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TR-8091
0,„ ���* S�U jy Town Hall Annex John M.Bredemeyer III, President '�� o Michael J.Domino,Vice-President � '`® l0 ; 54375 Main Road �``` ` P.O.Box 1179 James F.King,TrusteeiNg I ; Southold,New York 11971-0959 Dave Bergen,Trustee r 2; a@, Telephone(631)765-1892 Charles J. Sanders,Trustee I� i01 Fax(631)765-6641 COU .� BOARD,OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1186C Date:November 16, 2015 THIS CERTIFIES that the replacement of all existing pilings @,6'0"o/c(+/-150LF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in-kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing+/- 190' bulkhead., existing+/-100' stone jetty, +/-4' wide steps to beach, existing 10'x10' platform and 4'`wide staircase. At 54875 County Road 48, Southold Suffolk County Tax Map#44-1-4 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 19, 2013 pursuant to which Trustees Wetland Permit#8091 Dated March 20, 2013 and Coastal Erosion Permit#8091C Dated March 20, 2013 were issued and conform to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the replacement of all existing pilings @6'0"o/c(+1-150LF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in-kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing+/- 190' bulkhead, existing+/-100' stone jetty, +/-4' wide steps to beach, existing 10'xl0' platform and 4' wide staircase. The certificate is issued to AMY UYANIK owner of the aforesaid property. dot_ Authorized Signature John M. Bredemeyer 111,President ,•,,,, ,,,,,- \ Town Hall,53095 Main Rd. Michael J. Domino,Vice-President ,�,� oe. P.O. Box 1179 t o : James F.King Southold,NY 11971 : cn x Dave Bergen k`ti�O ��'�,1, Telephone(631)765-1892 0�. Charles J. Sanders 1 Fax(631)765-6641 , BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD {14 leg 1/112A/6— ?Pomo-Ott P� uct *P DD/l . DATE OF INSPECTION: S PrtA- P &IZc34tod-D. / Ch. 275 Ch. 111 Fj( ` acid ND No-"NSD`O DO Fr Lei i oo iiv e . INSPECTION SCHEDU Nr siva �oiilnvR- A6 r • S taA-N 1-0 (7 Pre-construction, silt fence 1St day of construction 1/2 constructed V' Project complete, compliance inspection. INSPECTED BY: 4.•,L COMME TS: CERTIFICATE OF COMPLIANCE: ,i ,,,,,- Town Hall,53095 Main Rd. 13FFQ( John M. Bredemeyer I[[,President �� OS P.O.Box 1179 Michael J Domino,Vice-President �'�� y o : Southold,NY 11971 James F. King ce) Dave Bergen Telephone(631)765-1892 y'bpl �OOIi��� Charles.1. Sanders Fax(631)765-6641 ,•' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 1/.2-177/1 Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, silt fence 1st day of construction 1/2 constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: —� CERTIFICATE OF COMPLIANCE: • James F.King,President ;'�p�© llFFQ(kC Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President ?a G `' , p - � P.O.Box 1179 Dave Bergen 4 t Southold,NY 11971 John Bredemeyer ;py 1 r�,�` Telephone(631)765-1892 Michael J. Domino ' �O 41 Michael 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 c 11 fp� / _ ✓ 41Y ,V .,) � i BOARD OF SOUTHOLD TOWN TRUSTEES (( SOUTHOLD, NEW YORK I i/ �' ` PERMIT NO. 8091 & 8091C DATE: MARCH 20, 2013 I (- ISSUED TO: AMY UYANIK I --S if PROPERTY ADDRESS: 54875 COUNTY ROAD 48, SOUTHOLD SCTM# 44-1-4 \\' ,I(; AUTHORIZATION Y\'� Pursuant to the provisions of Chapter 275 and/or Chapter III 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 March - Y 20,2013,and in consideration of application fee in the sum of$500.00 paid by Steven F. Uyanik or authorized I ` i (vac waiver of Town Board and subject to the Terms and Conditions as stated in the Resolution,the Southold Town /,\) C (r Board of Trustees authorizes and permits the following: '" �G 1� �' j Wetland Permit to replace all existing pilings @ 6'0" o/c (±150LF); all damaged :`�\ J and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed 1 \\\ ,, ' in-kind; all excavation work and stockpile material shall be protected with filter \ cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize - /( the existing±190' bulkhead, existing±100' stone jetty,±4'/vide steps to beach, existing I � N / 10'x10' platform and 4' wide staircase; and as depicted on the site plan submitted by '4'\'\ Amy Uyanik, last dated February 13, 2013, and stamped approved on March 20,2013. J v IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, i/\ F and these presents to be subscribed by a majority of the said Board as of this date. i ea (// ( , " t -- zst3 t - - �� • / � • TERMS AND CONDITIONS The Permittee Amy Uyanik, residing at 54875 CR 48, Southold, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 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 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. 