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TR-8109
�0 SUUj Town Hall Annex John M. Bredemeyer III,President �o�� y�lO Michael J. Domino,Vice-President 54375 Main RoadP.O. Box 1179 James F. King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,Trustee Fax(631) 765-6641 ��COMNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1000C Date: June 26, 2014 THIS CERTIFIES that the removal of existing timber bulkhead and replacement with 771f. vinyl bulkhead and 151f. return in same location as existing; removal of existing_timber deck supports for construction of bulkhead and replacement with new timber supports; existing deck remained undisturbed(29'x31.5" overall); removal of concrete walkway; 4'x4' wood deck at beach level At 645 Richmond Road East, Southold,New York Suffolk County Tax Map # 135-3-5 Conforms to the application for a Trustees Permit heretofore filed in this office Dated January 25, 2013 pursuant to which Trustees Wetland Permit Dated March 20, 2013,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of existing timber bulkhead and replacement with 771f. vinyl bulkhead and 151f. return in same location as existing;removal of existing timber deck supports for construction of bulkhead and replacement with new timber supports,• existing deck remained undisturbed (29'x31.5" overall), removal of concrete walkway; 4'x4' wood deck at beach level. The certificate is issued to HENRY GOETZ owner of the aforesaid property. dW4_ Irv% Authorized Signature John M. Bredemeyer Ill, President �OgUFfO(�C Town Hall,53095 Main Rd. Michael J. Domino,Vice-President ��� �G� P.O.Box 1179 James F. King y Southold,NY 11971 Dave Bergen o f Telephone(631)765-1892 Charles J.Sanders y��l �� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: kCh. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y2 constructed V/ Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: James F.King,President �0SS41' 0(r_AP Town Hall,53095 Main Rd. tp Bob Ghosio;Jr.,Vice President s y - P.O.Box 1179 Bergen e Dave B ar 4w. Southold,NY 11971 John Bredemeyer py C� Telephone(631)765-1892 Michael J.Domino �O( � 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 I" day of construction constructed Project complete, compliance inspection -Avid L4441116 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK I j PERMIT NO. 8109 DATE: MARCH 20, 2013 ISSUED TO: HENRY GOETZ PROPERTY ADDRESS: 645 RICHMOND ROAD EAST, SOUTHOLD SCTM# 135-3-5 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 March 20.2013,and in consideration of application fee in the sum of$250.00 paid by Henry&Marlene Goetz or authorized waiver of Town Board 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 remove 77 linear feet of existing timber bulkhead damaged by storm and replace with 77 linear feet of vinyl bulkhead and 15 linear feet of return in same location as existing; remove existing timber deck supports to construct bulkhead and replace with new timber supports; existing deck(29'x31.5' overall) to remain undisturbed; with the conditions of the removal of pre-existing concrete walkway; and addition of a 4'x4' wood deck at beach level; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated March 21, 2013 and stamped approved on April 12,2013. 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. �o�gUffO(�Cot o ; 401 i 0 0 TERMS AND CONDITIONS The Permittee Henry Goetz residing at 645 Richmond Road East 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. 0 0 James F. King, President �QF soujy Town Hall Annex 0 Bob Ghosio,Jr.,Vice-President 54375 Main Road�O l� P.O.Box 1179 Dave Bergen l�t Southold,New York 11971-0959 John Bredemeyer C4 ac Michael J.Domino �O Telephone(631) 765-1592 COWN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 20, 2013 Mr. Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: HENRY GOETZ 645 RICHMOND ROAD EAST, SOUTHOLD SCTM# 135-3-5 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 20, 2013 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of HENRY GOETZ 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 January 25, 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 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 March 20, 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 HENRY GOETZ to remove 77 linear feet of existing timber bulkhead damaged by storm and replace with 77 linear feet of vinyl bulkhead and 15 linear feet of return in same location as existing; remove existing timber deck supports to construct bulkhead and replace with new timber supports; existing deck (29'x31.5' overall) to remain undisturbed; with the conditions of the removal of pre-existing concrete walkway; and addition of a 4'x4' wood deck at beach level; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated March 21, 2013 and stamped approved on April 12, 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, James F. King President, Board of Trustees JFK/amn 5 � James F.King,President o W Town Hall Annex Bob Ghosio,Jr.,Vice-President Q + 54375 Route 25,P.O.Box 1179 Dave Bergen Southold,NY 11971 John Bredemeyer �Oj .�`�� Telephone(631)765-1892 Michael J.Domino Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO T � P�� anitL �►� �enry Goe� Z Please be advised that your application dated 25 has been reviewed by this Board at the regular meeting of 3 3 and your application has been approved pending the completion ot the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1 s� Day of Construction ($50.00) / '/2 Constructed ($50.00) V Final Inspection Fee ($50.00) Dock Fees($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of 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: $ Sb • D BY: James F. King, President Board of Trustees �ySUFFUCKCQ Peter Young,Chairman Town Hall,53095 Main Rd. Lauren Standish, Secretary y� T 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 Tues., February 12, 2013 the following recommendation was made: Moved by Doug Hardy, seconded by William McDermott, it was RESOVLED to SUPPORT the Wetland Permit application of HENRY GOETZ to remove 77 If. of existing timber bulkhead damaged by storm and replace with 77 If. of vinyl bulkhead and 15 If. of return in same location as existing. Remove existing timber deck supports and construct bulkhead and replace with new timber supports. Existing deck to remain undisturbed. Located: 645 Richmond Rd. East, Southold. SCTM#135-3-5 Inspected by: Peter Young, Doug Hardy The CAC Supports the application, however, recommends all structures, including the deck, should be landward of the bulkhead and the house should have gutters leading into drywells Vote of Council: Ayes: All Motion Carried � �1 FEB 1 5 2013 - Ecarr.1nt Inr;ice, i GC)t f2 � 135-3 s fw 46. Alk i f f: t y��yv � • � � - +i K, fir. 1 r . `' A low" `'�..`,�,, -.► �x , m/yr y �low � N 6 AL ♦ a �4'r f ; Y r i • suFFo1�. James F.King,President �� C P.O.Box 1179 Bob Ghosio.Jr.,Vice-President vd Southold,NY 11971 Dave Bergen ? Telephone(631 765-1892 John Bredemeyer ,�., T Fax(63 1)765-6641 Michael.l. Domino 'T' y�of � �aoT. Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: .3h7ZIZ En-Consultants on behalf of HENRY GOETZ requests a Wetland Permit to remove 77 linear feet of existing timber bulkhead damaged by storm and replace with 77 linear feet of vinyl bulkhead and 15 linear feet of return in same location as existing. Located: 645 Richmond Road East, Southold. SCTM# 135-3-5 Type f area to be impacted: altwater Wetland _Freshwater Wetland _,,�ound _Bay 0 Dis nce of proposed work to edge of wetland 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: Present Were: J. Kirfg B B. Ghosio D. Bergen, �f Bredemeyer /// Michael Domino D. Dzenkowski other Form filled out in th�,field by / -j-. Mailed/Faxed to: Date: ■ Ago � f db � ECEI �IE D R c df 1 y �f 4 w f f•, 'h January 23, 2013 NYS Dept. of Environmental Conservation SUNY Q Stony Brook n E Q [ V E , \ 50 Circe Road I�r,(Sf UD Stony Brook, New York 11790.2356 JAN 2 5 2013 Attention: Duty Analyst Southold Town RE: 65 RICt Homo ROAD EAST.SOUTHOLD, NY Boar of Tr s SCTM No.1000.135.0345 APPLicATION FOR PERMIT Dear Sir/Madame: We hereby submit four(4) copies of the proposed plans, applications, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 6314849332 or e-mail at jpatanjo@Wonline.net. Very fly yam, 9.1 P411 K Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 cc: Army Corps of Engineers NYSDOS Goetz. .. 