HomeMy WebLinkAboutTR-8018 John M.Bredemeyer III,President �,••���� S00,5,- - Town Hall Annex
Michael J.Domino,Vice President / l0 54375 Main Road
P.O.Box 1179
James F.King,Trustee Southold,New York 11971-0959
Dave Bergen,Trustee • G Q
.. �0,$ Telephone(631) 765-1892
Charles J.Sanders,Trustee
COUNT( Fax(631) 765-6641
Fax
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0970C Date: April 25, 2014
THIS CERTIFIES that the existing±140' of bulkhead along Peconic Bay; the addition
of a±60' return on the east side of the bulkhead; construction of 4' wide steps to beach;
restoration of area landward of bulkhead; and application of clear sealant to bulkhead
At 100 MacDonald's Crossing, Laurel,New York
Suffolk County Tax Map # 145-4-15
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated December 24, 2012 pursuant to which Trustees Wetland Permit#8018 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 existing±140' of bulkhead along Peconic Bay; the addition of a±60' return on the east
side of the bulkhead; construction of 4' wide steps to beach; restoration of area landward of
bulkhead; and application of clear sealant to bulkhead.
The certificate is issued to INA HASDAY owner of the
aforesaid property.
doe"— gr% 6,41097.69.0t
Authorized Signature
0 •
John M.Bredemeyer III,President ,���$UFFt1(,� Town Hall,53095 Main Rd.
Michael J. Domino,Vice-President 1,+'Z C�4 P.O.Box 1179
James F. King y z ; Southold,NY 11971
` 0.-
+ Telephone 631 765-1892
Dave Bergen ` `'F i P ( )
Charles J.Sanders `'y�'�1 4 *,it' � Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: //" " / '/ 8 ''5
Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1st day of construction
'/ constructed
Project complete, compliance inspection. .
INSPECTED BY: J+ K/ 6--
COMMENTS: -
A/ r1 t2 4 RE.77)/2 d No cJ 56,,fe 6 2)
.117r r" z /e Nic/6:44,6r/ 70 e 'I"-- /-G9.c ,649 1-- aryv GL,eri‘r�
0 e U',rz. o 57— a 4 ,e6?- 'A i ,ev h,e/c1 ,o1cK FE tom. :.
CERTIFICATE OF COMPLIANCE: / +
I
• •
Cantrell, Elizabeth
From: betsy@mooreattys.com
Sent: Thursday, April 10, 2014 3:09 PM
To: Cantrell, Elizabeth
Cc: pat; Phil Wells
Subject: RE:Ina Hasday final inspection-100 macdonalds crossing
Elizabeth okay, all has been redone. please put on for another inspection. thanks!
Betsy Perkins LA
Moore Law Offices
William b. Moore, Esq.
631.765.4663
Patricia C. Moore, Esq.
631.765.4330
mailing & physical address:
51020 Main Road
Southold NY 11971
fax number for both
631.765.4643
www.mooreattys.com
Original Message
Subject: Ina Hasday final inspection
From: "Cantrell, Elizabeth" <elizabethc @town.southold.ny.us>
Date: Tue, April 01, 2014 9:14 am
To: "Besty at Pat Moore's Office (betsy @mooreattys.com)"
<betsy @mooreattys.com>
Good Morning Betsy,
A final inspection was performed at Ms. Hasday's property located at 100
Macdonald's Crossing, Laurel. Unfortunately, at this time the inspection failed as
the work was determined to be incomplete. The sealant should be painted onto
the entire length of the return. At this time, it appears that the sealant stops a
distance from the most seaward end of the return. When the entire length of the
return has been sealed, please contact the office and we will schedule another
inspection.
Thank you.
Clerk Typist
Town of Southold
Board of Trustees
031-765-1892
1
S
John M. Bredemeyer 111,President ,,,':,00FO . Town Hall,53095 Main Rd.
Michael J. Domino,Vice-President 1++'���w P.O.CMG: Box 1179
James F. King H z ; Southold,NY 11971
Dave Bergen `G t` Telephone(631)765-1892
g =y�0 `a01,� � Fax(631 765 6641
Charles J.Sanders 1 4 $ ,o (631)
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE OF INSPECTION: /i'5/` /
'V Ch. 275 Ch. 111
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1st day of construction
% constructed
Project complete, compliance inspection.
INSPECTED BY: J -
COMMENTS:
CERTIFICATE OF COMPLIANCE:
• •
Town of Southold
A- 2 4 8 7 Suffolk County, NY
The People of the State of New York vs.
LAST NAME(DEFENDANT) FIRST NAME MIDDLE INITIAL
APT.NO.
STREET ADDRESS 'y,, �j ,�/JJ
Gi 1 /4‘..,�r/J iev /�C ZIP
CITY STATE
!&s-k 1 ,k C��-. ' " \-t t'5- o
UCENSE OR REGISTRATION NUMBER
STATE TYPE OF LICENSE DATE EXPIRES SEX DATE OF BIRTH OPERATOR
/MON Of� R OWNS VEHICLE
N�-/ (� OS 1 nt i I (,I LA OYES ❑NO
/1 THE OPERATOR OR REGISTERED ONG OF VEHICLE DESCRIBED BELOW DATE EXPIRES
PLATE NO.
