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Pymm, Marilyn & William
WILLIAM PYMM 9 East High Road Port Washington, NY 11050 (Day: 800-628-3603) (Evening: 516-365-9642) (Fax: 718-784-3696) (e-mail: wil I iam pymm@redyref.com) o ~ IAAY - 8 2013 5/6/2013 own Via Mail and VIA EMAIL Amanda.NunemakerCa~town.southold.ny.us Board of Town Trustees 't'own Hail Annex PO Box 1179 Southold, NY 11971-0959 ATT: Amanda Nunemaker RE: Administrative Permit Application dated 4/22/13 to remove sand under floating dock at 2504 Camp Mineola Rd Ext., Mattituck, NY 11952 Dear ,4manda: As per our telephone conversation this date, please accept this letter as my confirmation that I am withdrawing my Administrative Permit Application, since the proposed work is no longer required. Sinc r ty ills Pymm -Site Plan - Proposed modification AppliranC Wiliam Pymm, 9 E. tiiph Rd., Port Waehlnpton, NY t 1050 p~ SCT#1000-122-7.15 Prepared by: William Pymm William Tu(ara Cate' 3IBl2004 2482 Camp Mineda Rd SCT#1000.122-9-7.25 kWltlludc,NV 11952 2504 Camp MlneoW Rd.Ezt. Maltitudc, NY 11952 Southold Town, SuRdk Cwnty Loan: W 72-31' I N40.59' Datum: AL.W. PA ConaWdion Notes: Camp MlneoW Rd.Ezt All Lumber SYP CCA pressure treated 1.S Ibslw.8 max. retention All hardware M be hot dipped galvanized .„r- Proposed ModMCatlon: ~ r° ~ , yam,, 12'x4' Fixed Dock Extension 4 New Pies Relocatlon of Fbat 8 Ramp North APR Scale i Properly Address: 0' 30' So' q 2504 Came Mineda Rd.Ext. ~ J pt Maltlludc NV 11952 _ . _ a ° P/L IM - interodal marsh Sparona ahbmi8aa ~ kiaree SCT#1000.122-9.9A Edward Fox 2 A 445 E. tIOM St. -AptBE New Yak. NY 10021 75' James Creelr WIdN of Waterway 100' - POd 70' ~ I Flood ~@ Ebb f . i + ~l I r ~ i i i i i I ~ AlW Existlrg Timber Jellye AIiW a $.n ` NYSDLC APP VED A9 PER TEAM! AND CONU1T1ON3 OA PERMIT ND. ~ - SIDItXYDS _ - _ Acoes4 llnstallatlon by Great Peaxric Bay DATE ~ 2~~ Barge "2 * Site P an -Proposed modification Appkdnt William Pymm, 9 E. High Rd., Port Washington, NY 11050 Prepared ¢y: William Pymm P2 SCT#1000.122-7.15 y~04 WIIBam Tutano SCTffi1000-122-9-7.25 2482 Camp Mineoa Rd 2504 Camp Mineola Rd.Exl. Matdtudc, NY 11952 MattltudyNY 11952 Southdd Town, Suffolk County Lows: W72-31' / N40.59' Datum: ALW. PA CawWdion Notes: Mirteda Rd.Exl All Lumtxu SYP CCA pressure treated 1.5lbsla.k max. retention Carne - AII haNvnre to be hot dipped galvanized _ _ Proposed ModBcatlon: ~ p ^ 1Tx4' Fixed Dods Extension ~ij LS- ±I ~Ii 4 New Pries Relocation of Fleet 8 Ramp sale APA ? 