0 JOINT APPLICATION FORM For Permits/Determinations to undertake activities affecting streams,waterways, FM watertwdies, wetlands,coastal areas and sources of water supply. New York You must separately apply for and obtain separate Permits/Determinations from US Army Corps of state each Involved agency prior to proceeding with work.Please read all instructions. Engineers(USACE) APPLICATIONS TO 1. NYS Department of Environmental Conservation 2. Us Army Corps of Engineers 3. NYS Office of 4. NYS Depart- General services ment of State Check all permits that apply: Check all permits that apply: ❑ Stream Disturbance ❑ Coastal Erosion ❑ Section 404 Clean Water Act Check all permits that Check If this ❑ Excavation and Fill in Management ❑ Section 10 Rivers and Harborsapply: applies: Navigable Waters ❑ Wild,Scenic and qct [3 State Owned Lands El Coastal Under Water Con ❑ Docks,Moorings or Recreational Rivers ❑ Nationwide Permit(s)-Identify Consistency g e Platforms ❑ Water Supply Number(s): ❑Utility Concurrence Easement ❑ Dams and Impoundment ❑ Long Island Well (pipelines, Structures ❑ Aquatic Vegetation Control 3 conduits, ❑ 401 Water Qualitycables, etc.) ❑ Aquatic Insect Control Certification Precons[ructlon Notification - ❑Docks, ❑ Freshwater Wetlands ❑ Fish Control Q Y / ❑ N Moorings or El Tidal Wetlands ❑ Incidental Take of Endan- Platforms gered/Threatened Species 0 I am sending this application ❑ I am sending this 0 lam sending ❑ I am sending this application to this agency. to this agency. application to this this application agency. to this agency. S. Name of Applicant(use full name) Applicant must be: 6. Name of Facility or Property Owner(if different than HENRY GOETZ ❑' Owner Applicant) ❑Operator Mailing Address ❑ Lessee Mailing Address 1 AZALEA DRIVE (check all that apply) Post Office City KEY WEST Taxpayer ID(If applicant Post Office City is NOT an Individual): State FL Zip Code 33040 State Zip Code Telephone(daytime) Email Telephone(daytime) Email 305-295-7713 7. Contact/Agent Name 8. Project/ Facility Name Property Tax Map Section/Block/Lot Number JEFFREY PATANJO GOETZ RESIDENCE 1000-135-03-05 Company Name Project Location - Provide directions and distances to roads,bridges and bodies of waters: SEE LOCATION MAP Mailing Address 106 HEWITT BLVD. Street Address, if applicable Post Office City State Zip Code 645 RICHMOND ROAD EAST SOUTHOLD NY 11971 Post Office City CENTER MORICHES Town/Village/City County SOUTHOLD SUFFOLK State Zip Code Name of USGS Quadrangle Map Stream/Water Body Name NY 11934 SOUTHOLD ARSHAMOMAQUE POND Telephone(daytime) Location Coordinates: Enter NYTMs in kilometers,OR Latitude/Longitude 631 A84-9332 Email NYTM-E NYTM-N Latitude Longitude JPATANJO@OPTONLINE.NET 41°05't2" 72°24'49" 30INT APPLICATION FORM 09/10 This is a 2 Page Application Application Form Page 1 of 2 Both Pages Must be Completed SINT APPLICATION FORM- PAGE 2 OF 2 . Submit this completed page as part of your Application. 9. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose. Attach additional page(s) if necessary. Include: description of current site conditions and how the site will be modified by the proposed project; structures and fill materials to be installed; type and quantity of materials to be used (i.e., square It of coverage and cubic yds of fill material and/or structures below ordinary/mean high water) area of excavation or dredging, volumes of material to be removed and location of dredged material disposal or use; work methods and type of equipment to be used; pollution control methods and mitigation activities proposed to compensate for resource Impacts;and where applicable,the phasing of activities. ATTACH PLANS ON SEPARATE PAGES, REMOVE EXISTING HURRICANE SANDY DAMAGED BULKHEAD AND REPLACE WITH 77 LF OF VINYL BULKHEAD AND 15 LF OF VINYL RETURN IN ITS ORIGINAL LOCATION. Proposed Use: 0 Private ❑ Public ❑CommercialProposed Estimated Start Date: 3-1-2013 Com Ietian Date: 4-1-2013 Has Work Begun on Project? ❑Yes El No If Yes,explain. Will Project Occupy Federal,State or Municipal Land? ❑Yes ❑' No If Yes,please specify. 10. List Previous Permit/Application Numbers(if any)and Dates: N/A 11. Will this project require additional Federal, State,or Local Permits including zoning changes? Yes ❑ No If yes,please list: ARMY CORPS,NYSDOS,TOWH OF SOUTHOLD TRUSTEES 12. Signatures.If applicant is not the owner, both must sign the application. I hereby affirm that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or Indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to Indemnify and save harmless the State from sults, actions, damages and costs of every name and description resulting from said project. In addition, Federal Law, 18 U.S.C., Section 1001 provides for a flne of not more than $10,000 or imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies, onceals,or cove up a m rial fact; or knowingly makes or es a false,fictitious or fraudulent statement. si ure of Ap can Printed Name /' Title Date -e-,yQ t bsa L U WWlr& / —/ 7-/2 Ig ure f wne PrintedNameName Title Date 1Si to ent of A ted Nam ~ -Tid6p� 4 f Date • , 30INT APPLICATION FORM 09/10 Application Form Page 2 of 2 New York State Department of Environmental Conservation _ PERMISSION TO INSPECT PROPERTY By signing this permission form for submission with an application for a permit(s)to the Department of Environmental Conservation("DEC'),the signer consents to inspection by DEC staff of the project site or facility for which a permit is sought and, to the extent necessary, areas adjacent to the project site or facility. This consent allows DEC staff to enter upon and pass through such property in order to inspect the project site or facility,without prior notice,between the hours of 7:00 a.m.and 7:00 p.m.,Monday through Friday. If DEC staff should wish to conduct an inspection at any other times, DEC staff will so notify the applicant and will obtain a separate consent for such an inspection. Inspections may take place as part of the application review prior to a decision to grant or deny the permit(s)sought. By signing this consent form,the signer agrees that this consent remains in effect as long as the application is pending, and is effective regardless of whether the signer,applicant or an agent is present at the time of the inspection. In the event that the project site or facility is posted with any form of"posted"or"keep out"notices,or fenced in with an unlocked gate,this permission authorizes DEC staff to disregard such notices or unlocked gates at the time of inspection. The signer further agrees that during an inspection, DEC staff may, among other things, take measurements, may analyze physical characteristics of the site including, but not limited to, soils and vegetation(taking samples for analysis), and may make drawings and take photographs. Failure to grant consent for an inspection is grounds for, and may result in, denial of the permit(s) sought by the application. Permission is granted for inspection of property located at the following address(es): 645 RICHMOND ROAD EAST,SOUTHOLD NY 11971 By signing this form, I affirm under penalty of perjury that I am authorized to give consent to entry by DEC staff as described above. I understand that false statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 o the Penal Law.