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Burger, Eugene
BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT N0.7564 DATE: MAY 18.2011 ISSUED TO: EUGENE C. BURGER JR. PROPERTY ADDRESS: 2385 PINE TREE ROAD CUTCHOGU ~G~ SCTM# 104-3-2 ~~P~ 6 ~r e AUTHORIZATION 'jib` Pursuant to the provisions of Chapter 275 and/or Chapter 111 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 Mav 18, 2011, and in consideration of application fee in the sum of $250.00 paid by Eueene C. Bureer. Jr. and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct first and second floor additions to the existing single-family dwelling and proposed porch additions; and as depicted on the site plan prepared by Frederick Robert Weber, Architect, last dated Apri120, 2011, and stamped approved on May 18, 2011. 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. ;I - ~°~~f~~c n ~ 'rol gad' TERMS AND CONDITIONS The Permittee Eueene C. Burger Jr. residing at 2385 Pine Tree Road. Cutchoeue. New York as part of the consideration for the issuance of the Pemtit does understand and prescribe to the following: 1. That the said Boazd 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 Persnittee 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 Boazd of Trustees of the Town of Southold. 2. That this Pernvt 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 maybe 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 noncompliance with the provisions of the originating application may be cause for revocation of this Pernvt 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 tnarks. 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 Boazd will be notified by the Permittee of the completion of the work authorized. 9. That the Pemuttce will obtain all other permits and consents that maybe required supplemental to this permit, which maybe subject to revoke upon failure to obtain same. N SURVEY OF PROPERTY AT PECONIC - TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000-104-03-02 SCALE.• 1'=30' JUNE 10, 2010 - JUNE 18, 2010 (FLOOD ZONE & WATER METER) Lor 1s N 275.Q0' xom ~ i I N87 01'20"E ~ SPLIT RAp- FENCE (DELAP) 0.55 ~ ' I I _ --f!i ~-t2---',-- ro-__- ~ ,o•m ZONEX/~~ I ~ I ~ w N ~ I ; ~ ~ i ? / 80 A~ALT F.SF.9d 12.5' ~ ECK C~ a CAR. FIR. Q 11.1' 9.6' c 9.9 I I~ I = I v Nos L07 15 ze.e' FR. HSE dr GAR. a I I i I ~ 3 ~ r a.a• I I ~ I ~ co ~ ~ zzi' ~ 1 I ~ J VE~j,~~p~ n Si0C1(ADE fE _ O - - ~ ' , C~ u1 aYN ~ ~ ~ 'WALL I i V ~ FE a6N / - ~ sPUr RAIL FEr1cE ass 253.95' aa5 / ~ S8701'20"W LOT 14A AFB 21 2~,~~ W - Of L CERTIFIED TO: DAMES FAMILY TRUST CHICAGO T77LE INSURANCE COMPANY ~~GF NSW y0 a(Fit~~W LAN'' ~~P.aa~. PAEI;;S 'Q~ FLOOD ZONE FROM FIRM MAP 36103C0164H UNIMPROVED) SEPTEMBER 25, 2009 ~ ' ~ FN AREA=17,633 ~O. FT. ~ , . ; ELEVATIONS REFERENCED TO N. A. V. D. '88 TO TIE LINE ~ • ~ ! .Y'.LICt`N~ 9618 ¦ =MONUMENT ANY ALTERAPON OR ADDIAON TO 1HIS SURVEY lS A NOLATION ECONIC '~i'~'" { LOT NUMBERS REFER TO 'MAP OF NASSAU FARMS" ~Tngs PER s~cna~ i2os-SY/BD/NSION P.UALLC£R11FlCATIONS (631) 765-5020 ~ ~yJ1 -1797 FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909 ~ MARCH 28, 1935 AS FILE N0. 1179 WHOSE SIGNATURE APPEARS h~£OhLESS£D SEAL OF THE SURVEYOR SOUTHD~N. ~ 11971 T 86-357 L. - Jill M. Doherty, President ~~Of SOUTyO Town Hall Annex Bob Ghosio, Jr., Vice-President l~ 54375 Main Road James F. King ~ ~ P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen John Bredemeyer ~ ~ Telephone (631) 765-1892 ~,t'~ou?m,~ 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 APRE-CONSTRUCTION INSPECTION. FAILURE TO DO $O SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 15i day of constnlction ' '/z constructed X Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7564 DATE: MAY 18, 2011 ISSUED TO: EUGENE. C. BURGER. JR. PROPERTY ADDRESS: 2385 PINE TREE ROAD, CUTCHOGUE SCTM# 104-3-2 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 11 I of We Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on Mav 18, 2011, and in consideration of application fee in the sum of $250.00 paid by Eueene C. Bur eg r, Jr. and subject to the Terms and Conditions as stated m the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct first and second floor additions to the existing single-family dwelling and proposed porch additions; and as depicted on the site plan prepared by Frederick Robert Weber, Architect, last dated April 20, 2011, and stamped approved on May 18, 2011. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents [o be subscribed by a majority of the said Board as of this date. o~~~~'~c VJ n V~ 'C :ll. TERMS AND CONDITIONS The Permittee Eugcene C. Burp_er. Jr.. residine at 2385 Pine Tree Road. Cutchoeue. 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 Pemuttee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Pemuttee 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 maybe made to the Board at a later date. 3. That this Perntit 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 law 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 [o 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 Pennittee of the completion ofthe work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this pernut, which may be subject to revoke upon failure to obtain same. • w Jill M. Doherty, President ~~OF S~Ury~ Town Hall Annex Bob Ghosio, Jr., Vice-President l~ 54375 Main Road James F. King P.O. Box 1179 Southold, New York 11971-0959 Dave Bergen G Q John Bredemeyer ~ Telephone (631) 765-1592 I,YC,oU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 18, 2011 Mr. Eugene J. Burger, Sr. P.O. Box 934 Cutchogue, NY 11935 RE: EUGENE C. BURGER, JR. 2385 PINE TREE ROAD, CUTCHOGUE SCTM# 104-3-2 Dear Mr. Burger: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 18, 2011 regarding the above matter: WHEREAS, Eugene J. Burger, Sr. on behalf of EUGENE C. BURGER, JR. 