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Home My WebLink AboutTR-7887 James F.King, President ��Of snojyo Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road F.O. Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer o Q Michael J.Domino Telephone(631) 765-1892 COU Nn, ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0816C Date: November 20, 2012 THIS CERTIFIES that the replacement of existing platform and stairs; replacement of existing 3'x20' fixed dock• 3'x10' ramp, (2) 10"piles; 6'x20' floating dock At 5015 Vanston Road, Cutchoeue, New York Suffolk County Tax Map# 111-14-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 21, 2012 pursuant to which Trustees Wetland Permit#7887 Dated August 22, 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 replacement of existing platform and stairs; replacement of existing 3'x20' fixed dock; 3'x10' ramp, (2) 10"piles; 6'x20' floating dock. The certificate is issued to VANSTON PARTNERS LLC owners of the aforesaid property. 'ne'e 'r Signatu e Jill M.Doherty,President O�� Town Hall Annex F S�UriyO 54375 Main Road James F.King,Vice-President h P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 Bob Ghosio,Jr. v' e Telephone(631) 785-1892 John Bredemeyer Fax(631) 765-6641 courm, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: II Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 15S day of construction _ % constructed Project complete, compliance inspection. INSPECTED BY: o COMMENTS: f 1 ( U K CERTIFICATE OF COMPLIANCE: Shea; Oct "a " C0.112d ► b�25)12 James F. King, Presidem 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 __ Ist day of construction ~ constructed __ Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7887 DATE: AUGUST 22~ 2012 ISSUED TO: VANSTON PARTNERS LLC PROPERTY ADDRESS: 5015 VANSTON ROAD~ CUTCHOGUE SCTM# 111-14-3 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 August 22~ 2012, and in consideration of application fee in the sum of $250.00 paid by Vanston Partners LLC 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 the existing platform no larger than 32 square feet, and stairs with new timber in same location as existing; replace existing 3'x20' fixed timber dock with new timbers in same location as existing; proposed 3'x10' long timber ramp; replace 10" pile with new in same location as existing; proposed 6'x20' floating dock to replace storm damaged floating dock; and proposed 10" pile to replace storm damaged pile; with the condition that the vessel at dock is not to exceed 10' in beam width; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated July 25, 2012, and stamped approved on August 31, 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 Vanston Partners LLC, residing at 5015 Vanston Road, Cutchogue, 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 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 Penxfit 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-coTnpliance 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 Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 August 22, 2012 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Sheri Winter Clarry 705 Lighthouse Road Southold, NY 11971 RE: VANSTON PARTNERS LLC 5015 VANSON ROAD, CUTCHOGUE SCTM# 111-14-3 Dear Ms. Clarry: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 22, 2012 regarding the above matter: WHEREAS, Sheri Winter Clarry on behalf of VANSTON PARTNERS LLC 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 June 21, 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, a Public Hearing was held by the Town Trustees with respect to'said application on August 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, 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of VANSTON PARTNERS LLC to replace the existing platform no larger than 32 square feet, and stairs with new timber in same location as existing; replace existing 3'x20' fixed timber dock with new timbers in same location as existing; proposed 3'x10' long timber ramp; replace 10" pile with new in same location as existing; proposed 6'x20' floating dock to replace storm damaged floating dock; and proposed 10" pile to replace storm damaged pile; with the condition that the vessel at dock is not to exceed 10' in beam width; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated July 25, 2012, and stamped approved on August 31,2012. 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:S662.00 Very truly yours, King President, Board of Trustees JFK/eac James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Towa 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 ~3'-c~e c~l~ c~OI & has been reviewed by this Board at the regular meeting of ~-t.~o u,~-J-~,~:~.ot~, and your application has been approved pending the completion of {he 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) 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 m-application fees will be necessary. You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: F; ~e_cl ~ =- 3'~18'? 