STATE PLATE TYPE
❑N.Y. ❑N.J. ❑N.Y. ❑N.J. ❑ ❑PASS ❑COMM ❑
❑ DODGE
VEHICLE MAKE
❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC
❑ FORD ❑ OLDS ❑ PLYM
❑ TOYOTA ❑ VOLKS ❑
BODY ❑ 2 DR ❑ 4 DR ❑ BUS ❑ MCY ❑ S.W.
TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑
VIN NUMBER
DE C E I V E THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS
..__..i., PLACE OF OCCURRENCE THE, 1v lea,.J G I PCT
`D 0 /11 D w2 (c! l TY,T .VILLAGE HAMLET SUFFOLK COUNTY NY
n/ Q DATE OF OFFENSE I AM TIME PM G7/
MAY ` V �01� IN VIOLATION OF•S TTON S'UBBD, OF THE❑VEHICLE TRAFFIC LAW OF THE STATE OF NEW YORK
;I 1( ) ❑D.S. ❑COM ❑BUSI ❑HMAAZT
THER(SPECIFY) �w 2.:7s,.... ,� I DEFT VEH�
`•/ OTHER OFFENSE Lek L , MISDEMEANOR❑
of t ❑ MPH E IN A MPH ZONE I A4rei,.L t. �t,,t...,�f's'
Board Trustees
• ■
FACTUAL PART(NOT FOR NB) ��,,,ar j � /
THE ABOVE NAMED DE/��EN�DANT DID ON/THH STATED DATE,TIME D PLAC UJ` ` e7
—- ^-- I k.n i r— 'P7Jr Sik 4,--ek...-r o -L t R-.Gl iA.-)
I )of
7 I f` Ijj ) The Foregoig Te bed on nowl�V � �1"4.-[ �� dated Q�'2-5'13
CONTACT COURT❑
PARKING SCHEDULED FINE 3
!!I THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT
r :�-uJe(tIV±l)V.j SOUTHOLD TOWN JUSTICE COURT,63095 ROUTE 25,SOUTHOLD,NY 11971
,,30 4T DATE OF APPEARANCE(NOT FFORIVE
J ON JJ�-.�. l ( 2.01-5 AT /0.9— ^"`E:J
FALSE STATEMENTS HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE P.LN.Y.S.
COMPLAINANT DATE,y >ZI".-/7
BADGE I
4.---
/VI
COURT COPY
• •
Cantrell, Elizabeth
From: Cantrell, Elizabeth
Sent:. Friday, May 17, 2013 3:01 PM
To: Epple, Andy; Kirincic,John
Cc: Hulse, Lori
Subject: Wetland Violation
Jim King and Michael Domino went out on a field inspection and discovered a wetland code violation at 100
MacDonald's Crossing, Laurel. The owner's name is Ina Hasday;SCTM# 145-4-15. A Wetland permit was issued on
January 23, 2013 for the 140' long bulkhead and to add a 60' return on east side of bulkhead,construct stairs to beach
and restore the land behind the bulkhead. The Trustees discovered that the return was built using treated lumber on
the sheathing and some of the bulkhead sheathing was repaired/replaced with treated lumber which is against town
code.
The file is here in the office for your review. I will fax over what I can regarding this matter, if you need anything else,
please let me know.
Thank you.
Clerk Typist
Town of Southold
Board of Trustees
631-765-1892
1
. .
. .... _...
PATRICIA C. MOORE
Attorney at Law - MAR 2 5 2014 J
51020 Main Road
Southold, New York 11971
Tel: (631) 765-4330 5uuiltuJ �s���`
i
Fax: (631) 765-4643
March 24, 2014
attn: Lori M. Hulse, Esq.
Office of the Town Attorney
Town of Southold
PO Box 1179
Southold NY 11971
Re: People of the State of New York
v. Ina H. Hasday
Dear Lori :
With reference to the above Stipulation entered into on August
2, 2013, the neighbor never completed his bulkhead, therefore my
client painted the bulkhead with a clear sealant to seal the wood
(as required in the stipulation) . Please be advised that the work
has been completed.
By copy of this letter, we are requesting the Board of
Trustees to inspection and advise you that this matter is now
complete and we can close the file.
If you have any questions, please do not hesitate to contact
me. Thank you.
r
Vexytruly yours,
(LA ii' '-
Patricia . Mo r0/1Q-__
PCM ,
C: Board of Trustees
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James F. King, President
Bob Ghosio, Jr., Vice-Preside. at
Dave Berge~
John Bredemeyer
Michael J. Domino
Town Hall, 53095 Main Rd.
P.O. Box 1179 .