3. 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. 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 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. 8. That the said Board will 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 may be subject to revoke upon failure to obtain same. • 411-S-0;;;; /1' ;- James F. King, President Town Hall Annex Bob Ghosio,Jr.,Vice-President I. 54375 Main Road P.O.Box 1179 Dave Bergen igg * i Southold,New York 11971-0959 John Bredemeyer cn Att. Michael J. Domino 4, 0 Telephone (631) 765-1892 a lie Fax(631) 765-6641 ".• - test, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT #8091C Applicant/Agent: Amy Uyanik Permittee: Amy Uyanik SCTM#: 44-1-4 Project Location: 54875 County Road 48, Southold Date of Resolution/Issuance: March 20, 2013 Date of Expiration: March 20, 2015 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: To replace all existing pilings @ 6'0" o/c (±150LF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in-kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing ±190' bulkhead, existing ±100' stone jetty, ±4' wide steps to beach, existing 10'x10' platform and 4' wide staircase; and as depicted on the site plan submitted by Amy Uyanik, last dated February 13, 2013, and stamped approved on March 20, 2013. INSPECTIONS: Final Inspection SPECIAL CONDITIONS: none In accordance with Chapter 111-15 Erosion Protection Structures: XX A maintenance agreement is attached hereto and is a necessary special condition of this permit. BY: James F. King, President Board of Trustees • ',/ - - • James F. King,President '�/''�oF sours Town Hall Annex Bob Ghosio,Jr.,Vice-President /,`O� 04 ` 54375 Main Road P.O. Box 1179 Dave Bergen 4 T Southold, New York 11971-0959 John er Bredeme .`„ %r/' bc �I 9G p� Telephone(631) 765-1892 Michael J. Domino '� s 1Ye0UNT( 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) Amy Uvanik The owners of record of property at: 54875 Country Road 48, Southold, New York SCTM#: 1000-44-1-4 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: to replace all existing pilings Ca 6'0" o/c (±15OLF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in-kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; and for the existing ±190' bulkhead and existing ±100' stone ietty, 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 important natural resource features. Notarized ture owner of record /"\i'f) � CONNIE D. BUNCH Notary Public Notary Public. State of New York No. 01[3:,81F35050 Ou&hed in Sv.ffolk County Commission, Expires April 14,22/10 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. • ''''' ''''''' /''' ii.'''' • James F. King, President ',✓'SOF SOUP Town Hall Annex Bob Ghosio,Jr.,Vice-President I�•I $ OHO 54375 Main Road y P.O. Box 1179 Dave Bergen * * , Southold, New York 11971-0959 John Bredemeyer d+ ac G •, Telephone(631) 765-1892 Michael J. Domino "1/4-(4- ��� Fax(631) 765-6641 �'OoUNTI,% �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 20, 2013 Ms. Amy Uyanik 55055 North Road Southold, NY 11971 RE: AMY UYANIK 54875 COUNTY ROAD 48, SOUTHOLD SCTM# 44-1-4 Dear Ms. Uyanik: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 20, 2013 regarding the above matter: WHEREAS, AMY UYANIK 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, and Chapter 111 of the Southold Town Code, Coastal Erosion Hazard Areas, application dated February 19, 2013, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6.3 of the Local Waterfront Revitalization Program to the greatest extent possible through the imposition of the following Best Management Practice requirements: the issuance of a permit for described structures, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 20, 2013, at which time all interested persons were given an opportunity to be heard, and, 2 • • 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 and Chapter 111 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 for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of