* Print Name and Title Signature Date *The signer of this form must be an individual or authorized representative of a legal entity that: • owns fee title and is in possession of the property identified above; • maintains possessory interest in the property through a lease,rental agreement or other legally binding agreement;or • is provided permission to act on behalf of an individual or legal entity possessing fee title or other possessory interest in the property for the purpose of consenting to inspection of such property. Permission to Inspect Property Application Supplement 12/08 10 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I -PROJECT INFORMATION To be completed by Applicant or Project Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME HENRY GOETZ GOETZ RESIDENCE 3. PROJECT LOCATION: Municipality SOUTHOLD County SUFFOLK 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 645 RICHMOND ROAD EAST,SOUTHOLD NY 11971 SEE LOCATION MAP 5. PROPOSED ACTION IS: F] New E] Expansion Modficationtalteration 6. DESCRIBE PROJECT BRIEFLY: REMOVE AND REPLACE EXISTING BULKHEAD 7. AMOUNT OF LAND AFFECTED: Initially AI acres Ultimately •01 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 2✓ Yes ❑ No If No,describe brieffy 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? rt'l Residential [:] Industrial Commercial Agriculture [:] ParklForesUOpen Space Other Desrn e: RESIDENTIAL HOME 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? �✓ Yes No If Yes,list agency(s)name and permit/approvals: ARMY CORPS,NYSDOS,TOWN OF SOUTHOLD TRUSTEES 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? nYes n No If Yes,list agency(s)name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Yes Z✓ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor name: HENRY GOETZ Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 ENVIRONMENTAL QUESTIONNAIRE This is intended to supplement ENG Form 4345, Application for Department of the Army Permit, or the Joint Application for Permit used in the State of New York. Please provide complete answers to all questions below which are relevant to your project. Any answers may be continued on separate sheet(s)of paper to be attached to this form. PRIVACY ACT STATEMENT The purpose of this form is to provide the Corps of Engineers with basic information regarding your project. This information will be used to facilitate evaluation of your permit application and for public dissemination as required by regulation. Failure to provide complete information may result in your application being declared incomplete for processing, thereby delaying processing of your application. GENERAL--APPLICABLE TO ALL PROJECTS 1. Explain the need for, and purpose of, the proposed work. THE EXISTING BULKHEAD IS DETERIORATED AND IN NEED OF REPLACEMENT TO PROTECT AGAINST LOSS OF LAND. 2. Provide the names and addresses of property owners adjacent to your work site (if not shown on the application form or project drawings). SEE PLAN. (Please note that depending upon the nature and extent of your project, you may be requested to provide the names and addresses of additional property owners proximate to your project site to ensure proper coordination.) 3. Photographs of the project site should be submitted. For projects in tidal areas, photographs of the waterway vicinity should be taken at low tide. Using a separate copy of your plan view, indicate the location and direction of each photograph as well as the date and time at which the photograph was taken. Provide a sufficient number of photographs so as to provide a clear understanding of conditions on and proximate to your project site. 4. Provide a copy of any environmental impact statement, or any other environmental report which was prepared for your project. 0 9 5. Provide a thorough discussion of alternatives to your proposal. This discussion should include, but not necessarily be limited to, the "no action" altemadve and altemadve(s) resulting in less disturbance to waters of the United States. For filling projects in waters of the United States, including wetlands, your alternatives discussion should demonstrate that there are no practicable alternatives to your proposed filling and that your project meets with current mitigation policy (i.e. avoidance, minimization and compensation). THE NO-BUILD ALTERNATIVE WOULD RESULT IN LOSS OF LAND AND PROPERTY. DREDGING PROJECTS Answer the following if your project involves dredging. 1. Indicate the estimated volume of material to be dredged and the depth (below mean low water) to which dredging would occur. Would there be overdepth dredging? 2. You can apply for a ten-year permit for maintenance dredging. If you wish to apply for a ten-year permit,please provide the number of additional dredging events during the ten-year life of the permit and the amount of material to be removed during future events. 3. Indicate of your drawings the dewatering area (If applicable) and disposal site for the dredged material (except landfill sites). Submit a sufficient number of photographs of the dewatering and disposal sites as applicable so as to provide a clear indication of existing conditions. For ten-year maintenance dredging permits, indicate the dewatering/disposal sites for future dredging events, if known. 4. Describe the method of dredging (i.e. clamshell, dragline, etc.) and the expected duration of dredging. 5. Indicate the physical nature of the material to be dredged(i.e. sand, silt, clay, etc) and provide estimated percentages of the various constituents if available. For beach nourishment projects, grain size analysis data is required. 0 9 6. Describe the method of dredged material containment (i.e. hay bales, embankment, bulkhead, etc.)and whether return flow from the dewatering/disposal site would reenter any waterway. Also indicate if there would be any barge overflow. MOORING FACILITIES Answer the following if your project includes the construction or rehabilitation of recreational mooring facilities. 1.It is generally recommended that any fixed piers and walk ramps be limited to four feet in width, and that floats be limited to eight feet in width and rest at least two feet above the waterway bottom at mean low water. Terminal floats at private, non- commercial facilities should be limited to 20 feet in length. if you do not believe your proposal can meet with these recommendations, please provide the reason(s). 2. Using your plan view, show to scale the location(s), position(s) and size(s) (including length, beam and draft) of vesse/(s) to be moored at the proposed facility, including those of transient vessel(s) if known. 3. For commercial mooring sites such as marinas, indicate the capacity of the facility and indicate on the plan view the location(s) of any proposed fueling and/or sewage pumpout facilities. If pumpout facilities are not planned,please discuss the rationale below and indicate the distance to the nearest available pumpout station. 