5'q~?,gt, ~t3~ /,~ ~,~ ~ ~ ' ~'=3 -- - TOTAL FEES DUE: $ m BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, §ecrctary Town Hall, 53095 Main Rd. P.O. Box I 179 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., July 11, 2012 the following recommendation was made: Moved by John Stein, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of VANSTON PARTNERS LLC to replace the existing platform and stairs with new timber in same location as existing; replace existing 3'X 20' fixed timber dock with new timbers in same location as existing; proposed 3'X 10' long timber ramp; replace 10" pile with new in same location as existing; proposed 6'X 20' floating dock to replace storm damaged dock; and proposed 10" pile to replace storm damaged pile. Located: 5015 Vanston Rd., Cutchogue. SCTM#111-14-3 Inspected by: William McDermott, Jack McGreevy, John Stein The CAC Supports the application, however, the project was not staked as of July 11, 2012. The CAC recommends appropriate construction materials are used and there should be no disturbance to the eelgrass. Vote of Council: Ayes: All Motion Carried Michael .I. Domino PO. Box 1179 Soud~old, NY 11971 Telephone (631 765-1892 Fax (63 I) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: VANSTON PARTNERS LLC requests a Wetland Permit to replace the existing platform and stairs with new timber in same location as existing; replace existing 3'X 20' fixed timber dock with new timbers in same location as existing; proposed 3'X 10' long timber ramp; replace 10" pile with new in same location as existing; proposed 6'X 20' floating dock to replace storm damaged dock; and proposed 10" pile to replace storm damaged pile. Located: 5015 Vanston Rd., C utchogue. SCTM#111-14-3 Type 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: JChapt.275 Chapt. 11.1 other Type of Application: / Wetland __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission __Violation Modifications: Pr~esent Were: /"""J. King ~ Ghosio J, Bredemeyer___ Michael Domino D, Bergen, D. Dzenkowski other Form filled out in the~ld by Mailed/Faxed to: Date: Photo I - Looking East Photo 2 - Looking East Photo 3 ~ Looking East Photo 4 - Looking South Photo 5 ~ Looking North Photo 6 - Looking West Board' Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO, ..~.2.. ............. DATE: ISSUED TO ~i~ S, Ga~e~ ................... Au har za i Pursuant to the provis, lons of Chapter 61~ of the Laws .of the State of New York, 1893, and Chapter ~0~ of the .~.ws of the State of New York 1952: 'and the-Southold Town Ordinance en- titled ~'RE~ULATING AND 'THE PLACIN~ OI; OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and- the REMOVAL OF SAND, GRAVEL O'R OTHER MATERIALS FROM LANDS UNDER TOWN WATERSi" and in accordance wlfJ~ the Resolution of The Board'adopted at a meeting held on 19...~_.0.~, en~ in consideration Of the sum of $......~.2...'..~)... paid by .................................................... ~.~...~.t.....~? .......................................... of ............... ~._c.~..o..~......e. ........................................ N. Y, and sub, jeer to the Terms and Cond~flons fisted on the reverse s~de hereof, of Southold Town 'Trustees authorizes and permits the following: placement of 3' x 20' ramp, 6" x 20~ float and 20 to 30 cubic yards cE dredging, the depth below low water to be 3' instead of 6' at private REoperty, of W~ .~pp~io.~t at~,.W ..u~neweta. Po.nd, . all Iff eccoraance ?ne deta~ea speo~T~CaTiOn$ as preseflTea In the o~iginatlng application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal fo be efflxed, and these.~.resents to b~ subscribed, by a major~ty of the said Board as of this dat~ EW YORK STATE DEPARTM~N, O1: ENVIRONMENTAL COI~SERVATION PERMIT UNDER THE ENVIRONMENTAL CONSE]~VATION LAW ARTICLE 15. {Protection of Wa!er) [] ARTICLE 2S, (Tidal Wetlands) AI~TICLE 24, (Freshwater Wetlands) [] ARTICLE 36, (Construction in Flood Hazard Areas) 'COUNTY .... FIA CO~.U~UN~'-y NO. ~O~,.Jt:'JJO'J d GENERAL CONDITIONS 1. The P~.'rmillee shall file in the office of lhe appmpdale Regional Pe~mrt Adminislralor. · nofice of intention lo commence work at least 48 hours .n advance ol the time of commencement and shall also notify him promptly in writing el lbe complelion el the wort:, 2. The Ix'rmitled work shall be Subject to inspechon by an authorized r~.presemat~ve et the Depaflmen! of Environmental Conserva~iog who may order Ihe work suspended if the public inlerest so re~ulres. ~3. As a condition of the issuance of IhJs permilo Ihe applicant has ac- Ceoled expressly, by the execulion of I~e application, 1he full regal ~'es~oi~- 95-20,,4 (9/75) g. ,'~t the State of New York shall in no case be liable for any dam,' Or injury to the structure Or work herein aulhorized which may be caused resuil flor~ fulure operalions unde~faken by Ibe Slale for the co:se~va~io~ improvemeot of navigation, or for other purposes, and no claim or right com~e, nsation sba acc ue from any such damage. 9. Thai If Ihe display of lights and signals on any work hereby authorf, is not olbe~wise provided for by law, such .lights and signals as may be - sc;ibed by the United States Coast Guard shall be installed and mainta.: by and at the ex;ense el the owner. 10. All work carried out unde~ ghL~ permit shah be Porformad in ac, dance wilh esfablls~ engineering practice and in a workmanlike manner. 11. if granted under Articles 24 Or 25, fhe Oeportmaot reserves me to ~econsider this approval at any time and after due notice aed ~.eaNn; conrlnueo rescind Or modify this perndr in such a manner as may be fouml be just and equitable. U' upon the expiration et revocation el tMs modification of the wetland he;eby authorized has not been completed, applicanl shaIl..wilhou! expense fo the Slate. am:[ IO such extent and in ~ time and manne~ as the Department of Environmenlal Conseoratio= may reim remove ali or any port on of Ihe uncompleled sttuc ute or litl ar~ restore site Io its former condition. NO claim shall be made Against the Slate of ~. YO~ on account of any such removal o; ~tller~tton. June 18,2012 NYS Dept. of Environmental Conservation SUNY @ Stony Brook 50 Circle Road Stony Brook, New York 11790-2356 Attention: Duty Analyst RE: 5015 VANSTON ROAD, CUTCHOGUE, NY SCTM No. 1000-111-14-03 APPLICATION FOR PERMIT Dear Sir/Madame: We hereby submit four (4) copies of the proposed plans, application, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-848-7730. Very truly yours, She~ri Winter Clarry 705 Lighthouse Road Southold, NY 11971 CC: Army Corps of Engineers NYSDOS 6t7.