -' j.:~ : · M~ate of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: .,,A~ublic Hearing Held: q [l~ !1 ~'~ Resolution: NameofApplicant TOmB ~t%OPl~ 5~CcC~[C Address I~C~- ~¢0r~ ~'r{~ ~ Phone Number:( Suffolk County Tax Map Number: 1000 - ~ ~ mrope~y Location: I~g¢- ~6~ ~rk~ (provide LILCO Pole ¢, dMt~ce to cross steers, and location} AGENT: (If applicable) Address: Phone: ¢ Bo~d of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: ~,,~- Of 0 Previous use ofproperty: 0~ ~0.~'~,/~ Intended use of property: b~ ~o, Ya'~/~ ~eoc~ I~-'fiC~L Covenants and Restrictions: If "Yes", please provide copy. Yes /~ No Does this project require a variance from the Zoning Board of Appeals __ If "Yes", please provide copy of decision. Yes ~X No 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 ' I 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: Project Description (use attachments if necessary): Bo~d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeo£theproposedoperataons: ~t~0-~~ ~0C~/(~ Area of wetlands on lot: Io)F '~ t~ (~ square feet Percent coverage of lot: O % cubic yards cubic yards Closest distance between nearest existing structure and upland edge of wetlands: O feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? /x~ No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes ofproposed activity: V~(~' ,C?~1~'~1~0% ~0Q~C Are wetlands present within 100 feet of the proposed activity? No x~ Yes Does the project involve excavation or filling? ~ No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? .(cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts 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) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 3.PROSPECT OCATION: Municipality (~ ~'~,~ ~ ~)'~ County 4. PRECISE LOCATION: S~eet Addess and Road Intemec~ons Prominent landmarks etc -gr provide 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 5. IS PROPOSED ACTION: ] New [] Expansion ¢Modification / alteration map 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially (~ acres Ultimately (~ acres 8. ILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~VHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential I~lndustrial E~commercial [---]Agriculture ~Park/Fo[est/OpenSpace ~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or L~al) ~Yes ~ yes, agency name and permit / approval: No list -. 11 DOES ANY~ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~No yes. agency name and permit / approval: list R ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor N~r¢~(~ , /J ~' ! Dat : 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 617.47 If yes, coordinate U~e review p*'ocese and use the FULL EAF. E]Yes [~No B. WILL ACTION RECEIVE COORDINATED REVIEWAS PROVIDED FOR UNLISTED ACTION~ IN 6 NYCRR, PART 6t7.67 If No, a nagafive dedamben ma._~.be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED W1TH THE FOLLOWING: (Answe~ may be haedwntten, if ingib~e) C1. E~edng ak quality, sudase er groundwater quality ur qnantity, noise levels, exi~ traffic paffem, solid waste pmduc~o~l er disposal, pofential for erosion, drainage er fooding pcoblems? Explain briefly: C2. A~o[;~.;C, ~u,k,u;kgal. archaeological, histedc, or other natural er cultural msoumes; ~ comnl~ql(y o¢ rte~hborho~l character? E.x~otain briefly: ~.3. Vegetation or fauna, fish, ~,~effiish or wildlife species. ~,~,;~'..~anl habitats, ~ iftrnata~KI o~ endangered species? Explain bdetly: A ,.~...unk'y s ex~stmg p~ans or gee s as oi~:lally adopted or a change n use o~ &,l-~,.q[y of use of [and er ether natund resources? EX~ath bdefly C5 Growth, subsequent development, or related activf~es likely ID be reduced by the proposed action? Explain briery '" CS. Long term. shod term. cumulati~, or other effects'~t identified in C1-C57 Expla[a briery: ......... C?. ~lhor Im~act~ {thctuding changes in uso of either q~an~it¥ o~ i!t~ of ~noqt}~ ff~ain ~dofl~t: ....... ! D. VVILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAl PART I# - ~ ~ ~;~ATION OF SIGNIFICANCE (To be completed by ,e~e ~'y) . INSTRUCTIONS: F~x~ead~adver~ee~ec~identi~edab~ve~deK`m1i~ew~etheriti~subs~antia~arge~mperta~r~henvisesigni~ca~ Each effect should be assessed in ~oflflection with its Ia) seffing (i.e. urban or rural); (b) pr~ebi~ ~ oecur~g; (c) duratio~; (~) Irreversibflity; (e) suffident de~l to show that all relevan~ ~verse impa~ts have been HenlEted and ~ ~. If qUeSSofl d of part il was checked WILL NOT result in any significant adve~e envlm~rnantal knpac*s AND pmVMe, off Mtachme~ta as necessmy, the masons supporlfng tffi,, dofefmtaeflon. Board of Trustees Name of Lead Agency Date Print or TYl~e Name of Responsibin Officer in