Southold, NY 1197 [
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
INSPECTION SCHEDULE
__ Pre-construction, hay bale line
1st day of construction
¼ constructed
Project complete, compliance inspection
BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD, NEW YORK
PERMIT NO. 8018 DATE: J~NUARY 23 2013
1SSUED TO: INA HASDAY
PROPERTY ADDRESS: 100 MACDONALD'S CROSSING~ LAUREL
SCTM# 145-4-15
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 $250.00 paid by _Craig & Ina Hasday 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 for the existing 140'+/- bulkhead along Peconic Bay; to add a
+/-60 return on the east side of the bulkhead; to construct 4' wide steps to beach; and to
restore area landward of bulkhead; as depicted on the project plan prepared by
Patricia C. Moore, Esq., received on December 24, 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 Board as of this date.
Dave Bergen - Absent
TERMS AND CONDITIONS
The Permittee Ina Hasday, residing at 100 Macdonald's Crossing, Laurel, 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 Pennittee 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
January 23, 2013
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Ms. Patricia C. Moore, Esq.
51020 Main Road
Southold, NY 11971
RE:
INA HASDAY
100 MACDONALD'S CROSSING, LAUREL
SCTM# 145-4-15
Dear Ms. Moore:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, January 23, 2013 regarding the above matter:
WHEREAS, Patricia C. Moore, Esq. on behalf of INA HASDAY 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 24,
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 Headng 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,
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
Sduthold 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 Water[rent Revitalization Program, and,
RESOLVED, that the Board of Trustees approve the application of INA HASDAY for the
existing 140'+/- bulkhead along Peconic Bay; to add a +/-60 return on the east side of
the bulkhead; to construct 4' wide steps to beach; and to restore area landward of
bulkhead; as depicted on the project plan prepared by Patricia C. Moore, Esq., received
on December 24, 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
James F. King
President, Board of Trustees
JFWamn
James F. King, President
Bob Ghosio, Jr., Vic, c-President
Dave Bergen
John Bredemeyer
Michaet I. Domino
Town Hall Annex
54375 Route 25, P.O. Box 1179
Southold~ lqY 11971
Telephone (631) 765-1892
Fax (631 ) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
your application dated t 2- / 2- 0C/I 7.-- , has been
Please
be
advised
that
reviewed by this Board at the regular meeting of ] / ~ ,.5/]~ and
your application has been approved pending the completion ~)f 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)
V// Final Inspection Fee ($50.00)
__ Dock Fees ($3.00 per sq. ft.)
Permit fees are now due. Please make check or money order payable to Town of
Southoid. The fee is computed below according to the schedule of rates as set forth in
Chapter 275 of the Southold Town Code.
The following fee must be paid within 90 days or re-application fees will be necessary.
You will receive your permit upon completion of the above,
COMPUTATION OF PERMIT FEES:
TOTAL FEES DUE:
BY: James F. King, President
Board of Trustees
Peter Young, Chairman
Lauren Standish, Secretary
Town Hall, 53095 Main Rd.
P.O. Box I 179
Southold, NY 11971
Telephone (631 ) 765-1892
Fax (631) 765-6641
Conservation Advisory Council
Town of Southold
At the meeting of the Southold Town Conservation Advisory Council held Wed., January
16, 2013 the following recommendation was made:
Moved by Audrey Horton, seconded by Doug Hardy, it was
RESOLVED to NOT SUPPORT the Wetland Permit application of INA HASDAY to add
25' returns to east side of bulkhead and construct 4' steps to beach.
Located: Peconic Bay Blvd., Laurel. SCTM#145-4-15
The CAC does Not Support the application because there was insufficient information.
Applications should include numbered street addresses because notice of hearing
cards are not always posted, therefore making it difficult to locate the property.
Vote of Council: Ayes: All
Motion Carried
James F. King. President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J Domino
PO Box 1179
Southold, NY 11971
Felephone (631 765-1892
Fax (631 ) 765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time:
Patricia C. Moore, Esq. on behalf of INA HASDAY requests a Wetland
Permit for the existing 140'+ bulkhead along Peconic Bay; to add a 25'+
return on the east side of the bulkhead; to construct 4' wide steps to
beach; and to restore area landward of bulkhead. Located: 100
Macdonald's Crossing, Laurel. SCTM# 145-4-15
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland
__Sound Bay
Distance of proposed work to edge of wetland
,~¢~of Town Code proposed work falls under:
__Chapt.275 Chapt. 111 other
Type of Application: __ Wetland
__Administrative__Emergency
Coastal Erosion Amendment
Pre-Submission Violation
Info needed:
Modifications:
Present Were: -/J. King~:_~B. Ghosio
"3~B redem e~_ .-"Michael Domino
Form filled out in the field by
D. Bergen,
D. Dzenkowski
other
Mailed/Faxed to:
Date:
Jame~ F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York t 1971-0959
Telephone (631) 765-1892
Fax (631) 765-664].
