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Home My WebLink AboutTR-8030 James F. King, President Bob Ghosio, .Ir., Vice-President Daw Bergea John Bredemeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765- 1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ~ constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8030 DATE: JANUARY 23, 2013 ISSUED TO: JACK BIGGANE PROPERTY ADDRESS: 8871 OREGON ROAD, CUTCHOGUE SCTM# 83-1-34 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 Jolm & Mamaret Bieeane and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a timber stairway on the bluff; stair treads to be an untreated lumber; and as depicted on the site plan prepared by Creative Environmental Design, received on November 26, 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. TERMS AND CONDITIONS The Permittee Jack Biggane, residing at 8871 Oregon Road, Cutchogue, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this 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 uureasonable 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 it; 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 Mr. Jack Biggane 168 Euston Road Garden City, NY 11530 RE: JACK BIGGANE 8871 OREGON ROAD, CUTCHOGUE SCTM# 83-1-34 Dear Mr. Biggane: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, January 23, 2013 regarding the above matter: WHEREAS, JACK BIGGANE applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 26, 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, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JACK BIGGANE to construct a timber stairway on the bluff; stair treads to be an untreated lumber; and as depicted on the site plan prepared by Creative Environmental Design, received on November 26, 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 JFK/amn ' ;~ James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen $ohn Bredemeyer Michael $. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Sout~old, ~ 11971 Telephone (631) 765-1892 Fax (63l) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application dated I[/Z~/]Tj ~ i has been reviewed by this Board at the regular meeting of ~ ~ ' I] 9~$/I,--7 and your application has been approved pending the completion of ~e fol(owing items checked off below. __ Revised Plans for pro~p,~osed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) ½ Constructed ($50.00) Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$ .~, OD BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., January 16, 2013 the following recommendation was made: Moved by William McDermott, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of JACK BIGGANE to install a new timber stairway on bluff. Located: 8871 Oregon Rd., Cutchogue. SCTM#83-1-34 Inspected by: Doug Hardy, Audrey Horton, William McDermott The CAC Supports the application with an engineered erosion control plan for the structure. Vote of Council: Ayes: All Motion Carried James F King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J l)omino P O Box I 179 Southold. NY 11971 Telephone (631 765-1892 Fax (631 ) 765-6641 Date/Time: Southold Town Board of Trustees Field Inspection/Worksession Report JACK BIGGANE requests a Wetland Permit to construct a timber stairway on the bluff; stair treads to be an untreated lumber. Located: 8871 Oregon Road, Cutchogue. SCTM# 83-1-34 Type of area to be impacted: / __Saltwater Wetland Freshwater Wetland/Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: ,~etiand __Coastal Erosion __Amendment __Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: ~'~i King '"~. Ghosio ~ m Bredemeyer ~- Michael Domino __ D. Bergen, D. Dzenkowski Form filled out in the field by j, Mailed/Faxed to: Date: other BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK pERMIT No. DATE: ISSUED TO: JACK BIGGANE PROPERTY ADDRESS: ~71 OREGON ROAD CUTCHOGUE SCTM# AUTHORIZATION Pursuant W thc provisions of Chapter 275 and/or Chapter 111 of the Town Code of thc Town of Southold and in accordance with the Resolution of thc Board of Trustees adopted at the meeting held on ~, and in consideration of application fee in the sum of $.~5_Q__3~ paid by k B!l~C~ggg~ and subject to the Tem~ and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits thc following: Wetland Permit to construct a timber stairway on the bluff; with the condition that the project conforms to Chapter 236 of the Town Code - Storm Water Management; and as depicted on the site plan prepared by Creative Environmental Design, received on August 31, 2010, and stamped approved on October 20, 2010. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these p~sents to be subscnbed by a majority of the said Board as of thts date APPROVED BY BOARD OF TRUSIEE~ OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator JAN 2 2 2013 S0uth01d '[own Board of Trustees Date: January 18, 2013 Re: Proposed Wetland Permit for JACK BIGGANE SCTM#1000-83-1-34 JACK BIGGANE requests a Wetland Permit to construct a timber stairway on the bluff; stair treads to be an untreated lumber. Located: 8871 Oregon Road, Cutchogue. SCTM# 83-1-34 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. I~ng, 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 _/Coastal Erosion Permit Application ~Wetland Permit Application Administrative Permit Amendment/Trans fer/Exteosion k//~.eceived Application:~ ~ ~/Received Fee:$ ~ .c~) .¢~7 ~(~ompleted Application !Z ]i? Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent)_ ,,/LWRP Consistency Assessment Form ~]t~L ~/CAC Re ferral Sent: 1 /Lf]l~ / Date of Inspection: ' - Receipt of CAC Report: Lead Agency Determination: pTechnical Review: ublic Hearing Held: Resolution: NOV 2 6 20;2 Name of Applicant Mailing Address Phone Number:( ) 6g/' c/r 73 O-) Suffolk County Tax Map Number: Property Location: ot & '7 / Or.~ ~ ~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Land Area (in square feet): Area Zoning: L J Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions on property? __Yes ~ No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes V/ No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance fi.om the Zoning Board of Appeals? If "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 No Does the structure (s) on property have a valid Certificate of Occupancy? Yes __ No Prior permits/approvals for site improvements: Agency Date Vt' 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 Project Description (use attachments if necessary):. of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ,~'~Ai¥,~ ~ 4m A~.~_,es.~ -'~ t-,, r--c~ Area of wetlands on lot: q['-~ ~ square feet Percent coverage of lot: ' ~ ~ % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 0t'- o feet Does the project involve excavation or filling? C/~ No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Bo~ of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No t~Yes Does the project involve excavation or filling? L~ No Yes If Yes, how much material will be excavated? .(cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as proposed, including erosion increase or adverse effects on natural protective features. (Use attachments if necessary) 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 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-15 OF THE SOUTHOLD TOWN CODE I (We) ~ e ~. ~ ~,~,.,~-- The owner:~f record of property at: ~ ~" ') [ SCT.# o0o- ?) -o! -- in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: as shown on the attached licensed survey and/or site plan for the approved structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50% of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or Notary Public CONNIE D. BUNC!'~ Notary Public, State of Ne~, ~or No. 01BU6185050 imporl{i~,t natural resource features. N~/t~['ized signatur~ of ~er of record Quali[ied in Suffolk Cc~u?ty ~ ~, Commission Expires !~,pril ~ 4~ 2 ,k~_/io This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. PROJECT ID NUMBER PART '1 - PROJECT INFORMATION 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT / SPONSOR 2. PROJECT NAME Municipality ~~d~ddes~nand ~ ~,..). ~., County ~7,J ~,/~..~. 4. PRECISE LO Road Inter~ecfions, Prominent landmarks etc - or provide map 5' IS PROPOSED ACTION: E~ New [---] Expansi°n [~#icati°n ' altera0°~_~, 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially . ~) / acres Ultimately ~ OI acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~es r-~ No If no, describe bdefly: 9. WH PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~ntial E~lndus[rial ~]Commerclal ~]Agriculture r~]ParklForestlOpenSpace r~other (describe) 10. DOESACTION II'J.