4. Indicate on your plan view the distance to adjacent marine structures, if any are proximate and show the locations and dimensions of such structures. • • 5. Discuss the need for wave protection at the proposed facility. Please be advised that if a permit is issued,you would be required to recognize that the mooring facility may be subject to wave action from wakes of passing vessels, whose operations would not be required to be modifted. Issuance of a permit would not relieve you of ensuring the integrity of the authorized structure(s) and the United States would not be held responsible for damages to the structure(s) and vessel(s) moored thereto from wakes from passing vessels. BULKHEADING/BANK STABILIZATION/FILLING ACTIVITIES Answer the following if your project includes construction of bulkheading (also retaining walls and seawalls) with backfill, filling of waters/wetiands, or any other bank stabilization fills such as riprap, revetments, gabions, etc. 1. Indicate the total volume of fill (including backfill behind a structure such as a bulkhead)as well as the volume of fill to be placed into waters of the United States. The amount of fill in waters of the United States can be determined by calculating the amount of fill to be placed below the plane of spring high tide in tidal areas and below ordinary high water in non-tidal areas. NO FILL WILL BE IMPORTED FOR CONSTRUCTION. 2. Indicate the source(s) and type(s) of fill material. NIA 3. Indicate the method of fill placement(i.e. by hand, bulldozer, crane, etc.). Would any temporary fills be required in waterways or wetlands to provide access for construction equipment? If so, please indicate the area of such waters and/or wetlands to be filled, and show on the plan and sectional views. ALL WORK TO BE ACCOMPLISHED BY LAND WITH RUBBER TRACKED EXCAVATOR. The foregoing requests basic information on the most common types of projects requiring Department of the Army permits. It is intended to obviate or reduce the need for requesting additional information;however, additional information may be requested above and beyond what is requested in this form. Please feel free to add any additional information regarding your project which you believe may facilitate our review. LAND NIP OF PRISCILLA A. RAYMOND PPNN s� S.C.T.Y.Ax000-135-0.9-065 N 4012*X t N 4M2'30", E 70.00' 64.102' LN Le WLM hD air � a �4 •exiEl W16 h3 YAP OF RASTRINO SNORES (COMMON AREA) PA msids"CO mm i • $ �yA �•• a � !• SY0EIE9N NI NMM DAN ��•• SNE IM�AS fRJ �� 9� PRAY OWNER HENNA DRIVE GOER Ammmp PxW Pun KEY WEST. FL JM40 pip PORTIONS OF PLAN FROM SURVEY PREPARED BY: JFfflZEY PA�Ni.10 PrAwwo ff" MICHAEL K. WICKS LAND SURVEYM 106 HEOTT BOULEVARD 645 AMRADND MAD 2ASF 200 BELIE VIEW AVENUE,CENTER MORICHES, NY 11934 CENTER MORICHES, NY 11934 30UTROLq T M OF SOIITAO I) SURVEY LATEST DATED DECEMBER 11. 2012 631-484-9332 3MPFODM OSUMTT• w 16E 2 ata _.. Pas PROJECT - - LOCATION �qr♦ i �o.:=' Hash.momctk Pond y VON m PROJECT LOCATION MAP N.T.S. a q,V I�e�Mia� Daae w w as ca lr NSW lw nn4 lNFnm l�I ALE r u rtr 61C IOIpIE P®SR YgOn 511SIpllllt M 6 plKff NO N2St Md SISNBn •M pM'I112E f12WI0M C N01E 41RRI6 w dP ew m w n W11oN we manpowwr6»Lq ■ImwOw NBINI rnIfJFLt 1Vn W IIS Fr1410Y. FIIOImW r»22N F.q f .,e,■.,�d„� u r u2lmx eou®W Iatian 111111 L♦• onwam AS 1•'106 1'a onr.V Wa r oc. r Ioi o-Inc 4aoo vwn alelw TYPICAL SECTION A—A N.T.S. PROPERTY OWNER: HENRY h NMLENE GOER K�.OR}3040 wm IID NE PORTIONS OF PLAN FROM SURVEY PREPARED BY: 3MA�0 & aP I2%-12 MICHAEL K. WICKS LAND 9JRVEY94G 106 HEWITT 8011LEVARO 200 0711E NEW AVENUE, CENTER MORICHES. NY 11934 CENTER MORIC ES. NY 11934 samm"o, mrN Or swrmm SU(NEY uTEST BATED DECEMBER 11, 2012 631-484-9332 wpmtr=Mr. m 2 OF2 9 0 NEW YORK STATE DEPARTMENT OF STATE COASTAL MANAGEMENT PROGRAM Federal Consistency Assessment Form An applicant,seeking a permit,license,waiver,certification or similar type of approval from a federal agency which is subject to the New York State Coastal Management Program(CMP),shall complete this assessment form for anyproposed activity that will occur within and/or directly affect the State's Coastal Area. This form is intended to assist an applicant in certifying that the proposed activity is consistent with New York State's CMP as required by U.S. Department of Commerce regulations(15 CFR 930.57).It should be completed at the time when the federal application is prepared. The Department of State will use the completed form and accompanying information in its review of the applicant's certification of consistency. A.APPLICANT (please print) 1.Name: HENRY GOETZ 2.Address: 1 AZALEA DRIVE, KEY WEST, FL 33040 3.Telephone: Area Code( ) 305-295-7713 B.PROPOSED ACTIVITY 1.Brief description of activity: REMOVE AND REPLACE 92 LF OF STORM DAMAGED BULKHEAD DUE TO HURRICANE SANDY. 2.Purpose of activity: EXISTING BULKHEAD DAMAGED BY HURRICANE SANDY. 3.Location of activity: SUFFOLK SOUTHOLD 645 RICHMOND ROAD EAST County City,Town,or Village Street or Site Description 4.Type of federal permit/license required:ARMY CORPS 5.Federal application number,if known:NIA 6. If a state permit/license was issued or is required for the proposed activity,identify the state agency and provide the application or permit number,if known: NYSDEC C.COASTAL ASSESSMENT Check either"YES"or"NO"for each of these questions. The numbers following each question refer to the policies described in the CMP document(see footnote on page 2)which may be affected by the proposed activity. 1. Will the proposed activity result in any of the following: YES/NO a.Large physical change to a site within the coastal area which will require the preparation of an environmental impact statement? (11,22,25,32,37,38,41,43) . .. . . . . . . . . . . . . . 13 0 b. Physical alteration of more than two acres of land along the shoreline,land 0 0 under water or coastal waters? (2, 11, 12,20,28,35,44). . . . . . . . .. . . . . . . . . . . . . .. . . c.Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1) .. . . . . a Dx d. Reduction of existing or potential public access to or along coastal waters? (19,20). . . . . . Q j0 e.Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10) .. . Q f Siting of a facility essential to the exploration,development and production of energy resources in coastal waters or on the Outer Continental Shelf? (29). . . . . . . . .. . . . . . . . . . Q is g. Siting of a facility essential to the generation or transmission of energy? (27). . . . . .. . . . . a h. Mining,excavation,or dredging activities,or the placement of dredged or fill material in coastal waters? (15,35). . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . .. . ... . . . . . . . . . . . . Q is i.Discharge of toxics,hazardous substances or other pollutants into coastal waters? (8, 15,35) Q .0 j.Draining of stormwater runoff or sewer overflows into coastal waters? (33). . . . .. . . . . . . Q is It. Transport,storage,treatment,or disposal of solid wastes or hazardous materials? (36,39). Q D 1.Adverse effect upon land or water uses within the State's small harbors? (4).. . . .... . . . . a 2.Will the proposed activity affect or be located in,on,or adjacent to any of the following: YES/NO a. State designated freshwater or tidal wetland? (44). . .. . . . . . . . . .. . . . . .. . . . . . . . . . . . . 0 13 b.Federally designated flood and/or state designated erosion hazard area? (11, 12, 17,). . . . . Q im c. State designated significant fish and/or wildlife habitat? (7). . . . .. . . . . . . . . . . . .. . . . . . 0 d. State designated significant scenic resource or area? (24). . . . . . ... . . . . . . . . . . . . . . . .. Cr IM e. State designated important agricultural lands? (26).. . . . . . . . . . .. . . . . . . . . . .. . . . . .. . Q f Beach,dune or barrier island? (12). . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . g. Major ports of Albany,Buffalo,Ogdensburg,Oswego or New York? (3). . . . . . .. . . . . . . . Q h. State,county,or local park? (19,20). . . . . . . . . . . , , , x i. Historic resource listed on the National or State Register of Historic Places? (23). . . . . . . . Q 3.Will the proposed activity require any of the following: YES/NO a.Waterfront site? (2,21,22). . . . . . . . . . . . . . . .. . . I . . . . . . . . I . . . . . . . . . . . . . . . . . . .. 