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HomeMy WebLinkAboutTR-7970 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 __ Ist day of construction ~ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7970 DATE: DECEMBER 12~ 2012 ISSUED TO: JOHN M. SCOPAZ PROPERTY ADDRESS: 6300 INDIAN NECK LANE~ PECONIC SCTM# 86-7-2.1 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 December 12, 2012, and in consideration of application fee in thc sum of $250.00 paid by Valerie Marie Scopaz Planning Services 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 backfill with +/-200 cubic yards clean fill to restore the undermined embankment and re-vegetate disturbed area; installation of a proposed retaining wall approximately 75' in length with two (2) angled returns approximately 5'-7' in length; to reconstruct the existing stairs with associated platforms in-place from top of bank to beach; and for ordinary maintenance and repairs to the existing bulkhead; and as depicted on the project plan prepared by Valerie Scopaz, received on November 5, 2012 and stamped approved on December 12, 2012; and as also depicted on the survey prepared by Nathan Taft Corwin III, Land Surveyor, last dated August 25, 2008 and stamp approved on December 12, 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 M. Scopaz, residing at 6300 Indian Neck Lane, Peconic, 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 Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of 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 December 12, 2012 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD Ms. Valerie Scopaz 56755 Route 25 Southold, NY 11971 RE: JOHN M. SCOPAZ 6300 INDIAN NECK LANE, PECONIC SCTM# 86-7-2.1 Dear Ms. Scopaz: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 12, 2012 regarding the above matter: WHEREAS, Valerie Scopaz on behalf of JOHN M. SCOPAZ 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 November 5, 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, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 12, 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 have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JOHN M. SCOPAZ to backfill with +/-200 cubic yards clean fill to restore the undermined embankment and re-vegetate disturbed area; installation of a proposed retaining wall approximately 75' in length with two (2) angled retums approximately 5'-7' in length; to reconstruct the existing stairs with associated platforms in-place from top of bank to beach; and for ordinary maintenance and repairs to the existing bulkhead; and as depicted on the project plan prepared by Valerie Scopaz, received on November 5, 2012 and stamped approved on December 12, 2012; and as also depicted on the survey prepared by Nathan Taft Corwin III, Land Surveyor, last dated August 25, 2008 and stamp approved on December 12, 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 Ve; ou James F. King President, Board of Trustees JFK/amn James F. King, President Bob Ghosio, Jr., Vice~Prcsident Dave Bergen John Bredemeyer Michael I. 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 I Please be advised that your application dated reviewed by this Board at the regular meeting of has been 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) 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 Seuthold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ ~'(~, BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., December 5, 2012 the following recommendation was made: Moved by William McDermott, seconded by Doug Hardy, it was RESOLVED to SUPPORT the Wetland Permit application of JOHN M. SCOPAZ to backfill with +~-200 cy. clean fill to restore the undermined embankment and re-vegetate disturbed area; installation of a proposed retaining wall approx. 75' in length with two (2) angled returns approx. 5'-7' in length; reconstruct the existing stairs with associated platforms in- place from top of bank to beach; and for ordinary maintenance and repairs to the existing bulkhead. Located: 6300 Indian Neck Lane, Peconic. SCTM#86-7-2.1 inspected by: William McDermott, Doug Hardy The CAC Supports the application with the Condition appropriate construction materials are used. Vote of Council: Ayes: All Motion Carried James F. K~g, President Bob Ghosio. Jr. Vice-President Dave Bergen John Bredemeyer Michael J Domino PO Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Valerie Scopaz on behalf of JOHN M. SCOPAZ requests a Wetland Permit to backfill with +~-200 cubic yards clean fill to restore the undermined embankment and re-vegetate disturbed area; installation of a proposed retaining wall approximately 75' in length with two (2) angled returns approximately 5'-7' in length; to reconstruct the existing stairs with associated platforms in-place from top of bank to beach; and for ordinary maintenance & repairs to the existing bulkhead. Located: 6300 Indian Neck Lane, Peconic. SCTM# 86-7-2.