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 7045A
Date of Receipt of Application: February 11, 2009
Applicant: Ina Hasday
SCTM#: 145-4-t5
Project Location: 100 MacDonald's Crossing, Laurel
Date of Resolution/Issuance: Mamh 18, 2009
Date of Expiration: March 18, 2011
Reviewed by: Trustee James F. King, President &
Trustee Jill M. Doherty, Vice President
Project Description: For the existing 4'x25' walkway and masonry tim pit
surrounded by slate tiles.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code. The
issuance of an Administrative Permit allows for the operations as indicated on the
survey prepared by Nathan Taft Corwin III, last dated January 12, 2009, and
received on Febma.ry 11,2009.
Special Conditions: Re-vegetate the 15' wide area landward of the bulkhead
with native species.
Inspections: Final inspection upon the completion of replanting.
If the proposed activities do not meet the raquimments for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
James F. King, President
Board of Trustees
JFK:eac
SURVEY OF
P/O LOT 12 & LOTS 13 & 14
MAP OF
EDGEMERE PARK
SITUATE
LAUREL
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. I000-145-04-15
Nathan Taft Corwin III
Land Surveyor
?].c. _Iii
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
ISSUED TO Richard Zeicl/er
ufl ori atiou
Pursuant fo the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the ,1~. ws of the
State of New York 1952; and the Soufhold Town Oral,nonce. eh_..
flfled "REC=ULATING AND THE PLACINg, OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, CARAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS:" and in accordance with the
Resolution of The Board adopted afa meeting held on _P.~c.~ ...!~ ......
9 96 , and in consideration of the sum of $..~59.,..Qq... paid by
Eh-Consultants on behalf of R geidler
of ........................................ ; ..................................... N. Y. and subiect to the
Terms and Conditions listed on the reverse side hereof,
' of Soufheld Town Trustees authorizes and permits the following:
to remcrve and replace inkind/inplace 128 l.f. of bulkhead on
southwest side of property. Remove (2) angled sectio~ of
and replace with (1) 30' section to connect north & south
All bulkhead must be at current elevation. No Dredging. '
all in accordance with the detailed specifications as presented in
~" the originating appllcaf;on.'
Eye view easement must be re.~pected..A,s per map dated 1/16/97.
.. ~ IN WITNESS' WHEREOF, The sa,d Board of Trustees.here.
by causes, ifs Corporate Seal tO be affixed, and these ~.resenfs to
'" be subscribed by a majorlfy of the said Board as of +his date. ·
EN-CON~ULTANT$
13~9 NORTH SEA RD,
SOUTHAMPTON N.Y. 11968
516-283~360
.4
EN'CONSULTANTS
13~9 NORTH SEA RD,
$OUTHA/~PTON N.Y'. ! 1968
~16'283-6360
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO ..... ~8.~4 .............
DATE: ..~-~ ~2,....]:9.90
ISSUED TO .......... ~[(;.h ~.d ... ~.~id,]~ ~ ......................................................
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter'404 of the Laws of +he
State of New York 1952: and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OE SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on ...gu~e._;~l,...
19.9.0..., and in consideration of the sum of $ .................. paid by
of .................................................................................. N. Y. and subiecf to the
Terms and Conditions listed on the reverse s~de .hereof;
of Southold Town Trustees authorizes and permits the following:
To construct 90 L.F. of bulkhead to be attached to the
existing bulkhead to the south & be no higher at any locus
along its length. **SEE ATTACHED CONDITIONS**
all.|n accordance with the dele|led spec~ficaf}ons as presenfe~ in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees h~re-
by causes its Corporate Seal to be affixed, and these presents to
be~ubscrlbedbyamejorifyoft~Bo~_~a:dasoffhlsda~r,e.
Permit # 3844 Richard Zeidler CONDITIONS CONTINUED:
Every attempt shall be made to honor the existing ey View easement. Dredging
operations are not permitted with this permit. However, clean sand backfill material
may be recovered from above M.L.W. in the project area in the presence of and at
the sole discretion of the Bay Constable.
TERMS end CONDITIONS
The Peun/~ee Richard Zeid~er
1. That the said Board 'o~ Tnmees and the Town of ~outhold aze released from any ~
~ ~ ~oi~ ~ d~, ~ ~g~yor ~y~ a~to~ ~
~o~d~t to~ ~d ~e~dP~~h~~
~ ~ ~e~, ~ ~e ~pl~ ~clndon of ~ ~d ot T~ ~ ~e T~ ~ ~old
2. Tha~ dg~ p,~mk is wJid ~o~ a period
er~m~ted time requL-ed to complete the work involved, but shouM circumstances warm~ ~equest
for an ex~ensiofl may be made to the Boa~d ar e la, er
5. Tha~ rh~, Pera~k should be retaiaed iadefialtelY, or as lon~ az the said Permillze wishe~
lo malmala the smu:ture or pro~ect involved, to provide evidence re anyone concerned that au~h-
ozizatiofl was orlg~n~lly obtained.