0 0 b. Provision of new public services or infrastructure in undeveloped or sparsely populated sections of the coastal area? (5) Q 0 . . . . . . . . . . . . .. . . . . . . . . . .. . . . .. . . . . . .. . . . .. . . . . c.Construction or reconstruction of a flood or erosion control structure? (13, 14, 16). . . . . . . Q d. State water quality permit or certification? (30,38,40). . . . . . . . .. . . . . . . . . . . . . . . . . .. Q e. State air quality permit or certification? (41,43). . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . Q 4. Will the proposed activity occur within,and/or affect an area covered by a State approved local waterfront revitalization program? (see policies in local program document) .. . . . . . . . . . . . . Q. �x D.ADDITIONAL STEPS 1.If all of the questions in Section C are answered"NO",then the applicant or agency shall complete Section E and submit the documentation required by Section F. 2.If any of the questions in Section C are answered"YES",then the applicant or agent is advised to consult the CMP,or where appropriate,the local waterfront revitalization program document*. The proposed activity mustbe analyzed in more detail with respect to the applicable state or local coastal policies. On a separate page(s),the applicant or agent shall: (a) identify,by their policy numbers,which coastal policies are affected by the activity,(b)briefly assess the effects of the activity upon the policy; and,(c)state how the activity is consistent with each policy. Following the completion of this written assessment,the applicant or agency shall complete Section E and submit the documentation required by Section F. E.CERTIFICATION The applicant or agent must certify that the proposed activity is consistent with the State's CMP or the approved local waterfront revitalization program,as appropriate. If this certification cannot be made,the proposed activity shall not be undertaken. If this certification can be made,complete this Section. "The proposed activity complies with New York State's approved Coastal Management Program,or with the applicable approved local waterfront revitalization program,and will be conducted in a manner consistent with such program." Applicant/Agent's Name:JEFFREY PATANJO Address: 106 HEWITT BLVD., CENTER MORICHES, NY 11934 Telephone: Area Code( )631 84-9332 Applicant/Agent's Signature: Date: 1- 4 - 13 F. SUBMISSION REQUIREMENTS 1.The applicant or agent shall submit the following documents to the New York State Department of State,Office of Coastal,Local Government and Community Sustainability,Attn:Consistency Review Unit,1 Commerce Plaza,99 Washington Avenue-Suite 1010,Albany,New York 12231. a.Copy of original signed form. b. Copy of the completed federal agency application. c.Other available information which would support the certification of consistency. 2.The applicant or agent shall also submit a copy of this completed form along with his/her application to the federal agency. 3. If there are any questions regarding the submission of this form,contact the Department of State at (518) 474-6000. *These state and local documents are available for inspection at the offices of many federal agencies,Department of environmental Conservation and Department of State regional offices,and the appropriate regional and county planning agencies. Local program documents are also available for inspection at the offices of the appropriate local government. rrn SOUND ,sExo rs' p0 ' � � y ♦ s �sv pV� O x AleN v No v8's ONE, L b `� rom�uvno. a v _ _ _ / •\ Js Clta , x , m B x/ ` 14 OF SUFFOW NTY © e cnox -- COU MF�so�xm �vf ' man se'Ssxo March 22, 2013 D E Q E 8 V i DTown of Southold Trustees ,� Town Hall Annex Building MAA 2 2 2013 54375 Rte. 25 P.O. Box 1179 outhold Town Southold, New York 11971 T t s Attention: Elizabeth Cantrell RE: 645 RrAmoNo ROAD EAST,SouTHOLD,NY SCTM No.1000-13543-06 REVISED DRAwmes Dear Ms. Cantrell: Attached please find revised drawings based on comments addressed at Public Hearing regarding the above referenced project. Plans have been revised to remove the existing mete walk, add 10' buffer and 4'x4' platform on beach. If you should have any questions or require anything further, please do not hesitate to call me at 631484-9332. Ve ly J ey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 OFFICE LOCATION: ' OF SOUjyO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) H ,� Telephone: 631 765-1935 Southold, NY 11971 G �O Fax: 631 765-3136 COMM LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President luno U Town of Southold Board of Trustees FEB 1 3 2013 From: Mark Terry, Principal Planner LWRP Coordinator Southold Town Board f Trustees Date: February 12, 2013 Re: Proposed Wetland Permit for HENRY GOETZ SCTM#1000-135-3-5 NOTE: A laser fiche search indicates the bulkhead is not a permitted structure however it may predate regulations. Jeffrey Patanjo on behalf of HENRY GOETZ requests a Wetland Permit to remove 77 linear feet of existing timber bulkhead damaged by storm and replace with 77 linear feet of vinyl bulkhead and 15 linear feet of return in same location as existing; remove existing timber deck supports to construct bulkhead and replace with new timber supports; existing deck (29'x31.5' overall) to remain undisturbed. Located: 645 Richmond Road East, Southold. SCTM# 135-3-5 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the design meets 6 275-11. Construction and operation standards for bulkheads, retaining walls, revetments and gabions including: 1. Requiring a non-turf buffer. 2. Requiring a low sill bulkhead. 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 Office Use Only -- 'Oasla' Erosion Permit Application ✓Wetland Permit Application Administrative Permit Amendment/Trans rge,,r/Ex e'nsion B eceived Application: I1 /� /I j D Received Fee:$ Completed Application II 11 _Incomplete Il Il SAN 2 5 2013 _SEQRA Classification: Type 1 Type H Unlisted 4Coordination:(date sent) �// Southold Town W RP Consistency Ass s ent Form Boardf Trualu _ AC Referral Sent: Date of Inspection: Receipt of CAC Report: _Lead Agency Determination: _/echnical Review:�.�,� ✓ Public Hearing Held: I f Resolution: Name of Applicant HENRY GOETZ Address 1 AZALEA DRIVE, KEY WEST, FLORIDA 33040 Phone Number:( ) 305-295-7713 Suffolk County Tax Map Number: 1000 - 135-03-05 Property Location: 645 RICHMOND ROAD EAST, SOUTHOLD, NY 11971 (provide LILCO Pole#, distance to cross streets, and location) AGENT: JEFFREY PATANJO (If applicable) Address: 106 HEWITT BLVD.,CENTER MORICHES, NY 11934 Phone: 631-464-9332 01/30/2013 08:32AM 691460 SAVIK AND MURR�P PAGE 04/10 Board of Trustees Applicati-on 4"', GENERAL DATA E C E 0 V E Land Area(in square feet): saw JAN 3 0 2013 RES Area Zoning: Southold Town Previous use of property: RESIDENTIAL Board f Trulges Intended use of property: RESIDENTIAL Covenants and Restrictions: Yes X No If"Yes",please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes X No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes X No Does the structure(s)on property have a valid Certificate of Occupancy_x_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? X No—Yes If yes,provide explanation: Project Description(use attachments if necessary): REIVIME 77 LF Or EXISTING TIMBER BULKHEAD DAMAGED BY STORM AND REPLACE WITH 77 LF OF VINYL BULKHEAD AND 15 LF OF RETURN IN SAME LOCATION AS EXISTING. ^NWO�G y(j y{iwf f>w�b�yL 13"if 4- 6. s nA" IWULIr." Aid. r-tf/wse- ...t Now 4r.en�xR- S�//•r tS• �riSs,�y MCI(, ( as' x ?/•S' 7ue/wti) Zb AO-414- v •tFs t i{ro.C- 01/30/2013 08:32AM 69146 SAVIK AND MUR LP PAGE 02/10 WETLANDtTRUSTr�EE LANDS APPLICATION DATA 12emove "7'7 LF of- Purpose GPurpose of the proposed operations: 444.12 C ee- W 7'7 Lf vtr l b.,t;V lt<wB -2A*A /5 L(- a-Vt'yary 'Y S±se *; ews4i vp. R,.nw ar- #�s 41 m 1v&4 QcG/L h#?ri 45 Tm g6..,prxe r b• L V-A e-A weal le o 4t cc ...I Mai. -CO w bG4 s4e,-m• cx♦St' zf ope-e� 201 'Y 31•S ' O.,t/h(t) 'Pe re,~"O Area of wetlands on lot: 0 squaw feet Percent coverage of lot.