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland __ Sound ~,Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~--~,~hapt.275 Chapt. 111 __other Type of Application: '~ Wetland __Administrative__Emergency __Coastal Erosion __Amendment Pre-Submission __Violation Modifications: Conditions: / J. Bredemey~- Michael Domino Form filled out in the field by D. Bergen, D. Dzenkowski other Mailed/Faxed to: Date: SCTM# 86-7-2.1 ~00 Ill(liall Ileck Lalle,, Pe¢ollic SCTM# 1~$-? -2.t Valerie M~rie Scopaz ~*c/0 I ..... " I~ COLINTY OF SUFFOLK ® r.I OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, 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 From: Mark Terry, Principal Planner LWRP Coordinator Date: December 10, 2012 Re: Proposed Wetland Permit for JOHN M. SCOPAZ SCTM# 1000-86-7-2.1 Valerie Scopaz on behalf of JOHN M. SCOPAZ requests a Wetland Permit to backfill with +/- 200 cubic yards clean fill to restore the undermined embankment and re-vegetate disturbed area; installation of a proposed retaining wall approximately 75' in length with two (2) angled returns approximately 5'-7' in length; to reconstruct the existing stairs with associated platforms in-place from top of bank to beach; and for ordinary maintenance & repairs to the existing bulkhead. Located: 6300 Indian Neck Lane, Peconic. SCTM# 86-7-2.1 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 CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. 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 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 $OUTHOLD Office Use Only Coastal Erosion Permit Application _2~Wetland Permit Application __ Administrative Permit Amendmenffrrans~er/Extlensi°n Received Applicatio?j~'Z~ ~Received Fee $ ~ H'~/~yF~ L~u C ~Completed Application~_f~ __Incomplete ' t __SEQRA Classification: Type l~Type 1I Unlisted Coordination:(date sent) / / ~LWRP Consistency Assesstmen[ Form ~.L2~__ ./ CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ~7~_mublic Hearing Held: Resolution: NOV '$ 2012 Name of Applicant ~,/06td /'k/...,,..~/:),¢~ ~._ Mailing Address a~ 4 eo~ (,gj ~ ~ l~m W, ~ / ogo~ Phone Number:~ ~/~ / Suffolk County T~ Map Number: 1000 - ~ ~ T ~, Prope~y Location: q~ ~ ~r~ ~$~t~g~ (provide LILCO Pole ~, dist~ce to cross streets, ~d location) (If applicable) Address: ~g 7~ ~ ~ ~ B~d Of Trustees Applicatlo~ GENERAL DATA Land Area (in square feet): t//O/ ,7// dy, 0~. Area Zoning: Previous use of property: /t:7~'d',~,~'~'~/-/~'a 'c/ Intended use of property:. ~*d't~ ~/V/-t'~ Covenants and Restrictions on property? If"Yes", please provide a copy. Yes /~ No Will this project require a Building Permit as per Town Code? Yes )q No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. 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? )f Yes No Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? If yes, provide explanation: )~' No Yes Explanation of Application Goals The attached application for permit approval is designed to achieve the following things: 1. Ensure the stability of the bank adjacent to the house and patio. 2. Protect and retain (to the extent possible) the existing trees, shrubs, vines (and their root systems) at the top of the bank, so as to maximize the multiple ecological, as well as aesthetic, advantages of mature vegetation between the house and the water's edge. 3. Facilitate the planting of appropriate native vegetation within the existing and proposed fill areas, such as low maintenance, salt tolerant species capable of holding soil against future erosive events. E.g. various native beach grasses, Rosa Rugosa and others as may be recommended after consultation with regional experts, e.g. Comell Cooperative Extension. A more detailed plan will be submitted in time for review prior to the public heating. Challenges The site poses significant engineering and logistical challenges. 1. Due to the combination of high tide, sustained winds and wave action, the bluff along the entire waterfront edge of the property is unprotected and susceptible to further sloughing during future rainfalls, high winds and storm events. This bluff must be stabilized immediately. 