4. That ~he work involved will be sub]err to the inspection and approval of the Board or
irs agents, and flon-compIi~n~ wish the provisions of the o~iglna~.g application, may be caase for
revocation of this Pem~/t by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the work
herein autho~ized~
6. That theze shall be no interference with the Hght of the public to pass and repass along
the be~ch between high and low water mazes.
7, Th~ i/ future opeeadons of the Town of Southold re~ulre the r~oval and/or alteratiom
in the location of the work herdu authorized, or//, hz the opinion of the Board of Trustees, th~
WOrk shall cause tmreasooable obswac~on ~o free navigation, the said P~mlttee will be requlre~
UpOn due notice, to remove or alter this wod~ or project herein stated without e~pe.~es to the Town
o~ Southold.
8.' That ~he said Boazd will be not/Hod by the Permlt~ee oIf. he completion of the work auth-
odzed.
That the Peemlttee will obtai~ all other permits attd cease.ts e~m: may b~ reclulzed sup-
plement~! w this permit which m~y be sub}ect to revoke upon f~;l,,ee to obtain seine.
R/CHARD Z~IDL~H ~ RUTH Z~~..
~ ~ L A UR~L ~ua
~.,, ~~ ~,
sc~ /% 40' ~rE~p~. I~ 197~ ~--~-t00
OFFICE LOCATION:
Town Hail 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
Southoid
Board of Itu f~es
Date: January 16, 2013
Re:
Proposed Wetland Permit for INA HASDAY
SCTM# 1000-145-4-15
Patricia C. Moore, Esq. on behalf of INA HASDAY requests a Wetland Permit for the existing
140'+ bulkhead along Peconic Bay; to add a 25'+ return on the east side of the bulkhead; to
construct 4' wide steps to beach; and to restore area landward of bulkhead. Located: 100
Macdonald's Crossing, Laurel. SCTM# 145-4-15
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:
Require that the 15' vegetated buffer landward of the bulkhead be restored. The buffer
was required in Permit No: 7045A issued in 2009.
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
PATRICIA C. MOORE, ATTORNEY AT [.&W
51020 Main Road
Southold, NY 11971
(631) 765-4330
emaih pcmoore@mookeattys.com
LETTER
Subject
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
~oastal Erosion Permit Application
zWetland Permit Application
Amendment/Transfer/Extension
,~Received Application:
~Rcceivcd Fee:$
v/ Completed App~cation
~Incomplete ~ ~ '
__SEQRA Classification:
Type lType II Unlisted
cCOOrdination:(date sent)
AC Refcrm Sent: t
Date of Inspection: ' t
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
~Public Hearing Held:
Resolution: t
Administrative Permit
Name of Applicant
Address / [ ~'
Suffolk County Tflx Man Number: 1000- /q'~' - 0~- /,5~'
Property Location:
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: -~t~'~
(If applicable)
Address:
I. IIC[7/
Phone:
GENERAL DATA
Land Area (in square feet):
Area Zoning:
Previous use of property:
Intended use of property:
Covenants and Restrictions on property?
If"Yes", please provide a copy.
Yes K' No
Will this project require a Building Permit as per Town Code? Yes X No
If "Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review.
Does this project require a variance from the Zoning Board of Appeals?
lf"Yes", please provide copy of decision.
Yes ~ No
Will this project require any demolition as per Town Code or as determined by the Building Dept.?
Yes b( No
Does the structure (s) on property have a valid Certificate of Occupancy? ff 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
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: /ac- _square feet
Percent coverage of lot: %
Closest distance between nearest existing structure and upland
edge of wetlands:/~gA//f_A~ _feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~u//~ad feet
Does the project involve excavation or filling?
No X Yes
If yes, how much material will be excavated? '7'~D cubic yards
How much material will be filled? 7~ 0 cubic yards
Depth of which material will be removed or deposited: ~r~t/v'n~ 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
3.PP~ECT LOCAT~ON;,~ /~t
Municipality ~
4. PRECISE LOCATION: S~eet Addess and Road lnte~e~ons. Prominent landmass etc -or provide map
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor}
2. PROJECT NAME
cou.ty
SEQR
5. IS PROPOSED ACTION: [] New [] Expansion /[~] Modification / alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially · Z~-- acres Ultimately . ~-t.~ acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
OYes [] No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
[~Residential [-~lndusthal []Commercial [---]Agriculture [~Park/Forest/OpenSpace []Other(describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
]Yes [~No If yes, list agency name and permit / approval:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
~]Yes [---]No If yes, list agency name and permit /approval:
12. AS A RESULT OF PROPOSED ACTION WiLL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant / Spon~o~ a~q~m~.~
/~ Date:
Signa t u re~.~"~.~~
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. DOES AC~I'ION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review pro~ess a~d use the FUU. EAF.
171No
B. WILL,~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative
declara6o~ may be superseded by ane~hor immlved agency.