AMY UYANIK to replace all existing pilings @ 6'0" o/c (±150LF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in-kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing ±190' bulkhead, existing ±100' stone jetty, ±4' wide steps to beach, existing 10'x10' platform and 4' wide staircase; and as depicted on the site plan submitted by Amy Uyanik, last dated February 13, 2013, and stamped approved on March 20, 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, frao CZ James F. King President, Board of Trustees JFK/amn James F. King,President /' $UFF Town Hall Annex Bob Ghosio,Jr., Vice-President At dovt 54375 Route 25,P.O. Box 1 179 o , Dave Bergen Southold,NY 11971 at John Bredemeyer Telephone(631)765-1892 Michael J. Domino ' �� 1 , ' , Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: 4M 1 U� 11Vll Please be advised that your application dated 2I IQ Iia has been reviewed by this Board at the regular meeting of Si it AS and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) 'A Constructed ($50.00) r/ Final Inspection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement 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: $ c0 . D[) BY: James F. King, President Board of Trustees • 1 ro�ggFFD(� Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish,Secretary T P.O.Box 1179 rtr Southold,NY 11971 ** ��liriTelephone(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., March 13, 2013 the following recommendation was made: Moved by John Stein, seconded by Derek Bossen, it was RESOLVED to SUPPORT the applications of AMY UYANIK to replace all existing pilings, all damaged walers, sheathing and deadman systems, inkind/inplace; replace existing beach stairs inkind/inplace; legalize existing 190' bulkhead and 100' jetty; and existing 10'X 10' platform and 4' wide staircase. Located: 55055 CR. 48, Southold. SCTM#44-1-4 Inspected by: John Stein The CAC Supports the applications, however, requests clarification with regard to the structures being legalized for the purpose of repairs. Vote of Council: Ayes: All Motion Carried ECCEIVE 3 MAR 1 4 2013 121 SliVn Bnaru ul iru,,as I • /,gur FFO(Z- James E King,President O�� CO P.O.Box 1179 Bob Ghosio,Jr..Vice-President �� Gd �i Southold,NY 11971 Dave Bergen eq Telephone(631 765-1892 John Bredemeyer �, _ 2 Fax(631)765-6641 ,i Michael J. Domino e, 414 '4,2 ,2 (11 * '0337 Southold Town Board of Trustees )Field Inspection/Worksession Report Date/Time: 3/ )-:-.% 1,3 AMY UYANIK requests a Wetland Permit and a Coastal Erosion Permit to replace all existing pilings @ 6'0" o/c (±150LF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in- kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing ±190' bulkhead, existing ±100' stone jetty, ±4' wide steps to beach, existing 10'x10' platform and 4' wide staircase. Located: 54875 County Road 48, Southold. SCTM# 44-1-4 Type of area to be impacted: _Saltwater Wetland Freshwater Wetland AAound _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: Wetland Coastal Erosion Amendment _Administrative Emergency Pre-Submission Violation Info needed: Modifications: Conditions: OL-el Q/ -- Pre§ent Were: J. King ✓B. Ghosio ✓D. Bergen, V J. Bredemeyer ✓ Michael Domino D. Dzenkowski other Form filled out inthe field by J `ain-K-.=:-.e Mailed/Faxed to: Date: Am' 1ni k ' 1-i 3 113 t • 1 t .40 1 ;;> • ,,e ibisigh • 1\ ,,-.. H laillk•' l- ! , • T ,, s . gijr '.' lt 1 IfF, i., • - • -4-_ I.* . 40. : . .. a �- _ Alf., f k f i' 'f{ .=x'$l'/Mr:• - n t AF' t .r/ ��. -4' � * -•. f tl ry ni y Li.ck.HHI :,. 44_1 -Lf i ji 313 • • _ Agilli' Ilk '--`; ,,; -'ate"."_` .. g! Aar r fir- _ ; r- 'Net ' i . - _ f .y am0001100 L.lir i+4 P,`y.,, -'^._ .114. -. 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'• 4 kalleg466..\';.4:iirt.- '-'7...''.:.'t''',2,-.-...._4 4iii40. rile4......., ,,' :— .• 4. 01,af4lel' P I1 i4I r, l ) ' it ..,.N,_e,",.,,•,0,,,,•.„ ...::,.. -$•4.-•-,,. .. . -,,,,,--,..4I.,.-.-.---',, ...,. 0 w .,,,. - t,,,,-.v•t ,.. :‘,t . :, , • . . - _ ''4 E 4 /'l 1 -,„..4,; 1:: / .-,,, • 1 -.x. %;.111.'''..14i',/.'.;'''':47 w., ` ( t. 1 • T .•e r "4atli 4" "..,1",•L }'. \'• • c�' iii • .4. ` L�}fr 4 ., •_c ...,. "e._ `:- i • . { " d4 dedT _ ,e1 -itt�'•'../. � A as n .\ ;• . i, J N k —— c /'°bP V S — / / _. cc,ro zu i_. . q c MUM 11 "e b : .... H: / p9 a as 0 \ l r,, co„—.Fs„.... \ °•" C /o 6 a iP , �� �� / L . • ll ""M"...." �' COUNTY OF SUFFOLK O "c` I .