2. The underpinning of the existing stairs, which followed the contour of the old bluff face, was substantially destroyed by wave action and soil erosion, thus must be removed, along with what is left of the stairs. The configuration of the new stairs should be coordinated with the proposed bluff stabilization structure. This is likely to result in a shorter, more direct run of stairs. Due to the very real time and labor constraints posed by this emergency, the details of the proposed stairs will be submitted for Trustee approval as soon as they become available, most likely after the start of the proposed construction of the new retaining wall. 3. As seen in the enclosed pictures, the remaining shrubs and trees indicate a mature root system which provided extensive soil retention capabilities (not to mention water absorption). It is likely more soil would have been lost had it not been for these plants. For that reason, the existing vegetation that survived the storm should be retained to the greatest extent possible during the construction of this proposed retaining wall. 4. After the proposed wall is constructed and the fill is contoured to slope downward from the remaining lawn to the edge of the wall, it is proposed to introduce new native, salt-tolerant vegetation directly behind the new retaining wall up to the remains of the lawn. Again, please note: NO NEW LAWN AREAS are proposed or desired. The details 2 of this landscaping are being worked out with the assistance of regional experts and will be provided to the Trustees for their approval before any planting is attempted. 5. The first six feet of existing fill behind the existing bulkhead (seaward of the proposed retaining wall) seems to have been held in place by the extensive root system of the Rosa Rugosa plants that once blanketed this area directly behind the bulkhead. As seen in the pictures, many of the roots still remain. In the past, these roots have re- sprouted after storms. If they fail to do so this time, the area is proposed to be re- vegetated with new Rosa Rugosa plants and other appropriate species in accordance with recommendations by regional experts, which (as noted earlier) are being consulted prior to the preparation ora landscape plan. As noted above, NO NEW LAWN AREAS are proposed or desired. 6. To prevent scouring (due to storm tide wave action) of the existing land at the foot or toe of the proposed vinyl sheathing, we wish to place an approximately 6 foot wide bed of 30 to 40 pound rocks, anchored and secured by wire mesh, possibly back- filled with sand. If feasible, beach grass will be planted in this area as well. The contour or profile of this bed is proposed to be approximately one foot above the land seaward to the back of the existing bulkhead. Construction Details Retaining Wall: The proposal is to construct a corrugated vinyl-sheathed wall 15 inches deep which will be attached to 10" pilings, each 14 feet long. The pilings will be braced by 8" logs and attached to 8" square dead-man pins with 1" diameter rods of 8 to 10 feet in length. The pins are proposed to be placed landward of the sheathing but seaward of the brick patio. The top of the sheathing will be topped with either grating or wood. Fill will be brought in either by small front loaders from the side yards of the house or during low tide, accessing the beachfi'ont from either Indian Neck Lane or Robinson Lane, depending. If access is from Indian Neck, appropriate permit will be obtained from the Highway Department. If access is from Robinson, permission of the Robinson Lane Property Owners' Association will be obtained. The placement of the retaining wall is designed to mimic (to the extent possible) the pre- existing terrain, as depicted on the survey. The retaining wall will be tied into the bank as shown on Aerial Drawing, in order to prevent future erosion behind the structure. Fencing: A low fence is proposed at Point F (shown on the Aerial and Profile drawings) in order to prevent any one from venturing too close to the sloped area that will extend from the existing lawn down to the proposed retaining wall. Details of this fencing will be provided for Trustee approval prior to installation. 