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by A~plicant or Project Sponsor) 1. APPLICANT/SPONSOR 12. PROJECT NAME SHERI WINTER CLARRY / REPLACE EXISTING PIER AND DOCK 3. PROJECT LOCATION: Municipality CUTCHOGUE County SUFFOLK 4. PRECISE LOCATION (Street address and read intersections, prominent landmarks, etc., or provide map) 5015 VANSTON ROAD, CUTCHOGUE, NY 5. PROPOSED ACTION iS: [] New [] Expansion [] M~diflcatioWalteration 6. DESCRIBE PROJECT BRIEFLY: REPLACE EXISTING DAMAGED PIER, STAIRS, LANDING, RAMP AND FLOATING DOCK IN ORIGINAL LOCATION. 7. AMOUNT OF LAND AFFECTED: Ini§al;y .0t acres Ultimately .0! acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No if No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [] industrial [] Commercial [] Agricuflure [] ParkJForest/Open Space [] Other Descnbe: RESIDENTIAL BOAT DOCKING 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(s) name and permit/approvals: NYSDOS, TOWN OF SOUTHOLD, ARMY CORPS OF ENGINEERS 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? [] Yes [] No If Yes, list agency(s} name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WiLL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? DYes []No I CERTIF/Y THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam~ CLA~Y Date: ~- Signature: _,./'~f ~ I If the action is in the Coastal Area, and you are a state agency complete the I Coastal Assessment Form before proceeding w th this assessment OVER PART II - IMPACT ASSESSMENT (ToWompleted by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 [f yes, coordinate the review process and use the FULL FAF. DYes DNo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. E~] Yes DNo 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 traff~c pattern, 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 character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, 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 briny: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briny: D. WiLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? [] Yes [] No If Yes, explain briefly: E. IS THERE, OR tS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes ~r~ No If Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its Ia) setting (i.e. urban or rural); (bi probability of occurring; (c) duration; Id) irreversibility; (e) geographic scope; and If) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanaflons contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed, if quesflon D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ] Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. 'men proceed directly to the FULl EAF end/or prepare a positive declaraflon. [] Check this boxifyou have determined, based on the information and analysis above end anysupporting documentation, thet the proposed action WILl NOT result in any signiflcent adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) New York State Department of Environmental Conservation PERMISSION TO INSPECT PROPERTY By signing this permission form for submission with an application for a permit(s) to the Department of Environmental Conservation ("DEC"), the signer consents to inspection by DEC staffofthe project site or facility for which a permit is sought and, to the extent necessary, areas adjacent to the project site or facility. This consent allows DEC staffto enter upon and pass through such property in order to inspect the project site or facility, without prior notice, between the hours of 7:00 a.m. and 7:00 p.m., Monday through Friday. If DEC staff should wish to conduct an inspection at any other times, DEC staffwill so notit~ the applicant and will obtain a separate consent for such an inspection. Inspections may take place as part of the application review prior to a decision to grant or deny the permit(s) sought. By signing this consent form, the signer agrees that this consent remains in effect as long as the application is pending, and is effective regardless of whether the signer, applicant or an agent is present at the time of the inspection. In the event that the project site or facility is posted with any form of "posted" or "keep out" notices, or fenced in with an unlocked gate, this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further agrees that during an inspection, DEC staff may, among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soils and vegetation (taking samples for analysis), and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s) sought by the application. Permission is granted for inspection of property located at the following address(es): 5015 VANSTON ROAD, CUTCHOGUE, NY 11935 By signing this form, I affirm under penalty of perjury that 1 am authorized to give consent to entry by DEC staff as described above, l~/,~dfrstand that f~se statements made herein are punishable as a Class A misdemeanor pu~ Section 2~4 5 of the Penal Lctw. * VANSTON PARTNERS, LLC / OWNER ~ v ( / F- ~ . ~ s~. / '~ Print Name and Title Signature Date *The signer of this form must be an individual or authorized representative of a legal entity that: owns fee title and is in possession of the property identified above; maintains possessory interest in the property through a lease, rental agreement or