~DACTION I LVE A PERMIT APPROVAL, OR FUNDING, ,AGENCY (Federal,/8~te or Local) r~Yes L~No if yes, list agency name and permit / approval: NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL 11. DO 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 RESUL~OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT ~To be completed by Lead Agency) A. DOES AC'DION EXCEED ANY T~PE I THRESHOLD IN 6 NYCRR, PART 617;47 It yes, coo~dir~ale [he review process and uce the FULL FAF. B. WILL ,~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 if No, a eagafJve dectsm6o~ may be s~pemeded t~y aealher irlvelved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (A~swo;s may be handwrlffeo, If leglide) C1. Existing air quality, surface or gmundwato; quality or quantity, noise levels, exisling Iraffic paifem, s~id waste prnducliea or disposal, potential fe; ernsioo, dmleage or flooding pro~lems? Explain b~tefiy: I C2. Aesthefio, agrlcuitural, o;chaeofegisal, hislodc, or other eatural or cultural resources; or ~ommunlty or neighborhood charac{e~ F-xplal~ brlel~/: I C3. Vege~aliml o; tsuna, fish, shellfish or wildlife species, sigoiticent habitats, o; threatened or endangered species? Explain b~tefly: I C4. A communlys e~dsflng Iflatts or goals as off'~ally adopted, or a c~ange in use or iofe~slty of use of ~ or other natural ~soumes? F. xfflaln brleOy: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdefly: C6. Long term, shod term, cumulative, o; other effects not identified in C1~57 Explain briefly: I C7. (~therim aR esin eofeither uan eo ~ ' / D. ~N1LL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL EN¥1RONMENTAL ARFA [C~,I? Ill ~ea, e~lale briefly: I E. IS THERE, OR IS I~ERE UKELY TO B~l CONTROVERSY REI.~TED TO POTENTIAL/~DVERSE F_.N~RON MF_NT/M. IMP/V~FS? If ~es A~ _=!~: PART III - D~INATION OF SIGNIFICANCE (To be completed by Agency) INS*t~UCTIONS: Fm~ead~tadversue~ectider~ti~edabeve~determir~ewhetheritissubsta~§aLle~e~impertaM~r~themdsesignifican~ Each effe~ sho,.dd be assessed in connecflo~ with its (a) setting (i.e. urban o~ rural); (b) probability of o~curring; (c) duration; (d) kreversibility;, (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting mata~als. Ensure that e~planations contain ~ dofail to show that all relevant adverse impacts have been ider~Ufied and adequately addressed. If questicn d of pa~ Ii was checked yes, the detmmination of significance must evaluate Ihs potential impact of the preposed scion en the enulmnmenta! ~arac~a~stics of the CEA. FAF and/0r prepare a ~ declaration. Check this bex If ~¢ou have detemfiee~l, based ol1 the infomtafion and analysis above end suy s~t~p~Ong docume~taOco, that the pm~nsed ac~x WILL NOT result In any slgnlflce~ adverse erwironrcefltsl Impacts AND provide, oo attachments es eacessa~j, the masons supp~fl~g thi~ determinafi~t. Board of Trustees Name of Lead Agenc-.j m (~ ~"'Print or Type Name of Responslble~,~ le~Lead~ Agency ~Signatum of Responsible Officer i~d Agency President Title of Respoeaible Officer Signature of Pmpo;er (If different from responsible officer) James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredcmeyer Michael J. Domino Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of JAN 2 3 2013 Town JACK BIGGANE COUNTY OF ~ ~/~'} ST^T O wYo , AFFIDAVIT OF POSTING being duly sworn, depose and say: That on the t ~'day of 'Tt2 ~, oa.,.~ , 2013, I personally posted the property known as by placing the°Board of Trustees ~ffi'cial pc~ter 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 Wednesda% January. 23~ 2013. Dated: (~t~ature) Sworn to before me this ~i,~ £dday of~1~720/~ Notary,~0ubiic" Notary Public - State of New York NO. 01WA6155906 Qualified in Nassau Co~/~ty. /,,I y Commi~inn Expires NOTICE 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: .~,T'~~i~,~ SUBJECT OF PUBLIC HEARING: TIME & DATE OF PUBLIC HEARING: c,~~, ~o~9, o~3, ,~~,- ,~, o,- ~,~.~ If you have an interest in this project, you are invited to view the Town file(s) which are available for ins[:)ection.prior to the day of the hearing during normal business days between the nours ol'8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 PROOF OF MAll,lNG OF NOTICE ) MAIL RECEIPTS JAN 2 3 2013 Nsi'Qe' STATE OF NEW YORK COUNTY OF SUFFOLK ~VC , ~ [[qg.