3 John Scopaz November 9, 2012 Board of Trustees P.O.Box 1179 Southold, NYl1971 Re: 6300 Indian Neck Lane Peconic, NY Location: S/S Indian Neck Lane, 959 feet E/Robinson Lane, Peconic SCTM # 1000-86-07-2.1 Dear Sirs, This letter is to request the attached documentation be incorporated into the application. The documentation provides details and amends the previous application in the following manner: 1. Removes request for fencing at top of bank nearest the house. 2. Removes request for placement of rock at toe of proposed retaining wall. 3 Substitutes Rosa Rugosa for Beach Grass on the top of the proposed retaining wall. 4. All stairs are proposed to replaced in the approximate location and configuration as was existing and shown on survey. Since this work must be done before the ground freezes, please bring ANY concerns or questions to my attention ASAP via telephone. I can be reached at the following number: Cell: 203 912 6094 Again, I hope you will expedite this urgent request. Sincerely, 204 Corlies Avenue Pelham, NY 10803 6300 Indian Neck Lane 1 Peconic, NY John Scopaz Supporting Documentation The following narrative is intended to explain further the information provided in the attached Trustee application. Protection of Embankment 1. Due to the combination of high tide, sustained winds and wave action, most of the embankment along the waterfront edge of the property (about 87 fee0 was undermined, has lost its vegetative cover, thus is unprotected and susceptible to further sloughing during future rainfalls, high winds and storm events. This exposed land must be stabilized immediately - before winter sets in. 2. The ground around the cedar (at SW comer) shows evidence of cracking. Protecting the root system of the remaining shrubs and trees (three locusts) requires the roots be mm-covered with soil before winter sets in. 3. The proposed retaining wall is designed to mimic the previous contour/elevation. It will be set 12 to 14 feet landward of the existing bulkhead and will rise approximately 6 to 7 feet above the existing grade (behind the bulkhead). 4. After the proposed wall is constructed, the fill placed landward of the wall will be contoured to slope downward from the remaining patch of lawn to the edge of the wall. The face of this slope will be mm-vegetated with Rosa Rugosa. Please note: NO NEW LAWN AREAS are proposed or desired. If anything, the amount of lawn will be reduced. Access to Beach 1. The underpinning of the existing stairs, which followed the contour of the embankment face, was substantially undermined by wave action and soil erosion, thus must be removed, and replaced. The configuration of the new stairs will follow the outline of the existing stairs, as shown on the survey. Existing Bulkhead 1. The land behind the existing bulkhead (seaward of the proposed retaining wall) seems to have been held in place by the extensive root system of the Rosa Rugosa plants. As seen in the pictures, much of the root system remains. In the past, these roots have re- sprouted after storms. If these roots fail to regenerate by next spring, the area will be re-vegetated with new Rosa Rugosa plants. Native species of American beach grasses can be added in- between the new plants to hold the soil until the mgosa fills in. As noted above, NO NEW LAWN AREAS are proposed or desired. 6300 Indian Neck Lane Peconic, NY John Scopaz Supporting Documentation continued Construction Details: See attached drawings for more details Retaining Wall: 1. The proposal is to construct a corrugated vinyl-sheathed wall 15 inches deep which will be attached to 10" pilings, each 14 feet long. The pilings will be braced by 8" logs and attached to 8" square dead-man pins with 1" diameter rods of 8 to 10 feet in length. The pins are proposed to be placed landward of the sheathing but seaward of the brick patio. The top oftbe sheathing will be topped with either grating or wood. 2. The wall will be located 12 to 14 feet landward of the existing bulkhead. The placement and height (6 to 7 feet above grade of existing bulkhead) of the retaining wall is designed to mimic (to the extent feasible) the pre-existing terrain, as depicted on the survey. 3. The retaining wall will be angled then tied into the bank as shown on Aerial Drawing, in order to prevent future erosion behind the structure. Fii~l 1. Approximately 200 cubic yards of clean, sand fill will be brought in either by small front loaders from the side yards of the house or during low tide, accessing the beachfront from either Indian Neck Lane or Robinson Lane. (If access is determined to be most feasible from Indian Neck, appropriate permit will be obtained from the Southold Town Highway Department. If access is determined to be more feasible from Robinson, permission of the Robinson Lane Property Owners' Association will be obtained.) 