—O-0/0 Closest distance between nearest existing structure and upland edge of wetlands: 20 feet Closest distance between nearest proposed structure and upland i edge of wetlands-__-2'—feet JAN D 3 0 2013 Does the project involve excavation or filling? 3001019 Town X No Yes Board f Imam If yes,how much material will be excavated? 0 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: t% Manner in which material will be removed or deposited: N/A 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): THERE WILL BE NO DISRUPTION TO WETLANDS. 01/30/2013 08:32AM 69146 SAVIK AND MURROP PAGE 03/10 Board of Trustees Applieation COASTAL EROSION APPLICATION DATA j7e" . �77L$ •f fwsstu..f 'fr+��isye• b.,(.lGhs...R cl�nFs.�t�2 Purposes of proposed activity: by 17'¢.n^^ c..�t_� - y7 GN v L 11(,111- *^A 1f LF of, Qe-t%ot� 'u S4.4u .oS fzprY1y.•4 .py'fte.rf 4;'6Wr_ Qee1L irw,ng 4, Aa cyzwe iket .dem—A l wi &10w dt at/}eiC 5✓lpp rj. tX�S�' Os-s-/L ( 'YJ�X3LS" OuWw-!1� 'Ea Cr s7av r! �WsQ�S"f••r�s.Q, Are wetlands presem withilii 100 feet of the proposed activity? No X Yes Does the project involve excavation or filling? M x No YesIf Yes,how much material will be excavated? o (cubic yards)How much material will be filled? o (cubic yards)Manner in which material will be removed or deposited: NIA 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) THERE WILL BE NO NEGATIVE IMPACTS DUE TO THE BULKHEAD CONSTRUCTION. ALL EFFORTS WILL BE MADE TO AVOID DISRUPTION TO WETLANDS AND SURROUNDING PROPERTIES. 01/30/2013 08:32AM 69146 SAVIK AND MURRA" P PAGE 06/10 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION o be completed by Applicant or Proect Sponsor) 1. APPUCANT/SPONSOR 2. PROJECT NAME HENRY GOETZ GOETZ RESIDENCE 3. PROJECT LOCATION: Muridpaity SOUTHOLD Courcy SUFFOLK 4. PRECISE LOCATION(Sly"address and road IMersedlons,prominent Iandmarlis,air-,or provide map) 645 RICHMOND ROAD EAST,SOUTHOLD NY 11971 SEE LOCATION MAP 5. PROPOSED ACTION R Now ❑ Epiarrsion Q✓ Modi6COWalleralion 6. DESCRIBE PROJECT BRIEFLY: REMOVE AND REPLACE, 77 t.f •G Gaufd..J Ai ICIX0xfwjry ReAlt4x a 4Ue, dot4Ce- •x15{4 4$.w4e-f' K 54P1/-41 s 174fje7r7 �x I•t aracl+l/ tm rCw+Rt 7. AMOUNT OF LAND AFFECTED: Irfl* Al so= Ultimately -ol acres 8. MALL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? P)Yes ONO If No,describe bneay 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ❑] Resbersial 0 Industrial ❑Comm rcial L]Agnoulbae ❑ ParwPoreaVOpen space El Dow Describe: RESIDENTIAL HOME 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? 2✓ Yes ❑No If Yes,list agerxy(s)name and permluapprovals: ARMY CORPS,NYSDOS,TOWN OP SOUTHOLD TRUSTEES 11. DOES ANY ASPECT OF THE ACTION NAVE A CURRENTLY VALID PERMIT OR APPROVAL? Vas ❑V NO If Yes,fist agoncy(s)name and penWdappmals: 12. ASA RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? El Yes ❑✓ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicardlsponsar name: HENRY GOETZ .0 bate: / Z--ts Signature' If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II - IMPACT ASSESSMENT To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.47 If yes,coordinate the review process and use the FULL EAF. Yes 0✓ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative dedaralian may be superseded by another involved agency. ❑ Yes Q 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: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy? Explain brlefl . _ 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: ElYes No E. IS THERE,OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? It sex Iain: Yes Q No PART III-DETERMINATION 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(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(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. Nquestion d of part if was checked yes,the determination of significance mustevaluate the potential impact of the proposed action on the environmental characteristics of the CFA. Check this box ifyou have identified one or more potentially large orsignificant adverse Impacts which MAY occur.Then proceed direcuyto the FULI FAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed aclo WILL NOT result in any significant adverse environmental imparts AND provide, on attachments as necessary, the reasons supporting thi determination. Board of Trustees p ff U/ Name of Lead Agenc/y/ Date President 13 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer gnature of Responsible Officer in Lea envy Signature of Preparer(If different from responsible officer) • ��o�OgpFFD��ea Gy • .lames P. Kine. Prcsidcm ti lbwn I lall-53(195 Main Rd. Bob Ghosio. Ir. .Vice-President P.O. nos 1179 Dave Bergen Southold.N) 1 1971 John Bredemeyer R3��� ��� Telephone(63 1)765-1892 Michael.1. Domino `� y' Fax(631)765-6641 BOARD OF TOWN TRUSTEES D 4 V TOWN OF SOUTHOLD FEB 1 9 2013 Southold town BOARD OF TRUSTEES: TOWN OF SOUTHOLD are,of rustees --------------------------------------------------------------- In the Matter of the Application of HENRY GOETZ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTIN'GII � � I, 1= ptl�{� ((J residing at/dba Iota 4eW I+ 51\(d . C(fnVV MC)yICiUS IIS 4 being duly sworn, depose and say: That on the 13 day of kl9YLPRk�) , 2013, 1 personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday, February 20,2013. Dated: at3 • I,� )signlre) Sworn to before me this `'qday of k 20 13 otary Public Lodann PatanO Yak Ified in C CommIssiontExpires 17/201] ECE , FEB 1 9 p 013 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Southold TOWG ar ,Tr Name: Address: k1ChWtyl Qd.c. l( Q�u�rta/s ����� . 00 E�nV� I(n3o, SOu44nold ilq-71 c�0 fa rocrci 14, nn, ?a S . i�9m0nd �4 ,Sinn 1 S+rL Kt r 5t f3kcc Ids 11 Z23 STATE OF NEW YORK COUNTY OF SUFFOLK�� � pd-+a Kj residing at IDU +- VVI[�- 43� UQ C. W OL)f h d S / I , being duly sworn, deposes and says that on the day of , 20L-�?_, deponent mailed a true copy of the Notice set forth in the Board of Tru es 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 assessmeroll of the Town of Southold; that said Notices were mailed at the United States Post OffiI'Y r l"S , , that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this 1 ,9- Day ,9-Day of , 20_1� i6aaKPL nI p Notary Public Lor'arm P Notary Public ew York Qualified m k County No:01PA6150861 Commission Expires 08/07/20/`{ , 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. • OWNERS) OF RECORD: HenryGaefz. y To remove 1BJECTxOFmPUBLIC HEARING: of return in same location as existing; remove exp ccksu and replace with 77 linear feet of vinyl bulkhead and 15 linear feet supports; existing deck (29'x31.5' overall) to remain undisturbed, upports to construct buUchsad and replace with new timber TIME & DATE OF PUBLIC; HEARING: WeAAeU u, i r� , aDe - on carab�i- 6.'voPM • If you have an 'Merest in this prtomoject, you are invited to view the Town file(s) which are available for inspection rior 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 Board of Trustees Application• County of Suffolk State of New York HENRY GOETZ 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. 