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 21, 2011, 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 May 18, 2011, 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, z 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 EUGENE C. BURGER, JR. to construct first and second floor additions to the existing single-family dwelling and proposed porch additions; and as depicted on the site plan prepared by Frederick Robert Weber, Architect, last dated April 20, 2011, and stamped approved on May 18, 2011. 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: $100.00 Very truly yours, Jill .Doherty President, Board of Trustees JMD/eac ~ o~suFFtu,~~v Jill M. Doherty, President Town Hall Annex Bob Ghosio, Jr., Vice-President ys ~ 54375 Route 25, P.O. Box 1179 James F. King V ` Southold, NY 11971 Dave Bergen V' Telephone (631)765-1892 John Bredemeyer ~1 ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: EUGENE C. BURGER. JR. Please be advised that your application dated Aaril 21, 2011 has been reviewed by this Board at the regular meeting of Mav 18. 2011 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project XX Pre-Construction Hay Bale Line Inspection Fee ($50.00) 15t Day of Construction ($50.00) YZ Constructed ($50.00) XX 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: Pre-Construction Hay Bale Line Inspection Fee - $50.00 Final Inspection Fee = $50.00 TOTAL FEES DUE: $ 100.00 /l`~l w~ I c``~ ~ SS~e~ BY: Jill M. Doherty, President ~ ~n ~ Board of Trustees ~~g~FFO(,~c • Peter Young Chairman ~ - Town Hall, 53095 Main Rd. Lauren Standish, Secretary ~ P.O. Box 1179 Southold, NY 11971 ~~a Telephone (631) 765-1892 1 # Fax (631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 11, 2011, the following recommendation was made: Moved by Audrey Horton, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of EUGENE C. BURGER, JR. to construct first and second-floor additions to the existing single-family dwelling and proposed porch additions. Located: 2385 Pine Tree Rd., Cutchogue. SCTM#104-3-2 Inspected by: Audrey Horton Vote of Council: Ayes: All Motion Carried ~gUFfO(,~ Jill M. Doherty, President QV CLL P.O- Box 1179 Bob Ghosio, Jr.. Vice-President ~ ~ Southold, NY 11971 James P. King ti Telephone (631 765-1892 Dave Bergen 0 T Fax (631)765-6641 John Bredemeyer ~'F Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: l'~ I / EUGENE C. BURGER, JR. requests a Wetland Permit to construct first and second-floor additions to the existing dwelling and proposed porch additions. Located: 2385 Pine Tree Rd., Cutchogue. SCTM#104-3-2 T~yp~f 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: ~iapt.275 _Chapt. 1 1 -other Type of Application: Wetland -Coastal Erosion -Amendment _Administrative_Emergency Pre-Submission Violation Info needed: Modifications: ~l6 Conditions: Prese ere: Doherty VB. Ghosio `~J. King D. Bergen, J. Bredemeyer D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: R • ~ ~ , r y7~~ ~h. ~.f-~ I %j~ g . y ~T, 1 = ~ - - i~_ dir..`. ~i. ~ k - - _ _ ~ _ . r . ~ _ ~ - Q _ , - ~ ~ s, »~nt$'~ s ~~-~'~3:x.FSi.-' . 5~ Go(Z~ ~Z ~ ~..0 fl K--~ A.L'St W -1 Z_ ~ r ~~~r - _ _ _ ~~~A,r ~C-p Z _ ,a Q 'p" @ i _ _ _ ~ _ r r , Q _ ~ ~ . - _ N ~ y ~ , _Y ~ - _ ` ~~f13+~ ~ ~j0 IL ~IJCQ ~.1J~`~ • ~ _ ~ ~ ; a I~r / i " .ice - ~ ~.A _ _ ~ - ` _ - ~ ~ .:Y ' ~t _V ai ` f ~ _ ~ : # w l,~ ' r:. ' ~ ~y,~, 5+~ a 3¦ ":~~r-~'? ~ ~~~k'f ~ Ems. 'i~+~ ,Y ~ k ~ ~ ~ - ~~vti G. SCTMtl 106-3~2 S/11;2011 _ , - (i III~ i!~ cF. a ~ ,Ran.. ~ ' ~ ~ . I l / ~ PEEN a b\~¢i ~ ~ ~ m ass s"~Q. ~ ~ - ~ ° lw .w° P NP ~ r \ 1 / 4 LL \ \ " y " y BROAOWATERS COVE ~ \ g a off' r 4 s * rora_.P ~ourxao a J ~tym ~ ~ a~ a ~ ~ ~ vac 4 J~ ~ • a ~ , ~ O ' ~ ' ~ t m E . I V ~ ~ x ~ / ~~ur ice. zm C, J `2 Ogs ~N r~~ e~ ~ ~ ~ `tee o 4 / v. ~ - ~ `Sr4 _ ih ~ NAIWATER COTE ~ - V ~ m~ 12 ~ \ ~ ~ ~ `w n. a y Y 5u r~~ 511 - r ~ r c ~ - ~ iiu -O- m xoric[ CUUNiY OF SUFFOLK © ; x SWixOLO sccrwx xo E _ , Petl Aaperty lax Service Agency ~ a u - _ _ - - .«m.o u,mr rn.~ ~..r..gxr nm 1~4 0 1000 vovEar. u OFFICE LOCATION: ~QF SO!/Jh, MAILING ADDRESS: Town Hall Annex ~0~ Ol0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 cn ~ Telephone: 631 765-1838 ~ ~0 Fax: 631765-3136 ~~'~OOUNT'1,N~ LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM ` - _ _ To: Jill Doherty, President , Town of Southold Board of Trustees 'h lovrn " 8amr or T ~siees From: Mark Terry, Principal Planner - z_ LWRP Coordinator Date: May 13, 2011 Re: Proposed Wetland Permit for EUGENE C. BURGER, JR. SCTM#1000-104-3-2 Eugene J. Burger, Sr. on behalf of EUGENE C. BURGER, JR. requests a Wetland Permit to construct first and second-floor additions to the existing single-family dwelling and proposed porch additions. Located: 2385 Pine Tree Rd., Cutchogue. SCTM#104-3-2 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 denoted following Policy Standards and therefore