-> n_ — __...... . _ ,..,................a«. Pel Pmopsrtl'......ervce Agency v ^^ ...,.�� .... Mme o r , • ''" 'y- • OFFICE LOCATION: 'god-,A44 SOp7, - MAILING ADDRESS: MO Town Hall Annex P.O. Box 1179 54375 State Route 25 i; Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) T G �� Telephone: 631 765-1938 Southold, NY 11971 et Fax: 631 765-3136 `-_tcoUNT1,t 01. ,,, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ECEUVE To: Jim King, President RD Town of Southold Board of Trustees MAR 2 0 2013 From: Mark Terry, Principal Planner LWRP Coordinator Southold Town Beare of Trine Date: March 19, 2013 Re: Proposed Wetland Permit and AMY UYANIK SCTM#1000-44-1-4 No permits were found for the proposed actions. AMY UYANIK requests a Wetland Permit and a Coastal Erosion Permit to replace all existing pilings @ 6'0" o/c (±15OLF); all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in- kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing ±190' bulkhead, existing ±100' stone jetty, ±4' wide steps to beach, existing 10'x10' platform and 4' wide staircase. Located: 54875 County Road 48, Southold. SCTM#44-1-4 It is my recommendation that the proposed actions are INCONSISTENT with LWRP Policy 6.3 (below) and therefore, INCONSISTENT with the LWRP. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The structures described were not constructed pursuant to Southold Board Trustees permit under Chapter 275 Wetlands and Shorelines regulations. 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 �� *pf SO(/15,� _ Town Hall Annex • O� O� 54375 Main Road Bob Ghosio,Jr., Vice-President tt O y• P.O. Box 1179 * Dave Bergen * Southold, New York 11971-0959 John Bredemeyer • G Q �• . . �O t/ Telephone (631) 765-1892 Michael J. Domino O •� Fax(631) 765-6641 -- COUligtrolti ... 'I// BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD / Office Use Only ✓Coastal Erosion Permit Application V Wetland Permit Application Administrative Permit y _Amendment/Transfer/Ex ension Received Application: D r� Received Fee:$ Completed Application 7 /IQ 1 - I II __Incomplete 1 SEQRA Classification: FEB 1 9 2013 Type I Type II Unlisted_ Coordination:(date sent) �� WRP Consistency Assess I ent Form_ 3 Southold Town :I,. I If fluster, �AC Referral Sent: _ -.(CAC. to of Inspection: 13 Receipt of CAC Report: Lead Agency Determination: _ Technical Review: ,/Public Hearing Held: _ 1 K Resolution: Name of Applicant P1 LAt'i h c. Lc 4r Mailing Address 55 0 SS /� C11 -/s7P t'C - S Li Phone Number:06 g 73-6/5-y7 Suffolk County Tax Ma Number: 1000 - it 4 - 1 - 4 ti�7� Q nn Property Location: 00 I`1 1 y 0CS1 c * 8 AR.5714l'M Zno Q o (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: • Phone: C�Cdlo Boll of Trustees Application • GENERAL DATA Land Area(in square feet): (p Z/ Sao S Area Zoning: S Previous use_of property: k)5(D e aXiii (✓ Intended use of property: 6 S c D e4A+1 A L_ Covenantsand Restrictions on property? Yes K No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes K No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes K No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes )c No Does the structure (s) on property have a valid Certificate of Occupancy? K 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? K No Yes If yes, provide explanation: /4/w Q 5-veal Project Description(use attachments if necessary): REPLACE I;xcstia() h(t-�NSC 6-O �c- lT� I$ Lo +c,W�` ule /An f: - +-0ac / L ) ! ...! .t, i I :Oa = � . "ASL ek a i.— R'` n -) -i �� /A� PlAce '/ ALL DEAD 140) SyS}ets tr &c4 u4ten7Ao;3 e /kc n&.. �t5 P btu n, , AU, G ACA UATOu wttR ls SittiqxLe S b# k,br ijw r(01-612--CCb Si L+race iCl5�tw5 13e-dck i46t_ to be Re0,0E-el 012- Reck-Ace( (xl Kotth IY.i � 4M �� / U c3' e-x slAiS 2 l?o'L"a/ exi-s,cic j 44' /6J0 CFO 4¢cC.L. j. Boar/1r Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 'eMiL /f, I COt,4ocf f \SFC &�/,% D( D.,4-00166,0 Er kiorrric.4-tc S sits /, cn-k '„ec.4l.o r'wt -e=q,ak g -�'iir�11-1/A 3-V-2,;c re t ,;w0 SI.-tie UU ZS Area of wetlands on lot: itd) square feet Percent coverage of lot: I Closest distance between nearest existing structure and upland edge of wetlands: ±/ Ito I feet 65C(s-ri A-5 Closest distance between nearest proposed structure and upland edge of wetlands: 41 /b feet f7 kt$("4,4-5 Does the project involve excavation or filling? No S4 Yes If yes, how much material will be excavated? 