2. The fill will be contoured to slope downward from the edge of the existing lawn down to the top of the proposed retaining wall. As noted earlier, this area will be planted with Rosa Rugosa. Stairs 1. The stairs are proposed to be replaced in the same configuration and aligmnent. 2. The supporting timbers will be of non-CCA treated lumber (ACT) and the treads will be of Timber Tek. 6300 Indian Neck Lane Peconic, NY Bo of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: ~~ ,~,/'rt.,tf~/6~r.~x~- Area of wetlands on lot: -- o - .square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve e: :.:.-::.:~.~-q orlh~'~/ No /~' Yes If yes, how much material will be excavated? How much material will be filled? o~ o ~-~9 '-'-Eubic yards cubic yards Depth of which material will be removed~') ./t9 feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 617~20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME 3.PROJECT LOCATION: Municipality ~/~ ~ 4. PRECISE LOCATION: S~et Addess a~d R~d Intemec~ns. Prominent landmass etc -or provide mad IS PROPOSED ACTION: ~ New ~ ~pansion ~M~ificaaon/altemfion DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: ~ Initially acres Ultimately acres ¢:~-o¥~/ 8. WILL PROPOSED ACTION COMPLY WITH EXiSTiNG ZONING OR OTHER RESTRICTIONS? E~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~71'Residential []Industrial []Commercial i"~AgricuIture []Park/Forest/OpenSpace E~]Other (descdbe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL yeY (Federal. State or Local) s r--'l No If yes, list agency name and permit / approval: ll. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r'--IYes I~No If yes. list agency name and permit / approval: 12. AS A ~ESIJ OF RE LT PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 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 A~lency) A~ ODES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate Ihe review process and usa the FULL FAF. f-I e.s rTINo B. WILL .~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be supemeded by another involved agency. I--lYes [~]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be haodwritten, if legible) C1. Exisfing air quality, sudasa 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. Aesthetic, ag~icufiuml, archaeological historic, or other n~'u'ral or cultural resources;'~[ commu~ o~ neighborhood charact~ Explain briefly: I C3. Vegetation or leona, fish, shelffish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefly: / I C4. AI community's existing pians or goals as officially adopted or a Ch~nge"~'~se or intensity o, use of land or o"~ ;~* natural resources? Explaitl bdell,: '" I C5. Growth, subsequent deve opment, or related activities likely to be induced by the proposed action? Explain b~efly: CO. Long lerm, short term, eumuleti¥o, o~ other e~ects not identitied in C'i-C67 Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEA~? tlr yes, explain briefly: E. IS THERE, OR IS THERE LIKELy TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Ifyes explain: PART III - Ut:l t:R.MINATION OF SIGNIFICANCE (To be completed by Pcjency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, irepoltant or otherwise significanL Each effect should be assessed in connectiee with its Ia) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; Id) irmversibility; (e) geographic scope; and (0 reagnitude. If necessary, add attachments or reference supporting reatsrtals. 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 reust evaluate the poten tialimpact of the proposed action o n the envtronmental charac~.etistios of the CEA Check thle box If you have idanfifed one or more potentially lange or significant adverse impacts which ~aAY occur. Then prosaed direc~y to the FUIJ EAF and/or prepare a positive declaralton. C_~qeck this box If you have determined, based on the information and analysis above and any supporting documentafion, that the proposed acfiol WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi dete~minaUon. Board of Trustees Name of Lead Agency Print or Type Name of Responsible Office~ in Lead Agency ~igna~ure of Responsible Officer in Lead~.