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HomeMy WebLinkAboutTR-7989 James F. King, President ~~OF SO(/j~o/_ Town Hall Annex Bob Ghosio, Jr., Vice-President `0 54375 Main Road yy P.O. Box 1179 Dave Bergen ~ T Southold, New York 11971-0959 John Bredemeyer ~ C Michael J. Domino ~ Telephone (631) 765-1592 ~~,~iourm,~' Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0861C Date: June 3, 2013 THIS CERTIFIES that the removal and replacement of +/-1251f. of bulkhead; replacement of (214'x4' platforms with (2) 4' wide sets of stairs to beach; fill; re-vegetation of disturbed azeas up the bank At 11012 Great Peconic Bay Blvd., Mattituck, New York Suffolk County Tax Map # 126-6-10 Conforms to the application for a Trustees Permit heretofore tiled in this office Dated December 3, 2012 pursuant to which Trustees Wetland Permit #7989 Dated January 23, 2013, 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 removal and replacement of +/-1251f. of bulkhead; replacement of (2) 4'x4' platforms with (2) 4' wide sets of stairs to beach; fill; re-vegetation of disturbed areas up the bank. The certificate is issued to MARLENE LANE CIVIC ASSOCIATION owner of the aforesaid property. ~w t~ Authorized Signa ure James F. King, President o~gllffQ~~.co Town Hall, 53095 Main Rd. Bob Ghosio, Jr., Vice-President P.O. Box 1179 Dave Bergen ~ Z Southold, NY 11971 John Bredemeyer Oy Telephone (631) 765-1892 Michael J. Domino ~f ~ ~.aC Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE F INSPECTION: ~ ~ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/z constructed Project complete, compliance inspection. INSPECTED BY: 1 J COMMENTS: ~ ~ CERTIFICATE OF COMPLIANCE: ~ gtIFFQi.,~ James F. King, President pp~ COG Toum Hall, 53095 Main Rd. Bob Ghosio, Jc, Vice-President o ~ P.O. Box 1 l79 Dave Bergen W T Southold,lVY 11971 John Bredemeyer o ? $ Telephone (631) 765-1892 Michael J. Domino y'~'Oj ~ ~`ap! 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction / Y2 constructed ? Project complete, compliance inspection • BOARD OF SOUTHOLD TOWN TRUSTEES ~ SOUTHOLD,NEW YORK PERMIT NO. 7989 DATE: JANUARY 23, 2013 ISSUED TO: MARLENE LANE CIVIC ASSOCIATION ~ PROPERTY ADDRESS: 11012 GREAT PECONIC BAY BLVD.. MATTITUCK i SCTM# 126-6-10 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 January 23.2013, and in consideration of application fee in the sum of WAIVED as per Town Boazd Resolution# 2012-885 and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits [he following: i Wetland Permit to remove +/-125 If. of storm damaged bulkhead and replace with code compliant new bulkhead; replace lost fill; and replace two 4'x4' platforms with two 4' wide sets of stairs to beach that were washed out by the storm; stairs will comply with existing code and construction standards with the condition of re- vegetation of disturbed areas up the bank; and as depicted on the project plan prepared by Richard Zahra, received on December 3, 2012 and stamped approved on January 23, 2013. 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 Boazd as of this date. ,may Airl+~ ~o~g11FFQ(,tc ~ ~ N ~ - ,F I I TERMS AND CONDITIONS A~. , The Permittee Marlene Lane Civic Association residine at 11012 Great Peconic Bav Blvd.. 'r Mattituck, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: F 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee. will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated tune required [o complete the work involved, but should circumstances warrant, request for an extension nay be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Pernttee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause utreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board wilt be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which maybe subject to revoke upon failure to obtain same. James F. King, President ~~OF SO//% Town Hall Annex Bob Ghosio, Jr., Vice-President ,`O 54375 Main Road P.O. Box 1179 Dave Bergen 1~t * Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino ~ i~ Telephone (631) 765-1892 ~~yCOU~'~~ Fax (631) 765-6641 $OARD OF'1'OW1V'I'~iJGTF.F.G TOWN OF SOUTHOLD January 23, 2013 Mr. Richard Zahra, President Marlene Lane Civic Association 445 Marlene Lane Mattituck, NY 11952 RE: MARLENE LANE CIVIC ASSOCIATION 11012 GREAT PECONIC BAY BOULEVARD, MATTITUCK SCTM# 126-6-10 Dear Mr. Zahra: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 23, 2013 regarding the above matter: WHEREAS, Richard Zahra, President on behalf of MARLENE LANE CIVIC ASSOCIATION 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 December 3, 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 January 23, 2013, 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, z 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, VVHEREAS, llle Board haS deteililiiied that the prcject as proposed will not affart tha 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 MARLENE LANE CIVIC ASSOCIATION to remove +/-125 If. of storm damaged bulkhead and replace with code compliant new bulkhead; replace lost fill; and replace two 4'x4' platforms with two 4' wide sets of stairs to beach that were washed out by the storm; stairs will comply with existing code and construction standards with the condition of re-vegetation of disturbed areas up the bank; and as depicted on the project plan prepared by Richard Zahra, received on December 3, 2012 and stamped approved on January 23, 2013. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Y ~ James F. King President, Board of Trustees JFK/amn - - ~o~~g1VFf0E~-c James F. King, President w ~ Town Hall Annex Bob Ghosio, Jr., Vice-President w ~ 54375 Route 25, P.O. Box 1179 ' Dave Bergen ~.j. ~ Southold, AIY 11971 John Bredemeyer ~Oj .Yt •Mb0 Tetephoae (631) 765-1892 Michael J. Domino 7!' Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD To: Kic~ai-~ Zal~r~ (Pi-P~r~d n~-~ /~l~rl ne,l~~e~t~ ~-~S'a.l~-lion Please be advised that your application dated 2 has been reviewed by this Board at the regular meeting of Z3 3 and your application has been approved pending the completion of the ollowing items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1s` Day of Construction ($50.00) YZ 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 re-application fees will be necessary. You will receive your permit upon. completion of the above. COMPUTATION OF PERMIT FEES: final ~v~s~pe~~h'on -~'ee - ~ 5D . Ob _ TOTAL FEES DUE: $ 50 • Cab BY: James F. King, President Board of Trustees m a~. le d X13 g '""`v~ RESOLUTION 2012-885 ADOPTED DOC ID: 8343 'IrHIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION N0.2012-885 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 4, 2012: RESOLVED that the Town Board of the Town of Southold hereby waives Trustees' permits fees for any repairs or construction, that in the sole discretion of the Boazd of Trustees, are determined to be related to Superstorm Sandy, until January 2, 2013 C~~Q~' Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER: Christopher Talbot, Councilman AYES: Ruland, Talbot, Doherty, Ktupski Jr., Evans, Russell ~o~~ggFfOt~-~o~ • ~ s~ Peter Young, Chairman y - Town Hall, 53095 Main Rd. Lauren Standish, Secretary ~ T P.O. Box 1179 ~ Southold, NY 11971 ~'~/~j ~.aO~' Telephone (631) 765-1892 Fax (631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., January 16, 2013 the following recommendation was made: Moved by Doug Hardy, seconded by Derek Bossen, it was RESOLVED to NOT SUPPORT the Wetland Permit application of MARLENE LANE CIVIC ASSOCIATION to remove 125 If. of damaged bulkhead and replace with code compliant new bulkhead; replace lost fill; replace two sets of stairs, 4' wide and with a 4'X 4' platform. Located: 11012 Great Peconic Bay Blvd., Mattituck. SCTM#126-6-10 Inspected by: Audrey Horton, William McDermott, Derek Bossen The CAC does Not Support the application because there is insufficient information and recommends a site plan for the project. Vote of Council: Ayes: All Motion Carried 1 ~ -Iii 'i, ; ~ ~I ~ _ lr~~~~ I soclhniu town 6oa~d o' lrestas g~}F FO(k James P. King. Presldenl ,`~y CO P_O. I4os I U9 1406 Ghosio. .Ic. Vice-Presldent i~~~ GS Np Southold, NY 11971 Dave f3erern ~ v ~ ~ Telephone (631 765-I R92 John Brcdcmcycr P. ~y 1w ~ Fas (631) 765-6641 Michael l Domino ~ ~ 't' s ~~o~ao'. Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: ~ g-~pg 3 Richard Zahra, President on behalf of MARLENE LANE CIVIC ASSOCIATION requests a Wetland Permit to remove +/-125 linear feet of storm damaged bulkhead and replace with code compliant new bulkhead; replace lost fill; and replace two 4'x4' platforms with two 4' wide sets of stairs to beach that were washed out by the storm; stairs will comply with existing code and construction standards. Located: 11012 Great Peconic Bay Boulevard, Mattituck. SCTM# 126-6-10 TXpe of area to be impacted: -Saltwater Wetland -Freshwater Wetland -Sound -Bay Distance of proposed work to edge of wetland Part~f Town Code proposed work falls under: hapt.275 _Chapt. 111 -other Type of Application: ~/Wetland -Coastal Erosion -Amendment Administrative_Emergency Pre-Submission Violation Info needed: Modifications: Conditions: `"~~~°l ~~1C~y Pres Were: J. King Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled oy~in(the fi~~ by~~~~~ C~ Mailed/Faxed to: /S ~ Date: ~ti~~ quoin ~e(mi~ NYS L~ARTMENT OF ENVIRONMENTAL CONSl~ATION Notice of Intent for General Permit GP-0-12-006 -Hurricane Sandy General Permit Pursuant to Environmental Conservation Law Article 70 DEC use only DEC use only DEC Permit No. v Effective Date: October 31, 2012 - Expiration Date: October 31, 2013 Project LOCatipn: Marlene Lane/Peconic Bay, Mattituck. SCTM#126-6-10 Town of: Southold County of: Suffolk Name of ApplicanVOwner: Marlene Lane civic Association Phone: Mailing Address: Po Box 1082 City: Mattituck Email: State: NY ZIP: 11952 Permit COntaCt (if different from ApplicanUOwner): Michael A. Kelly Phone: 631-298-1259 Mailing Address: 1x50 Marlene Lane City: Mattituck Email: mke11y15Qoptonline.net State: NY Z1P~ 11952 Authorization Tvpe Tidal Wetlands, Article 25, 6 NYCRR 661 Excavation 8 Fill in Navigable Waters, Article 15, Title 5,6 NYCRR 608 Water Quality