10 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: 0 feet Proposed slope throughout the area of operations: M fr1 C tit tX(Sr M-5 Manner in which material will be removed or deposited: BAcK E(0E eta- 'I f-' AZ++ utPMN €cW l -1' W �F ILL EKcc0A*c -Reitat,p 5-K tSt t vvss 5kre i j 1 Rout kb ken S fifth +o See LI4Ge E Q-ecAA-e #5 heeteo 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): NDN Boar.)f Trustees Application • COASTAL EROSION APPLICATION DATA Purposes of proposed activity: f lep4(c. NJ Lf( he ' b 46 Pt* RAC he S4LDy (teak ���5' s Rxa Are wetlands present within 100 feet of the proposed activity? s No iN Yes Does the project involve excavation or filling? No "C Yes If Yes, how much material will be excavated? (D (cubic yards) How much material will be filled? ( (cubic yards) a Manner in which material will be removed or deposited: ((i71%/sly fcbe— Rtat IGLU, ZvCcl'u R'(t B€L t-0 E1'05'A5 5 Lei-' :1'y &l- Ad/et �elpf,Ace 6u, at AA& D Le* a4 SC 4:0\3 S-?0 vee Describe the nature and extent of the environmental impacts to the subject property or neighbonng 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) NOti2 - e if k RekAcevteslt cc Ek(5'\-1a) T{ 4 SiiRuctope — to CIA 1 c • 617.20 • SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1_APPLICANT/SPONSOR 2.PROJECT NAME RMC.{( u { aviJLc 3.PROJECT LOCATION' �j // Op (� t I .45-°nunitip 15— Ober. Ra . County St S o ilk_ 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 407c "iort ga. Ri-. 4, g' 5o /d 5. IS PROPOSED ACTION: ❑ New ❑Expansion Ki Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: tot-IC/it ,r �j " '� if do �/v u l• lr.{ JU 7.AMOUNT OF LAND AFFECTED: Initially acres ,I Ultimately .. I acres 6.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Licil Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) rk Residential n Industrial n Commercial nAgricullure ❑Park/Forest/Open Space Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) •, ill Yes nNo If yes, list agency name and permit / approval: -1--Ru9tee5 I i t GP t9",t_'Per Acre lel JC 51-02-m tAT'f.)tA4 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? V r1Yes No If yes, list agency name and permit / approval: CD 0cc G ems.AL -IW t,`t fes- 10 u►, VAT*r46 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Ekes NNo • I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature____________ .,r./� 'Pr-3C If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment • • Project Description (use attachments if necessar /Y): Rfro4GE Aci t'xnt-is PiLiw`J�]` C-p Clc- k5S L6 Au- DEAD Lsi SYS4,945 o te-SCc9it �.w, Wel) ( .€n CRR -45 PeeAeo i& 16k1P' AU, &CA OXITOo way Sire ikkhoeiAt, �i� ���,m� � to/ rof--ece C iA75r.+reisce , ta- tis 13e44cc . SIOL to be Ref4ita1 og QP (-htej (r1 jVU ) JYIPace- , ) s I/, p ±lto/LJ77 %2� ea7s -.cp je4' /D 0/71 "% Sb`cf/j-1-0 4€-csc • • • PART II- IMPACT ASSESSMENT(To be completed by Lead Agency). A. DOES ACTION EXCEED ANY TYPE I THRESHOW IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. 0 Yes a No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes ©No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten.if legible) Cl. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological.historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a'change in use or intensity of use of land or other natural resources?Explain briefly: a C5. GrovRh,subsequent development,or related activities likely to be induced by the proposed action? Explain briefly: i� I. .. ... _.. ... _ _ C6. Long term,short term,cumulative,or other effects not identified in Cl-CS? Explain briefly: C7.•Other impacts(including changes in use of either quantity or type 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 yes,explain briefly: nYes a No E IS THERE,OR IS THERE UKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: Q Yes Q No • • PART 111-DETERMINATIONS OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant Each effect should be assessed in connection with its(a)setting Os.urban or rural);(b)probability of occurring;(c)duration;(d)Irre ersbiGly;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part t was dhedred yes,the determination ofsignificance mustevaivate hepotentialImpactoftheproposedadbnontheenvlronmentaldharaderisd softheCEA Check this box If you have