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HomeMy WebLinkAboutTR-8169 CER ,IANCE Date: October 5, 2016 THIS CERTIFIES that the removal and replacemeq'bf 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"• construct a 16 linear foot bulkhead return on west side of property reconstruct timber stairs-, and remove two cedar trees;with the condition to establish and subsequently maintain a 10' wide non-turf buffer landward of bulkhead; At 52332 CR 48, Southold Suffolk County Tax Map#1000-135-3-17.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 9,2013 pursuant to which Trustees Wetland Permit#8169 Dated May 15, 2013,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal and replacement of 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot bulkhead return on west side of property;reconstruct timber stairs; and remove two cedar trees;with the condition to establish and subsequently maintain a 10' wide non-turf buffer landward of bulkhead. The certificate is issued to ANN AMIAGA owner of the aforesaid property. .X Authorized Signature J. I John M- Bredemeyer III, President 1; °�� ` �o�y;;` Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 P.O. Box 1179 Glenn Goldsmith o z ` ",F.' A. Nicholas Krupski ® Southold, NY 11971 • c? '�° T elephone (63 1) 765-1892 Charles J. Sanders 1 , „ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: a i-z--d ZO V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction Y constructed ►✓ Project complete, compliance inspection. 6 INSPECTED BY: COMMENTS: e CERTIFICATE OF COMPLIANCE: /ames F. King, Pr~ideat ~ Bob Ghosio~ Ir., Vice,-P~:esideat . : Daw B~ ./oh~ Bmd~ncyer Michael ,r. Domino ' BOARD OF TOWN TRUSTEES TOWN: OF SOUTHOLD Town Hall, 5309~ Main RtL · · P.O. Box 1179 8ou~h~ld, jqY 1197I Telephone (631) 765-1892 Fax (63 l) 765-664 ! 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 Pm-construction, hay bale line 1s~ (Jay of construction __ ~ constructed Project COmplete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 8169 DATE: MAY 15~ 2013 ISSUED TO: ANN AMIAGA PROPERTY ADDRESS: 52332 CR 48~ SOUTHOLD SCTM# 135-3-17.1 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 May 15~ 2013, and in consideration of application fee in the sum of $250.00 paid by Ann J. Amiaga or authorized waiver &Town Board and subject to the Terms and Conditions as stated in the Resolution, the Southo[d Town Board of Trustees authorizes and permits the following: Wetland Permit to remove and replace 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot bulkhead return on west side of property; reconstruct timber stairs; and remove two cedar trees; with the condition to establish and subsequently maintain a 10' wide non-turf buffer landward of bulkhead; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated April 4, 2013, and stamped approved on May 15, 2013. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Ann Amiaga, residing at 52332 CR 48, Southold, New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: Thai the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and Iow water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed oftbe subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375Main Road P.O. Box 1179 Southold, NewYork11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 May 15, 2013 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Jeffrey Patanjo 106 Hewitt Blvd. Center Moriches, NY 11934 RE: ANN AMIAGA 52332 CR 48, SOUTHOLD SCTM# 135-3-17.1 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 15, 2013 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of ANN AMIAGA 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 April 9, 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: issuance of permit on structures; proposal is for a replacement of an existing bulkhead, not for a newly proposed bulkhead in a new area; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 15, 2013, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the 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 ANN AMIAGA to remove and replace 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot bulkhead return on west side of property; reconstruct timber stairs; and remove two cedar trees; with the condition to establish and subsequently maintain a 10' wide non- turf buffer landward of bulkhead; and as depicted on the site plan prepared by Jeffrey Patanjo, last dated April 4, 2013, and stamped approved on May 15, 2013. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule,) Fees: $ 50.00 James F. King President, Board of Trustees JFK/amn James F. King, President Bob Gho$io, Ir., Vice-President Dave Bergen John Bredemeyer Michael $. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Sou&old, NY 11971 Telephone (631) 765-1892 Fax (63 l) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated L~L/~/~,~ i [ has been reviewed by this Board at the regular mee!ing of ' -~'/~;] _/-~ and your application has been approved pending the completion df the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) lS~ Day of Construction ($50.00) ½ Constructed ($50.00) v// Fipal 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: $ ~.,~, BY: James F. King, President Board of Trustees Peter Young, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631 ) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 8, 2013 the following recommendation was made: ANN AMIAGA to remove and replace 80 If. of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing; raise elevation 6" from existing; construct 16 If. bulkhead return on west side of property; reconstruct timber stairs and remove two cedar trees. Located: 52332 County Rd. 48, Southold. SCTM#135-3-17.1 SUPPORT - conditioned upon receipt of bulkhead construction plan. Do not recommend raising height of bulkhead. Proposed by Doug Hardy, seconded by William McDermott. All in favor .lances F King. President Bob Ghosio..Ir. Vice-President Dave Bergen .Iohn Brcdemeyer Michael ,I Domino PO Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax(631)765-6641 Date/Time: Southold Town Board of Trustees Field Inspection/Work Session Report Jeffrey Patanjo on behalf of ANN AMIAGA requests a Wetland Permit to remove and replace 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot bulkhead return on west side of property; reconstruct timber stairs; and remove two cedar trees. Located: 52332 County Road 48, Southold SCTM# 135-3-17.1 Type of area to be impacted: __Saltwater Wetland __Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 __Chapt. 111 other Type of Application: __ Wetland __Administrative__Emergency Coastal Erosion Pre-Submission __Amendment Violation Info needed: Modifications: Present Were: v~j. King B. Ghosio ~/j. Bredemeyer. ¢" Michael Domino Form filled out in the field by /~ / __ D. Bergen, D. Dzenkowski Mailed/Faxed to: Date: other Photo S0uth0id Board Photo 2 Photo Photo 4 April 4, 2013 NYS Dept. of Environmental Conservation SUNY @ Stony Brook 50 Circle Road Stony Brook, New York 11790-2356 Attention: Duty Analyst 52332 CR 48 SOUTHOLD, NY SCTM No. 1000-135-03-t7.1 APPLICATION FOR PERMIT ECE VE APR - 9 2013 Southold Town Board of Trust~ 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 631-484-9332 or e-mail at jpatanjo@optonline.net. Very truly yours, 106 Hewitt Blvd. Center Moriches, NY 11934 CC: NYSDOS Ann Amiaga New York State .1OZNT APPLZCATZON FORM For Permits/Determinations to undertake activities affecting streams, waterways, waterbodies, wetlands, coastal areas and sources of water supply. You must separately apply for and obtain separate Permits/Determinations from each involved agency prior to proceeding with work. Please read all instructions. US Army Corps of Engineers (USACE) APPLICATIONS TO 1. NYS Department of Environmental Conservation Check all permits that apply: [] Stream Disturbance [] Excavation and Fill in Navigable Waters [] Docks, Moorings or Platforms [] Dams and Impoundment Structures [] 401 Water Quality Certification r.~reshwater Wetlands I~ Tidal Wetlands [] Coastal Erosion Hanagement [] Wild, Scenic and Recreational Rivers [] Water Supply [] Long Island Well [] Aquatic Vegetation Control [] Aquatic Insect Control [] Fish Control [] Incidental Take of Endan- gered/Threatened Species sending this application to this agency. 2. US Army Corps of Engineers Check all permits that apply: [] Section 404 Clean Water Act [] Section 10 Rivers and Harbors [~Nationwide Permit(s) - Identi~ Number(s): Preconstruction Notification - / [] N ~'~ am sending this application to this agency. 5. Name of Applicant (use full name) Applica must be: []Operator Hailing Address [] Lessee (check all that apply) Post Office City Taxpayer ID (If applicant ~o~L R, [ (~ iS NOT an indlvidua0: Cod f I J Telephone (daytime) EmaJl 7. Contact/Agent Name Company Name Hailing Address Post Office City State Zip Code LIq3q Telephone (daytime) 3. NYS Office of General Services Check ail permits that apply: [] State Owned Lands Under Water [] Utility Easement (pipelines, conduits, cables, etc.) [] Docks, Hootings or Platforms [] T am sending this application to this agency. 4. NYS Depart- ment of State Check if this a lies: ~Coastal Consistency [~[ am sending this application to this agency. 6. Name of Facility or Property Owner (if different than Applicant) Mailing Address Post Office City State Zip Code Telephone (daytime) Email I8. Project / Facility Name Property Tax Hap Section / Block / Lot Number ,~r41~Ox~.. tZ..tS,~t.~e¢ tooo- 135' 03'1'7.1 Project Lffcation - Provide directions and distances to roads, bridges and bodies of waters: Street Address, if applicable Post Office City State Zip Code NY Town / Village / City County Name of USGS Quadrangle Hap Stream/Water Body Name Location Coordinates: Enter NYTHs in kilometers, OR Latitude/Longitude NYI'M-E NYI-M-N Latitude Longitude 3OZNT APPL/CATZON FORM 09/10 This is a 2 Page Application Application Form Page I of 2 Both Pages Must be Completed tNT APpLTCATTON FORM - PAGE 2 OF 21 t this completed page as part of your Applicatior g. Project Description and Purpose: Provide a complete narrative description of the proposed work and its purpose. Attach additional page(s) if necessary. Tnclude: description of current site conditions and how the site wHI be modified by the proposed project; structures and fill materials to be installed; type and quantity of materials to be used (i.e,, sqoare ft 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. ATT&CH PLANS ON SEPARATE PAGES. Proposed Use: Proposed Estimated ~/. / ~- '1.