other legally binding agreement; or is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in the property for the purpose &consenting to inspection &such property. Permission to Inspect Property Application Supplement 12/08 New York State 1OZNT APPLZCATZON FORM For Permits/Determinations to undertake activities affecting streams, waterways, waterbodies, wetlands, coastal areas and sources of water supply. You must separately apply for and obtain separate Permlts/Detarminatlons from each involved agency prior to proceeding with work. Please read all instructions. APPLICATIONS TO I, NYC Department of Environmental Conaervation Check all permits that apply: [] Stream Disturbance [] Excavation and Fill in Navigable Waters [] Docks, Moorings or PJatforms [] Dams and 1Impoundment Structures [] 40! Water Quality Certification [] Freshwater Wetlands [] Tidal Wetlands [] Coastal Erosion Management [] Wild, Scenic and Recreational Rivers [] Water Supply [] Long !sland Well [] Aquatic Vegetation Control [] Aquatic Insect Control [] Fish Control [] !ncldental Take of Endan- gered/Threatened Species [] 1 am sending this application to this agency. 2. US Army Corps of Engineers Check alt permits that apply: [] Section 404 Clean Water Act [] Section 10 Rivers and Harbors Act [] Nationwide Permit(a) - identify Number(s): Preconstruction Notification - [] y/ I--]N [] ! am sending this application to this agency. US Army Corps of Engineers (USACE) 5. Name of Applicant (use full name) Applicant must be: SHERI WINTER CLARRY [] Owner [] Operator Hailing Address [] Lessee (check all that apply) 705 LIGHTHOUSE ROAD Post Office City SOUTHOLD Taxpayer ID (If applicant is NOT an individual): State NY ZiP Code 11971 Telephone (daytime) Email 631-848-7730 7. Contact/Agent Name Company Name Hailing Address Post Office City State Zip Code Telephone (daytime) 3. NYS Office of General Services Check all permits that apply: [] State Owned Lands Under Water [] utility Easement (pipelines, conduits, cables, etc.) [] Docks, Moorings or Platforms 4. NYS Depart- ment of State Check if this applies: [] Coastal Consistency Concurrence [] I am sending this application to this a,~ency. 6. Name of Facility or Property Owoer (If different than Applicant) VANSTON PARTNERS, LLC [] ! am sending this application to this agency. Mailing Address 4 ASHFILEDS LANE Post Office City CONYERS FARM NORTH GATE GREENWICH State CT Zip Code 06831 Telephone (daytime) Emall 8. Project / Facility Name Property Tax Map Section / Block / Lot Number 5015 VANSTON ROAD 1000-111-14-03 Project Location - Provide directions and distances to roads, bridges and bodies of waters: SEE ATTACHED MAP Street Address, if applicable Post Office City State Zip Code 5015 VANSTON ROAD CUTCHOGUE NY 11935 Town / Village / City County SOUTHOLD SUFFOLK Name of USGS Quadrangle Map Stream/Water Body Name SAG HARBOR WUNNEWETA POND Location Coordinates: Enter MYTHs in kilometers, OR Lstitode/Longitude NYTH-E NYTM-N Latitude Longitude 72-26.926W 40-59.923N 3OTNT APPLICA1/ON FORM 09/10 This is a 2 Page Application Application Form Page I of 2 Both Pages Must be Completed ub~mit i~ APPLTCAT~ON FOR. - PAGE 2 0Ft2 . Su m~ t is completed page as part of your Apphca mn 9. Prejleet Description and Purpose: Provide a complete narrative description of the proposed work and its purpose. Attach additional page(s) if necessary, thclude: description of current site conditions and how the site will be modified by the proposed project; structures and fill materials to be installed; type and quantity of materials to be used (i.e., square ft of coverage and cubic yds of fill materiar and/or structures below ordinary/mean high water) area of excavation or dredging, volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource impacts; and where applicable, the phasing of activities. ATTACH PLANS ON SEPARATE PAGES. REMOVE AND REPLACE EXISTING DAMAGED AND/OR DETERIORATED STAIRS, LANDING, DOCK, RAMP AND FLOATING DOCK IN THEIR ORiGiNAL SIZE AND LOCATION. Proposed Use: [] Private [] Public [-Icommerclal I Proposed Start Date: 10/1/2012 Has Work Begun on Project? [] Yes [] No ]If Yes, explain. I Estimated Completion Date: 10/15/2012 Will Project Occupy Federal, State or Municipal Land? [] Yes [] No [f Yes, please specify. List Previous Permit / Application Numbers (if any) and Dates: N/A/ 11. Wig this project require additional Federal, State, or Local Permits including zoning changes? [] Yes [] No If yes, please list: ARMY CORPS OF ENGINEERS, NYSDOS, TOWN OF SOUTHOLD ~[2. Signatures. Zf applicant is not the owner, both must sign the application. [ hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 2:[0.45 of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, adsing out of the projed: described herein and ag~es to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said project. In addition, Federal Law, :[8 U.S.C., Section :[00:[ provides for a fine of not more than $~.0,000 or imprisonment for not more than S years, or both where an applicant knowingly and willingly falsifies, nceals, or covers up a material fact; or knowingly makes or uses a false, fictitious or fraudulent statement. SHERI WINTER CLARRY ~ ~ I I ~ ~l~ f~' [ ~- 1 ~ ' ' Printed Name Title Date VANSTON PARTNERS, LLC OWNER ~ '- I ~*- I )- PHnted Name Title Date Signature of A~lent Printed Name Title Date 3OZNT APPLZCATZON FORH 09/1.0 Application Form Page 2 of 2 NEW YORK STATE DEPARTMENT OF STATE COASTAL MANAGEMENT PROGRAM Federal Consistency Assessment Form An applicant, seeking a permit, license, waiver, certification or similar type of approval from a federal