is CONSISTENT with the LWRP provided the following: If the action is approved to further Policy 5: Protect and Improve Water Quality in the Town of Southold and Policy 6; Protect and Restore the Quality and Function of the Town of Southold Ecosystem it is recommended that a landscaped buffer be required landward of the bulkhead. LANDSCAPED BUFFER --Aland area of a certain length and width which is planted with indigenous, drought-tolerant vegetation similar to that found within the immediate proximity of the parcel. Vegetation shall be installed in sufficient densities to achieve 95% ground cover within two years of installation. Survival of planted vegetation shall be 90% for a period of three years. Maintenance activities within the buffer are limited to removing vegetation which is hazardous to life and property, trimming tree limbs up to a height of 15 feet to maintain viewsheds, replanting of vegetation and establishing afour-foot-wide access path constructed of pervious material for access to the water body. [Added 12-15-2009 by L.L. No. 15-2009] Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Jennifer Andaloro, Assistant Town Attorney i ~ Albert J. Krvpski, President ~~Of SDUTy~ Town Hall James King, Vice-President ,`O l~ 53095 Route 25 Artie Foster .~f. .IL P.O. Box 1179 Ken Poliwoda ? T Southold, New York 11971-0959 Peggy A. Dickerson .r~, G ~ Telephone (631) 765-1892 I.YCOU~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application Wetland Permit Application Administrative Peanit _Amendment/Transfer/Extension APR 2 ~ 2011 ~r, , Received Application:~~ ~ ~ReceivedFee:$ z,~ T ~ CompletedApplication_ y'a~/ ~~r;; _Incomplete i. _ , _SEQRA Classification: Type I_Type IIUnlisted _Coordination:(date sent) ~/LWRP Consistency Accrccmrn~ Form ~~ac~// _ _,LCAC Referral Sena _ ~ f p~ ~ J' Date of Lispectic , ~ / Receipt of CAC Report:/ Lead Agency Determination: Technical Review:_ !Public Hearing Held:, Resolution: Name of Applicant ~~.1,6~~\~ C_J. ~(2,(~_~_I~Z Address 2~J~j5 f tN)~ ~1R.13~, Rpfgp ~CG640Ccd.LE~ PhoneNumber:((o~~ `E18- 1fo5~ Suffolk County Tax Map Number: 1000 - ~ O 9' - ~ nj - p?1_ Property Location: ~,'1jQib? plnrt; `lNi,~ ~7~~~,~ t (t35 Nerz,'\1k-off Wry 1.,~ttyE ~ lt~rrtwr~Ro~lr~p~__ (provtde LILCO Pole distance to cross streets, and location) AGENT: ~/w17P1G r~uG 1 °.~fK (If applicable) Address: p0. ~>C ~1~vg' t LusT'~~yti.pfpl,\,'~t ~~~?~jCj Phone: ~`}i\) 9g~-~~{fn~ ~ ~j11 SUN-06-2004 00:49 From: To:6317345249 P.2~2 ~d of Trustees Application CGI,'NERAL DATA Land Area (in square fcct): -~1 ~(p~j 'Co -rt,G, l.ttir~~ Area Zoning: 4~ - _ - Previous useofproperty: S~Ny~i.fG ~iFmlty? Cntended use ofproperty: CNSLrt.g ~^'~..P^~F~.u.~ W/ ~p~q-C~~ C'ovcnants and Kcstrictions: Yas a~Nn It"`Yes",please provide copy. Ikaes this project require a variance; from kle Zoning Board of Appeals . - Yes _ ~ ~No It"`Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency I)ute NY.S P~c-~ wb.~-~K~caxbl No prior permits/approvals for site improvements. Has any pennitlapproval ever heen revoked or suspended by a govemmenltil agency'1 ~ No Yes If yes, provide explanation: . Project Description (use attachments if necessary): /mflrz,~~ 'fib. ~~51NSq.-_slnlbl~ F~v~>,r~ pW''~t-S~f ~ -~'~+~R1>•W_S l'~V~-E ~rl Un1E., w/ ~t?sn~.ticQ tc~.s~u.c~~.,~-.1J~ Gl~zs~"fo W~SL,b,,?ti?~, RPR-27-2011 09:37RM From: ID: BURGER CONSTRUCTION Paee:002 R=94~ ~rd of Truateea Applicatic• WETLAND/TRUSTEE LANDS APPLICATION DATA. Purpose of the proposed operations: L W'N.rCg cS~.6~r.L [i~t,~~nT1nKe cSLtSfo1.-~, ~16w~L111 [~fW-1~1~Co FnKw Area of w nds on lot: ~ ~ squaze feet Percent coverage of lot: X5,9 Closest di tanc between nearest existing structure and upland edge of w~s: 1rJ feet Closest di t ce between nearest proposed structure and upland edge of w~~s: feet Does the project involy excavatio r filling? No X Yes ~ Fo~n,nl ID2sfwN I~LCfLV/~TtaN ~N rJ . 12YlMO VAL. .OF Yv~l'~«-~ If yes, how much material will be excavated? g'O cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: (off feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: ~/~ik-~ 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): ~v~ S~~T FbNUM~ ~ C~ ~x2tr.-~~p ~OwvttT.rce Cot.rs'p2~l.G'(~o~1 ~rd of Trustees Applicati~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: ~ap~ L1.V61.ICo sP~ -Co sly ~.?W .~l~k.n~ Are wetlands present within 100 feet of the proposed activity? No~ Yes Does the project involve xcavation r filling? No .X Yes If Yes, how much material will be excavated?_~(cubic yards) How much material will be filled? MdQJ~, (cubic yards) Manner in which material will be removed or deposited: ~i~c.filr,~ Describe the nature and extent of the environmental impacts reasonably anticipated resulting frotlm~' implementation of the project as proposed. (Use attachments if necessary) IyP ~'1Z~I ' ~cnPTL GIP~~ !'~'I.l. fi~ ~ , D~/~l~C~e, 1-c- Co t~.~ t nIR~ ~tiW 1-~ f~-ilQ~ /~CtJ'rJ s1N Ft~t..x.H.~, ~ BE ~%i1ar,~ Duot,i'.XR C~~t~C~Tls~! _ PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APP CANT/SPO O 2. PROJECT NAME l~tfla.l~ ~KRbt~L_' ~'1°l°i-tr.6r.JT_' ~G~ar~ c. - .owN ~WRfi7~-Z ~~~bter~G6 3.PROJECT LOCATION: 1a~~ Municipality ~f1~A.~''+ County ~t t v ~.{C. 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map '1.''85 1'?uE ~lQ~ 135.16 Na(~L}O~ N~6oglli-w.~~uutro~onat 5. IS PROPOSED ACTION : ~ New ®Ezpansion ? Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: G~N~JCr~t~TWN ~ b+'Wb~Tlot-rte ~-1~f4~fC~ S(-l~fk. ,6cr`iD ~YZr~Vt'~~ C fZbMoV ~ S1lrcip /irND Luc,] 7. AMOUNT OF LAND AFFECTED: Initially t acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ? No If no, describe briefly: T9~wWHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ICI Residential ~ Intlus[rial ~ Commercial Agriculture ~ Park /Forest /Open Space ~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, 6R-FtlMfjIN6, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) 06 ~~ry,,.-r~.._.~. laYes ~NO If yes, list agency name and permit /approval: sue. e~`~^~'~~~~~~~ lick ~ 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 1~Yes ~NO I/ yes, list agency name and permit /approval: ~~•s, p~.r , Fyn ~ ~~L w "or ` 1II2-~.-ILA'~S A R~~EiS~U"~~LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? LJres ~{vo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor Name Dale: Signature ~ If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART It - IMPACT AS$F.SSMF.NT o be feted b Lead A e A ODES ACTION E%(~EO ANY TYPE I THRESIi0L0IN 8 NYORR, PART 817.4E Ayes, eoaMnate Are reNew process and use the Flll1 FAF. Yes ~ No - . & VYILLACiION REE~IVE C1)ORDAtAT~ REVIEW AS PROVgEO FOR IAAJSTEO ACi10NS pV 8 NYCRR, PART 617.87' ANo, a negaiAYe dsdaraAOtr mepr be srrpaseded by arrWrer Nvalvrrd lr, Yes" QNo C. COULD ACTION RESULT NJ ANY AOVER8E EFFECTS ASSOCIATED VNlli THE FOLLOVtINO; (Arrewera may ba handa7Kkn, A kAble) CY. ErdagnB krereabn. draNrage w~ 4 w WAY. noise IeNels. edsArg taAk patterir, scAd waste produoBon w disposal, Ao~nB problems? Wispy: No - C2 Aestlretlc, ardraeologkxil, iristorio, w atlrer nebxM w pulbaai resoulaes: w oomlraar6y w neiphbpyaaA dreredeR F~gllairr W~apy. No CS. Vegetatltxr w fauna, Ash. aheAAdr wwAdBte spades. , w Axeaterred~wendmpered spades? F~gIWn Wleay: No C4. Aaamraasly's axidig plans araosb as dA~ly~adgxed,waduxgehuse orMausty ofusedlarW woAkrnmwa4resawces7l3pldn Wlelly; . No C8, O[oxiAr. wbsequerd developrn2ra, a reWled adtvWes Akely b be tnduoed by Are prapasad ac8on? ~Mr bdeay; No ce. tiaq Germ, ahgrt term. uxraaatlve, wotlrer effects sot kenAfied m CiCB? 6gxainbdeAy: . No C7. OArw. in use.of eAher uamity a type of enwgy7 sin WteA . Na O. VYa1 THE PROJECT WIVE AN IMPACT ON THE ENVIRONMENTAL giARACTFI2ISTICS 7W1T CAVSEO THE ESTABUSHMF_NT OF A rx:IticAL ENVIRONM~'EIN-~TA7GAREA 7 bdeA . Yes ~ Q ~ E IaTHERE,ORiSTH&2EUKELYTO CONT'ROVERSYRELATEOTOPOTEN7W.ADVERSEENVIRONMt3'ITALN~APACTS71f Yes~No 'ART N -OETEFiAA1NAYION OF SNit~1CANCE (To be oompN.~6ed byApeaoyJ , fN1STialCTtoNS: ForeachsbremaelWCtidenAfiaflabov~e.detelprkrewhaAtarkisauWAsmAAl,largo. impartaftforadiefxAsesigtr>raanL Eech .Red,rholflftbe a~ssea M rwnlbfdon wAlr Aa (aV aet~g c+s. taboo a Hasp; ro) of ooartkp; fw avraAon; (tg : car aud~ .Iaw ~ • AMfd aAaaarente ar aefereltoe auppormg matetals. rxrwnA Afat er~IarlaAans oa,taal MAPeaB tlaVe beef) WerrBttedaad adeglrAOglyaddre>~ed. lFgttesdoa d ofpmt A was dreclted ' ybA,tltede0amtkreAoneftdgngiwtroemuetevaNla6AthepotellAalYrpedoElheproposadeeAmrfontlrealrNoml~Ndtafadextsit~ofAreCEA lxbdrArbbaalfyouhavaWerlBAedonewmorepolenBaNytar6ear6grYA~edrersaYlpsdswtlidf WlYaoafr: ThenProeOeddkeglY~tlre PJ1F atrd/or prepare a poddse,dedareAorl. Giadc Arta box Ayou have defenrArred, traced on the hkxnrtlAan surd analysis abuse suM arty srrppertlirp.doamranlaAon, Aral the proposed AYIL.L NOT reWf W arry dBdfArxM ad~reree emrbmm~mrbd knPeds AtW proNde, on alfadKlrents as neoease~r, Aye reasons supPatkM delanMnaAon. Board of Trustees Name of lead Agency Uate~/' - Jill M. Dohs President w ype ame o Resporrslble Officer M Lea Agency ~ TIAe of Responsible Officer I" (i! es cer n Lea Ag Signature of Prepares Ifd corn respo ble officer) _ I ~d~~r Town of Southold Erosion, Sedirnentation 8r Storm-Water Run-off ASSESSMENT FORM i J~~ Pgo~o LDCATION: S.c.T.M. M. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A ~ '41 ~ ~ ~ O Z t'~' STORM-WATER, GRADING, D NAGE ANB EROSION CONTROL PLAN ~ 'Co`t"` CERTIFIED BY A DESIGN PROFESSIgNAL IN THE STATE OF NEW YORK. SCOPE OFWORK -PROPOSED CONSTRUCTION ITEM # / WORKASSESSMIIVT Yes No a. What b the Total Area of the Project Parcels? (Include Total Arm of all Parcels bated within ~ VCq~I thds Project Retain All SOOrm-Water RurWR the Scope tN work for Proposed Constructlon) ' Generated by a Two (2") Inch Reinfap on Site? ~ ' / ? ts.F.IArea) (This.kem xdtl include aN run-oR created by site b. What k the Total Area M Land Clearirg clearing arW/or txrnstrudion actlvitles as wetl as all arM/or Ground DisWrbarrce for the proposed , Site Improvements and the permanent creatlon of censWCtion activiry4 impervious surfaces.) ts.F. rA~) 2 Does the Sdte Plan andlor Survey Show All Proposed PROVIDE BRIEF PRO]ECI' DESCRIPTION (RarMe adduond Peseea NeeaMi - Drainage Structures Indicatlng Size & Locatlon? This ? Item shall Include all Proposed Grade Changes and Sbpes Controlling Surtaca Water Flow. 3 Does the Site Plan and/or Survey describe the erasion ) ? and sediment control practices that will be used b contrd site erosion and storm water discharges. This item must be maintained throughout the Entlre Conshuction Pedod. 