~ J~rivate [-J Public J--Jcommercial I Start Date: I.J-I_,,~ I Completion Date: Has Work Begun on Project? [] Yes [~l~o If Yes, explain. Will Project Occupy Federal, State or Municipal Land? [] Yes J~'~'o If Yes, please specify. List Previous Permit/Application Numbers (if any) and Dates: Will this project require additional Federal, State, or Local Permits including zoning changes? E~es /D~_,~1 ~,~?~ [ ~0o~ { ~Fo,~.~ ~f~ [] No If yes, please list: 12. Signatures. If applicant is not the owner, both must sign the application. ! 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 ali 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 suits, 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 fine of not more than $10,000 or imprisonment for not more than 5 years, or both where an applicant knowingly and willingly falsifies, conceals, or covers up a material fact; or knowingly makes or uses a false, fictitious or fraudulent statement. Signature of Applicant ~ Printed Name Title Date Signature of Owner ~ Printed Name Title Date -5~n~ff~o~'Age~t ~ Printed Name t Title/ Date d from this Agency for the proje~d~sdribed irt Title .IOZNT APPLY'CATION FORM 09/10 Application Form Page 2 of 2 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by A~)plicant or ProJect sponsor) 1. APPLICANT/SPONSOR 12. PROJECT NAME 3. PROJECT LOCATION: 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. PROPOSED ACTION IS: [] New [] Expansion [~Modiflcation/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially t ~'l acres Ultimately . O I acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXiSTiNG LAND USE RESTRICTIONS? [~Yes [] NO If NO, describe briefly 9. WHAT I,=~_~PRESENT LAND USE IN VICINITY OF PROJECT? M Residential [] Industrial [] Commercial Describe: [] Agriculture [] Park/Forest/Open Space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? [~Yes U No If Yes, list agency(s) name and permit/approvals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [~ if Yes, list agency(s) name and permit/approvals: 12. AS A RESULT OF PROP..OSED~ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] Yes [~'N o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicantJsponsor name: ~c~j r,J tc~l't,q ] ~ ~ ~q- 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 I OVER Reset : PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. j']Yes [~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROV DED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. r'~ Yes UNo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Ansv~rs may be handwritten, if legible) C1. Existing air quality, sun'ace 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, shelffish 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, shod term, cumulative, or other effects not identified in C1-C57 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)? [] Yes [] No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explain briefly: 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 rurai); (b) probability of occurring; (c) duration; (d) [rreversibility; (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 II was checked yes, the determination of s[gnificance must evaluate the potential impact of the proposed action on the environmental characteristics of the C EA. ] Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. [] Check this box ifyou have determined, based on the information and analysis above and any supporting documentation, that the proposed actionWiLi NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding this determina6or Name of Lead Agency Print or Type Name of Respens b e Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer {If different from responsible officer) ReSet 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 staffofthe 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 staffto 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): 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 of 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 ENVIRONMENTAL QUESTIONNAIRE This is Intended to supplement ENG Form 4345, Appllce#on for Depa,;,,,ent of the Army Permi~ or tho Joint Application for Permit userl in the State of New York. Please provide complete answers to all questions below which are relevant to your project Any answers maybe continued on separateMs) of paporto be attached PRIVACY ACT STATEMENT The purpose of this form Is to provide the Corps of Engineers with besic Information regarding your project. This Information will be used to facilitate evaluation of your permit application and for public dissemination us required by regutaden. Failure to provide complete Information may result in your application being declared Incomplete for processing, thereby dsiaying processing of your application. GENERAL-APPLICABLE TO ALL PROJECTS 1. Explsin the need for, and purpose of, the proposed work. THE EXISTING BULKHEAD IS DE ~ t:RIORATED AND IN NEED OF REPLACEMENT TO PROTECT AGAINST LOSS OF LAND. 2. Provida the names and addresses of property owners adjacent to your work sito (if not shown on the application form or project drawings). SEE PLAN= (Please note that depending upon the nature and extent of your pmjeat, you may be requested to provide the names and addresses of add/donsi property owners proximate to your project site to ensure proper coordinaffon.) 