agency which is subject to the New York State Coastal Management Program (CMP), shall complete this assessment form for any proposed activity that will occur within and/or directly affect the State's Coastal Area. This form is intended to assist an applicant in certifying that the proposed activity is consistent with New York State's CMP as required by U.S. Department of Commerce regulations ( 15 CFR 930.57). It should be completed at the time when the federal application is prepared. The Department of State will use the completed form and accompanying information in its review of the applicant's certification of consistency. A. APPLICANT (please print) SHERt WINTER CLARRY 1. Name: 705 LIGHTHOUSE ROAD, SOUTHOLD NY 11971 2. Address: 3. Telephone: Area Code (6:~1) 848-7730 B. PROPOSED ACTIVITY 1. Brief description of activity: REPLACE EXISTING DAMAGED PIER, STAIRS, LANDING, RAMP AND FLOATING DOCK IN ORIGINAL LOCATION. 2. Purpose of activit,d: r ^,o, ,,~ ....... ~ ..... o ........... ,o~ ~, o, ~,,~,., ,.,.D AGE. 3. Location of activity: SUFFOLK CUTCHOGUE 5015 VANSTON ROAD County City, Town, or Village ARMY CORPS OF ENGINEERS 4. Type of federal permit/license required: N/A 5. Federal application number, if known: Street or Site Description 6. If a state permit/license was issued or is required for the proposed activity, identify the state agency and provide the application or permit number, if known: NYSDEC D. ADDITIONAL STEPS 1. If all of the questions in Section C are answered "NO", then the applicant or agency shall complete Section E and submit the documentation required by Section F. 2. If any of the questions in Section C are answered "YES", then the applicant or agent is advised to consult the CMP, or where appropriate, the local waterfi'nnt revitalization program document*. The proposed activity must be analyzed in more detail with raspect to the applicable state or local coastal policies. On a separate page(s), the applicant or agent shall: (a) identify, by their policy numbers, which coastal policies are affected by the activity, (b) briefly assess the effects of the activity upon the policy; and, (c) state how the activity is consistent with each policy. Following the completion of this written assessment, the applicant or agency shall complete Section E and submit the documentation required by Section F. E. CERTIFICATION The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved local waterfront revitalization program, as appropriate. If this certification cannot be made, the proposed activity shall not be undertaken. If this certification can be made, complete this Section. "The proposed activity complies with New York State's approved Coastal Management Program, or with the applicable approved local waterfront rewtahzatmn program, and will be conducted m a manner cons~stant vnth aneh progr . SHERI WINTER CLARRY Applicant/Agent's Name: Address:705 HGHTHOUSE ROAD, SOUTHOLD NY 11971 Telephone: Area Code (631)848-7730 Applicant/Agent's Signature.' ~/~ __ F. SUBMISSION REQUIREMENTS 1. The applicant or agent sba0 submit the following documents to the New York State Department of State, Office of Coastal~ Local Government and Community Sustainability, Attm Consistency Review Unit, 1 Commerce Plaza, 99 Washington Avenue - Suite 1010, Albany, New York 12231. a. Copy of original signed form. b, Copy of the completed federal agency application. c. Other available information which would support the certification of consistency, 2. The applicant or agent shall also submit a copy of this completed form along with his/her application to the federal agency. 3. If there are any questions regarding the submission of this form, contact the Department of State at (518) 474-6000. *These state and local documents are available for inspection at the offices of many federal agencies, Department of environmental Conservation and Department of State regional offices, and the appropriate regional and county planning agencies. Local program documents are also available for inspection at the offices of the appropriate local government. Policy 44 Yhere will be n~) negative effect to the vegetated tidal wetlands or wildlife and fish habitats by this proposed action. N 111 August26,2012 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 5015 VANSTON ROAD, CUTCHOGUE, NY SCTM NO. 1000-111-14-03 NYSDEC REF. NO. 1-4738-041225100001 REVISED PLANS Dear Trustees: Attached, please find four (4) copies of revised plans which have been revised as requested during the Public Hearing held on August 22, 2012. Plans have been revised to shrink the size of the fixed platform to 30 S.F. which is under the maximum allowable 32 S.F. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours~_. 2y~Pata~jo~~ 106 Hewitt Blvd. Center Moriches, NY 11934 Cc: NYSDEC Shed Winter Clarry - Agent 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office UseOnly 7~wOastal Erosion Permit Application etland Permit Application Administrative Permit --Amendmant/Transfer/Extansion ~ece~-ved Application:7 ~0104 [[ > ~ReceivCd Fee:$ ,..~Completed Application (O ~[zlA [ __Incomplete __SEQRA Classification: Type I Type II Unlisted ¢oordination:(date sent) ~/L~VRP Consistency Asse~smen, t Form/19 ~'~C Referral Sent: ~[ 0'0~[t ~' ..