Certification, Section 401 Clean Water Act, 6 NYCRR 608 Coastal Erosion Management, Article 34, 6 NYCRR 505 Proiect Description: R -mnv Jr -h iild 1 5 lip ar f - t by 4 t hiflh damaDed bulkhead- two set_c of 4 feet wide beach acrPSS stairs (with 4'x4' platform, 5 steps) and approximately 60 cubic yards of fill. Tvpe of Proiect: ? Stabilization of existing functional storm-damaged dwellings, decks and walkways with temporary bracing and pilings. ? Construction of a single 4' wide access walkway to access damaged dwellings. ? Installation of up to four rows of sandbags or 1 cubic yard sand cubes at the toe of storm damaged structures or eroded escarpments. ? Placement of sand and/or material equivalent to existing material at the toe of eroded escarpments. O Repair or reconstruction of stairways that were functional before Hurricane Sandy. ? Re-grade eroded dunes. t] In-kind/in-place repair or reconstruction of bulkheads and shoreline erosion structures that were functional before Hurricane Sandy. ? Repair or reconstruction of existing public roads, bridges, utilities and other public infrastructure. Certification: I have read this permit and will construct this project in compliance with the terms and conditions of this permit and the Environmental Conservation Law and applicable regulations. I understand that any false or inaccurate statements made in the application for this permit are punishable as a Class A misdemeanor. As a condition of this permit, I accept full legal responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agree to indemnify and save harmless the state from suits, actions, damages, and costs of every name and description resulting from this project. Michael A. Kelly 11/27/12 Applicant Signature /Name Date ? By checking this box, I certify that I am the responsible Applicant for this NOI. Mike Kelly From: SandyRl <SandyRl@gw.dec.state.ny.us> Sent: Tuesday, November 27, 2012 220 PM To: Mike Kelly Subject: Confirmation Receipt re: NOI General Permit/Marlene Lane/Peconic May Attachments: General Permit GP-0-12-006.secure.pdf Subiect: General Permit GP-0-12-006 - Humcane Sandv General Permit This confums our receipt of your Notice of Intent for GP-0-12-006 which is the General Permit authorizing recovery and repair work associated with storm damage from Hurricane Sandy. A copy of the General Permit is attached and it is also available on DEC's webpage, http:/lwww.dec.ny.gov/publ is/76659.htm I. Please ensure that those doing the actual work understand and comply with all terms and conditions of the General Permit. Any failure to conform with the scope of activities and conditions of this permit shall be treated as a violation of the Environmental Conservation Law If you have questions or encounter unforeseen problems during the course of the work, contact the Regional Permit Administrator for your county: For Nassau and Suffolk Counties: NYS DEC REGION 1 Regional Permit Administrator SUNY @ Stony Brook 50 Circle Road Stony Brook, NY 11790-3409 (631)444-0365 fax: (631)444-0360 email: rldep(cr~gw.dec.state.nv.us Or Contact: NYS DEC Division of Environmental Permits 625 Broadway Albany, NY 12233-1750 (518)402-9167 fax: (518)402-9168 email: depprmt~aa~i-.dec.state.nv.us Mike Kelty <mkellylSC~optonline.net> 11/27/2012 1:32 PM Please see attached. 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Main Rd. & Youngs Ave.) Southold, NY 11971 G Q Telephone: 631 765-1935 • ~O Fax: 631765-3136 ~~OOUNT'I,N`~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ~G~ ~ , To: Jim King, President ~ JAN ~ g 2013 Town of Southold Board of Trustees ~ ~ so~.~lr~~ol~~.: ~u;m From: Mark Terry, Principal Planner t;~~mor,.~~,~,~. LWRP Coordinator Date: January 16, 2013 Re: Proposed Wetland Permit for MARLENE LANE CIVIC ASSOCIATION SCTM# 1000-126-6-10 Richard Zahra, President on behalf of MARLENE LANE CIVIC ASSOCIATION requests a Wetland Permit to remove +/-125 linear feet of storm damaged bulkhead and replace with code compliant new bulkhead; replace lost fill; and replace two 4'x4' platforms with two 4' wide sets of stairs to beach that were washed out by the storm; stairs will comply with existing code and construction standards. Located: 11012 Great Peconic Bay Boulevard, Mattituck. SCTM# 126-6-10 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 provided the following: 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 ~~Of S~l/JyO Town Hall Annex Bob Ghosio, Jr., Vice-President ~0 6 64375 Main Road P.O. Box 1179 Dave Bergen * * Southold, New York 11971-0959 John Bredemeyer Michael J. Domino ~ ~ ~O Telephone (631) 766-1892 O~~,CO~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Uae Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit _Amendment/Transfer/ x Sion eceived Application: 2.- ~E(; 3 2~~2 ~ReceivedFee:$ ~'P~ ~ !;v I QS 1" )~<<oli.{ io~~ ~ompleted Application ~-,(I -~;~j ' Incomplete ~ ~ _ - SEQRAClassification: r - TypelTypelIUnlisted_ - _Coordina[ion:(date sent) _ ~ ~ ~ ~ ? LWRP Consistency Assessme [ Forrn I I L I I _ ~ CAC Referral Sent: j /~(3 Date of Inspection: Receipt of CAC Report: Lead Agency Determination:_ _ Technical Review: Public Hearing Held: ~ 3 _ I, __,_Resolution: Name of Applicant~t r )girt G Lu.r ~ G+ v+r. ~ss octa ~i n Mailing Address p D )3 ox ) G ~ ~ ~ fvv v ! 