Identified one or more potentially large or sl9nlflcant adverse Impacts which MAY occur.Then proceed directly to the FULL EAF and/or prepare a positive dedaraton. Chedc Us box Ifyou'have determined,based on the Information and analysis above and any supporting documentation,that the proposed actor WILL NOT result M any significant adverse environmental Impacts AND provide, on attachments as necessary, the reasons supporting(hit determination. Board of Trustees Q *pr S 20i3 Name of Lead Agency .. Date ✓i910tTf F. J(otl/` President Print or Type Name of Responsible Officer � t in Lead Agency Title of Responsible Officer Sig ure of Responsible Officer in ad Am� ey Signature of Prepare/(If different from responsible officer) ' ' F MAILING OF NOTICE U.S. Postal Service.., ITIFIED MAIL RECEIPTS CERTIFIED MAIL., RECEIPT N (Domestic Mail Only;No Insurance Coverage Provided) S For de ivery information visit our website at www..usps�coma r E Address: rrn postage $ 0911 p Certified Fee 33.10 T! f J Postmark CI R Mum Receipt Pee VAT p (Revilement Required) p Restricted Delivery Fee $0.00 at (Endorsement Required) ra 36 j q /19/2013 Rl Total Postage&Fees $ , ru nl Sent To (G a,ej l( . `i Street, N. 'C/'p�. /142�Gd ._.t}7�r 1 p�._ Nor PO Box No. !S- __ cagt: ON,State,Zit; sem-_• S Y /(0 3 0 PS Form 3800. s1 0 See Reverse for Instructions PS Form 3suu,minium caw STATE OF NEW YORK COUNTY OF SUFFOLK D f�/YI�J ?keen (� , residing at 5$9 S� �C.i( 2A e d. S'cv�N �,p/� , being duly sworn, deposes and says that on the t9 day of--Feb(ti� , 20/ 9, 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 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 ' o 'V Ao E , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. 7 Sf Sworn to before me this I a.4 Day of r-eistk4Otn , 2013 Croy.NA) A eIA, i r Notary Public CONNIE D. BUNCH Notary Public, State of New York No.016U6185050 Qualified in Suffolk Coi ray Commission Expires Ap;,1 t4,,'zd1110 •t.0to y '?: Junes I Flap. presiding I 4 �7 lu��n Hari. 53095 ADain Itcl_ Ilnh( hush). Ir. . A ie -I'resident � .7 I'_O nov 1179 Dave liagnsyn ikt Southold NY 11971 John IiredemeGccr 44Q� �0 t elephone 16+11 765-1592 Michael J. Domino N # ILs (631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of AMY UYANIK COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE CO3/PLETED.1 ITER POSTING REMAINS I:S'PT-ICE MI? EIGHT lit ES' I. S an e k residing at/dba 155 3-Aka Q d 7/ being duly sworn. depose and say: That on the ID day of lia-zj7Ol3. I personally posted the property known as 54&75 �� � d_ S4�D` C / /927/ 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; March 20, 2013. Dated: 72c �� 1. (signature- (7 Sworn to before me this /S4\ day ofiA0, k.013 aL Notary Public CONNIE G. BUNCH Notary Public. State of New York No. 01BU8185050 Qualified in Suffolk County Cornrr:on Expires April 14, 2CC�L, NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. • OWNER(S) OF RECORD : Amy Uyani \c SUBJECT C)F PUBLIC HEARING. To replace all existing pilings @ 6'0" o/c (±150LF), all damaged and broken whalers/sheathing to be repaired or replaced in-place using untreated wood; all deadmen systems to be excavated/inspected/repaired or replaced as needed in-kind; all excavation work and stockpile material shall be protected with filter cloth/silt fence; existing beach stairs to be repaired or replaced in-place; and to legalize the existing ±190' bulkhead, existing ±100' stone jetty, ±4' wide steps to beach, existing 10'x10' platform and 4' wide staircase. TIME & DATE OF PUBLIC HEARING: • 1Je4nesctj. fTlorc.h ?4 aO13- ofor oboe 230 If you have an interest in this protect, you are invited to view the Town file(s) which are available for inspectionrior to the day of the hearing during normal business days between the hours ofp8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 eor Le _ • Town of Southold Z Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM ='$ g,' PROPERTY LOCATION: S.C.T.M.ft THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A -=ift 01 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN is�trict section Block —Cor CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM ft / WORK ASSESSMENT YesNo a. What is the Total Area of the Project Parcels? I I Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within `ilk L�" Generated by a Two(2')Inch Rainfall on Site? the