~ency ~side~ [] Title ~ Ra~ons~ 0~ '~ k V Town of Sou' old Erosion, Sedimentation & Storr~-Water Run-off ASSESSMENT FORM PROPE,R~ LOCATION: S.C.T.M. ~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~ STORM.WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN District Section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NI~N YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION iTEM# / WORKASSF_BSMENT ? Yes No a. What is the Total Area of the Project Parcels? (Include Total Ama of all Parcels located within '~ Wit this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Consbuction) Generated by a Two (2') rich Rainfall on Site'~ b. What is the Total Area of Laed Clearing (S.F. / Ac~s) (This item will incJude all run-off created by site and/or Ground Disturbance for the proposed ,~ clearing and/or constroction activities as well as all consbuction activity? ~ Sits Improveroents and the permanent creation of impervious surfaces.) (S.F. / Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROI/]DE BRIF.,,F PROJECT DESCIUlvllON (~-,~ ~ p~,,~ u Ne.d~) Drainage Structures Indicating Size & Location? This ~tem shall thclude all Proposed Grade Changes and ~. ,~,/dC*'¥'t~g,-~c,d.~ ~ ~ ~ 3 D°es the Site Plan and/°r Survey describe the er°si°n and sediment control pracgcas that will be used to fi~,~,~ ,.~, ~ ~_~, ,~/--/~'~ - ~ ~,~/.~ control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. x,q~-e--~-~ ..-~rx.~. ~ 4 wi,, th~ Project Require any Land Filling. Grading or Excavation where there is a change to the Natural Existing Grade Involving more tha~ of Maledal withth any Parcel? .~_~-' ~ ~'~4/A/~, Encom ss,ng an Area in E.c.sofF,ve housand 1'2'] (5.000 S.F.) Square Feet of Ground Surface? -- ~ Is this project within the Trustees jurisdictionL~ General DEC SWPPP Requirements: or within One Hundred (100') feet of _a--yVetia~d,or are part of a larger common plan that will ultimately disturb one or mom acres of land; which Exceed Fifteen (15) feet of Vertical Rise to requlmd, post-construction storm water management practices that w~l be used and/or Removal of Vegetation and/or the Construction of any r~l coum- o ........................................... ss ~ll~at I, ....~..~.~ .-..~...~......~...~.../~.. ~ being duy sw6m, deposes and says that lie/she is the applicant tbr Permit And that he/she is the ~.~...i. ....................... Owner and/or representative of the Ova~er or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are t~ue to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; 4, FORM - 06/10 Qualified in Suffol C~);~r~'!~,,/n Comm ssion Expires Ju?, : ~,~' c~ 3 2Fi2 / [TIFIED MAIL Address: I~) (E~dorsement Requirel ~--q Postage Cer[ified Fee Return Recefpt Fee (Endorsement Required) Restri~ed Dellvew Fee (Endorsement Required) Total Postage & Fees cowry oF SUFFOLK , being duly sworn, deposes and says that on the ~-~,oh day of ~e.~¢& , 201,3..>deponent mailed a true copy of the Notice set f~rth 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 &said persons are the address of said persons as shown on the current assessment mil of the Town of Southold; that said Notices were mailed at the United States Post Office at ..~oto~.g>t-~ ~ that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of.,~C~,a~e~ 20 J~ Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01BU6185050 Qualified in Suffolk County Commission Expires April 14, :2~)/ PROOF OF MAIL1NG NOTICE For Scopaz at 6300 Indian Neck Lane, Peconic, NY 86 7- 1 Barbera and Bruce Beaney Fruit Ledge Road Brookville, NY 11545 86-7-2.2 Ruth E. Miller Residential Trust 6400 Indian Neck Lane Peconic, NY 11958 86 - 6 - 19 Eleanor Bodenstein Revocable Trust 6135 Indian Neck Lane Peconic, NY 11958 86 - 6 - 20 Barry Root 16 Horse Hollow Road Lattington, NY 11560 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 JOHN M. SCOPAZ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at/dba CD~"'/~-'~ ~'~tOW4 0~ A/~ being duly swom, depose and say: That on the,~ay of ~e_~-~fi~[_, 201~;xI personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public heating. Date of hearing noted thereon to be held Wednesday, December 12~ 2012. Dated: Sworn to before me this ~c~ day of~-~220 13 (signature) Notary Public 3ONNIE D. BUNCH Notary Public, State of New YcFk No. 01BU6185050 Qu~!ified in Suffolk Count',/ .. Commi.:sion Expires April 14 2 .~_ko NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: ~ob~, I~. 