C. CO(JLD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answem may be handwdlte~, if legible)
C1. F-~sting air quality, surface er gmuodwster quality or quanlity, noise levels, existing fraffic baltem, solid waste ix~duction or ~lis~osal.
p~enfial for erosion, drainage or flooding problems? Explain brier]y:
C2. Aesthetio, aglicullural, archaeolog ca, h~toric, or o~er ~aturul or cultural rescu~ces; or community or neighborhood character? F'~le briefly:
C3. V~-~=;o[;~l ~r faurm, fish, shell~sh o~' wildlife species, sigl~iicard habitats, or ~r reatened or e~la~ species? Explalrl b~efly:
I ..........
C4. A communiys exlsli~g plans or goals as officially adopted, or a cha~"i'~ use or hllen$1ty of use of land o~- otl~r natural resources? I=~l=z. briefly: I
I
· C7. er ~mpacts t~nclodm~ chanties ~n use of e~ther quaatit~' or t}~e of energy? Explain briefly: ......
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA CEA ? (If ~'es, explain
E. IS THERE. OR IS 'I~IERE UKELy TO BI~I CONtrOVERSy RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~es
PART III - D~; ~<MINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, laq]e, important ~ othenvise s~gniftcanL Each
effect should be assessed in con~ with its (a) setting (Le. urban or rural); (b) probability of oc=J~'ring; (c) duration; (d) irreversibly; (e)
geographic scope; and (t) magnitude. If necessaly, add attachments or reference supporting materials. Ensure that explanations ¢o~ltain
sta~fid~ent delall t° sh°w that all relevant adverse impa~ts have been identiSed and adequately addressed. If question d of part ii was d~cked
yes, the detemtination of slgnlficance must evaluate ihe potentlalimpactof the prefx~ed a~ion en ~ en~l ~m~ ~ ~
EAF and/~' pmpore a posi~ve dedara~o~.
Check ~ ~ if'you.have de~l. based on ~e thfocmatlon a~d analysis above a~l a~y Suppo~ d~umenta~, that ~e peeposad acllo~
WILL NOT result in any signit]ca~t adverse emiror~e~tal Impacts AND I~vide. o~ attachments as necesse~y, the masons supporting ~
determination.
Board of Trustees
Name of Lead Agency
teed
Date
President
Title of Respoesitfle Officer
Signature of Preparer (if different from responsible officer)
PATRICIA C. MOORE
Attomey at Law
51020M~n Road
Southold, NewYork I197!
Tel: (631) 765-4330
Fax: (631) 765-4643
January 11,
RECEIVED
JAN 1 6 2013
Southold Town Clerk
2013
~TIFiED A~%IL
RETURN RECEIPT REQUESTED
RE: INA HASDAY ~i ,i
PREMISES: 100 MACDONALDS CROSSING, LA~EL
SCTM: 1000-145-4-15
TOWN 07
Dear Neighbor:
I represent the above with regard to property located 100
Macdonalds Crossing, Laurel, New York.
She has submitted an application to the Southold Town Board
of Trustees for a wetland permit as more fully outlined in
attached Hearing Notice.
A copy of a portion of the survey is also enclosed.
The hearing on this matter has been scheduled for WEDNESDAY,
January 23, 2013 on or about 4:00 p.m. at Southold Town Hall.
If you have any questions, or you wish to support this
application, please do not hesitate to contact me.
Thank you.
yours,
~a '~.~M~0re
PCM/bp
encls.
C:.Ina Hasday
!via email)
ECEIVE-
JAN 1 7 2013 -'
$outhold Town
~rd of Trustee~
.lames F. King. Ihcsidcnt
Bob (;hosio..Ir . Vicc-I>rc~,ident
F)axc Bergen
John Bredcme3 er
Michael J. l)omino
I mxn Hall. 53{)95 Main Rd
P.O. Box 117g
Southold. NY 11971
Tdephone (631 ) 765-1892
Fax {63 I) 765~6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application of
INA HASDAY
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
JAN 2 3 2013
beihg duly s~v~i:'n~'depose and sa~
AFFIDAVIT OF POSTING
, residing at/dba C/l) ~l. ~a
That on the ¥15 da3,' of ~f)~/'X~( , 201 ~ I personally posted the property known as
by placing the Board ofTrustee~ offidiai poster whe~ it can easily be seen, and that 1 have checked
to be sure the poster has remained in place for eight days prior to the date of the public hearing.
Date of hearing noted thereon to be held Wednesd~¥~ January 23, 2013. ~
Dated: \-
('signature)
Sworn to before me this
'Z_.2day of..h~ 20B
BETSY A. PERKINS
Notary Public, State of New York
No, 01PE6t 30638
Qualified in Suffolk Coun~
Commission Expires July I
NOTIC
OF HEARING
NOTICE IS HEREBY GIVEN that a .public hearing will be hel.d by the
SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Ma~n Road,
Southold, New York, concerning'this property.
OWNER(S) OF RECORD: ~'h~.
SUBJECT OF PUBLIC HEARING:
For the existing 140'+ bulkhead along Peconic Bay; to add a 25'+ return on the east side of the bulkhead; to construct 4' wide steps to
beach; and to restore area landward of bulkhead.