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. y� Signature SWORN TO BEFORE ME THIS I , DAY OF VCtnUOf 120 3 +° �'• Notary Public-State of Florida I- : Commission#EE200051 ate& '"�. ,,hP My CommisatanfxEirea I ','•�'dr's�°T`- May 20,2018 Notary Public Ard of Trustees Application • AUTHORIZATION (where the applicant is not the owner) 1, HENRY GOETZ residing at 1 AZALEA DRIVE (print owner of property) (mailing address) KEY WEST, FLORIDA 33040 do hereby authorize JEFFREY (Agent) PATANJO to apply for permit(s) from the Southold Board of Town Trustees on my behalf. wner's signa ure) APPLICANVAGENUREPRESENTATIV E 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. YOURNAME: GOETZ, HENRY (Last time,first name,middle initial,unless you are applying in the time 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 Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X 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 thisday of yA-Y,. A3 Signature / Print Name e.yn.y ae-�? ' i Form TS l • • (MV Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: s.c.T.M.r. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 1000 135 03 05 STORM-WATER.ORADM6,DRAINAGE AND ERG8IGN CONTROL PLAN 8� -B6 rTe —r= CERnFiED BY A DEMON PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM p / WORK ASSESSMENT Yes No a. What is the Total Area of the Pnryect Protests? 1 Will this Project Retain AN Storm-Water Run-Off (Include Total Area of all Parcels located within 6340/0.146 Generated by a Two(Y)Inch Rainfall on She? — the Scope of Work for Proposed Construction) F/�) (This Item will include all run-off created by site X b. What is the Total Area of Land Clearing clearing and/or construction activities as esti as all ID and/or Ground Disturbance for the proposed 1540/0.035 Site Improvements and the permanNd creation of Construdbn activity? (S.F./Aar) impervious surfaces.) PROVIDE-BRIEF PROJECT DFSCRIMON IPrndasAddm,ar wwm Neeaaah 2 Does the Site Plan and/or Survey Show ca Proposed — El Structures Indicating Size 8 Location?This X Item shall Include all Proposed Grade Changes and REMOVE AND REPLACE 92 LF OF STORM DAMAGED Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion El WITH NEW VINYL SHEETING. and sediment control practices that will be used to X control site storm e.erosion and stowater discharges. This Item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading a Excavation where Mere Is a charge to the Natural X Existing Grade Involving more an 200 Cubic Yards — M of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area In Excess of Five Thousand ❑ X (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 Trusteas jurisdkdbn General DEC SWPPP Remlramenb: or within One Hundred(109)fe ttof a Wetland or submission of a SWPPP Is required for at construction acltAtlas Involving and Beach? disturbances of ore(1)or more acres; including disturbances of less men one acre Net 7 Will there be Site preparation on Existing Grade Slopes El pan of a larger common plan Mat we ultMetely dlshxb ar one or macres Mend: which Exceed Fifteen(15)feet of Vertical Rise to Including Construction activities involving sdl d6urbitoas of lea,than one(1)acre where One Hundred(I W)of Horizontal Distance? X the DEC has detemtned that a SPDES permit is required for start,water discharges. (SWPPP's Shall meal the Notation Raqulremente of the SPOES Goren)Permit 8 Will Driveways,Parking Areas or other Impervious for Storm Water Discharge from Construction eelk*-Permit Na,OP-0+10-001.) Surfaces be Sloped to Direct Storm-Waler Run-OU ❑ X 1.The SWPPP Shall be prepared prior to the submitted of the NOI.The NO]shall be Into and/or In the direction of a Town rightof-way? Ntrmated to UM Department prbrto ge canunencenlsnt of Construction richly. 2.The SWPPP shall describe the smalon and sediment control practkas and where 9 Will this Project Require the Placement of Material, required.postconshuc0an storm water masa emam practices that win be used and/or Removal of Vegetation and/or the Construction of anyX nominated m reduce the polutenm n storm water discharges and to assure Dem Within the Town Right-of-Way,or Road Shoulder — complence with the terms and conditions of this permit.N addition,the SwPPP shall Arae?Iota mbm ami NOT Include the bautYtlen nrodernrMw) identify poterdlal soumas of pollution vhlch may reaeom bit be expected to aced the quality of storm water dachmges. NOTE: NMy Meanto Qm 9Ore#.r WhNlnateMawarWwMaehwk Men S.M SWPPPs that require the postconstrucdon storm water management practice In a Box and the comebmcaon site dtess Is between 6,000 S.F.a i Ave nm a , component shall be prepared by a quelil ed Dealgn Professional Licensed In NOW Von a Stam•WY ,Oreding,Orahume It Erosion Central Wan to Required by the Town of that is knwMedgeebe h the principles and precious of Slohn Walter Management. Southold and Must be Submitted for Review Prior to Woolen aAny euNmng Permit (NOTE: AChedt Mari(#)aMkr rWr Qm MPa Wrara CmWNApoko$mI STATE OF NEW YORK, COUNTY OF...........................................SS ; a..6L6•, Amber McCrory l�Q hY s ��si ;:` o„' Notary Public-State of Florida That l,.........f..l.lr........... ......1!'......................_...............bei, duh'swnrn,de hands `-h t11iWSIG�111ffH40f9s�e t, jNemed lelgdngDocumenq ;y ,"�,da,rCM CorrynlsslbrtE Iran And that he/she is the (( t t�/V-r/%-- „ y May 20,2016 ................................................. ...... ..................:..................................... . (Dann,connector,Agent,Cwporet, .... 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 beforemethis; 1 ............1...Y A.L`...... \e..y..�.d eof,...C..r�xn�U�GL�rjI�.... .... ,20..1.3 Notary Public: ..........��.rf.P.1.�GN.....:.....U.�: .5..�(.d..!✓ .... ........... (/ (sigMhxe a Apptcanp FORM - 06110 01/30/2013 08:32AM 69146 SAVIK AND MURRJWP G- PAGE 05/10 hoc-t"� 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 Parmits and other mintsterial 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",then the proposed action may aftt the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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 f� ®� local libraries and the Town Clerk's office. D E Q W E I3. DESCRIPTION OF SITE AND PROPOSED ACTION JAN 3 0 2013 SCTM# 185 03 05 SoutThe Application has been submitted to(checkappropriate res nse)'. oard ofld Town response)' Bar of Tr e Town Board D Planning Dept- [' Building Dept. 0 Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g.capital Q 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: REMOVE AND REPLACE 77 LF OF STORM DAMAGED BULKHEAD WITH 15 LF RETURN. i.✓ Ct/1w_ L"~Et.. -, $ wm, Ct,r:p . 9tiv64.'r $2,ek u 4r,dA ar G..- IX NU.e -�[.whth S.�B4itS 4ktSt'ws dfCIL (z4 ' ic3/•S 'puCr'wQj -t® C444 ►n. triva�iS��l�r�Q 0 0 Location of action: 645 RICHMOND ROAD EST, SOUTHOLD Site acreage: 0.146 Present land use: RESIDENTIAL Present zoning classification: RES 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: HENRY GOETZ (b) Mailing address: 1 AZALEA DRIVE,KEY WEST FLORIDA 33040 (c) Telephone number: Area Code( ) 305-295-7713 (d) Application number, if any: N/A Will the action be directly undertaken, require funding,or approval by a state or federal agency? Yes El No❑ If yes,which state or federal agency? NYSDEC, NYSDOS, US ARMY CORPS OF ENGINEERS 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. ❑x Yes ❑ No ❑ Not Applicable PROJECT ENHANCES COMMUNITY CHARACTER BY WAY OF PROVIDING A VISUALLY PLEASING AND FUNCTIONAL BULKHEAD. 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 K' Yes No LJ 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 [1] No 0 Not Applicable PROJECT ENHANCES VISUAL QUALITY BY PROVIDING A VISUALLY APPEALING BULKHEAD. 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 E No �] Not Applicable PROJECT PROTECTS THE LOSS OF LAND AND EROSION DUE TO TIDAL CURRENTS AND UPLAND RUNOFF. 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 0 Not Applicable PROJECT PROTECTS WATER BY WAY OF PROVIDING A BARRIER FOR SEDIMENT EROSION. Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. [7 Yes [] No xx Not Applicable ACTION HAS NO EFFECT ON ECOSYSTEMS. 