4 Wiil this ProjeG Require arty Land Filling, Grading or ? j Excavation where there is a change to the Natural -V/ Existing Grade Involving more than 200 Cubic Yards - of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities ? / Encompassing an Area in Excess of F'rve Thousand V ~ (5,000 S.F.) Square Feet of Ground Surtace? i f) Is there a Natural Water Course Running through the ? Site? Is Mis Project within the Trustees jurisdiction I, General DEC SWPPP Reautremenb: or within One Hundred (100') feet of a Wetland or SuMdssbn d a SWPPP B requked fa tip Conswclmn adNHkis krwNklp sot Beach? dfsmrbances of one (1) or mwa acres; Including d§mrbances of mss Men one acre Mat . ~ era part of a larger mmmon pan that wiM upimatey disium one or more acres or Wnd; 7 Will there be Site preparation on Existing Grade Sk>pes I indudkg Conshuctlon acWilks fnvdving sea d'smrbances of Mss Men one (1) acre where which Exceed Fifteen (15) feet of Vertical Rise to ? ? i the DEC has delerm'rred Mat a SPDES perrMt O required forstorm water dischayes. One Hundred (100') of Horizontal Distance? (SWPPP's Shall meet Me Minimum Raquiromenb of Ma 3PDE3 General Permit $ WIII Driveways, Parking Areas or other Impervious ? for Smrm Water Dfuharges from ConsWCtlon ectlviry -PermN No.6P-0.70-001.) Surfaces be Sloped to Dlreci Sk]nn-Water RUf1-01f t. The SWPPP snap be prepared pkx m Me subMtbl of the NIN. The NOI shat be into and/of in the direction of a Town dghtof-way? submMted to tta Depermenl pier m pie oorMrenoemeM d conswctlon aclNpy. 2. The SWPPP shop dasaibe the eresbn and sedkrlenl contrd precpces and where 9 Will this Project Require the Placement of Maledel, regprad, pnhrorromrclian smrtn wabrm~n~gement pacllas Mat wN ba used andfor Removal of Vegetatlon andlor the Canstructlori of arty constructed m reduce Me papubMS h slam water discharges and m assure Item Within Me Town Rightrof--Way W Road Shoulder ~ - rnngllerwe wiM IM arms and cond'ipons of Ma pxmil In eddabn, Me SWPPP ahep Areal (rhu rwmwa Norrnduae tlw lnataeetlm amw.w.y Aprana) idenpy pomntlal sources of piartlon whlA may reasorelAy he expected m aflecl Me . quapry of stem wafer dLSCheryas. NOTE: It Any Answer b Qussdens Ons Mrouph Nina b Answered wiM • Cheelr Msrlc 3. AA SWPPPS Met requke Me poslconsirudion smrm wear management Dractlce In a aoz and Me eomtruetlon sea dbtwWrwe b bNrresn S,OW SF. a t Aws m araq mmponant shay be prepared M a quaiiped Desfgn Prefesskmal Licensed in New York a SmrmAVMp, darling, Drainage 8 Erosbn conbol Plan Is Rpuired bytlw Town W that Is krwMadgeeble in the prmclples and precttces of Storm Wamr Management SouOrold and Must M Submitted br RaNsw Pdor to Isausrice dArly auliderg PsrmR (NOTE: ACneQ Meek t,t)eriwor Ansxerforoadi Weedeng RepAed bra Caipleb Appaf®Em) S1'A7'E OF NEW YORK, I I~~I I COUNTY OF0... ('J/ ~/t.~..- SS That I, .........a.~4 ~~tSf.' being duly swo ,deposes and says that he/she is the applicant for Permit, ~ iN Ndvidual stgNrg ) ' Md that hr/she is the !~N..?..!....... l (rNmer, Conbacmr. a OMcer, emJ 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. Swom [o before me this; ..........~.t~ day of . , 2Q.~~ Notary Public i IiED>~il ignalure of Appicant) FORM - 06/1 0 ryNO.01~E6099317 UUalifiad to Suffolk County c~ s.vt. ae. 1 1 TQWN OF SOUTFiD~ CHAPTER 23fi = ST'QRM 11VA~ER MANAG~MEN'T ~T.ORMWAT~R POLLUTION PREVENTION PLAN (SWPPP) A. Cieuerat Town of Southold SWPPP Requirements (Far Land Distnrbaaee between S,Ot10 3F and 1 acre in area) I. The SWPPP shall be.prepared prior to ihe.application fur Building Permit. 2. The SWPPP shad describe the.erosion and sediment control practices and where required, post-construction storm water numagement practices that wt~t bs used andfor constructed to rerluce_ flee pollutants in storm wateF dischaxges and to assu;e.cotnpliancewitbthe terms attd cotidittons Qf Town t;ode f>hapter 236' for Storm Water Management prior to the issuance of a Tvwn l~u~ding Pemut. In addition, the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the quatity of storm water dischitrges. 3.. Atl ~WPPPs that require apost-construction storm;vuater management practice component sliatl be prepazed by a gttal~ed design..professiana/that isknowledgeable in the;principies and practices of storm water:management-and treatirrent. 4:The-owner, contractor or operator must keep the SWPPP current so that it at all times accurately documents the erosion and sediment control practices that are being used or will be used during construction, and all post-construction storm water management practices that wilt be cortsiructed on the site. A:t a minimum,. the owner, contractor or operator sha11 emend the SWPPP: ; a. whenever the current provisions prove to be inetTective in minimizing pollutants in storm water discharges ii-om the site; ,b. whenever these is a Change in design; construction, orapexation at the construction site that has.or could have an effect on the discharge ofpollutants; and c. to address issues or deficiencies identified during an inspection by-a Building inspector, or other regulatory authority. 