1 95 ~ Phone Number:( ) 6~ / - Z 95' - l l Suffolk County Tax Map Number: 1000 - / 2 - ( ' / D )IoI2, Property Location: h'ler`lehe <~in e ~P= o n =a ~u„r «I~~ I'~'1Qr le>7e Lane Qeu. (provide LILCO Pole distance to cross streets, and location) AGENT: I2il~-Lard ZG1 ~ r~A hhe.stt~~-,`t -l~Ar~cne~ur~C ~~v~a ~sSva (If applicable) / Address: ~1~/c5 M/,~r/~nC ~,!<ne. ~kt'-~i'tvc-~~~ /I~~ 2. Phone: l7 ~ Z qB -c5~.~ l ~~,k ! ~ t ,a- ~ ,~1 ' >~rd of Trustees Application • GENERAL DATA J Land Area (in square feet): Fr n e r ti la ; d~ : n = ~u, dfTOS y /l~~~w( z i c c.'f ant 4 =L ~ 4 o t s F Area Zoning: Previous use of property: Intended use ofproperty: Covenants and Restrictions on property? Yes _Ff No If "Yes", please provide a copy. I Will this project require a Building Permit as per Town Code? Yes ~No If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Pians will be required. Does this project require a variance from the Zoning Board of Appeals? Yes _~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.? ~r _Yes No Does the structure (s) on property have a valid Certificate of Occupancy? Yes ~No S~/'UC'~"'"L' Prior permits/approvals for site improvements: ~~,f Agency Date .S~o?r~lotp1 ~rnKS~PG~ -CI r,;,: ri 00 i 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): 17~~ ~-o L+~ nni c.~ ~ Su-r,c~~ _ (Re•ncve r28'l~r,eur ~ee~.yo~ ~(k,.,,uuul 6~l Ic~c1 w,-,d re?oce, Wi'~"1'L CO dd CC~'~'t~) /wv p, nGer> b?~~t~,C/e~~ rib lq~f rC11J ~ckG~)~'fiO a6J X14 P~ ~CLAyyNJ '~Lt~~ /LL)~E- ,~t ~'Le~'G STN/~ wlIl fG'Ih~l wI/K `~'Lf hn 60L1<F Ct^,Lt IS'TU N<~GI NCLJ. ~'~N j pirvirf+-,Jrerl wil/Fle <1' w~da c~ 6'"xy ~P~c.~) ~~~.-n,ew~Gl .to..~,-~ ri5~~it Bo~ of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~ nOV i c~ r c~ u ~ r~ ~ " pnD ~-ec~ew Area of wetlands on lot: / 20 0 - : Ho u square feet Percent coverage of lot: 1 Q Closest distance between nearest existing structure and upland edge of wetlands: feet i Closest distance between nearest proposed structure and upland edge of wetlands: Q feet Does the project involve excavation or filling? i No Yes If yes, how much material will be excavated? 66 cubic yards How much material will be filled? 6 O cubic yazds Depth of which material will be removed or deposited: t f feet Proposed slope throughout the area of operations: Z ° Manner in which material will be removed or deposited: ('"1 ~a ~u~n ~ owl i 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): rl 0Yl e I I sn.2o SEAR PROJECT ID NUMBER APPENDIX C STAFE ENVIRONMENTAL pUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ~ j PART 1 -PROJECT INFORMATION (To be completed by Applicant or Projec[ Sponsor) ! I- t. APPLICAM' / SPONSOR qq ~ 2. PROJECT NAME _ f- h^Q~~(Gn~~ itnG L; vro ss oc lu rra.- ~ r~ m ~ 1 Ic6,~Q vrs 3.PROJECT LOCATION: r,.+ 1 MenlciPaliry ~ r(~ 1 ~C ~ N County ~ v~,~d ~ l 4. PRECISE LOCA/TION: Streetrr~~Adtless and Road Intersections. Promlrlent landmarks etc - or wov(de maP Iti)Qr`IJ?h~l. GCVI~ PtuG~ ~j / ) } t~ r M~Eh~I.UriL ~tCOrntL 6 BIvA ~A~UL®r-tl ~ ~ G}.l'~13~ GN. 5. IS PROPOSED ACTION : ? New ? Expan n ®Modifiration /alteration ~ i, 6. DESCRIBE PROJE ~ BRIEFLY: ~ ~u r~ L~ a ~1I~c ~ ece rvv. b e u c%+-. Q EG LA4 S ru 1 f d ll "~I a'+~.U I I WAS ~~°GVT ~re ~r. )+rvr C..4+~t.G vCWr(~y S~LI~r ul MJ7a's3/U-uJ ,I 1 / ~n l ( ~ wrl( ~ s(/wrG~ wllw [t 2/rXYr (J[ci~~vr..t A-rl~ hN v~ ~I'r-r~^1 i. j . I, 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimatety acres r1U.~` Z 'i 00 S - 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ? No It no, describe briefly: I is it ~i 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as marry as appy.) Residenfial ? Induslnal ? Commercial ?Agriculture ? Park /Forest / Opan Space ~ Other (describe) G i 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, iis[ agency name and permit !approval: 17. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ?Yes ~7No If yes, list agency name antl permit /approval ' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ?Yes No 1 CERTIFY THAT THE INF~ION PROVIDED ABOVE IS TRUE TO THE BEST OF MV KNOWLEDGE Applicant /Sponsor ~ / /t 'i~ Date: /')O ~ j Si azure ~ - L~~- ~ ~ J ~ p / Z Ifthe a is a Costal Area, and you are a state agency, i complete the Coastal Assessment Form before proceeding with this assessment II I PART it -IMPACT ASSESSMENT o be tom leted b Lead A enc A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 It yes, coordinate the review process and use the FULL EAF. Yes Q No B. VNLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negagve dedaratton may be superseded by another involved agency. Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwdtten, H legible) C1. Fxisttng ak quality, surface or groundwater quality or quantfly, noise levels, existing fretfic pattern, solq waste production or disposal, polengal for erosion, drainage er flooding problems? Explain briefly: C2. Aesthegc, agdculTuml, archaeological, histod0. or other natural or cultural resources; or community or neighborhood charade(! Explain briefly: C3. Vegetafion or fauna, fish, shellfish or wildlifespedes, sigMficent habitats, or Threatened or endangered species? Explain briefly: C4. A community's existing plans a goals as olfxJally adopted, or achange In use or intensity of use of land or otlrer natural resources? Explain briefly: C6. Growth, subsequent development, or related adivRies likely to be induced by the proposed action? Explain briefly: C6. Long term, shon term, wmulative, or other effects not identified in C7-C57 Explain bnefly: ~ C7.~ Ofher im ads indudi than es in useof either uan6l or t e of ene ? E ain bdefl ; - - ~ ~ - D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTA6LISHMENF OF A CRITICAL ENVIRONMENTAL AREA CEA ? If es a lain briefl Yes a Na E IS THERE, OR IS THERE LIKELY TO B CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ain: ? Yes a No PART IQ -DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverseeffedidentfiedabove,detemlinewhetherit issubstaofial,large,knportarrtorotherwisesignificant Each effect should be assessed in connection with its (a) setting (i.e. urban or rump; (b) probability of occurdng; (cj duwfion; (d) irreversibgity; (e) geograpltk scope; and (f) magnitude. K necessary, add attachments or reference supporting materials. Ensure that explanations contain - suffidemdetail toshow that aU relevant adverse hnpads have been identified and adequately addressed. Pquestton d of part n was checked yes, thedetertnination of signifK;ance mustevaluatetlte potential knpadofthe proposed action on the ernironmentalaharacterisfics oftha CFA Check alts bazNyou FtaMe kleMified one ormore potendaflylarge orsignificemetlverse kttpacts wttkh MAY olxxx. Than proceed directly to the F lAF and/or prepare a posahne dedarefion. Check tltis box Hyouhave determined, based on the hlfomlagon and anatysis above and any suppoNng doaunenfafion, that the proposed a 1MLL NOT result in any significant adverse environmental hnpads AND provide, on attachments as necessary, the reasons supporting ttf determination. Board of Trustees p (//~,(J y cZ C7/3 Name of LeadCCAgency Date V~ `n F 1 s. ~~i~~ President p Pnnt or Type Name of Responsible Officer in Lead Agency 7iae of Responsible Officer Q,~.k.~ ~ /~.H•, Sgnature of Responsible Officer in L Agency Sgnature of Prepamr (If different from responsible officer) • ~o~SpfFO[,~~o James F. King, President ~ ~ Town Hall, 53095 Main Rd. Bob Ghosio, Jr. , Vice-President ~ ~ P.O. Box 1179 Dave Bergen Southold, NY 11971 John Bred~7ncyer ~'~d Telephone (631)765-1892 Michael J. Domino 1 ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of MARLENE LANE CIVIC ASSOCIATION COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, 2/GA/A~ D Zq fFts?t1 ,residing at /dba ~f yt' M A oz L f_= ti L p- ?'7 iTrJC /c 7y,~1 being duly sworn, depose and say: That on the day of i o , 2013, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday. January 23, 2013. Dated: i/ L K i signature) Sworn to before me this ~7G~-'' dayofQaa.20i3 Notary Public . , A~IC OF NENd r','i - SUFFGLK CGU"!~' ' u:!. ~ S FATE IjF tJE>r~i~ YGPi~: - SUFFG.K C~~o Gi~i',dl EXP{RES MAY 4, - 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. ~Y1o~le~ne Lc~,~ • OWNER(S) OF RECORD: ~;v;~ ~}~c~0.+~on SUBJECT OF PUBLIC HEARING: to remove +/_125 linear feet of storm damaged bulkhead and replace with code compliant new bulkhead; replace lost fill; and replace two 4'x4' platforms with two 4' wide sets of stairs to beach that were washed out by the storm; stairs will comply with existing code and construction standards. TIME & DATE OF PUBLIC HEARING: l,Jedresda~, ~o~nuaryo?~ o~?O13- on ora~~- ~-~.'ov PM • If you have an interest in this protect, you are invited to view the Town file(s) which are available for inspection prior 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 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: l`7 1 Ga~iZ LA /~~}~L L NC` clV iG ~SSo~, h'J T i I ~ v c% STATE OF NEW YORK COUNTY OF SUFFOLK /1/~NAceD Zc9/r~G1Ii ,residing at .~/L/'$~ MAOZLiz`/~iz ~1~ Mid ~1 ~u a/c ~i y ,being duly sworn, deposes and says that on the day of ~ ~ q N. , 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 respective names; that the addresses set opposite the names of said persons aze 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 i7 Q I /TV cK ,that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. C Sworn to before me this ,~0'`k Day of a~ . , 20 i 3 ~L(,L-GQQ~ /~~CG'LfrC- Notary Public noraRVRU~~~,.sri~,~ u, _ NO 49 , cJ~t=~-_~ TER E~'PI?E~' F.1r'a 4, ~aor~l ~ ~ RESOLUTION 2012-885 • ADOPTED DOC ID: 8343 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION N0.2012-885 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 4, 2012: RESOLVED that the Town Board of the Town of Southold hereby waives Trustees' permits fees for any repairs or construction, that in the sole discretion of the Board of Trustees, are determined to be related to Superstorm Sandy, until January 2, 2013 ~~Q~Y " Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER: Christopher Talbot, Councilman AYES: Ruland, Talbot, Doherty, Krupski Jr., Evans, Russell INl4B ~'~111t~~;~CW 11~r~QCIA710N INC. 1 U94 r ~b 6'~~ Y2V w A , c - ~ ~ Data { ,r ~ x l~" Dollars ~ n:a. ,t' s a' f ~ ~ p 3 ~4. FY'') ~ ek ~ t5. S . ~ IlP S ~V; Ilr1r ~4 t~4!