3. Photographs of the project site should be submitted. For projects in ddsi areas, photographs of the wotmway vicinity should be Men at Iow tide. Using a separate copy of your plan view, Indicete 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 proximata.to your project site. 4. Provide a copy of any environmental impact statement, or any other environmental report which was .prepared for your pro]ecL 5. Provide a thorough discussion of altemedves to your proposal. This discussion should Include, but not necessarily be limited to, the 'no action' alternative and alternative(s) resulting in less disturbance to waters of the United States. For filling projects In waters of the United States, including wetlands, your alterna#vss discussion should demonsirate that there are no practicable altomativss to your proposed filling and that your project meets with current mitigation policy (i.e. avoidance, minimizafion and compensation). THE NO-BUILD ALTERNATIVE WOULD RESULT IN LOSS OF LAND AND PROPERTY. DREDGING PROJECT~ Answer the following if your project Involves dredging. 1. Indicate the estimated volume of material to be dredged and the depth (below mean Iow water) to which dredging would occur. Would there be overdepth dredging? 2. You can apply for a tsn-yssr permit for maintenance dredging, if you wish to apply for a tan-year permi~ please provide the number of addYdonal 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 materisi (except landfill sites). Submit a sufficient number of photographs of the dewatering and disposal sitss as applicable so as to provide a clear indiceffon 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, dregiine, etc.) and the expected duration of dredging. 5. Indicate the physical nature of the material to be dredged (i.e. sand, sil~ clay, etc.) and provide estimated percentages of the various constituents if available. For beach nourishment projects, grain size analysis data is requimdo 6. Describe the method of dredged materiel contelnment (i.e. bay bales, embankment, bulkhead, etc.) and whether return flow ~om the dewatsring/disposel site would reenter any waterway. Also indicate if there would be any barge overflow. MOORING FACIUTIES Answer the following if your project includes the construction or rehabilitation of recreational mooring facilities. 1. It is generally recommended that any ftxod piers and walk ramps be limited to four fast in widih, and that floats be limited to elght fast in width and rast at lasat two fast above the waterway bottom at mean Iow water. Termiosl floats at private, non- commerclel fecllitias should ba 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 elze(s) (including lenu;;,, beam and draft) of vessel(a) to ba moored at the proposed facility, including those of tranelent vessel(s) if known. 3. For commercial mooring sites such as marinas, indicats the capacity of the facility and Indicate on the p/an view the location(s) of any proposed fueling and/er sewage pumpout tscilltles. If pumpout facilities ere not planned, please discuss the rationale below and Indicate the distance to the nearest available pumpout station. 4. Indicate on your plan view the distsnca to adjacent marine structures, if any are proximate and show the locations and dimensions of such structures. 5. Discuss the need for wave proMcfion at the proposed facility. Please be advim~i that if a p~mR is issued, you would be required to recognize that the moering tacilRy may be subject to wave action from wakes of passing vessels, whose ope,.~;;ons would not be required to be modified. Issuance of a permit would not relieve you of ensuring the intagrity of the authorized structure(s) and the Unitad States would not be held responsible for damages to the structure(s) and vessel(s) moored thereto from wakes from passing vessels. BUI. KHEADING/BANK STABIDZA TION/FILUNG ACTIVITIES Answer the following if your project includes co~.struction of bulkhesding (also retaining walls and seswalls) with backfill, filling of waters/wetlands, or any other bank stabilize#on fills such as riprap, revetmanls, gat)ions, etc. 1. Indicate the total volume of fill (including backfill behind a structure such as a bulkhead) as well es the volume of fill to be placed into wa~rs of the United States. The amount of fill in waters of the Unltad SMtes can be determined by calculating the amount of fill to be placed below the plans of spring high tide in tidal areas and below ordinary high water in non-tidal areas. NO FILL WILL BE IMPORTED FOR GONSTRUCI'ION. Indicate the source(s) and ~/pe(s) of fill matarlel. 3. Indicate the method of fill placement (i.e. by hand, bulldozer, crane, etc.). Would any temporary fills be required in waterways or wadands 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 Deparlment of the Army permits. It Is Intended to obviate or reduce the need for reque~ng addlffonal informa6cm; howev~, additional information may be requested above and beyond what Is requested In this form. Please feel free to add any addi~onal informa~on regarding your project which you believe may facilitate our review. 