Lead Agency President Title of Responsiffie Officer Signature of Respons/ble officer in Lead Agency Signalure of Prepaeef (If diffe~f~l ~'om responsible officerJ Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN ~ District Section Btuck Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION~ ITfLM# / WORKASSESSMENT I Yes No a. What is the Total Area of the Project Parcels? (tuclude TotalArea of all Parcels located wfthin ~ ~1'~ ~)' q~'¥. I GeneratedWill this Project Retain Ali Storm-Water Run-Offby a Two (2") Inch Rainfallo~ Site? the Scope of Work for Proposed ConstmclJon) (This item will include all mn-off created by site b. What is the Total Area of Land Cleadng (S.F. I Ac~e~) clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed O Site Improvements and the permanent creation of construction activity? impervious surfaces.) (s.F. / ^ems) 2 Does the Site Plan and/or Survey Show AJI Propesed ! PROVI])E BRI[~ PROJECT DESCRIPTION (P~.~ ~d~.aipag. ~ N~) Drainage Structures Indicating Size & Location? This -x/ r~ item shall include all Proposed Grade Changes and '~ ~\~ '~.~}~ li~ (~0~ '~(-'O~ . Slopes Contrelling Surface Water Flow. and sediment control practices that will be used tot' ~(~._ki,) ~(~)~'~D~O~\ ~0~03.Y~(5~ } (.~ I)~ ~0~) controlsiteerosionandstormwaterdischarges. This item must be maintained throughout the Entire Construction Period. h'0.~ '~\(~'n~,~S 4 Will this Project Require any Land Filling, Grading or ) ~,~0~O~ t'~\~)~,~.~ ~/~0~ ~ 0~(~ Excavation wbere there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards 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 Trustee~ jurisdiction~L~ General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is required for all Canstmctlan activi~es involving $oi~ Beach? d~turber~ces of one (I) or more acres; including disturbances of lass than one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a larger common plan that will u~imately disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise to including Construction activities involving soft disturbances of [ess than one (1) acre where One Hundred (100') of Hedzontal Distance?~ -- the eEC 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 f~om Construction activity. Pe~it NO. GP~0.10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off~ ~_ t The SWPPP shall be prepared p~er to the subrnittsl of the NOI. The NOI shall be n o and/or n the direction of a Town right-of-way9 submitted to the Department prior to the commencement of construction activity. 2. The SWPPP shall describe tbe erosion and sediment control practices and where 9 Will this Project Require the Placement of Material. regeimd, post~onstmctlan storm water management practices that w~l 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 Right-of-Way or Road Shoulder STATE OF NEW YORK, That I ....... ~...]..O...(~So¥i.d~....d~s..~;...~..~.~;~.I ............. ~.,.. being,duly swtrn, deposes and says that he/she is the applicant for Pen]fit, O;vner and/or representative of the Owner or Owners, and is duly authorized to perform or have pefforn~ed the said work and to make and file this application; that all statemenks contained in this application are mae to the best of his lmowledge and belief; ;md that the work will be performed in the manner set forth in the application filed herewitl~. Sworn to before me this; ............... -~..~ .......................... day of ..... ~.~-..~ ~ .~.....~. .................. 20!.~ FORM - 06/10 Ul- 4ZI I James F. King, Presidenl Bob Glmsio, Jr. , Vice-Presidem Dave Bergen John Bredemeyer Michael .I. Domino Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of JOHN & MARIE SHACK COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING ', /r]fl~f'/~' 5~aC~ , residing at /dba ./ag,ftc5'~-' being duly swo~ dep~e and~: That on the~d day of ~ ,201~1 personally posted the prope~y 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 fbr eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed, April 18~ 2012. Dated:~_~- ~0 - 02-0 [c~ (signature~ ' Sworn to betbre me this ~.~0 day oft-,--cO,20 ~ o~. Notary Public ~ ~ No 01WA6140~.4~ Quahf)ed in Suflol~ County. C~mmissio~ Expires Januaq 3~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: d N~e) C. [{ate of Delivery ferent from item 17 nyes [] No [] Instmed Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) ; AtticleNumber(Trartsferfroms~,,,~.__.~?O-j,~ '1,57r] Or]O.j, Form 3811, February 2004 Domestic Retum Receipt Swom to before me this ~0 ee~ifled Mail I-I Express Mall [] Registered [] Return Receipt for Merchandise says that on the copy of the Notice ~e above n~ te addr~ses set ts sho~ on ~e c~t dl~ at ~e Unit~ S~tes Post to each ofs~d p~sons by Day of v.,xc, acc~ ,20 Notary Public No. OIWA6 40448 Qua f ed in Suffolk County a C~nmission Expires Janua~ 3g.