~fateoflnspection: 'J!ll !!? - ___Receipt of CAC Report: ___Lead Agency Determination:__ Technical Review: Resolution: Name of Applicant ~/,~lfi~r~X ~'~,~ Phone Suffolk County Tax Map Number: 1000 Prop<y Location: ~O I~ ~~ (provide LILC(~ Pole #, distance to cross streets, and location) AGENT: ~r--'~ ~'~4~r' C&~'~ (If applicable) Address: ~ ~i~~ ~a~ of Trustees Application Land Area (in square feet): Area Zoning: SFR Previous use of property:_ Intended use o f property:_ Covenants and Restrictions: If "Yes", please provide copy. GENERAL DATA 29, 345 SF RESIDENTIAL RESIDENTIAL Yes x No Does this project require a variance from the Zoning Board of Appeals __ Yes x 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 x No Does the structure (s) on property have a valid Certificate of Occupancy x Yes __No Prior permits/approvals for site improvements: Agency Date x No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary): REPLACE EXISTING STAIRS, PLATFORM, ~P%%,%~DOCK AND FLOAT IN ORIGINAL LOCATION. B d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: REPLACE EXISTING BOAT DOCKING FACILITIES WHICH KAVE BEEN DA~4AGED AND DETERIORATED. Area of wetlands on lot: soo square feet Percent coverage of lot: 1, ? % Closest distance between nearest existing structure and upland edge of wetlands: 2~± feet Closest distance between nearest proposed structure and upland edge of wetlands: 200_+ feet Does the project involve excavation or filling? x No Yes If yes, how much material will be excavated? o cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 0 Proposed slope throughout the area of operations: o ~ Manner in which material will be removed or deposited: N/A 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): REPLACE EXISTING UNUSABLE FACILITIES FOR BOAT DOCKING. Bo of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: REPLACE EXISTING STAIRS, pLATFORM, DOCK, RAMP AND FLOAT IN EXISTING LOCATION. Are wetlands present within 100 feet of the proposed activity? No x Yes Does the project involve excavation or filling? x No Yes If Yes, how much material will be excavated? 0 _(cubic yards) How much material will be filled? 0 (cubic yards) Manner in which material will be removed or deposited: N/A 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) NO ENVIRONMENTAL IMPACTS FROM PROJECT. 617.20 Appendix C State Environmental quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR ~2. PROJECT NAME SHERI WINTER CLARRY / REPLACE EXISTING PIER AND DOCK 3. PROJECT LOCATION: Municipality CUTCHOGUE County SUFFOLK 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5015 VANSTON ROAD, CUTCHOGUE, NY 5. PROPOSED ACTION IS: [] New [] Expansion [] Modificationlaltemtion 6. DESCRIBE PROJECT BRIEFLY: REPLACE EXISTING DAMAGED PIER, STAIRS, LANDING, RAMP AND FLOATING DOCK IN ORIGINAL LOCATION. 7. AMOUNT OF LAND AFFECTED: Initially .01 acres Ultimately .0! acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [] Industrial [] Commercial Describe: RESIDENTIAL BOAT DOCKING [] Agriculture [] ParkJForest/Open Space [] Other 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(s) name and permit/approvals: NYSDOS, TOWN OF SOUTHOLD, ARMY CORYS OF ENGINEERS 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No If Yes, list agency(s) name a~d permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes []No I CERTI~' THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam~ CLARRY Date: ~. ~ ~ o J ~.~ Signature: _..~. 't~ I If the action is in the Coastal Area, and you are a state agency complete the Coastal Assessment Form before proceed ng w th this assessment I OVER 1 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 the review process and use the FULL EAF. ['--~ Yes ~']No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS iN 6 NYCRR, PART 617.67 If NO, a negative declaration may be superseded by another involved agency. r-~ Yes [~]No COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED W~TH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surfaco or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I C2. Aestheticl agricuiturail archaeologiCal, historic, or ~)ther natural or cultural resources: or community or neighborhood character? Explain briefly: I C3. Vegetation or faunal fishl shellfish or wildlife Species, significant habitats, 0; threatened or endangered ip~i~;;~ Explain bdeflyi I C4. A commundy's existing plans or goals as officially adoptedl oia change in use o~ inte~ity of use of land or other ~u~i ~s~urces? Explain bdefly: I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly I C6. Long term, sho~ term, cumulative, or other effects not identified in C1-C57 Explain bdeflyi I WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA/CEAI? Ill )'es, explain briefly: [~Yes [~NoI E. IS THERE, OR iS THERE LIKELY TO BEI CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: i--lYes 171No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potentialimpact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl FAF and/or prepare a positive declaragon. Check this box if you have determined, based on the information and analysis above and any suppoding documentation, that the proposed actior W~LL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi= determination. Board of Trustees Name of Lead Agency Sig~ture of Responsible Officor in Lead '~ncy Date President Title of Responsible Officer Signature of Preparer (If different from responsible officer) Town of Southold Erosion, Sedimentation & Storm.Water Run-off ASSESSMENT FORM PROPEF~rY LOGA'nOH: $.C.T.~I. fi:. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A SCOPE OF WORK - PROPOSED CONSTRUCTION l'll~ / WORKASSESSMENT I Yes No (Include Tolal Area of all Parcels rocated within I Wilt this Project Retain Ail Storm-Water Ruff-Off (s.~.,^~..