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 any proposed 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: /~ ~',~' fi~r~n ~ ~. ~ ~-- 2. Address: ~ ~"~ ~ e. iL q~l,, 3. Telephone: Area Code ( ) $'~ I ' B. PROPOSED ACTIVITY 1. Brief description of activity: 2. Purpose of activity: 3. Location of activity: County 4. Type of federaI permit/license required: 5. Federal application number, if known: City, Town, or Village Street or Site Description I 6. Ifa state penm~hce ~se was ~sued ot ~ requ ed fo t ~e p upo~ed act v ty, ~de ~t fy the state agency and prov de tle application or permit number, if known: 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) ................ [] [] b. Physical alteration of more than two acres of land along the shoreline, land under water or coastal waters? (2,11,12,20,28,35,44) .......................... [] [] c. Revitalization/redevelopment of a deteriorated or underutilized waterfront site? (1) ...... []. ~ d. Reduction of existing or potential public access to or along coastal waters? ( 19, 20) ...... I~ .~ e. Adverse effect upon the commercial or recreational use of coastal fish resources? (9,10)... ~...~ f. Siting of a facility essential to the exploration, development and production of energy resources in coastal waters or on the Outer Continental Shelf7 (29) ................... g. Siting of a facility essential to the generation or transmission of energy? (27) ........... h. Mining, excavation, or dredging activities, or the placement of dredged or fill material in coastalwaters? (15,35) .................................................... ~...~ i. Discharge of toxics, hazardous substances or other pollutants into coastal waters? (8, 15, 35) j. Draining of stormwater runoff or sewer overflows into coastal waters? (33) ............ k. Transport, storage, troa~ment, or disposal of solid wastes or hazardous materials? (36, 39). 1. Adverse effect upon land or water uses within the State's small harbors? (4) ............ 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) ................................ ~ ~ b. Federally designated flood and/or state designated erosion hazard area? (11, 12, 17,) ..... c. State designated significant fish and/or wildlife habitat? (7) ........................ ~' '~ d. State dealgnated significant scenic resource or area? (24) .......................... ~ ~ e. State designated important agricultural lands? (26) ............................... __ f. Beach, dune or barrier island? (12) ........................................... ~. .~ g. Major ports of Albany, Buffalo, Ogdensburg, Oswego or New York? (3) ............... ~..~ h. State, county, orlocalpark? (19,20) .......................................... Q ..~ i. Historic resoume listed on the National or State Register of Historic Places? (23) ........ ~..~ 3. Will the proposed activity require any of the following: YES / NO a. Waterfront site? (2, 21, 22) ................................................. [] [] b. Provision of new public services or infrastructure in undeveloped or sparsely populated sections of the coastal area? (5) .............................................. [] [] e. Construction or reconstruction of a flood or erosion control structure? (13, 14, 16) ....... ~' ~ d. State water quality permit or certification? (30, 38, 40) ............................ ~]' '~ e. State air quality permit or certification? (4i, 43) ................................. []- '~ 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 prol~'am document) .............. ~J_ __~ 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 am 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 must be 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." 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 certifieatinn 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. e~rth rneters~lO0 ~ N DR. OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: May 13, 2013 ECEIVE I~ of Tmst~ Re: Proposed Wetland Permit for ANN AMIAGA SCTM#1000-135-3-17.1 Permits for the structures were not found. Jeffrey Patanjo on behalf of ANN AMIAGA requests a Wetland Permit to remove and replace 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot bulkhead return on west side of property; reconstruct timber stairs; and remove two cedar trees. Located: 52332 County Road 48, Southold. SCTM# 135-3-17.1 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. 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 Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The structures described were not constructed pursuant to a Town of Southold Board of Trustees review or permit. 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 __Coastal Erosion Permit Application ~Wetland Permit Application Amendment/Transfer/Extension ~_ReceivedApplication: /~//c)/I ~ Received Fee:$ Completed Application ~t]9/I ~ Incomplete __SEQRA Classification: Type 1 Type II Unlisted__ Coordination:(date sent)  LWRP Consistency Assessment Form CAC Referra} Sent:~ Date of Inspection: 'q'7~5'/1'~ ~ Receipt ofCAC Rep'o~'t: t Lead Agency Determination: Technical Review: ~Public Hearing Held: ~'-//757~ Resolution: ! t Office Use Only Administrative Permit ECEIVE APR - 9 2013 ~outhold Town Board of Trustees Name of Applicant ,4,,rd ,/~ m I'a4~ Address ~3~, Ct Phone Number:( ) 6'31- '7/~Y"- :73~3 Suffolk County Tax Map Number: 1000- t~,5- 09- Property Location: 5- ~ 53.1 £~ q~ 5o~,"tt~olrd ~! (provide LILCO Pole #, distance to cross streets, and location) (If applicable) Address: t v to /4ewt-eq- fdL~d_ £o--/'e( /~or/c-,%s Phone: ~oard of Trustees Application Land Area (in square feet): Area Zoning: g,,e 5 Previous use of property: Intended use of property: Covenants and Restrictions: GENERAL DATA Yes v" No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals __Yes ~ No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes ~/ No Does the structure (s) on property have a valid Certificate of Occupancy ~ Yes __No Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permWapproval ever been revoked or suspended by a governmental agency? / No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~oard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeoftheproposedoperations: ~e','~,'*~e ~r~fl- replace q~o CF Area of wetlands on lot: Percent coverage of lot: · ~e.