++1~ 24~; ;+N.I,~It~ il~~~i4 s mix~ue d~~k Town of Southold Erosion, Sedimentation 8 Storm-Water Run-off ASSESSMENT FORM _ ~ ~ PaoPERTY LoCATgN: s.C.T.M. M. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM•WATERr GRADING DRAINAGE AND EROSION CONTROL PLAN i - "6G rF'eF 'Son 'B ebTi T- CERTIFIED BY A DES N P NAL IN THE STATE O NEW YDRK. i SCOPE OF WORE -PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMEN'T' Yes No a. What is the Total Aree of the Prodetl Pamela? ~ Will this Projed Refain AH Storm-Water Run-Ofl (Indude Tool Area of all Parcels located wlThin , „ _ ~p Generated by a Two (2'~ Inch Rainfall on Sile? the Smpe of Work for Proposed Constructlon) fs(iS~P r~a)r~ (This hem wtll mdude all run-otF Oeated by stte ? i a What is the Total Area of Lantl Clearing Il-- cieNing amhor consWctlon acdvitles as well as all ant/or Ground Ditdtrrbanca for the proposed 2 f7 OS y-'} Site Improvements end the permanent deation of conswd(on adNity7 -~-L--~- impervious surfaces) (g P. t ) 2 Does the Site Plen and/or Survey Show All Proposed PROVIDE BRIEF PROJF.CI' DFSCRB'110N Ia~wrNrAaaNbntl arlwaH) Drainage SWdures Irtdice5rg Size & Location? This ~ ~ 1 Item shall include all Proposetl Grade Changes and Re~,l~lb'?f~ ~~~b ~i ,tt !vr wA ~opesConbollfngSUdaceWaterFlow. 1 11 rr- JJ II 3 Does the Ske Plan andor Survey desdibe the erosion ll_TfeLJ r`-E Ar. LI +t ~ 1 4.t-7+•1Cd u~lrw.a hs.l' L ~ ant sediment wnhol practlces that will be used to ~ tt control she erosion and storm ureter discharges. This dy~ ~ R ? i^Yk CLLrt.L Sit-.~Q~ item must be mainfafned throughout the Entire ~ Construction Pedod. 4 Will this Project Require arty Land Fllirg, Grading or Excavation where there is a change to the Neural ? Fxisttng Grade InvoNing more than 200 Cubic Yartls of Matedal within any Parcel? 1j Will th(s Application Require Land Disturbing Actrvihes Encompassing an Area In Excess of Fve Thoraand ? (5,000 S.F.) Square Feet of Ground Surtace? s Is there a Natural Water Course Running Through the a , Site? Is tlris Project within the Trustees judsdidion ~ ' General DEC SWPPP Requirements: or within One HUndfed (100') feet of a Wetlantl Or Submission of a SWPPP is required for e0 corewdbn adirNes invdveg so9 Beach? diatwbsnces d one (t) or more scree; lmirdbg disNrbenceg of kss wan one aae that 7 Will titere be She preparation an Existing Grade Slopes am pare of a larger common plan thM Hill uaimatey dLSNrb one or more acres of land; which Exceed Fifteen (15) (bet of Vertical Rise to 'uxJUdry Constnsdbn edivi0es irnroNing sat d'aturbanrzs of less Nan one (td acre where One Hundred (100') o(HOrizoMal Distance? the DEC has tldemnned Mat a SPDES permd 6 requred forstorm water discharges. { SWPPP'a Shall meN the Minimum Requuarnants of We SPDES Gerwral Pertnil $ Will DdVewayS, Parking Areas or diter Impervious ? I rot Storm Wabr Dbchargea hom Consbuc0on acliNty • PertnR No. GP-0.16007.) SUrfaCe9 be Sloped to Direct Storm-Water Run-Off f ' t. iha SWPPP shay be prepemd prior to the suGnitlai dthe NOT. The NOI steal be into andlor in Nle direction oT a Town dghtof--way? r submitted b the DepercneM prior to he commencement d conswction adlviry. ! 2. The SwppP shat dasaLe me eresbn and sediment coned predices and where 9 Will this Project Require the Placement of Material, j regdred, post-wmaucnon spanvater managemsM pracucea dtM wAI ba used erdlor Removal of Vegetatiwl andlor the Construction of any cdnstmded to reduw the pd4bnb h stormwaler discharges end ro assure Item Within the Town Right-0f-Way w Road Shoulder ~ i i compliarax+with the tame erW mndilor¢dlhis permx In addEan,tleSWPPP Shag a?Itau ttam Mxlrm lmlWrdw WbaYlandpMwal APmws.) 'I identlty potentlal soumea d polutlon wltlch may reawreby be expected W aced the quelly of storm walertlbcherties. NOTE: My MSVCb6ueatbna One through Nina is MSwaM VANadeck Mark !i' 3. AI SW PPPs That requ've the poG-congWaOon storm water nenagemeM preclke M and tle aovtrueaon aka ~eturtarree k between 8,000 S.F.81 Aen In aroa, i component shall be prepared by a guarded Design profissbnel Lkensed in New Vork a Storm~Watar, GradMg, Drainage 8 Eroabn Control Phn b Required by tM Town d ' i SeuNdtl and Nuet be Snbmkted far Review Mwto bwance o(My Buil Permk. i l 1ha1 is kriaNedgeabk » the pdnciples eM predices or Storm Wa[¢r Mamgerrent. ~^0 , (NOTES AQixk r~wk(~)anNw Answer breaN DUrslm is Reg a¢E fore Complete Aoprmtlonl li 1i SPATE OF NEW YORK, COUNTY OF...s U.rr~L~......... SS That h! ~f~..~.~..~...........~.~:~~.~ being duly sworn, deposes and says that he/she is the applicant Cor Pemtit, (Name d ImOWdal slgMrg Document) And that he/she is the I~J~S/D~/~.l........°t~...,(~rg4L,(.,r,%',/v~; ......Lf?,...._c/.V1~........