~ 2 Does the Site Plan and/or Survey Show Al/Proposed i 5 Will ~is Applicat~0~ Require Lend Disturbing Acfivffies Site? Is this Project within the Trustees Jurlsdlotion STATE OF NEW'YORK, COUNTY OF ........................................... SS 7~t VANSTON PARTNERS LLC ' · - at I ................................................................................. being duly sworn, deposes and says that he/she is the apphcant for Permit, And that he/she is the OWNER Owner and/or representative of the Ovmer or Owners, and is duly authorized to perform or have peffoFin~)t the said work and to make and file this a~plication; that all statements contafi~ed in this application are mae to the b~t of hi/knOwledge and belief; ,md that the work will be performed in the manner set fo~& in the application filed herewi&. ~ / / Sworn to before me,this; /~ .// / / Notaq, Public: .....~..~....~......~ //.~...../......~ ..:: .......................... FORM - 06/10 (NI Hl,'~. Notary Publi~State of New York No. 01 KE5006684 Qualified in Suffolk County Commission Expires January 4, 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of VANSTON PARTNERS LLC COUNTY OF SUFFOLK) STATE OF NEW YORK) A F F i D A ¥~-T--Or I~O-S'~NG I, ,_~ ...... siding at a being duly sworn, depose and say: That on the i O day of 7-ol c/ ,201]. I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that 1 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, July 18~ 2012. Dated: Sworn to before me this day o~.~ 20 ~ ~ lqo~ary ~lic Notary Public, State of New York No. 01H06120440 Qualified in ~uffolk County / ~ Oomm ssion Exr~ ~'; Dec. 20, _ / ~' PROOF OF NIAILING OF NOTICE ATTACH CERTIFIED MAI1 RECEIPTS Address: STATE OF NEW YORK COUNTY OF SUFFOLK day of 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 .~O0-[!40 ~ ~¥- 115 ~( I , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn tO before me this Dayof ,20 z - -- Notaryj~uglic rio. · residing at "~)~- L[~ kl'~60-'f~-- ~0~, , being duly sworn, deposes and says that on the ,20_~._, deponent mailed a tree copy of the Notice PROOF OF 1VIAILLNG OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: cOUNTY E i ro , residing at .~-/-t'/~/'r-//~'~e- 12c.~d, h0 ~ ~/'/ I ICl ~3 I , being duly swom, deposes and says that on the day of ,20 , deponent mailed a true copy of the Notice set forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there r~spective 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~atHhOI3 ~q'/ II~i qq (certified) (registered) mail. · that said Notices were mailed to each of said persons bY Sworn to before me this / 2-- Dayof Jt~[~, ,20. , CAPITAL MANAGEMENT LP ~05-?~2-1 ~01 I Chris Pla grant authorization to Jeffrey Patanjo h~ addition to Sheri Clarry to speak on my behalf for my pcnc[h~g wetlmlds applical~Oll with the Regards, / of Trustees Application AUTHORIZATION (where the applicant is not the owner) I~ VANSTON PARTNERS, LLC (print owner of property) CONYERS FARM NORTH GATE GREENWICH CT 06831 WINTER CLARRY residingat 4 ASHFILEDS LA/~E (mailing address) do hereby authorize SHERI (Agent) to apply for permit(s) from the Southold~ard of ~ehalf. (Owner's signature) Bo~of Trustees Application County of Suffolk State of New York C/~/-S ----o~tE~ ~/W~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIED 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 AGP3~ES 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 COMPLETatl~G THIS APPLICATION, I HEREBY AUTHORIZE THE TRUfl:J'EES, THEIR AGEN~ fiR REPRESENTATIVES(S), TO ENTER O~xet'~IY.A~,OPERTY TJ~ENSPF~T T~E PR EM ISES IN CON JUNCTION ~ir/~F~.~~IC~N/ wS~Wiature ~ SWORN TO BEFORE ME THIS_~/ JL~-21-2012 10:43 FROM: 9i63i61440@9 P.I~i Board o£ ?zuscees ~pplication Cotmt7 of Suffolk $~tc of New York ~ ,6z,~ Z ,~ ~_ ~,A,~"__.~ ..... ~/~ .~. BEING DULY SWORW DEPOS~ A~ AF~$ T~T H~S~ IS ~E APPLICA~ FOR T~'~O~ TRUE ~ ~E B~ST OF HI8~ ~OW~E ~D B~, ~D ~AT A~L WO~ W~L BE DONE ~ ~ ~ER 8~ FORTH ~ ~IS ~PLICATION~ ~ MAY S~ ~O~D SY ~ SOU~OLD TO~BO~' O~ ~UST~S. T~E ~L~C~ AO~E$ TO HOLD T~ TOV~ OF SOU~rOLD ~ ~ TO~ ~US~S ~DER OK BY ~R~E OF S~D ~(S), ~ G~D, IN CO~L~ ~IS ~PLICATION, 1 ~REBY AUTHO~ZE THE TRU~E$, T~m AGe)fiR R~SE~ATI~S), TO ~TER O~~ER~ T~$P~ ~E PREMISES ~ cON~NCTION ~~~~[C~ of Trustees Application County of Suffolk State of New York SaERZ ~x~E~ CLARrt¥ 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 1N 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. SWORN TO BEFORE ME THIS /q DAY OF ~-"C)//l ~._ ,20 / ~-~ CYNTHIA d. KESSLER Notary Public, State of New York No. 01KE5006684 Qualified in Su~iolk County ,-),~,,~' Commission Expires January 4. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics vrohibits conflicts of interest on the part of town officers and employees. The purpose of this form is to t~rovide information which can alert the town of vossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: VANSTON PARTNERS, LLC (Last name, first name, middle 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 X 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 Form TS 1 Submitted this/~ada~ of J~ t/ Signature Print Nan~e 20]~ I~-~ 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", then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# xxx x4 03 The Application has been submitted to (check appropriate response): TownBoard [-~ Planning Dept. [] 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: REPLACE EXISTING DAMAGED STAIRS, PLATFORM, DOCK, ~MP AND FLOAT FOR BOAT DOCKING. Location of action: 5015 VANSTON ROAD, CUTCHOGUE Site acreage: 0.673 ACRES Present land use: RESIDENTIAL Present zoning classification: SFR 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: SHERI WINTER Cr~U~RY (b) Mailingaddmss: 70s LIGETROUSE ROAD, SOUTHOLD NY 11971 (c) Telephone number: Area Code ( )_ ~31 848-7730 (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? ~umY CORPS OF ENGINEERS 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 ACTION MEETS POLICY REQUIREMENTS. 