-~rru~t qt~lo~r ~-r^~s 4.tg t~n~e ~ trees. .square feet Closest distance between nearest existing structure and upland edge of wetlands: 5' feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the project involve excavation or filling? ~/ No Yes Ifyes~ how much material will be excavated? How much material will be filled? ~ l~q 16 cubic yards cubic yards feet Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: / Manner in which material will be removed or deposited: 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): 6t7.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by ADplicant or Project Sponsor) 1. APPLICANT/SPONSOR /2. PROJECTNAME 3. PROJECT LOCATION: Municipali~ 50~.l~ Coun~ 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. PROPOSED ACTION IS: [] New [] Expansion [~Modification/alteration DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially t ~ 1 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [~es [] No If No, describe bdefly 9. WHAT IS.PRESENT LAND USE IN VICINITY OF PROJECT? [~Residential [] Industrial [] Commercial Describe: [] Agriculture [] Park/Forest/Open Space [] Other ~0. ~~ESAcT~~N~N~~LvEAPERM~TA~PR~vAL~~RF~~D~~G~~~w~R~LT~~ATELYFR~MA~~~THERG~~ERNMENTALAGENCY (FEDERAL, STATE OR LOCAL)? [~Yes [] No If Yes, list agency(s) name and permit/approvals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~ If Yes, list agency(s) name and permit/approvals: t2. As A RESULT OF PRO~.~.~AOT,ON WILL ~,ST,NC PERM,T~APP,OVAL REOU,RE MO~,F,CAT,ON? ~ ~es I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Signature: If the action is in the Coastal Area and you are a state agency, corn plete the Coastal Assessment Form before proceeding w th th s assessment OVER Reset PART II - IMPACT ASSESSMENT (To be'completed by Lead A~lency) A~ DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review pre(ess and use the FULL FAF. I--I [71No WILL .~CTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 ~f No, a negative dectsrafion may be superseded by another involved agency. r-lYes r~lNo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existiog air quality, surface or groundwater quaifiy or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain bdefly: I C2. Aesthetic. agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I C3. Vegetation or fauna, fish, shellfish o1' 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? Expiain briefly: I C5. Growth, subsequent develepment, or related activities likely to be induced by the proposed action? Explain bdefly: I C6. Long term, short term, cumulative, or other e~fects not identified in C1 -C§? Explain briefly- I C7. Other impacts {inciudin~ chan~es in use of either quantity or t;/pe of ener~;r? Explain briefl~'; D. WILL/HE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTAeLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICFA)? Ill )'es, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If '~es explain: r Yes r N°l ......... PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edabeve~determinewhetheritissubstantiai~Iarge~imp~rtant~r~therwisesigni~cant~ 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; end (0 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 ii was checked yes, the determination of significance must evaluate the potential irepact of the proposed action on the environmental characteristics of the CEA. Check this box ffyou have ifientiged one or more potentially large or significant adverse Impacts which ~4AY occur. Then procaed directly to the FUL FAF and/or prepare a posi~ declaration. Check this box if you have determined, based on the information and analysis above and any suppmliog documentstion, that the proposed acflo WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necassa~y, the reasons supporting thi determination. Board of Trustees Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency ~g-nature of Responsible Officer in Le~/~4~gency Date President Title of Responsible Officer Signature of Preparer (If different from mspensib~e officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: PTV7 STATE OF NEW YORK COUNTY OF SUFFOLK t~, ~'I~{~)["~('}.ta L'~ I [ .'~_., being duly sworn, deposes and says that on the - ~.~ day of ,~,O1~ t } ,20[~, deponent mailed a true copy of the Notice set forth in the Board ~of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons 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 ~ ~, that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this ~C) Day of.~trD~ i [ ,20~ i- U0- Notary Public I..] Lo~n Patanio Bob (;hosk)..h'., Vicc-Prcsidcm Dave Bergen Michael J. I)omino n Ihfll. 