~,b~n~dulyswom, d~s~dsays~aton~e ~ adaySf ~'- ,20~d~nmtm~a~e~pyof~eNofi~ set fo~ M ~e Bo~ of T~t~ Applimfion, dir~ to each of ~e ~ve nm~ p~ ~ ~e addr~ s~ opposite ~c r~p~fivc n~; ~at ~e ad~s~ s~ op~site ~e ~ of ~d ~m ~ ~e ad~ of ~d ~m ~ shorn on ~e ~ent ~s~ent roll of~e Tom of Sou~ld; ~t ~d No~ w~e m~ at ~e Uffit~ S~t~ Post Offi~ at ~,~ ~0~; ~ ~, ~at s~d Nofi~ w~e m~l~ to ~ch of s~d p~sons by / Sworn m before me ~s ~ Not~ Public Commission Expires March 30.20 J/~ PROOF OF M~II,ING OF NOTICE ATTACH CERTIFIED MAll, RECEIPTS d ~l JAN 23 20]3 Nam. e: STATE OF NEW YORK COUNTY OF SUFFOLK ~U '~t~ e,.,¢ . ~ ,~ I I q] j~ ,beingdulyswom, deposesandsffysthatonthe '~Jrh ' dalJof ~ ~'~r;3 ,201~ , deponent mailed a tme copy of the Nofice set forth in the Board of Trustees Application, diri~cted to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~-d~. ~ -~ ~¢~q., P)/, that said Notices were mailed to each of said persons by c axn o CEIeT. Sworn to before me this ~k///~ Day of ~(~o~. ,20 /3 Notary Public Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATtON: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN District 5action BlOCk Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUG. rlON l'rltuVl# / WORKASSESSMENT I Yes No a. What is the Total Area of the PrOject Parcels? (Include Total Area of all Parcels located within ~-- ~, ~ I Will this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Construction) ~] Generated by a Two (2") Inch Rainfall o~ Site? (a.F. t A~es) .~.~ (This item will include all run-off created by site What is the Total Area of Land Clearing .~- / ~- ~ ~ clearing and/or constrdction activities as well as all b. and/or Ground Disturbance for the proposed ~ ~/. ~ d J / '". Sfte Improvements and the permanent creation of construction activity? / (S.F. tAc~s) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PR#V//)[ BRieF PRO~ECT DE,SCBZ]~[ON (pr~ ~t~n~ p~ ~N~e~a} Drainage Structures Indicating Size & Location? This item shall include all Proposed Grade Changes and -- ~----~ ~w.~.~,- Slopes Controlling Surface Water Flow. d 3 Does the Site Plan and/or Survey describe the erosion r=~ ~-~"-w~w/W ~ ~ /t,'f,-~C-~r andsedimentcontrolpracticesthatwiltbeusedto control site erosion and storm water discharges. This -- -~-t/. ~ --']--~ ~ ~ ~ item must be maintained throughout the Entire Construction Period. ~ ~J~ ~ o ~= i=- 4Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural I ,~1 Existing Grade involving more than 200 Cubic Yards of Matedal within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.} Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction ;eneral DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission of a SWPPP is requked fo~ all Construction activities invoivthg soil Beach? disturbances of one (1) or mom acres; including disturbances of lass ~han one acm that 7 Will there be Site preparation on Existing Grade Slopes am pan of a larger common plan that will ultimately disturb one or mom acres of land; which Exceed Fifteen (15) feet of Vertical Rise to I/I i~cJuding Construction activities involving so~l disturbances of less than one (1) acm where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit la required for storm water discharges. SWPPP's Shall meet Ihe Minimum Requirements of the SPDES General permit 8 Will Driveways, Parking Areas or other Impervious I~ Sto~m Water Discharges f~m~ Construction activity - Permit No, GP-~-I 0-001.) Surfaces be Sloped to Direct Storm-Waler Run-Off 1. Tm~ SWPPP shall be prepared ~ to the submittal of the NOI. The NOI shall be into and/or in the direction of a Town right-of-wa.y? 2. The SWPPP sha~ describe the ems/an and sndimen[ control p~actices and where 9Will this Project Require the Placement of Material, consfo~ctod to reduce the pollutants la storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder Notary Public, State of New York STAq~ OF NEW YO~, <~: .~r No. 01BU6185050 COUNTY OF .....~....~..~. ........ SS Qualified in Suffolk County ~.. Commission Expires April 14, 2~/(~ That I,. ............................................................................... being duly sw6m, deposes and says that he/she is thc applicant for Permit, And that he/she is the .................................................................................................................................................................... Owner and/or representative of the Owner or Owners, and is duly authorized to perform or bare performed the said work and to make and file this application; that all statemenLs contained in this application are ~ue to the best of his knowledge and belief; and that the work will be performed in the manner set fo~,h h~ the application fded herewith. Sworn to before me this;~('~ ~('~o~'~ ....... .~...{~.:.-~ ...................... day of....~....~..~.~ ............ 201.¢~, FORM- 06/10 Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. 