5copo~ SUBJECT OF PUBLIC HEARING. To backfill with +/-200 ¢ubic yards clean fill to restore the undermined embankment and re-vegetate disturbed area; installation of a'proposed retaining wall approximately 75' Jn length with two (2) angled returns approximately §'-7' in length; to reconstruct the existing stairs with associated platforms in-place from top of bank to beach; and for ordinary maintenance & repairs to the existing bulkhead. TIME & DATE OF PUBLIC HEARING' 6~cbesdo. y, 'De ce,,.,t~' ~.q, ,~ol~- on ~,r~ ~.'oo Pr~e If you have an interest in this project, you are invited to view the Town file(s) which are available for inspectionprior to the day of the hearing during normal business days between the hours of'8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 )ard of Trustees Ap~ County of Suffolk State of New York JtO ~t~J /~. J616~76,~ BEING DULY SWORN DEPOSES AND ~F~S THAT ~/S~ IS T~ ~PLIC~T FOR T~ ~O~ DESC~ED PE~T(S) ~ T~T ~L STATE~NTS CONT~D ~ ~ ~ TO T~ BEST OF ~S~R ~OWLEDGE ~ BEL~F, ~ ~T ~L WO~ W~L BE DO~ ~ T~ ~R SET FORTH ~ T~S ~PLICATION ~ AS MAY BE ~PRO~D BY T~ SOU~OLD TO~ BO~ OF TRUSTEES. T~ ~PLIC~T AG~ES TO HOLD T~ TO~ OF SOUTHOLD ~ T~ TO~ TRUSTEES ~ESS ~ F~E FROM ~Y ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY V~T~ OF S~ PE~T(S), ~ G~TED. ~ CO~LET~G T~S ~PLICATION, I ~BY AUTHO~E T~ ~US~ES, T~ AGENT(S) OR ~P~SENTATI~S(S), TO EN~R ONTO ~ PROPERTY TO ~SPECT T~ P~SES ~ CON~CTION ~TH ~W OF T~S ~PLI~TION swm~ vo ~o~ ~ m~ 3 { o~y ov O~o~ ,20t~ Not~ Public Board of Trustees Applicat~' AUTHORIZATION (where the applicant is not the owner) (print owner of Droperty) / Southold Board of Town Trustees on my behalf. ~ (0wner's s:ature/ ~ (mailing address) do hereby authorize (Agent) to apply for permit(s) from the 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics orohibits conflicts of inter*st on the tart of town 6ffleers and emoloveas. The ouroose of this form is to orovide information which can alert the town of oossible conflicts of inter*st and allow it to t~e whatever action is necossarv to avoid same. YOUR NAME: (Last name, first name, x~nJddle initial, u~lcss you am applying in the name of someone else or other etllity, such as a company. If so, indicat? 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 (I f "Other", name the activity.) Do you personally (or through your companyl 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 I f 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 ~hild is (check all that apply): __A) the owner of greater than 5% of the shares of the corporate stock oftbe applicant (when the applicant is a corporation); __B) the legal or beneficial own9' of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, paflne~', or employee oftbe applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submittedtbis day of /'gXg 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). 3~ B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM#/tg"~'~ - ~d,-OT_-~ ./ 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~ listing both supporting and non- suD~ortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at tt~ ~hr~.s website (southoldtown.northfork.net), the Board of Trustees Office, ~l~anning Department, all! local libraries and the Town Clerk's office. ~ [ NOV ' § 2012 The Application has been submitted to (check appropriate response): Town Board ~ Planning Board ~ Building Dept. ~ Board of Trustees Catego~ of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital [--] constmction, planning activity, agency regulation, land transaction) ~] Co) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: ~, ~*'-~"~ .~/~'- Present l~d 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) Name of applicant: CO) Mailing address: (c) Telephone number: Area Code ( ) j~,~ ~,~'~/ (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 ali 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 (NotApplicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI - 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 Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southoid 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 Apg 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 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 the Town of Southold. See LWRP Section III ' Policies; Pages 38 through 46 for evaluation criteria. [] Ye~ No ~ Not Applicable Attach additional sheets if necessary WORKING COAST 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 Attach additional sheets if n~cessary 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 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 John M. Scopaz November 2, 2012 Board of Trustees Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Dear