53(195 Main Rd P.O. Box I 179 SouthoM. NY 11971 I clcphonc (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ANN AMIAGA COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING 1'0 F,E COMPI. ETED 4 bi'ER I'ONIING REMAI,'~N 1.¥ PI. ACE I:OR EIGIII' D4 YS being duly sv~orn, depose and sa3": That on the~claD, of, ['YIO.¥,.. ,20~'..I personally postcd the property known as by placing the Board of Trustees ollScial poster where it can casily be seen, and that I have checked to be sure the postcr has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday~ May 15~ 2013. Sworn to before mc this ~ day oflY~ 201:5 Notary Public U Lofiann Patanio uua[ .me~jp_~ Commission E~ NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be hel.d by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Ma~n Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: /~r~n/~/~i~l~ SUBJECT OF PUBLIC HEARING: To remove and replace 80 linear feet of deteriorated timber bulkhead with new vinyl bulkhead in same location as existing and raising elevation 6"; construct a 16 linear foot bulkhead return on west side of property; reconstruct timber stairs; and remove two cedar trees. TIME & DATE OF PUBLIC HEARING: 6,3¢~~,/,/~/' 15, oqo~-~ or o,.bou.+ 5'.'~rn If you have an interest in this project, you are invited to vi.ew the Town file(s) which are available for inspection prior to the day of the heanng during normal business days between the hours 0[8 a.m and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 ~oard of Trustees Application County of Suflblk State of New York ,4~'w' /4~ ~'*,~a. 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. SWORN TO BEFORE ME THIS Signature DAY .¼ ,2ol3 ( ,]'~ Not~ry~uSlic JEr?'!!Frrr* R NoaryPu~ . ~ t.Qfq,~,vYork Qualified In S~ ~o!k County Commission Exp~les November 18, 20 [~ ~oard of Trustees Application (print owner of [Sroperty) 5vathol~, ~ IIq?l AUTHORIZATION (where the applicant is not the owner) residingat 3'053;~ (2IL q~ (mailing address) do hereby authorize (Agent) ' to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The ]'own of Southold's Code of Ethics prohibits confiicts of interest on the part ol'town officers and emolovees. The numose 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 someone else or other entity, such as a company. If so, indicate thc other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance l'mstee 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 l'own 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 Soathold Title or position of that person Describe the relationship between yourself(the applicant/agenffrepresentaiive) 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 ova~er 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 intcresl in a non-corporate entity (when thc applicant is not a corporation): C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this __day of Signature Print Name 200 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM THE FOLLOWIN6 Ae~I'IONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, r&RADIN~ DRAINAGE AND EROSION CONTROL PLAH CERTIFIED BY A DESIGN PROFE8SIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CON$'i'RUCfiON a. What is Ihe Total Area of the P~ect Parcais? (Include Total Ama of all Parueis Iocetad within the Scope of Work for Pmpoced Construction) b. What is the Total Ama of Land Cleedng and/or Ground Dtstu~bance for ~he proposed construction activity? ri']aVl # / WORKASSESSMENT Yes No 2 Will this Project Rofain NI atorm-Watar P, un-Off Generated by a Two (2')Inch Rainfa, o~ Site? (This item will inclade ail mn-off created by site clearing and/or constr~cfion actvilJes as wai~ as all Site Improvements and Ihe permanent c~eat/or~ of impe~4ous surfaces.) Does the Sita Plan and/or Sur~ey Show Al, Proposed Drainage Structures ledicedng Size & Location? This ttam shall Include all Proposed Grade Changes and $k~pes Controlling Surface Water Flow. Does the Site Plan andlor Survey descfipe the erosion control site eroaion and storm water drschames. T~ts item must be maintained throughoul the E~re Construction Pedod. Will thrs Project Require any Land Fifling, Grading or Excevaii°n where there is a shange t° the Natural of Material within any Parcel? Will this Ap~licaito~ Require Land Disturbing Actvlties Encompassing an Area In Excess of Five Thousaed (5,000 S.F.) Square Feet of Ground Surface? Is there a Natural Water Coume Running/brough the $ita? ts ~hi~ Pm.~¢t within the Tm~ta~ Juri~:llcton or within On® Handmd I100') f~ot of ~ W~thnd or Will them be ,~ita pl~paraiton on Fmdstln~ Or, de Slopes which Exceed Fifteen (15) feet of Vertical Rise t~ One Hundred (100') of Horlzontai Distance? w,q Driveways, Parring Areas or o~her Impewlous Surfaces be Sloped to Direct Stom1-Wa~r Run-Off into and/or in the direction of a Town right-of-way? Will this ProJest Redulre the PMcement of btatadai, Removal of Vegetaiton andlor tbe Co~stmcten of any Itam Within the Town RJg~t-of-Wa~ or Road Shoulder STATE OF NEW YORK, ~ ~-i' 1' / coum ................... ss That 1, .~...4~.._~..rg...~..o..........0~oi;..;.~....,~.~.~;.[___..._ ................... g y depos s and says that he/she is the applicant for Pennk, And that he/she is the ................ ...~..~...~....~......