5. The Building E)epaifinent may notify the owner, contractor or operator at anytime thatthe SWPPP does not meet one or more of the minimum regpiretrients of the buildtng pmt. `l'he toti&c~Ition shaft be in ~+tittng and #deniafy the provisions of the BWPPP that r+ttlai~r:inodt°Dn Wilhin finrteen (14) calendar days ofsuch aotiftcation; or as otherwise mdicatid by the Town, ttte ottmr:*r; co~rttt;;actor or operator shaft-mare the required.changes to the S~'VPPP' and submit written notification to the Town that the ehan&es have base made. If the owner; .contractor or operator. does-pot respond to the Tawn's comments is the spea$ad time frame, the Tours may issue a stop wArk order anri>'ar suspend the cnrrent $uilding:Pemrit. r 6..1'rior to tt~ commencement of construction activity, the owner,- eoxitraCttrrar opera~r most identify the contractor(s) and subcontractor(s) that will be .responsible for rePtactrt~ ~g sett maintaining the erosion apd sett Wig' Wig' SWPPt?t and fhe contractor(s)-und sgbconhacto s that wilt be contras 1~ wed it the r() responsilrk for construing the post- construetion storm water management practices included in the 5 WPPP. The owner, contractor or operator shaft have each of the contractors and subcontractors identify at feast Otte person from their company that will be responsib}e for implementation of the SWPPP. h. The dimensions, m~ specifications, installation details, an~peration and maintenance requirements tai' all erosion and sediment control practices, Inclpde the Location and sizing of any temporary sediment basins and shvctural practices that will be used to divert flows from exposed soils; i. A maintenance inspection schedule for the contractors) to ensure continuous and effective operation of the erosion and sediment control practices. The maintenance inspection schedule shall be as aeoordanee with'the regttirerrients ia. the most current version of the technical stat?dard, New Yisrk State Standards and Specifications for Erosioa atic# . Sediment Control;. ' A descriptitig of the pollution prevcatle~'~ that wili~be used to control litter, conshuction chemicals and construction debris from becoming apollutant source in the storm water discharges; B: BeauiretI S~l'PB C® ~t~: Tarvn ol5ont uld Storm Water poL.~tt~.. i>.. K n. {Ror Land Atstarbapce betwee7rz 5,fltl6 SiR and. ~ acre.3lr area) , . MINiMUNFSITE PLAN RE(1UIREMEPdT9 1. Applicant information: Provide name, legal address, and telephone number:< 2. Common address,. Suffolk County 7"ax Map Ito. and iegaf description of site. 3. Signature and stamp of registered Design Professional (grctutect! engineer i surveyorl and/or design/owner certification... 4. Vicinity map: 5. Existing and proposed meppirag artd plans ENlaximum scale of ti'', 5©' or greater cletait) which illustrate at a minimum: Q Existing and proposed topography (minimum o€ 2-foot contours recommendedj; t~ Perennial and intermittent streams andfar Nattiraf tNafer Course; Mapping of predominant soils and location qf. teat hole or.site-specific botehol~a investigations that have been pertormed, ~ ' Boundaries ctf existing predominant gegetation and proposer! #imits of,eleatang; Location and baunsi~ies of resFittrce ptpte>;}fort.:~1 stieh as wetlartEls, Jalc~, ponds, and other setbacks {e.g:, etr~atn bttifei~s dttinkirig waterweil setbacks, septic setbacks); ® Location of existing and proposei# roads, buildings, and other structures, Location of existing and proposed. utilities {e.g., watet,.sewer, gas; electric). and easements;' Loption of existing oriel proposed conveyance s~sfems such as grass chatutels, swales, storm drainsor other storm water g#4~"s Flow paths; ~ Location of #toodp{ain/floodway limits sett .Fetafiot~sf~iW ot` site to upstream anti downstream properties and drainages; ~ Location and ditnen~ions ttf proposed ~tan+aef rnbdifications, such a5 br4dge or culvert crossings where applicable; . ® Location, size, maintenance access, and limits of disturbance of proposed structural storm wa#er Management practices; i • ~~A$~F~~CQ • Jill M. Doherty, President - Town Hall, 53095 Main Rd. ~ P.O. Box 1179 Bob Ghosio, Jr. , Vice-President n~ lames F. King ~ Southold, NY 11971 Dave Bergen y'~ ~a Telephone (631) 765-1892 John Bredemeyer 1 ~ Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ~ EUGENE BURGER JR. COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ? / ~l ,residing at /dba / / being duly sworn, depose and say: That on the day of ~j/~ , 201f, I 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 beheld Wed, Mav 18, 2011 on or about 6:00 PM. Dated: (signature) worn to before me this f day of'YYbc~2(Vf ar Public LAUREN M. STANDISH Notary Public, State of New York No.O1ST6164008 Qualified in Suffolk County , Commission Expires April 9, 2015 • ~~o~OgyFFO(,~coG • Jill M. Doherty, President N Town Hall, 53095 Main Rd. Bob Ghosio, ]r. ,Vice-President ~ T P.O. Box 1179 James F. King `t` Southold, NY 11971 Dave Bergen ~~0~ Telephone (631) 765-1892 John Bredemeycr ~ ~ Fax (631) 765-6647 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of EUGENE C. BURGER, JR. COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,~~c~,.r-o ~ y~< ~ ,residing at/dba d ~~5 / .Y~f~ s ~ ~~~ha~~-~ being duly sworn de ose and That on the y day of , 2011, [personally posted the property known as by placing e Board of Tru es otticial poster where it can easily be seen, and that I have checked to be sure the emained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to beheld Wed, May 18, 2011 on or about 6:00 PM. Dated: (signature) Sworn torb~ef`o'r'e me this '~T t'\ day ort ~ wra 20~ ~ CONNIE D. BUNCH U Notary Publk:, State of New York N0.01 BU3165050 ~ ~~~1~~ Co miee ondE~fApr1/14ry2~J~-. Notary Public PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: e~,q-~l.'