TIME & DATE OF PUBLIC HEARING:
If you have an interest in this project, 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
BOARD OF TRUSTEES
TOWN OF SOUTHOLD: NEW YORK
In the Matter of the Application of
INA HASDAY
Applicant's Land Identified as
1000-145-4-15
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT
OF
MAILING
I, Betsy Perkins, residing at Mattituck, New York, being duly sworn, depose and
say that:
. ~,...
On th~e~" day of January, 2013, I personally mailed at the United States Post
Office in Southold, New York, by CERTIFIED MAIL, RETURN RECEIPT REQUESTED,
a true copy of the attached Legal Notice in prepaid envelopes addressed to the
neighbors on the attached list.
Attached hereto is the white receipt post-marked by the Southold Post Office on
said date.
Sworn to before me this f~ 7~/
day of January, 2013
(Notary Public)
MARGARET C. RUTKOWSKI
Notary Public, State ot New York
No. 4982528
Qualified in Suffolk County
Commission Expires June 3, ~
ECEJVE
dAN ! 8 2013
$ou~old Town
Board of Truste~
PLEASE list, on the back of this Affidavit or on a sheet of paper, the lot numbers next to
the owner names and addresses for which notices were mailed. Thank you.
HASDAY
SCTM: 1000-145-4-15
NEIGHBOR LIST
TOWN OF SOUTHOLD
PO BOX 1179
SOUTHOLD NY 11971
SCTM: 1000-145-4-5
JOAN R CHRISHOLM
PO BOX 313
LAUREL NY 11948
SCTM: 1000-145-4-16
GEORGE J HOCKBRUECKNER SR
CAROL A HOCKBRUECKNER
PO BOX 637
LAUREL NY 11948
SCTM: 1000-145-4-14.1
ECEIVE
JAN I 8 201:]
SoubSold Town
Board of Trustee~
RECEIPT RECEIPT RECEIPT
7104 2438 8090 0000 0365
7104 2438 8090 0000 0341 7104 2438 8090 0000 0358
FROM: FROM: FROM:
Moore Law Office
SEND TO:
TOWN OF SOUTHOLD
PO BQX 1179
SOUTHOLD NY-1~971
FEES:
TOT~: .... / $ 5.75
SEND TO:
JOAN R CHRISHOLM
PO BOX 313
LAUREL NY 1~948
FEE~:~
Re)~tncted ~/ / ....
postmaRK 8R DATE
SEND TO:
GEORGE J HOCKBRUECKNER $
CAROL A HOCKBRUECKNER
PO BOX 637
LAUREL N
FEE~! ;<~'~'---'-~;'~ .~'
C~,~fi~d Fe~/ 2 95
R~tur~ Receipt
POST~ OR DA~
' Town of
~ Erosion, Sedimentation & storm-water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN
~ D~ct S~ion Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTTION [fl~M# / WORKASSESSME2qT ] Yes No
a. What is the Total Area of the Project Pamels? Will this Project Retain NI Storm-Water Run-Off
the(IncJude TotelAma of all Parcels located withinscope of Work f~ Pmposed Construction) ' ~'"' __ I Generated bY a Tw° (2') Inch Rainfall °n Site? q4
b. What is the Total Ama of Land Clearing (S.F. I A=es) (This item will include ail run-off created by site
cleadng and/or construction ac~vitJes as well as all
and/or Ground Disturbance for the pmpesed ' ~ ~ Site Improvements and the permanent creation of
construction acl~vtiy? impervious surfaces.)
(S'F' I Ac~es) 2 Does the Site Plan andlor Survey Show Ail Propesed /~/~_~j~__ D
PROVIDE BRIEF PROJECT DESCRIPTION (P~,~,~P~.~,.~,,~ DrainageStmctureslndicatingSize&Locaben?This
Item shall Include all Proposed Grade Changes and
Slopes Controlling Surface Water Flow.
and sediment control practices that will be used to
· ~ control site erosion and storm water discharges. This
,~J(/' ~, ~'~. ,~'~ ~C:~ item must be maintained throughout the Entire
- - Construction Period.
~?~_ ~-,? f~' /~ (:~- 4 Will this Project Require any Land Filliog, Grading cr
Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards [--I
of Material within any Parcel?
5 Will this Application Require Land Disturbing Activities r--~
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.) Square Feet of Ground Surface?
6 is there a Natural Water C°urse Running thr°ugh the
Site? Is this Project within the Trustees jurisdiction
General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or
Submission of a SWPPP is required for all Construction activities in, ok, ing soil Beach?
disturbances of one (1) or mom acres; including dislurbances of less than one acre that 7Wilt there be Site preparation on Existing Grade Slopes r--'-I ·
am part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fift,e, en (15) feet of Vertical Rise to ] I/)'//~
including Construction activilies involving soil disturbances of tess than one (1) acre where One Hundred (100 ) of Horizontal Distance? L~J -~
the DEC has de~ermined Ihat a SPDES permit is required for storm water discharges.
SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways. Parking Areas or other Impervious r"~ ,/ix
for Storm Water Discharges from Construction activity - Permit No. GP-O.I 0.001.} Surfaces be Sloped to Direct Storm-Water Run-Off
1. The SWPPP shaft be prepared prior to the submittal of the NOI. TYre IdOl shail be into and/or fn the direction of a Town right-of-wpy?
2. ~e SWPPP shall descdbe the erosion and sediment contml practises a~ whem 9 Will this Project Require the Placement of Material. D~..~
STATE OF NEW YORK, ('~ ~'~' /~,~
COUNTY OF ..p.~.l.~ ............... SS
'l~at I, "' '~' '~'"~'~.4~ifi~~ ........... being duly swbm, deposes and says that he/she is the applicant lbr Permit,
And lhat he/she is the ~ ~
...................... ~ ~~i~'~;;;'~i ................................................................
Owner and/or representative of the Owner 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 ill this applicafio0 are true to the best of his lumwledge and belief; and
that the work will be performed in the manner set forflx in the application fded berewith.
Sworn to before me this;
............................................... day of. ........................................... ,20 .....
Notaxy Public: ......................................................................................................................................................................
FORM - 06/10
Boa~f Trustees Applicatlon
County of Suffolk
State of New York
~/~ /~ vdt/. BEFOG Du~Y swoRN
DEPOSES AND ^FFI~S THAT ~E/SHE IS THE API'UCANT FOR THE ABOVE
OESCRIBE~, ~'ERMTT(S) AND T.AT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE EEST OF HISSER ~OWLEDGE ANO ~ELIEF, ANO THAT A~L WO~
WILL BE DONE IN THE MA~ER SET FORTH IN THIS APPLICAT~O~ 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 Prop~y Owner
SWORN TO BEFORE ME THIS ,~5~ C/ DAYOF ~C
,20_
BETSY A. PERKINS
Notary Public, State of New York
No. 01PE6130636
Qualified in Suffolk Cou0lY
Commission Expires July 18,.A''~
BO of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
(print owner ofpropertg)
residing at ///~ ~-J~t,~J'
(mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(Owner's signaturOt
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Tqwn of Southold's Code of Ethics orohibits conflicts of interest on the tort of town offieem and emnlovees. Thc nuroosc of
this form is to nmvide information which can alert thc town of vossible conflicts of intem~t and allow it to take whatever action is
~id same.
(Last name, f~t name, ~iddle initial, unless you am applying in file name of
somcone else or other entity, such as a company. If so, indicate thc other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other", name the activity.)
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business,
including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
YES NO ~
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title Or position of that person
Describe the relationship between yourself(the applicanffagenffreprescntative) and thc town officer or employee. Either check
the appropriate line A) through D) and/or describe in the space prooided.
The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):
__.A) the owner of greater than 5% of thc shares oftbe corporate stock of the applicant
(when the applicant is a corporation);
__.B) the legal or heneficial owner of any interest in a non-corporate entity (when ~he
applicant is not a corporation);
__.C) an officer, director, partner, or employee of the applicant; or
__.D) thc actual applicant.
DESCRIPTION OF I~LATIONSHIP
Form TS 1
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. Thus~ each answer must be explained in detail~ listinl~ both supporting and non-
suooortiw, 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 ~
website (sontholdtown.northfork.net), the Board of Trustees Office,
local hbranes and the Town Clerk s office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
The Application has been submitted to (check appropriate response):
TownBoard ~ Plannin~Board~ Building Dept. [] Board ofTrustees
Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification: ~-~
Nature and extent of action:
Location of action:
Site acreage:_
Present land use:
Present zoning classification:
If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: -~t
(c) Telephone number: Area Code ().
(d) Application number, if any:.
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes [--] No [-~ If yes, which state or federal agency?.
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation
criteria.
Yes ~ No [] Not Applicable
/
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
~] Yes ~] No [~ Not Applicable
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
Yes No Not Applicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III - Policies Pages 8 through 16 for evaluation criteria
~ Yes [] Noi ~ Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
Yes [] No [~]Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
through 32 for evaluation criteria.
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.
~ Yes~ No ~-~ Not Applicable
Attach additional sheets if necessary
WDRKING COAST POLICIES0 ~
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
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
A~tach 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
P~PA~DBY~
TITLE
DATE
-7 ¢y~'7
~
\
O\
/
×
\
,
~PPROVED BY--
.~ ~OARD OF TRUSTEES
T~ OF SOUTHOLD
b '~' 6 Whaler
Whaler
HWF'! 2 0
Tie Rod
LWH 0' 0
Whaler
8"x 5' Deadman
2' ~ i)],0 T+G
Length
141 Along Peconic Bay
25 Return
Bulkhead Peturn Cross Section
8'X 16 Piling
Ina Hasday
100 HacDonalds Crossing
Laurel, NY
ECEIVE
$outholdTown
Board of Trustee~