~.. ............................................................................................................................ Owner and/or representative of the Owner or Owners, and is duly authorized to perfom~ or have pedormed the said work and to make and f'fie this application; that all statements contained in figs application are/amc to the best of his knowledge and belief; ,and that the work will be performed in the manner set forth in the application ~ed herewith. Swo~m~ to beifore me this; · ..... .................... ..................... ....................... ........ U .............. Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action may affect 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 webs itc (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ~35' t'3 The Application has been submitted to (check appropriate response): TownBoard [] Planning Dept. [-~ Building Dept. [] BoardofTrustees Category of Town of Southold agency action (check appropriate response): (a) (b) (c) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) Financial assistance (e.g. grant, loan, subsidy) Permit, approval, license, certification: Location of action: Site acreage: Present land use: ~ £ttl,e.-~4-t ~[ Present zoning classification: ITc ~.. ,~e n4-~,,~L~ 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: A ,,a ~, ~4,'~ ~ ,- ~ ,~ (b) Mailingaddress: y~'35:~ cFI.- qel, , c~,.,.,41,,olel, t,.~l ~l~-'ll (c) Telephone number: Area Code ( ) 6,'31' -7~,5- ¢'3q3 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [~ NolO] lfyes, which state or federal agency? 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. V-~Yes [] No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Santhold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~ Yes [] No [~ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria ~Yes [~ No [~ Not Applicable C ,, rren-P~, 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 AUach 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 evaluatio.~riteria. [] Yes [-~ No I_~ Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes [] No [--~Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section Ill - Policies; Pages 34 through 38 for evaluation criteria. [] Yes [] No ~Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section Ill - Policies; Pages 38 through 46 for evaluation criteria. [] Yes~ 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 L/WRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [~ Yes ~] Nor-n/it~] 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 Ill - 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 - Polices 65 through 68 for evaluation criteria. Yes I I No[~ Not Applicable Created on 5/25/05 11.'20 AM April 4, 2013 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 RE: 52332 CR 48 SOUTHOLD, NY SCTM No. 1000-135-3.:8, ~ 7.1 APPUCATION FOR PERMIT ECE VE ApR - 9 2013 --' Soul,old Town Board of Truste~ 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, 106 Hewitt Blvd. Center Moriches, NY 11934 Southold Town Board - Letter Board Meeting of March 26, 2013 RESOLUTION 2013-280 ADOPTED Item # 5.44 DOC ID: 8695 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-280 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MARCH 26, 2013: RESOLVED that the Town Board of the Town of Southold hereby waives Trustees' permit fees for any repairs or construction, that in the sole discretion of the Board of Trustees, are determined to be related to Superstorm Sandy, until May 1, 2013. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER: William Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell Page 2 APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD ,DATE I.__% NOTES: 1. PORTIONS OF SITE PLAN FROM SURVEY PREPARED BY: NATHAN TAFT CORWIN Ill LAND SURVEYOR 1586 MAIN ROAD, JAMESPORT, NY DATE SURVEYED: JULY, 30 2003 2. LOT AREA = 20,854.32 (0.48 ACRES) PROPERLY OWNER: ANN AMIAGA 52332 C.R. 48 SOUTHOLD, NY 11971 PREPARED BY: JEFFREY PATANJO 106 HE'WI1T BOULEVARD CENTER MORICHES, NY 11934 631-484-9332 DATE REVISION BULKHEAD PERMIT PLANE ECE VE Southold Town Bgar~i of PROPOSED PLAN 52332 C.R. 48 $OUTHOLD, TOffN OF $OUTHOLD SUFFOLK COUNTY, NY TAX ~AP .NO. 1000-136-03-17.1 SCALE: 1 "=40' DATE: 4-4-13 SHEET: 1 OF2 Hasharnomuck Po~d PROJECT LOCATION MAP N.T.S. -- PROJECT LOCATION PROPOSED 8' liP CCA / / LAY-LOG PILE PROPOSED S" lip CCA Pr O.C. 8' LENGSH. BOLTED TO/ LAY-LOG WITH 3/4" ~ GALVANIZED THRU-BOLTS. PROPOSED 14' LONG 1" GALV. lie ROD, 6' O.C. PROPOSED 3~6" REAR EXlS'~NG BULKHEAD TO BE REMOVED IN TYPICAL SECTION A-A N.T.S. dOTES: 1. PORTIONS OF SITE PLAN FROM SURVEY PREPARED BY: NATHAN TAFT CORWIN III LAND SURVEYOR 1586 MAIN ROAD, JAMESPOET, NY DATE SURVEYED: JULY, 30 2003 2. LOT AREA = 20,854.32 (0.48 ACRES) PROPERLY OWNER: ANN AMIACA 52332 C.R. 48 SOUTHOLD, NY 11971 PREPARED BY: JEFFREY PATANJO 106 HEWlTr BOULEVARD CENTER MORICHES, NY 11934 631-484-9332 -PROPOSED TIMBER TOP CAP 'PROPOSED 12' LONG 8'e CCA TREA]ED liMBER PILE, 6' O.C. NOTE: REMOVE EXISIING BULKHEAD STRUCTORE IN ITS ENTIRE'IY AND INSTALL NEW BULKHEAD IN THE EXACT SAME PosmoN AS EXIST]NO. RAISE ELEVAIiON 6" ABOVE EXlSIING TOP CAP ELEVATION. 6"x6' CCA TOP & Bo'FrOM WALE 10' LONG C-LOC 9000 VINTI. SHEETING DATE REVISION BULI~-I~AD PERMI? PLANE PROPOSED SECTION · LOCATION MAP 52332 C~ 48 SOUTHOLD, TOFN OF SOUTHOLD SUFFOLK COUNTK NY FAX ¥~ NO. ~000-~85-08-~Z~ SCALE: AS NOTED DATE: 4-4-13 ~HEET: 2 OF 2