0 Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ NoE] Not Applicable ACTION HAS NO EFFECT ON AIR QUALITY. Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Ed Not Applicable ACTION HAS NO EFFECT CAUSED BY SOLID AND HAZARDOUS WASTE. 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. ❑ Yep ln No❑ Not Applicable ACTION IS LOCATED ON PRIVATE PROPERTY. 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. 2 Yes 0 No ® Not Applicable 0 0 ACTION IS LOCATED ON SINGLE FAMILY RESIDENCE AND UTILIZED TO ACCESS BEACH AND WATER. 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© Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No © Not Applicable Created on 512510511:20 AM January 23, 2013 Town of Southold Trustees Town Hall Annex Building rE aVE54375 Rte. 25 P.O. Box 1179 Southold, New York 11971RE: 645 RICHMOND ROAD EAST, SOUTHOLD, NY SCTM No. 1000-135-03-05 APPLICATION FOR PERMrr Dear Sir/Madam: We hereby submit one original and three (3) copies of the proposed plans, application, check, photographs and required data for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, ' V Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 ®` RESOLUTION 2013-189 ADOPTED DOC ID: 8608 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-189 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON FEBRUARY 26, 2013: RESOLVED that the Town Board of the Town of Southold hereby waives Trustees' permit fees for any repairs or bonstruction, that in the sole discretion of the Board of Trustees, are determined to be related to Superstorm Sandy, until April 1, 2013. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS MOVER: Jill Doherty, Scott Russell SECONDER:William Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell e, 467 r � 7 n q 846 RIC rr I �+ �����rli I i�i���t�!.M' �� ' ( u$I 791a11 4i I Order of e tars a hOy�gQ�tP Y1Q✓ w ALN i'ck OJAKss 'PA � For w l/ APP MED 9Y E C 0 VDD BOARD OF TRUSTEES TOWN OF SOUTHOLD MAR 2 2 2013 DATE outhold Town I Tr s L 'OUNTY ROAD 48) E (66'w'DE) ROAD LAND N/F OF PRISCILLA & RAYMOND PYNN ??01 S.C.T M#1000-135—03-005 N 41.12'3 E 54.79' N 41012'30" E 70.00' 870 8.85 Xv v m LITILPOLE �jCy 5Hm i E z OH u� 7 � o x7.79 63 MAP OF EASTWIND SHORES '��'. , •., • . , ..,... \ MASONRY WICK T 5.9 (COMMON AREA) � 2 Story N 7.47XFrame w Residence #654 t� FTLL 11255 51 .F4.20 ^� m ly 20.8/ , T „ 7.45X io 3.5 i MR OF DISRUPTION AND fiA GROUND DISTURBANCE w v0 o' RAISES o NE OF 10' NON-NRF BUFFE r a " t. a+ , 4.87 ]gip '•' 7 5 .•�Ww ROPOSED 77 LF VIWL BULKHEAD 5.13 °^"7 CpN i.• ter ,. (IN SAME ALIGNMENT AS EXIST.) C ' 0 57+ 3 ROPOSED 4'z4' GREI?THEART PLATFORM RwPi• ' S 19 i''' ISRNG DECK TO REMAIN. REPLACE DAMAGED /'• i'' TIMER SUPPORTS AS REQUIRED TO STABILIZE DECK. 3.1 EMME EXISTING CONCRETE SLAB ROPOSED 15 LF VINYL BULKHEAD RETURN 1,1 D p0 i• (IN SAME ALIGNMENT AS EXIST.) '(10 AgsJJA 3-21-13 PER TRUSTEES MEETING 3-20-13 PROPERTY OWNER: DATE REVISION HENRY & MARLENE GOER BULKHEAD PERMIT PLANS SCALE: 1 AZALEA DRIVE KEY WEST, FL 33040 1"=zo' PROPOSED PLAN DATE: PREPARED BY: 12-28-12 PORTIONS OF PLAN FROM SURVEY PREPARED BY: JEFFREY PATANJO MICHAEL K. WICKS LAND SURVEYING 106 HEWITT BOULEVARD 645 RICHMOND ROAD EAST 200 BELLE VIEW AVENUE, CENTER MORICHES, NY 11934 CENTER MORICHES, NY 11934 SOUTHOLD, TOWN OF SOUTHOLD SURVEY LATEST DATED DECEMBER 11, 2012 631-484-9332 SUFFOLK COUNTY, NY SHEET: TAX YAP N0. 1000-135-03-05 1 OF 2 PROJECT LOCATION . r o r' Hashamommk , Jx� Pond A. it r♦ PROJECT LOCATION MAP N.T.S. EXISTING DECK ABOVE NOT PROPOSED ALUMINUM OR CCA SHOWN. TO BE STABILIZED TIMBER TOP CAP DURING CONSTRUCTION. PROPOSED 10' LONG 10'0 CCA TREATED TIMBER PILE, 6' O.C. PROPOSED 3"X6' REAR WALE NOTE: REMOVE EXISTING BULKHEAD STRUCTURE IN ITS ENTIRETY AND INSTALL NEW BULKHEAD IN THE EXACT SAME POSITION AS EXISTING. RAISE ELEVATION 6" ABOVE EXISTING TOP CAP ELEVATION. 0 PROPOSED 6'x6' CCA TOP & BOTTOM WALE PROPOSED 8' TIP CCA EXISTING BULKHEAD EXISTING CONCRETE PAD TO BE LAY-LOG PILE TO BE REMOVED IN REMOVED ITS ENTIRETY. PROPOSED 8" TIP CCA PILE, 6' APPROMINTE H.H.W. EL 25! O.C. 8' LENGTH. BOLTED TO / LAY-LOG WITH 3/4' GALVANIZED THRU-BOLTS. \ \\ \�\�\ \ \\ / // // / // / / //\// / APPRO%WTE M.LW B. 0.0! PROPOSED 14' LONG 1' DW. GALV. TIE ROD, 6' O.C. /\Oji\//�\//�//��//��/j%\✓%\��/a//\�/\ \ PROPOSED 8' LONG C-LOC 9000 VINYL SHEETING TYPICAL SECTION A-A N.T.S. 3-21-13 PER TRUSTEES MEETING 3-20-13 PROPERTY OWNER: DATE REVISION HENRY & MARLENE GOETZ BULKHEAD PERMIT PLANS SCALE: 1 AZALEA DRIVE AS NOTED KEY WEST, FL 33040 PROPOSED SECTION DATE: PREPARED BY: & LOCATION MAP 12-26-12 PORTIONS OF PLAN FROM SURVEY PREPARED BY: JEFFREY PATANJO MICHAEL K. WICKS LAND SURVEYING 106 HEWITT BOULEVARD 645 RICHMOND ROAD EAST 200 BELLE VIEW AVENUE, CENTER MORICHES, NY 11934 CENTER MORICHES, NY 11934 SOUTHOLD, TOWN OF SOUTHOLD SURVEY LATEST DATED DECEMBER 11, 2012 631-484-9332 SUFFOLK COUNTY, NY SHEEP: TAX YAP N0. 1000-135-03-06 z of z (COUNTY ROAD 48) MIDDLE (EE'WIDE) ROAD SURVEY OFPROPERTY SITUATE SOUTHOLD y TOWN OF SOUTHOLD a SUFFOLK COUNTY, N. Y. A o� SURVEYED: DEC. 11, 2012 _o NOTES: 1. PROPERTY KNOWN AS TAX MAPA 1000-135-03-05 2. LOT AREA = 6340.54 SQ.FT. (0.146 ACRE(S)) 3. THIS SURVEY WAS PREPARED USING A TRIMBLE rn y Oy, LAND N/F OF PRISCILLA & RAYMOND PYNN S3 ROBOTIC TOTAL STATION. x 99 OOn 4. DATUM: MEAN LOW WATER = 0.00' 3 S.C.T.M#1000-13$-03-005 5. PREMISES KNOWN AS 645 RICHMOND ROAD EAST. i N 41.12'3 ' E x 54.79' N 41°12'30" E 70.00' ✓lY0 ^ 8.65 V v_ o �A UTILPOLE rn 19.9' ' Y i STANDARD NOTFS f E N o r^ M /]� �. �' (\•CSA"y4+ SHED m v1 1. COPYRIGHT 2012 MICHAEL K. WICKS LAND SURVEYING p LA�� O( 1/ Cvy� K1/ S 1 4 -4 2. UNAUTHORIZED ALTERATION OR ADORION TO THIS SURVEY MAP BEARING A `i �O4 �\Oq M1 41 LICENSED LAND SURVEYOR'S SEAL ISA MOILATTON OF SECTION 7209, m W /y SUB-DIVISION L 2, OF NEW YORK L IS EDUCATION NAW. 3. ONLY 0 ARE GENUINENRAUE ANRY SURVEY ECCTT COPIES OFS WITH ME THESURVEYOR'S EMBOSSED SURVEYOR'S ORKRNAL m A WORK AND OPINION. X7,79 �.L 4. CER IFICAFONS ON THIS BOUNDARY SURVEY MM SIGNIFY THAT THE MAP M �y, NRY WM.K P T. 'v MAP OF L'AST{{VIND .SHORES WAS PREPARED IN ACCORDANCE WIN THE CURRENT EXISTING CODE OF � '(� \ '1 7.56 ( M�D PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE 21,2 ��35.9�' 0 (COMMON AREA) ASSOCIATION OF PROFESSIONAL LAND SURVEYORS, INC. THE CERTIFICATION IB > O Y LIMITED TO PERSONS FOR WHOM THE BOUNDARY SURVEY HAP IS PREPARED, u TO THE TIRE COMPANY, TO THE GOVERNMENTAL AGENCY, ND TO THE K �''�(J LENDING INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP. m 2 Story A�tO' �/ • 5. THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. P 7.47 X rj N 6. THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS NE 3 4 RFram'? NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED. IF NY UNDERGRE SHOWN. ME ROUND GY es1y1ide nce / IMPROVEMENTS OR ENCROACHMENTS ARE IMPROVEMENTS OR ENCROACHMENTS TNOT OR ACOVERED BY THIS SURVEY. to �' 11��� ME RO ERTY (OR DIMENSIONS) ARE SFORSA SPECIFIC PURPOSWN HEREON ES AND USE AND THEREFORE Q ME NOT INTENDED TO GUIDE THE ERECTION OF FENCES, RETAINING WA . O FFL-12,55 PO015, PATIOS PLANTING AREAS, ADDITIONS TO BUILDINGS, AND ANY OTHER � B,FL-4.20 �.� 15.1 10.4' O TYPE of coesrnuwoN. o 11, X7.51 a ly' (p COPIES OF THIS SURVMAP NOT BEARING THE LAND SURVEYOR'S INKED 20.8/ SURVEY MAP 7.45 X OR EMBOSSED SEAL SHALL NOT BECONSIDERED TO BE A VALID COPY. C/) ) rn 0V L/1 0 F� 3.5 R. 6.0 v RAISED w000 W O WOOD DECK 1n.� r� d 'o RE1E �i UNE � o m OE0.�1<tiN G '� N�',N wptFR q' 5.13 4.87 i.76 DENS 7`�• / `pW wo, v 00 � . 3„ W / MICHAEL K WICKS, P.L.S. #50390 E s 1n051 .7 E poND MICHAEL K WICKS ,,�C /���� NOV SURVEYING76 3.14 CN" Mo 200 BELLE VIEW AVENUE, E CEN A 1V1 TER MORICHES, NEW YORK 11934 i A•RS VOICE: 631.874.0156 - FAX. 631.909.3845 RECORDS OF RICHARD C. DRAKE SCALE: IsURVEYED BY: DRAWN BY: SHEET: A.C. 1 OF 1 u