Mr. King, President And Members of the Town Trustee Board; Thank you for your prompt response to my request of October 31 st for an Emergency Permit. The Board's quick response is both commendable and appreciated. I have since spoken with contractors about emergency work within the parameters of the permit. As I have been given to understand, I am allowed to bring in temporary fill, but must file for a permanent permit in order to construct any additional holding structure such as a secondary retaining wall. After consulting with contractors, it has become evident that the topographical and geographic constraints of the site, combined with the severity of the erosion and the potential safety of my house, are such that I must ask for permanent permits immediately. The work allowed under the terms of the emergency permit will not protect my property. As the enclosed photographs will illustrate, stabilization of the sheer, perpendicular face of the bluff must be undertaken immediately lest I lose the remaining trees, their roots and ultimately my house. The next heavy rainfall has the potential to wreak even more severe damage. I respectfully request this application be entertained sooner than the next scheduled meeting in December. Enclosed are the requisite surveys, photographs and plans for the proposed retaining wall. If you have ANY questions or concerns, please contact me (or my agent: Valerie M. Scopaz) immediately. Our contact information is included within the application form. Sincerely, Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 I) 765-1892 Fax (63 I) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Emergency Permit Application ___Coastal Erosion Permit Application ~Wetland Permit Application Amendment/Transfer/Extension Received Application: Received Fee:$ Completed Application Incomplete SEQRA Classification: Type I____Type li Unlisted Coordination:(date sent)_ LWRP Consistency Assessment Form CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Lead Agency Determination:__ Technical Review: Public Hearing Held: Resolution: Administrative Permit OCT .-1 1 2012 Name of Applicant Address Phone Number:( ) ~5/ 7~-~t~/ Suffolk County Tax Map Number: 1000- Property Location: ~ll,,ff-? f<~",4~7 (provide LILCO Pole ~, dist~ce to cross s~eets, ~d location) AGENT: ~/~ .~ (If applicable) Address: ,..~7 ,~ ~'~ (~'o//~,._ Phone: Board of Trustees Ap~,licatio~ Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions: GENERAL DATA Yes ~9~ No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date Yes ~ No __ No prior permits/approvals for site improvements. Has any permiffapproval ever been revoked or suspen,ded by a _X No If yes, provide explanation: governmental agency? Yes Project Description (use attachments if necessary): of Trustees Applicati~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are'wetlands present within 100 feet of the proposed activity? /X( No Yes Does the project involve ~ No ..~ Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? '-~C> (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 6t7.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR,.~7~./_~,~// ',~ ~/~F ~ 2. PROJECT~~NAME .~~ 3P~JECT LOCATe: ~ - ~ ~ / '/. · I /. / 4. PRECISE LOC~ION: S~eet Addess-~nd ~ intemec~o~s, Prominent landmass etc -or orovid~ map SEQR 5. IS PROPOSED ACTION: [] New ~] Expansion ]~odification / alteragon 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~]Yes [] No If no. describe briefly: 99 V~/HAT tS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential [~]lndustrial []Commercial I~Agriculture []Park/Forest/OpenSpace []Other (descdbe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMAYELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~'Yes [~lNo If yes, list agency name and permit / approval: 11. UUtz;3 ANY A,~P'~L;I~-~I~ ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? t]--lYes I~.No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE !NPORMATION ~/~IDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant , Sponsor Nam N//O~/4~ JI/ ~' ~,/~)4 '~- Dnte: ~p I, t.e act¢is a CoZ Lr~you are a s~te agency, lete the Coastal Assessment ~efore proceeding with this assessment NOV - 5 2012 NOV - 5 2012 .... NOV - 5 2012 Vt,-'?,) Nathan Taft Co~ Land Su III PHONE (631)727-2090 Fax (631)727-1727 SURVEY OF PROPERTY SITUA T£ PECONIC TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-86-07-2.1 SCALE 1"=40' AUGUST 25, 2008 AREA = 110,711 sq. ff. (TO TIE LINE) 2.542 ac. TEST HOLE DATA ~rveyor