Scope of Work for Proposed Construction) 16, (This item will include all run-off created by site a (S.F./Acres) b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed ' ikGee Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F./Aces) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIPTION (Provide&Wiliond Pages as Needed) Drainage Structures Indicating Size&Location?This K ❑ Item shall Include all Proposed Grade Changes and Pt > _— —fit n rs� Slopes Controlling Surface Water Flow. l r1 3 Does the Site Plan and/or Survey describe the erosion p D ' II, cp.p .a • j/ ('fl PLikeand sediment control practices that will be used to K ❑ control site erosion and storm water discharges. This u. l� S 7 item must be maintained throughout the Entire �i.:W4.1�%�� a �I �� 9 Construction Period. 4 Will this Project Require any Land Filling,Grading or S��JJ ��L(�I�_�,.r ynn Excavation where there is a change to the Natural et c l l ctc_ t Existing Grade Involving more than 200 Cubic Yards III A_ -. of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities INa 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 General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes are pad of a larger common plan that wit ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to • including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that 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 for Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off II K 1.The SWPPP shall be prepared prior to the submittal of the NOI,The NOI shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, '.. required,post-constructiona storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any K constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit In addition,the SWPPP shall Area?lists Iter will NOT include the Installation of Driveway Aprons.) • identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.Eel Acre In area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water,Grading,Drainage S Erosion Control Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit (NOTE: A Check Mark(4)and/or Answer for each Question is Required for a Complete Application) STATE OF NEW YORK, CONNIE D. BUNCH COUNTY OF SS Notary Public, State of New York No. 018U6185050 Qualified in �S uffol Cou t�dlJ,, That I, ...1�—.1L.(II u..._QY.f:.t. being duly sworn,deposes and sobeilmfikd{tt1:?ftt314"e4FAf yffull4�`2'venni?, me of indivitl signing Document) _ And that he/she is the .Q.l-x1.31..er (Owner,Contractor,Agent,Corporate Officer,etc.) 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 in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; Notary Public: &Ur\W &A . .. ... '' 41'.(Sig4 of Applicant) • FORM - 06/10 • • ,I 4 Project Description (use attachments if necessary): flFPIgCc ALL, txr5�-/. 3 h/Ctwt v -p oc�e''� j L�� � .�. C. !..... • i il:. W A u..04. t ": v! ati • i � RGA n .) - � '� � �%1 / (froY�Ge A� � DeAp k SyS 1 s 1 o Ito�Kc4 vii+e07i+o eUiRe,0462: CR tC�II '/t5 IJeeM ICS' 16/Q Aft, &CAI/+• 03 Wye , - k_�.. -� r �1 4- t(ke2--C 755+� e� etc l5}iw5 13e44c-k S I sat— to be Rem( Op_ keiuceD (xJ K.00b iY14u.ce Ye qac && e-x Ve'z� f��o°9121% e s je-140. /6 0/t Boaref Trustees Application County of Suffolk State of New York ,,4� SA 14 Q.ti BEING DULY SWORN DEPOSES ANY-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. 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. avt., // v Signatt of P' rty Owner SWORN TO BEFORE ME THIS l9 DAY OF t' _ ,20 / 3 O)w-D L ) Notary Public CONNIE D. B of w York CH Notary Public, State No.0181_16185050 Qualified in Suffolk County I L Commission Expires Aprii 14, • • APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee �C Change of Zone Coastal Erosion K 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 applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): • A)the owner of greater than 5%of the shares of the corporate stock of the applicant • (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of�-209 Signature Pi--sots, Print Name AKA,' Ll Gastt) Form TS l f • Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. 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. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3: 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- supporting 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 ��n,,,,� . s website (southoldtown.northfork.net), the Board of Trustees 0 61tel he Planning Departm: 1 local libraries and the Town Clerk's office. FEB 1 9 2013 B. DESCRIPTION OF SITE AND PROPOSED ACTION - outholdITe�sTown !IT SCTM# P ') c. � 1� PROJECT NAME l(��) L k\\,e11 () rRe f}t4- Purr � e SAN, c egin t . IhAC£ The Application has been submitted to (check appropriate response): / mm Town Board ❑ Planning Board Building Dept. Board of Trustees [ ] 1. 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: at = ter ,ce k cS�-ftis sut^Kt s1 DA-491-661) B/ - t C • "Le. 3.164-n„oy Pe • • (Xisd*`� /01X/0 '1 -, /to I 5 l Proiect Description (use attachments if necessary): RF_pLAGE txcit,s h(L4,s@, c-0 cc..`74 Lio L t•�!..... . ri.:. -_ WAu._� ':a oti i i.� R . I o ) "i ti flo YLAGe M +/ta10 a1�9d Sys s 11o2--&c4v4en ceD ea �f(, &cA u4 Lt St-A<pis 1 trt-1-P.et_S i74(4,c&r Ucier-o) to/ c/fe2-Cc 5 Lf-F , bK 15/`4 z 13e+4c�t �sf4!L to V-e Rep4i—a o Qe ces (kl tout, jYi'P)4ce 7!a / e-x i s� r F 01.9 c//he' tout, "is t/C 01-1 - Location of action: Caj 111 auk ZIT ' • Site acreage: it (f Present land use: CS' *- Present zoning classification: t—: (ID 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: Wt L1 (A La et i I,c (b) Mailing address: 3 ) 5-5- CrL+ c_ i C� d-p l c , to 7 7) 9 71 (c) Telephone number: Area Code g 313— 6 53 7 (d) Application number,if any: Will the ac ion be directly undertaken,require funding, or approval by a state or federal agency? Yes No If yes, which state or federal agency? b E C- 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 ReP4Ig ) ( 541(N) 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 111 No 0 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 I I No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III— Policies Pages 8 through 16 for evaluation criteria Yes No glNot 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 HI—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applied!. • 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. n Yes n No 1K Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes.�sSee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes 1 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. n Yen No Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES • • Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III —Policies; Pages 47 through 56 for evaluation criteria. Yes No Fic 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 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 b( 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 11`I Not Applicable PREPARED BY TITLE DATE a /� . S0�N( ( € n� 6<a 0-0° 01 € `11 ------- ici, ECE11VE nh U • y�. / Al FEB 1 9 2013 LONG 0)6 tz 2' O • . Southold Town �� : :'. :'•n .f Tr see lIO •Q 1\\ed o�°n9 0 . 5 Qe1 , °/. k cn • yz,o /� 1111 ? s° vier • °f b° mind o I.'01-fart' W ? ,,4-P I r S\Oa Q. v* O 0 5/ " V � / CA r e r °� b.5 KO" p h° i r GO'1,P 5'`_ o O •f .e;,et. Z r - co O < e T o Plan Notes: -k * ALL EXISTING PILING SHALL BE7 REPLACED AT 6'-0" O.C. +l-. (150 L.F.) 0 1'9 -•G ' * ALL DAMAGED OR BROKEN WHALERS f yrk, o r- (-) AND/OR SHEATHING SHALL BE vitt't 92ati s O O REPLACED IN-IfiN & IN-PLACE WHERE P � O NEEDED OR REQUIRED. (,{,n kN "3 * ALL DEAD MAN SYSTEMS SHALL BE LOO o� e In EXCAVATED AND INSPECTED AND 73 SHALL BE REPAIRED AND/OR REPLACED T AS NEEDED IN-KIND. A * ALL EXCAVATION WORK AND Z STOCKPILE OF MATERIAL SHALL BE R PROTECTED AS NEEDED WITH SILT .. n AA FENCING TO PREVENT EROSION. ('' n * EXISTING BEACH STAIR SHALL BE % \, , `.\,_ REPAIRED OR REPLACED AS NEEDED. < ALL WORK TONNO-& IN-PLACE. n4 Q 0 � , 1213 - CERTIFIED TO, �// j26.86 1 TRW TITLE INSURANCE CO. ut '` THE PRUDENTIAL HOME MORTGAGE CO. INC. .:041>„0•00" (0/� 55 �Od W. • p D) FEHIM UYANIK (NORTH O� SEVGI UYANIK S, 18 \� (( FO 4005 S A0 N as Per flied Mop C RO 8 ChB moot.. 4 Rood COASTAL. EROSION HAZARD LINE from COASTAL EROSION HAZARD AREA MAP Photo # 55-581-83 AREA = Z 4353 ACRES to tie line LOTS 12 13 & 14 MAP OF PROPERTY OF Wl-i YOUNG & R.J. GOODALE FILED SEPT. 11, 1929 MAP NQ-585 AT ARSHAMOMOQUE TOWN OF SOUTHOLD APPROVED BY SUFFOLK COUNTY, N Y.' 1000 44 - 01 - 04 BOARD OF TRUSTEES SITE PLAN TOWN OF SOUTHOLD DATE: February 13,2013 Scale: 1"=50' DATE Avp -7-o Zz,/J NOTE: / // THIS SITE PLAN HAS BEEN TAKEN FROM A SURVEY PREPARED BY JOHN T.METZGER, PECONIC SURVEYORS,P,C. DATED-OCTOBER 29,1991 91-273