~ 0 ~,, Board of Trustees Application County of Suffolk State of New York //~/gT/']~ ~20/(-.~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS ~z g cO, DAY OF ,20. '2 Notary Public T~MMI ,I. ·. 0.C~t61421!1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town offieem and emnlovees. The nurvose of this form is to omvide information which can alert the town of oossible conflicts of intem~t and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Lost name, firs~name,~iddle initial, unless you are applying in the name or someone else or other entity, such as a company. If so, indicate, the other person's or company's name.) NAME OF APPLICATION: (Cheek 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 ~ lfyou answered "YES", complete the balance of~s 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/agcat/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 o?vner 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, parmer, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this . ,~t~o f~ 200[~ Signature , . Print Name /l~l[trle, Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listin~ both supporting and non- supporting, 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. DESCRIPTION OF SITE AND PROPOSED ACTION scm# The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board ~] Building Dept. ~-] BoardofTrustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: ~ · ~ Location of action: Site acreage:. Present land use: Present zoning classification: '-~- If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nameofapplicant: ~CX¢~*.o %~O. C2/Q. (c) Telephone number: Area Code ( )_ (o 3 [ ~ t~ ~) r} _ (o 0 [ ~- (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? ~)[ 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 ~ 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 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 Appl~le 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/ u 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 [-~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of thc Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ye f3 No [] No, Applicab,e Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southoid's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~ Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island ,Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~ Yes [] No ~-~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes [--] No ~ Not Applicable . , ~ '~ o Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section Ill - Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~ No [] Not Applicable DATE APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD JDATE ,,(-/,'z~ /~' ~_ ,,/z_ HYDROGRAPHIC MAP Surveyed: 12-19-11 Situate: Greenport Town: Southold Suffol County, NY Datum: M L L W I 1" = 30' I ROBERT H. FOX ~t'S PLS# 50197 Box # 366 Aquebogue ,NY 11931 VACANT PUBLIC WATER IN STREET SHORE TEST BORING 7CZI106 ~./ ~.~ ~k ~o~ Lo~ OL ~own Cl~y CH · ~Ier ~ Brow~ ooy CH · o~et ~ Brown CIoTeI S~d 5C ~afer ~ Pale Br. e~ z.? N. 50'38'30' E. IO' m~4 I00.00' E'XI$ TING 'IE 11.7 LOT 1(~ o.~ LOT 1~ ZONE LOT ZONE AE ( el. --~ __ ..., ~ S. 54'15'/0' W. ' 114.22' FLOOD ZONES FROM FIRM 36105C0159 5/4/98 PIPES COVE ELEVATIONS ARE REFERENCED TO NGFD = 15,746 sq. ft. to tie line ~'Y AL TERA 770N OR ADDITION TO Th~ ~URVE'Y IS A tqOLA T~ON OF SEC770N ~09 OF THE NEI¢ YORK STATE EDUCATION LAW, EXCEPT AS PER ~ECTTON ?209-SUBDIVISION ~. ALL CERT~ICA TION~ HEREON ARE VAL~ FOR THI~ MAP AND COPtES THEREOF ONLY F SAID MAP OR COP~$ ~E,4R THE JV~I~EE, SED SEAL OF THE ~URVEYOR WHOSE ~ 7~RE APPEARS HEREOI~, A~)ITIONALL~Y TO COMPLY WITH ~41~ LAW THE TERM 'ALTERED BY' MUST 86 USED 8Y ANY AND ALL ~URV~YOR$ UTILIZJV6 A COPY OF ANOTHER SURVEYORS MAP. TERMS SUCH AS 'JV~ECTED' AND '~ROUGHT'TO'OA TE' ARE NOT ~1 COMPLIANCE WI77'l THE LAW. SURVEY OF LOTS 16, 17 & P/LOT 15 COLLAR FILED JUNE 29, 1950 FILE NO. 1759 A T GREENPORT- .o ~ TOWN OF SOUTHOLD .~ . SUFFOLK COUNTY, N Y. ..~ 1000 - 47 - 02 -P/O 26 RAIN RUNOFF CALCUL4 HOUSE AFTER CONSTRUCTION -2147. sq. ft. 2147 x 0.17 x I = 365 cu. IL 365/22.3 = 16.4 VF GARAGE = 545 sq.-fl ASPHALT DRIVE = 59Z sq./f. GARAGE & DRIVEWAY = IJ37 ~q.f/. 1137 ~ 0.1~ ~ I = 193.3 cu. lf. /93..3122.3--= 8.7 VF / 25.1 VF PROVIDE 4 DW$ 6'¢ '- 7' DEEF OR EOUAL LOT COVERAGE EXISTING 2234 sq.(f. 2234115746 = 14% A T COMPLETION OF CONSTRUCTION 2692 sq. fl. ' 2692115746 = 17% 'SCALE.- 1" = 20' SEPT. ~, 1998 JAN. ~7, ~007 (PROP. ADDIT3 JUNE ~ ~007 (LOT COVERAGE] ~UG. 12, ~009 (PROP. ADDITION) 49618