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 ACTION IMPROVES DETERIORATED VISUAL COMPONENTS BY REPLACING MISSING AArD DETERIORATED STAIRS, DOCK AND FLOAT. 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 LESS THAN 50% OF THE STRUCTURE WAS DAF~AGED. DUE TO WATER DEPTH, FLOAT MUST BE REPLACED AT PREVIOUS LOCATION. 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 ACTION HAS NO EFFECT ON WATER QUALITY. 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 Applicable ACTION HAS NO EFFECT ON ECOSYSTEMS. At~ach 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 ACTION F~S NO EFFECT ON AIR QUALITY. 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 ACTION }{AS NO EFFECT CAUSED BY SOLID AND }{AZARDOUS WASTE. 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 HI - Policies; Pages 38 through 46 for evaluation criteria. [] Ye~ No [] Not Applicable ACTION IS LOCATED ON PROVATE PROPERTY. 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 ACTION IS LOCATED ON SINGLE FAMILY RESIDENCE AArD UTILIZED FOR RECREATIONAL BOATING ACTIVITIES. 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 ACTION WILL PROMOTE RECREATIONAL RESOURCE FOR LANDOWNER BY WAY OF BOATING ACTIVITIES. 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 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 Created on 5/25/05 11:20 AM APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: VANSTON PARTNERS, LLC (Last name, first name, middle 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 activily.) 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 X If you ansxvered "YES". complete the balance of this tbrm 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 applicanlYagent/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 thm~ 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) thc 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 DI the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this Signature / Print Narae June 18, 2012 Town of Southold Trustees Town Hall Annex Building 54375 Rte 25 P.O. Box 1179 Southold, New York 11971 RE: 5015 VANSTON ROAD, CUTCHOGUE, NY SCTM No. 1000-111-14-03 APPLICATION FOR PERMIT Dear Sir/Madame: We hereby submit one original and three (3) copies of the proposed plans, application, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-848-7730. Very truly yours, She~ri Winter Clarry 705 Lighthouse Road Southold, NY 11971 ADDRESS~ 5015 VANSTON RD. N. 82'05'00' LOT 247 / / // L 0 T LOT LOT NUMBERS REFER TO "AMENDED MAP A OF NASSAU POINT" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON AUGUST lB) 1922 AS FILE NO. 156 FLQOD ZQNES FROM FIRM Z6103COOO2H 9/25/09 ANY ALTEF~TION Off ~TI~ TO ~ S~Y ~ A ~AT~ ~ SEC~ 720g ~ T~ ~ Y~ STATE ~T~ ~. EXiT AS ~ ~CT~ 7E09 - ~ 2. ALL ~TI~S ~ ~ VAL~ F~ T~ ~P ~ C~S T~E~ ~Y E SA~ ~P OR C~S B~R T~ ~SS~ SEAL ~ T~ S~VEY~ W~SE ~ TURE APP~RS ~RE~ AREA = 29,545 sq. ft. to tie lines CERTIFIED ; VANSTON PARTNERS~ LLC VISTA LAND SERVICES CHICAGO TITLE SERWCES 249 ELEVATIONS ~ CONTOURS ARE REFERENCE£ TO N.A.V.D '88' 313.30' 296-14 o I // // / SURVEY OF PROPETY AT NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. .~< ..... - 1000 - 111- 14 - OS Scale: 1" = 30' /< May 2, 2012· ' "':"', ' ~tcon~ s~[vO~s' ~.c. (631) 765 - 5020 FX (65/) 765 - /797 P,O. BOX 909 /250 TRAVELER STREET 12 173 SOUTHOLD~ N.Y. 11971 -- STRR'#AYS NEW 11MBER IN SAME LOCA]ION AS EXIS~NG EXIS~NG P!~TFORM ~ NEW TIMBER MTH SIZE OF MAX ~2 ~[~'flNG ~' MDE X 20' LONG FIXED ~IMI~R PIER MTH NEY/ 11uBERS IN SAME LocKnoN AS E~ST1NG REPRESENTS WATER DEPTH IN INCHES BELOW MEAN LOW WATER NOTES: 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM 2. LOT AREA: 29,345 S.F. / 0.674 ACRES 3. PORTIONS OF SURVEY FROM SURVEY PREPARED BY: PECONIC SURVEYORS, PC SOUTHOLD, NY SURVEY DATED MAY 2, 2012 10' LONG ~IMB~R RkMP TO REPtACE PREVIOULY PERMITED PiLE YlflH NEW IN SAME 100'~ TO N)JACENT SHOREUNE · P~ 6' ~ X LO~ ~ ~ TO ~E ~ ~ ~Y ~M~ 10 ~ ~ ~ P~SLY ~D BOARD OF TRUSTEES TOWN OF SOUTHOLD REVISEO 07-25-12 PER IRUSIEES COMMENIS DATED 7-22-12 REVISED 07-08-12 Per NYSDEC COMMENTS DATED 6-27-12 PROPER~ OWNER: P'ro.pose(~ J~'r SCALE: 1 "=30' PROPOSED PLAN BATE: 06-17-12 5015 VANSTON ROAD NASSAU POINT, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY SHEET: IAX MAP .NO. 1000-111-14-03 ~ OF 2 VANSTON PARTNERS, LLC 4 ASHFIELDS LANE CONYERS FARM NORTH GATE GREENWICH, CT 06831 PREPARED BY: JEFFREY PATANJO 106 HEWlTI' BOULEVARD CENTER MORICHES, NY 11934 (SEE 'liMBER RI/ TO RJR,aCE DAV,~ED APPROYJMATE M.H,W. 2.5+ 150 100 50 0 X LOCATION :'-::-. ',:2 '--= =---~u,,~R~--::-;~~ "~. ~ ~'zw ~i ~ .:=:" 1,~ ',,~ /, /I ~" ~. ~'7 ." ~ ~" 'l ~,~:' F ' , ~ 12ooo~ ~ ~ ~ '-~ TYPICAL PIER SECTION N.T.S 1. ELEVATIONS REFER TO N.G.V.D. 1929 DATUM i~i REPRESENTS WATER DEPTH IN INCHES~ 4 ASHFIELDS LANE BELOW MEAN LOW WATER J LOCATION MAP NiT,S. ~ ~ ~ f!!~ !! AUG 29 ~" RE¥1SED 07-25-12 PER TRUSTEES COMMENTS DATED 7-22~12 REVISED 07-08-12 PER NYSDEC COMMENTS DATED 6-27-12 PROPERTY OWNER: NOTES: VANSTON PARTNERS, LLC CONYERS FARM NORTH GATE 2. LOT AREA: 29,545 S.F. / 0.674 ACRES GREENWICH, CT 06851 5. PORTIONS OF SURVEY FROM SURVEY PREPARED BY: PREPARED BY: PECONIC SURVEYORS, PC JEFFREY PATANJO SOUTHOLD, NY 106 HEWI~ BOULEVARD SURVEY DATED MAY 2, 2012 CENTER MORICHES, NY 11934 PROdECT _JE:~O jDO seal ,i~r SCALE: N,T,S. PROPOSED SECTION & DATE: LOCA~IOig I~P ~6-17-12 5015 VANSTON ROAD NASSAU POINT, TOWN OF $OUTHOLD SUFFOLK COUNTY, NY ~HEET: TAX MAP NO. 1000-111-14-03 2 OF 2