~SSac(,R2,'/G n% (Owner, Canlreclon Agent, Corporate steer. ate) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to ~ ~I - make and file this application; that all statements contained u7 this appliation are true to the best of his latowledge and belief; and I, that [he work will be performed in the'mtanner set fo~rt^h in the application filed herewith. Sw~o ym to be~ re th)y of.....~ N ~ 20A~. No Public......... 1M, ,t` (56gnetme sarN) FORM - 06/10 AL A MlrovA NOTARY PUBLIC-STATE OF NEW YORK No. O1 MI6249841 Gualifhlld In Suflolk County My Commiulon Expir~l Oafobsr t t, 2015 PROOF OF MAILING OF NOTICE ~ i ATTACH CERTIFIED MAIL RECEIPTS ii 1. Name: Address: ~ i< ii j' I. STATE OF NEW YORK COUNTY OF SUFFOLK residing at ,being duly sworn, 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 II 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 ' i Office at that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETU1iN RECEIP'T'. Sworn to before me this Day of , 20 ~ I Notary Public I II I NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES. TOWN OF SOUTHOLD In the matter of applicant: /~ur~n~ l~wtQ _rviG ~sst*C. SCTM# /Z(v' ~ ` la YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: /oL/aC ~ L X ( i / rvG- lZ`r i on tf ' L S Cj v l-/< /f C A D WN/c-// 1~l-~S /J/!r-r~aG~~i~ /J vi= To _/fv~~'Zicgi-'~ SAnipy ~~7U~ ~(r t(1 (.Q. ~wL SP~~ 0~ ~2Ij,G t~ Q [ Gejd ~5 `~R INI w ~ 7n [~IMB-..Sis n a~° Y'w.s(t, `1 X~1 ~ i 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: I 7~i>`~ Q~ /a~=l~t -f /3LV~F P~a~'~27y wy/~l< /s a ~,rn~~zo ~y T/-/i~ Mir ~~/3_'=2S o~ 7~fi= /yrar2t~civl~ rig cevic ,g5soc, ~NrG,Ef lS ~=~Si o~ MR- l2oi~i~fz7'T/1yLe2s /~/IaPi-/ti's W~~Sr kjr 3. That the project which is subject to Environmental Review under Chapters 7N~ V~i!'2 ~ ti~ : 96,111 and/or 275 of the Town Code is open to public comment on: ~t1?L. DATE: You may contact the Trustees Office at 765-1892 or in writing. ' L The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal.I PROPERTY OWNERS NAME: ~4~~iz/"~ C~v~e .9S~S~crasian/ MAILING ADDRESS: ?7b oX f(2~ /H~~- ~ulc A/N ii4SL PHONE AGENT: _ ~/~~g.2p ZJa l~ FAA MAILING ADDRESS:__~f45 rit~o2ti~n-.~- 4A- t~t3~~y"r~-vcX ,~y,~iq,rZ PHONE ~ - S".?/~ I Enc: Copy of sketch or plan showing proposal for your convenience. i i MARLENE LANE CIVIC ASSOCIATION PO BOX 1082 MATTITUCK, NY 11952 November 20, 2012 Southold Town Board of Trustees: This purpose of this document is to affirm that Marlene Lane Civic Association (MEGA) members are aware of the submittal of Trustee Permit application for the replacement/repair of the Marlene Lane Beach bulkhead and two sets of beach access stairs which were damaged and washed away due to Hurricane Sandy. This affirmation will be confirmed with receipt and deposit into the MLCA bank account of specific assessment funds for completion of the project. DEC 2 0 2012 Sincerely, Richard Z President Marlene Lane Civic Association Boa of Trustees Application County of Suffolk State of New York C1fA~D Zp yin {Ki-S / iJ uT ~/t'l L C/~~ BEING DULY SWORN I DEPOSES AND AFFIRMS THAT H SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Pr Owncrpp SWORN TO BEFORE ME THIS_~~_DAY OF_ T~lDVQ1µ~P,r Zp~ ALBENA MITOVA i NOTARV PUBLIC-STATE OF NEW YORK No. of \A15249841 I`~~ 1n~ fluoilf!sel iC Suir~!5. rc!rnty J~Y V (11 ,n ~ My COmmlulon Expnv..:ciuoer 11, 2013 WWW~~~~~~~~ ~~~~,,,444 1 Notary Public i i eo~ of Truateea Application • AUTHORIZATION (where the applicant is not the owner) I,/'li+e(L~ Nr. LLB c;~r~ ~~o! a'es~~i gat 1/L/S~ ~f`~1-~~~ L-~ (print owner of property) (mailing address) i f'~ r7`r17ub/C ,l~ y ! / X5'2 do hereby authorize~~cygcFlD Z1iN~11 ' (Agent) Pat~zs ~"d Lam- A ~ to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ~ (Owner's signature) I i I APPLICANT/AGENT/REPRESENI'A1'IV~ I TRANSACTIONAL DISCLOSURE FORM i, The Town of Somhold's Code of Ethics prohibits conflicts of interest on the of [own officers and empJQyees. The g rose of this form is b provide information which can alert the town of possible copflids of mtetest and aiknv it to take whatever action is e)y to avoid same n r~~ l nn i YOUR NAME: Y?lAr`I6atL Anne Ctv~G IiJSCL iGti~e... 'tc.i L~L1 ~-ZA~I+L( I~'-- (Last name, first name,apiddle inifial, unless yoo are applying Id the name of ~ someone else or other entity, sudr as a company. If so, indicak theother person's or company's name.) ~ ~ i NAME OF APPLICATION: (Check all thaz apply.) Tax grievance Buildipg ~ I,. Variance Trustee X - I Change of Zorte Coastal Erasion Approval of plat Mooring Exemption from plat orofiicial map Planning I' Other Qf"Other', name the activity.) Do you personally (or through your rnmpany, spouse, sitifing, patens or child) have a relaUonship.with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or busincss igterest "Business inletesP° means a business, including a partnership, in which [he town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns mote than+~5°h of the shares. YES NO __L` i if you answered "YES", complete the balance of Nis form and date and sign where indicated. ~ Name of person employed by the Town of Southold Title or posi5on of that person _ ~I , _ Describe the relationship between yourself (the applicanUagentlrepresentative) and the town officer or employee. Either check I the appropriate line A) through D) and/or describe in the space provided ~ li I The town officer or employee nr his or her speuse, sibling, parent, or child is (check all that applyl: _A) the owner of greater than 5%of the shares of the corporate stock of the applicant ~ ~ ~ I. (when the applicant is a corporton); _ B) the Icgal or beneficial owner of any interest in a non-corpornte entity (when the applicant is not a corporation); ~ ~ - C) anofficer, director, partner, or empbyee of the applicant; or ' _D) the actual applicant. DESCRIPTION OF RELATIONSHIP ii i Submitted this day of 200 _ Si~tazure- Print Name - I Form TS 1 ~ I Town of Southold LWRP CONSLSTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pernuts* 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 j making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. i 2. Before answering the questions in Section C, the prepazer 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 sitmificant beneficial and adverse effects upon the coastal area (which includes all of Southold Townl. 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will ' affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thos, each answer must be explained in detail, listine both suuuortin¢ and non- sunportine facts. If an action cannot be certified as consistent with the LWRP policy standazds and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town plf Sou~old s website (southoldtown.northfork.net), the Board of Trustees Office, the Plar~aitg Department, ali ~ ~ local libraries and the Town Clerk's office. : ' - 3 2(J~2 L Wit.. B. DESCRIPTION OF SITE AND PROPOSED ACTION _ - _ PROJECI'NAME~ln~ ~uc¢ 4~ a..~,4 h~1~~aado~.c~~S~airl cva~l~ec(-vv~ba ~~rP~~«i.~S"~?! The Application has been submitted to (check appropriate response): ?J J Town Board ? Planning Board ? Building Dept. ? Board of Trustees ] . 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) Pemut, approval, license, certification: ~ , x' Nature and ext++ent' 1of action: 1]?L AFC I-t~rrlLUn2 Sit ~--~y".,[~.G Cwi~. KI~~GCG ILS I~ne~~r-I-tL'~C!?~ Io.,Il~~euc~ v~~, ~bc~.¢ e6w,n~iu....~ new ~i, I kl.tu~ R. Slav; II u,,,.cl rc~ lure two .ie~a ~s ~a Ins ~w~~rw. d~.,te~-~s«.~~ e~ w,tlo Y~X4` >la ~^~y~Q s¢Va-.-. NiSer~J ~ l Location of action: MarLir~c Lune Ci~ac?n t 1Heirla~,el-.i.,~a,~c~~ccc~,~ (3u~ $ 1 vc~= Site acreage: IS Ooh Arc i~_c-~ d re u = Z 400 ,5~ ~ >Z~ Present land use:__ [~GLlG Pmsent zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a} Name of applicant: 1'Iprlyine Ln,,,L 'tocia`~¢v~- (b) Mailing address: D i:3 o x (0~2 f'l ~ '1 j- ~ ~v c k~l t( I~ f 9 sZ (c) Telephone number: Area Code O (x~ ( Z Q ' x'31 1 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No ~ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Pracfices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY I 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 I 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 A licable PP Attach additional sheets if necessary Policy 3. Enhance visaal quality and protect scenic resources throughout the Town of Southold. See ~ LWRP Section III --Policies Pages 6 through 7 for evaluation criteria ? Yes ? No ~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III -Policies Pages 8 through 16 for evaluation criteria Yes 0 No ®Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III ~ - Policies Pages 16 through 21 for evaluation criteria Yes ~ No ~ Not Applicable i I i. Attach additional sheets if necessary Policy 6. ProteM and restore the gnatity and function of the Town of Southold ecosystems including Significant Coastal FSsh and Wildlife Habitats and wetlands. See LWRP Section III -Policies; Pages. 22 through 32 for evaluation criteria. ? ? i Yes No Not Applicable Attach add~honal 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 evaluatiop criteria. ? Yes ? No ~ Not Applicable _ G _ I PUBLIC COAST POLICIES i I 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. n ? Ye ~ No ~ Not Applicable i i i Attach additional sheets ifnecessary WORHING 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 necessary i 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 'i I I I~ Attach additional sheets if necessary ' Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III -Policies; Pages 65 through 68 for evaluation criteria. ? Yes ? No ~ Not Applicable PREPARED BY~ m~~t. ~ Kam! TITLE 11~4~i~- T~~s?Yw~""` DATE r i z ~ I ~L /~~LO Pi '2 fY L/NL - ~ ~ i, -3 2017. ' ' ~ ~ p ~ I ~ - ~ !m,~sr l7~N~mF-^ ~i__ l : 1~ k - w GAl v~ N-x~ j ~~n+ ~~;i~ ~ ~ ~ = O• I Rp lllnq! ~ L 7Kser5 S-friny~~~~~~~is~v~ i ~ ~ ~i-/Q W V I ~ ~~J~~ GD~ ~S~r`0. 1 e 6~ ~ ocl '1' j~~=AC l/ _ ,mil ~ FA_ . - - ~ T APPROVED BY BOARD OF TRUSTEES rOwN of souTt+O~D i DATE + Zg 13 ~ ~ ~ ~ - - ~~~a_N /c y - - - as' t ~ "1 rBcACy/ ~y~~=A 7'0 /~iGN wai~~ r~An/c ~ S:Z~ ^I4~ ~J+ ~~'Ga1..nn~z-e god %~~~,6<.~D~a(~a K i~ J 0 U ~ ~`I' i"~A?IL,~,~C Ga, C/V/G ASS~ciAj/ov 3~3Z _ / ~ ~ - SGR Li_