1N 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 o~ SWORN TO BEFORE ME THIS O~:~'fh DAY OF ~3'8o~'~"¢X~21~ ,20 /~. Notary Public CONNIE D. BUNCH Notary Public, State of New Yor~ No. 01BU6185050 Qualified !n Suffolk Coun[y Commission Expires April 14, 2r~ BO~ of Trustees Application (print owner of property) AUTHORIZATION (where the applicant is not the owner) residing at. (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thc Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officom and emolovees. The anranse of this form is to nrovide information which can alc~ thc town of oossible conflicts of interest and allow it to take whatever action is lo av id YOUR NAME: (Last name, first name, z~iddle initial, unlcss you are applying in the name of someone else or other entity, such as a company. If~o, indicate thc other 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% o~J~e 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 applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (cheek all that apply): ___A) 'd~ owner of greater than 5% oftbe shares of the corporate stock of the applicant (when thc applicant is a corporation); ___lB) the legal or beneficial owner of any interest in a non-coq)orate entity (when the applicant is not a corporation); __.(2) an officer, director, partoei', or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Town of Southoid 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 Waterfxont Revitalization Program. A proposed action will be evaluated, as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3: If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- suooortin~ facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION scm# 0 o f 5 PROJECT NAME [ ffl 6. The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board E] Building Dept. ['-] Board of Trustees ~ Category of Town of Sou(hold 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: (b) Mailing address: (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. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III -~ages 3 through 6 for evaluation criteria [~ Yes ~ No[7~1 I 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 [~NotAppHcable 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~lh~ough 16 for evaluation criteria I I Yes II No, , Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LYVRP Section III - PoliCies Pages 16 th~ug~l~l~for evaluation criteria ~ Yes ~ No[7(1~ I 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 HI - Policies; Pages 22 through 32 for evalua~riteria. Yes No ~Not Applicable Aaach 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 Aaach additional sheets if necessary Policy 8. Minimize enviro~nental degradation in To.w.n of Southold from solid waste and hazardous substances and w~e LWRP Section III - Policies, Pages 34 through 38 for evaluation criteria. [] Yes ~-~ Nod--3 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public r~ources of the Town of So~f61d. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~ [] Yes~ No ~_1 Not Applicable ARach additional sheets if necessary WORKING COAST POLICIES Policy I0. Protect~-~S°uth°ld's water-dependent uses and promote siting of new water-dependent nses in suitable locations. See~VI~P Section III - Policies; Pages 47 through 56 for evaluation criteria. [-~ Yes [] N0/[7~I Not Applicable At~ach additional sheets if necessary Policy 11. Promote susta~able use of living marine resources in Long Island Sound, the Peconic Estuary and Town wat~. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~-~ Yes [] No~ Not Applicable At~ach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for eval~ga~n criteria. ~'~ Yes [] NwfT~I Not Applicable At~ach additional sheets if necessary Policy 13. Promote a~b~op~ate use and development of energy and mineral resources. See LWRP Section HI - Polie~f, Pages 65 through 68 for evaluation criteria. [] Yes ~ No ~ Not Applicable PREPARED BY ~ % ~ TITLE ~ k~ o ~'*.<..~ DATE // ~rr~OVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD r NOV 26 APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD I / // ;I / Ill I ,// / '/ /// ~ / / ~'~ ii/ *~"~' i '~'"~a.,'~....,/ / I / I AUG 3 1 LoNO iSLAND SURVEY OF PROPERTY AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-51-04-13 SCALE; I ~=30' MAY 16. 2006 $83'50'00"W SOUND vlEF 117.86' AREA=23,047 SQ. FT. TO TIE UNES ANY AL TI~RA T/ON OR ADO/T/ON TO Il-ilS SURVEY IS A VIOLATION OF ,b~CTIOIV 720~0F' T/'IE NEW YORK STATE EDUCATION LAW,, EXCEPT AS PER SECT/ON 7209-SUBDIVISION 2. ALL CERTir"ICATIONS HEREON ARE VALID FO~ TWIS MAP AND COP/ES THEREOF ONLY I/; SAID MAP OR COPIES BF..,~ THE IMPRESSED SEAL OF THE SURVEYOR WI'lOSE SIGNATURE APPEARS HEREON. I =MONUMENT · =REEAR SET SOUTHOLD, N Y