~S ~I.~CE 13 T~4t..1_ TAE. C.~e~.t..t, ~~v~~t-le.~~ , ~1.~. llat~l w>1.~~,F}~ z. PcC~~-r`n~AN 1L-(~ ~u~U1Lw ~~w~nn Pte, _ c~-o~E, 5, a~~~~N w~~a., c.r~ ©t~eaa ~oSE~+{ . titer ~..~.y 23q© ~ 1 ~ -t-~r-.~~. Q-~- ~~STA `r~ MIL 1..~ C, v-~ck{o E,v~ ~ ~,`i. \ 1°135._._ _ _ STATE OF NEW YORK CrOUNTY OF/S~UFFOLK n Cvr~~,-~ l.3 ~ -A~ ,residing at ~ ~ PE w e T/~a t_ F"~ C being duly sworn, deposes and says that on the day of /l'L Q , 20~, deponent mailed a true copy of the Notice set forth in the Board of Trus ees 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 aze 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) (registered] mail. Sworn to before me this 7~ Day of (~{~(An~l_ , 20_~ CONNIE D. BUNCH ~ Notary P~Nc, State of NosJ York wl\M~ No.01BU8185p5C Y \ C~~~En Suffolk Couni Notary Public ~vea April 14, 2~ ~ - ~ M1 ~ ~ ~ ~ M1 ~ O' S m • M1 rv r~ ..D ,a Postage ~ E0.44 0952 ~ Postage $ f0.44 f1J Cenifetl Fee f2.~7. N Certifietl Fee f2 ~ .'k' p Retum Receipt Fee ,\Di 2 o rk p Post t ~ p (Entlorsement Requiretl) f2.~ Here S p Retum Receipt Fee ~ b p (Entlorsement Requretl) f2.~Q ~ Here\ Restrictetl Delivery Fee _ ~ p (Endorsement Required) f(I~(~ ~ I Ok ~ Restrictetl Delivery Fee '~L N ~ M1' J ~ O (Endorsement Requiretl) fQ.QQ ) `0 ~ , M1 ~ total POStageB Feea $ f5~~ $ / ~ Total Postage 8 Fees f5.59 O Sent To ~ ~ ~ p Sent Ta Street. Apt. No.; . _ - 0--.-..._-------------------------"-- M1' or PO Box No. - . y~ ~ I~G ~ ~ ~ O Streef, Apf No.; /J 2 ~ n (~-~~7 ~._•1--~it5t...-G,~`,'K/G.--..- f~ ar PO BOx NO. - L?\0.....P\{..~~.. 1 ~`_'~'E-V~-+~....-. Ciry, State, ZlP+4 - - - - 'Qa v eJ u • y . 1 \qo Dit,, Bfata, ZtP+a - :.r . ,r. ~ ~ p • . ~ M1 I ~ ~ Postage $ fQ.~l ~ r~ Postage $ fQ.~l rV Certlfietl Fee u..~ ~ ra 2 p ostmark Certified Fee p Return Receipt Fee ~ O ~ ~ostm f ~ p (Entlorsement Requiretl) fz.~ Here ~ Retum Receipt Fee r~ Here b Resiricfetl Delivery Fee ~ ~ (Endorsement Required) fG.~Q ~ ~ O (Endorsement Requiretl) f0.~ ~ / ~ ~ i Restridetl Delivery Fee ~ N p (Endorsement Required) fQ.~ ~ ~ Total POStageB Fees $ f°j,59 ~'l1/?/~mV~~ M1 ~_Oi Total Postage 8 Fees $ f5.59 4~51ivf~. o sent re pp ~ ~ , p SheeGA~NO.; AS ~~w Sen! o 'F-.k-~r-..-~-- ~ IU_Lt4!~_~_~k'R~?LE....t~Q.t-'~N---- or PO BOx NO. 2~0 p Sireei. T,v-f~~'a`.: GiN Stale. ZIPt4 / ^ M1 ar PO Box No. I 1 ~l S chy ware,-ziP,a -1-- ----LeL.71l~pY ~ E'-w--- uTC.I~}t~ r :rr rr. MqY-24-2004 00:29 From: To~1030 P.3~4 and n£ Trustees ~licatinn AU'PgORig~iq'Tp~1 r ~j~~~, (where the applicaat ie not the owner r' reszding at (print owner of property) (ma.iling addxess) k M'f do &ereby aut'~criae ,~y,. (Agent) ~k~~__to apply for permit(s) frown the &outhoid eoa„td p~ 1'Own Trustees oa my be17aJ,£. (owner's signature) 8 MRY-24-2004 00:29 Frem: To:~29510p0 P.4~4 Hoard o£ Trustees Appllcat5,on County of Suffolk State at'New York ^--~s E G. ~ n>•~osirs AND AFFAtMS stiirrG nUGY swoRlV - Dl3SCRD66D THAT HPJSHE TS THE APPLICANT FOR THE AEOVE 'rRR~' TO TIDE BP p)}u ~ ICNU L 5TA'l'EMENt'S CONTAtIV.F,,,p HEREW AR8 W,Tt.L BE DONE IN THE IVIANNFLTt SET FOR~TI-IG IIV THIS APPI.ICATTO AND AS MAYR Hl; APPROVm BY 1'HE SOUTHOLT? TOWN BOARD OF TRTJSTEES. 'T1iE APPLICANT AGREES TO BOLD THH'r0~ OF SOUTFIOLD AND TTY Tp~ TRTJSl'EE5 13ARMI,ISSS AND FREE FROM ANY AND ALL DAMA(3FSS ,AND CI.AiMS ARISING UNbi31t OR Tay VIItTUE OF SAID PERMI'T'(S), ~ ~ COSH, f~O ,I,~S API'LICAT70N, ? Hwy AUT~IORiZE THE TRUSTEES, AGENT(S) OR REPRESENTATTVEg(3). TO ENTER ONTO 1.ViY PROPERTY TU TNSVF,CT THE PREMISES IN CONJUNCTION WITH REVTIsV~r OF THIS APP[dt;ATION. Signature SWORN TO BEFORE ME THIS j L( -f'fi ~-~C~= Notary Public MY ~mm~1m g des F+b. aS.4D@ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM I The Town of Southold's Code of Ethics prohibits conflicts of interest on the Dart of town officers and employees The otrrpose of P ' forth is to provide information which can alert the town of possible conflicts of trrterest and allow It to take whatever action is necessary to avoid samppe. - YOUR NAME: O ~ f C'Q ( ~ Q'^' (Last n e, fus[ name, griddle iniL ,unless you amore applying m the name of someone else or other entity, such as a tympany. If so, indicate theother person's or company's name.) NAME OF APPLICATION: (Check all that apply.) - ~ Tax grievance Building ~ Variance Trustee i 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 [he Town of Southold? "Relationship" includes by blood, rgarriage, or business interest. "Business interesP' 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. i I Name of person employed by the Town of Southold ' Title or position of that person Describe [he relationship between yourself (the applicanVagent/representative) and the town officer or employee. Either check ! i, the appropriate Tine 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 tfiat apply): A) the owner of greater than 5%of the shares of the corporate stock of the applicant I (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corpom[e en[iTy (when the applicant is not a tyrpomtion); C) an officer, director, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ~ ~ day of /7- ? ~ 200 Signature Print Name Form TS 1 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 aze 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 deternunation of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the prepazer 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 sienificant beneficial and adverse effects upon the coastal azea (which includes all of Southold Town 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standazds and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standazds 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 Boazd of Trustees Office, the Planning Department, all local librazies and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ~a~,p - low- 03- O~ PROJECT NAME ~GO~ ~~1 ipL-A1 Ck. The Application has been submitted to (check appropriate response): Town Board ? Planning Board ? Building Dept. ? Board of Trustees 1. Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ? construction, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: ~ /~ct~n ~~N S "ro ~E. l~s ~.d^lti ~,~CIS'i'l~Jfr~ CcN `~TtilA,c.Z1.f:N No Gloss '~to W~.h,.?ASl I~.rt E ~srtir~ st?~ htlr~ Vi Location of action: ~-~J~Jrj ~1'~. IyRnL~ N`( Site acreage: . ~ /SLR~,~ l l ~ 6'~ s.F. Presentlanduse: 5~nit;,L,G P.~'vlW DW~i.I.N.~_ Present zoning classification: ~-4,p 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provid~e-d-': (a) Name of applicant: l~yy616t3~ G. ~7tdR~(g.19(Z (b) Mailing address: Z~ ~1 Ne. ~Y2~ ~o~~ CJU'C~eyoCal.1.G, N (c) Telephone number: Area Code ( ) 6?7~ ~ (05, (d) Application number, if any: Will the actio{n~be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III -Policies; Page 2 for evaluation criteria. Yes ? No ? Not Applicable IS Zflr?~ CZe~17f~a~ll1,I~L_ IhIV~VV'Ess ~a !'~r~[i'h~.l~ 1~?~Da7.IT?h'L, b' T2l.d.Ci'TIA~., ~c~GtDrn~, l.tU ~ l~?o G,os~ ~ wl;s} w?rsTE+ 1R~~ Yh.4twl~'i~ttJF1Q s~ ~ Wln.~, P~ pww?>D~ bu_ ~s cam' la~l R®o~- 1D2~n?•t•~~ Attach additional sheets if necessary W l'•~1.. ~Q ~v11J1~.> w~ ~{ty,t~J~1.t..5 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 1d.JVot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III -Policies Pages 6 through 7 for evaluation criteria ? Yes ? No ? Not Applicable D "}i~1V~y i~ ITV C~ V1SuRsL C.1k~'~RA~Ca1A2_ OF'('Li'~E IJCR • "CNL E~5Zl.1.Ys~ Wlt6R~ ~ ~ ~M.~.t.cA'u,R.e wUw~ Y3~ nn~?`t~+~tr..s~, Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Se(ct~io"n III -Policies Pages 8 through 16 for evaluation criteria Yes ? No ? Not Applicable W lw N o C.tA'.lsth'oE, G 'p4~ S-? SITL=~ W kii.C-{R- l S atW~leaRfots~ Flk'~- l~bn~~ 'llle~ IZ~fcNtG ~l1oT-~ ~s ~r~ 2o?~t~ x 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 ~'~,bE 1s C®rtinil~CR'~o 'i'.o ~L'~u6yt.C., ~,.s.~1~2 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. ? ? ? Yes No Not Appl• ble H'H+-t S~-G ~k ~\~•T r~'sNC~Q ~r.11A.1> NJ s-t'RCW-3h~ b~ItJLe Csa.15'~IOtJ. tZs~o(= ~,IshJ.6~~ wln.c~ Y~1~. Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III -Policies Pages 32 through 34 for evaluation criteria. ? Yes ? No ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III -Policies; Pages 34 through 38 for evaluation criteria. Yes ? No ? Not Applicable rc~~-rn..~tQ ~61•t1-r~~ ~yb'lsw-- w?w ~ti u,-n~.?2Ev~, ~,.Lb111t.R; OlL 'j7+sNK- 1N 7~4b~1Mk3.JC WM1 J 5~,, U oNV-~ 'Ma,c.~._ ~ZL~IO~.STI~+n.. G~/,42,~~. W bw !3~ ~bN- ~/LT-o~S~trN /1SNlp Co?.1'f~sj t~S C-~2 ~?~~~~fi«.1 Ohs Wbu, ~ Ixclu~a~ ~t.rrlr~ Cs~N~u.r1'le~c t~ 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 LW12P Section III -Policies; Pages 38 through 46 for evaluation criteria. ? Ye? No~ Not Applicable t~~t>Rol„ 1 s~br ~~srL.rn t~~'- /k~.~,aa 1~ kz.2..~zS ~r"~ 1S ~ ~ttQ~uc~ 1(Ls~eu~2.c..~ Attach additional sheets if necessary WORHING COAST POLICIE~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III -Policies; Pages 47 through 56 for evaluation criteria. ? Yes ? No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III -Policies; Pages 57 through 62 for evaluation criteria. ? Yes ? No ~ Not Applicable 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 s ~Era~ ~uN2.'Qo u.trc~l nl4 p~p~T i~ ~ ~,,fz l~ w rt,~? If"cl. ?.ro .6~R~.cy~,~aut2J~a, lets 4iZs.6'C+b In1 NYh~2 ~llmur+~t-r~-i 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 ts~-ny21A.[~RRat-+ W~u. 'Q~ W 131.t.. L~.3'stM~1dC~ ot~ W yu. ~ ~l~ l N ~t-j,/2_ tbtnn 1~.6~1.1..1 cQ 1A 5 E . PREPARED BY 11~J W~ TITLE TC~- DATE V Q+~( • (~RCg®f~R&CCZ 52 PK)YAC: PATH, ~O BOX 1374), WATER MLL, PEW YORK 11976 Tfi 631.754-5555 R®BI~R~' 41 EAST MAPLE ROAD, GREEPJLAWN, PEW YORK, D740 FAX 631.261-K~84 WEBER QR~~1051'E~4 April 21, 2011 , Southold Town Trustees APR 2 1 2011 Town of Southold Annex PO Box 1179 Southold, New York 11971 i RE: EUGENE C. BURGER, JR. 2385 Pine Tree Road, Cutchogue, NY SCTM# 1000-104-03-02 Southold Town Trustees: Attached please find the following documents submitted in an application for a Wetlands Permit. 1- Three (3) copies of the Application 2- Three (3) copies of Owner Authorization for site inspection 3- Three (3) copies of Agent Authorization 4- Three (3) copies of Short Environmental Assessment form 5- Three (3) copies of existing survey 6- Three (3) copies of Architect's site plan 7- Three (3) copies of pictures of existing house and site 8- Three (3) copies ofLWRP 9- Proposed floor plan 10-Fee . Thank you very much. Very truly yo\ylrs, I~ FREDERICK R. WEBER, R.A. t° ~ L t, _ {si;, C~z~. aF _ _ - i ~ ~ I L~.4'~1un w+k,N - - ~~n~~ wow ~I _-~~i-io6- _ 2 _ ~ _ - - ~ ~ ~ _ ~ ' J - D 1-- I. ~ ~"°~W ~ i I \ III ' - _ ~-I.~AICQ ~ r ~G ~ I II ~ ~ li pY~ _ ~ - _ _ I i ~ ~ i - _ I I i i, ~ -I- - _ - _ ~2o1.G--- -