3 I ProPenY Address: 1 0' 30' 60' ~ 2504 Camp Mineola Rd.Ext . ; J p~ MaltlWdc NV 11952 i _.r 0 IM - intartldal march PA. Spartlna altbmi8ora ~ House SCTCiWO.122.9A.4 ~ ,c Edward Fox ~ 445 E. 8081 SL -Apt.BE New Yak, NY 10021 75' James Creek Width of WaMnvay 100' - i. POd ~ 7a Flood ~ ~ _ r Ebb 1 i r i i i i i ALW i AF1V1/ Existirp Tknber Jellys i r i i i i i i ~ N Y S D n G APP VED A9 PER TERMB AND COh UlT10NS OF PERMIT NO. ~1 ~5(p'~5 Acoass llnslallatlon by Great Peconic Bay DATE p~ 2~~ Barge ~ TVI" °a9?.'f0.0 I 6A2AL :~6 PLAN SUFFOLK CO MEALTNDEPT.APMIOV C SUFFWIL COUNiY DEPARiNENt Of MFALtH SERVICES .I___ f f :iad j.P~a ~ ^~JG~ ~ N.S. NO. 87-50-201 zu ~ 51 FAANIY DWFLUNG OILLY - r f r ~ ~-R- ,.v UTr Ui. DA ~ ~ 5. REf. ND. E7-.t f c r -t: a' ~r ~ f a~ n r~ ~ ~Lp -~.z.3 ~i.F i ~ 7f $FA hT~ IM >tAaBe dkpmel Rd ReM mPVb MtilNes ha a°` !~H) y,,l A~ c .c zap - r ~.j A 96f :.3U! akeemMveeeeafNpecOeg er mis DeRermleal rR O °r_ 1 . a a R ~ Rae, roeAa De Nasr,mn. ~ ~ ~ L * „A s-~• e p~,i, " ~ ~ o I ~Lt 9 It 59 dM'Sj s Chk R rasa R wesCRekr n N/F k Ng h I R ~ Si~TEMENT OF INTENT 1, ai a ~ '4. I THE WATER SUPPLY AND SENAGE DISPOSAL Jt ` ii6d'Y^~)~ .Y J e9 •y~ fJY•3a 1 ~ O (SYSTEMS FOR THIS RESIDENCE WILL ` NtNer s`'~y ` j~F" p ' T ~ I CONFORM TO THE STANDARDS OF THE yw aMdr~ f _J - I SUFFOLK CO. DEFT. OF NEALTN SERVIG[S. I 7 ~/.'yh1 pf t I ISI AMLICANT ` l ` 'as'p-~ N: d.,s::so •abe ~N;b 99 I auFFOLN fOUNTY DEPT. OF NEALTN ,Yre SERVICE4 -FOR APPR9V AL OF .Y ~L ~ /~mmf~ ?s- I ~7F~ ( CONSTRUCTK)N ONLY / h , ~ i DATE: / ii 'T ~ Af~e I N. 1. REi. NO_ 87-50-LC71 I t/ ~ l ~ r ~ APMOV[D: ~I ~ /~R / ' 4 y ~ _ -':"1 r } ~ 9UFFOLR CO. TAX IM~.06E16N/1Y~/1: - ~-~^-i ' `T.' DIET. SEET. ~ SLOCK NEL. ( ~ ~ N lvlav o~ r~Ra~-y ~ / SIJR.Yi YEP POiL Dw ADORE9~ ~ I l p~a~ 9 Enef High Pond t ~ ~ ~ ~9 ~ ' a n PYMM Por+ Wash~re7/on. M.Y. jfl3i°~'1 Y a,~ n T!T(1CK N. Y. DEED: L. r. 2 APR 2 2 2013 s. ~ . \ ~ ~t I Southold Town J ~ i~Of ~F p/~ h v' p ~ f Tr aohrK+ #a' fol.r s,gaer eo. o. aw. -a"_ - .c ifs ~ ; Q ~5 Cnreott awa bw/, N. G. v. D.)frolw: _ ~~Y_ g t l 2~bSIANd Mial.4 wolYl+'~Y ..1~1 lw. . ~._s - y_ Y?ewRisd! arQ let ! of efr~rro?ed evb- `.b~µ„~ !E~ ,_s g~'v/IiIN. Ia~FI~AY.a?e. Or Q6. AJItD. yak _ 9 r / - ooy.~r SEAL r/ ..5 ~ fdiEEY!!~i!(!O Ault//COtJ z;//y ~p T'!l~/IS'-hlp/iPONG6 (lO. 4d so ,r 1: teH.iab A,rrerrded.:sdpl' ~l, r9B~ n9effAed t'eb.r;,/td6 ...:F~ r,o? r7,r9aT B ^ - - - IN7~ERIGK VAN NYL. R ..q,r Ee,r9ed K++ '7 PEGO Nrc J ~ Y M1ror 1, x989 ~yµ-~-- Oec. 21 19p LIC[NEED LANG fURVEVORE ~ .:%i . CY+ 27, 199Y: RT NEW YORK I soFFO~,r ,lames F. King President ,L~~~ CpG P.O. Box 1179 Bob Ghosio, Jr., Vice-Presidem ~ Z Soutlrold. NY 11971 Dave Bergen ~ ? Telephone (631 765-1892 john Bredemeyer ,y T Fax 1631) 76Y6641 Michael .I. Domino ~ ~ yglpl # ,~aor. Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: MARILYN & WILLIAM PYMM request an Administrative Permit to remove the sand from the grass west of catwalk, under and around catwalk, and under floating dock by hand using a wheelbarrow and shovel; and to deposit the sand along southerly side of property. Located: 2504 Camp Mineola Road Ext., Mattituck. SCTM# 122-9-7.25 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 -Coastal Erosion -Amendment Administrative_Emergency-Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: J. King _B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. 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I n t A I x f p Y~ O , ~1 ' ~W ~ • p ~ 3j .N" om ~ d s C ~ i 9' xI F / ~ li + o ~ ,e di / 4 p q / ~ x ~ i O _ ~ l s o ao ~;.:w.. ~ i 1OO G ..n..~,~m p ~ . °o~ ~ ~ ,"w, ~ r ~ : .i ~ oa ~ ~ ~ ~ m. f ~..o. ~ Tr F _ ~ ~ ~ ? © 1;.N 'N ' 4~r I• pi p p• fY ~YW sir _-~1 4 ~ ~ ' 9 NpW t. p' J .v,ae e.~. • a,... 1 J - ~ -r. ~ • y ~.-u ~ r - - ~ xmrc COUHrv OF SUFFOLK © v ~croxxo .ry_ a~i ~ ~ _ e aw~iroa0'TS~9.mn~Y a 722 ~ ~ Nunemaker Amanda • From: William Pymm <williampymm@redyref.com> Sent: Monday, May 06, 2013 10:36 AM To: Nunemaker, Amanda Subject: RE: Trustee Permit App Attachments: Administrative Permit App - Withdrawn.PDF Dear Amanda: As per our telephone conversation this date, please accept this letter as my confirmation that I am withdrawing my Administrative Permit Application, since the proposed work is no longer required. I have sent the original of this letter via mail. Thank you for your help in this matter. RE: Administrative Permit Application dated 4/22/13 to remove sand under floating dock at 2504 Camp Mineola Rd Ext., Mattituck, NY 11952 Sincerely, William Pymm REDYREF - Dawnex Industries INTERAGTIVE KIOSK PRODUCTS 8 TELEPHDNE SPECIALTIES 1 nvismn nl 6_V8 intenu:bve. Ii7r. 3P, rt t. Icwnth at I any Island Cdy. NV 11107 t. 718.784-3690 x117 t. 718.784.3696 e Wlllempymm O~fedYfBLCOm va WNlW-redvref.com 1 • James F. King, President • ~OF SO(/jy .Town Hall Annex Bob Ghosio, Jr., Vice-President ~O~ 54375 Main Road P.O. Box 1179 Dave Bergen #t * Southold, New York 11971-0959 John Bredemeyer G Q Michael J. Domino '.2 ~ ~O Telephone (631) 765-1892 Fax (631) 765-6641 ~'~OOUIff'1,N~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit _AmendmenUTran f r/Ext nsion e gg11 ~eceivedApplication:3 D E W Y G D ~eceived Fee:$ ~C`ompleted Application Incomplete APR 2 2 2013 _SEQRA Classification: Type I Type IIUnlisted Coordination:(da[e sent) . I I _ ' /I1 ~ outhold Town i~LWRP Consistency As a smen[ Fonn `-f I %(p/l ~ f T us ~tjC Referral Sent: _ rT ~Pfate of Inspection: Receipt of CAC Report: Lead Agency Determination: chnical Review: ~blic Hearing Hel Resolution: Name of Applicant ~ f ~ iii / ~ Mailing Address 9 ~S~ /lief /C ~ ~wA~hr~ /oa/ ~1 / f'o ~J Phone Number:( > ,s/~ 36 s 96 y ~ Suffolk County Tax Map Number: 1000 - / ~ ~ ~ 9 7 ~ s Property Location: s Cy ~,gaiD ~iu,~v/1 K~L QX~ ~f~ef~ y //95 (provide LILCO Pole distance to cross streets, and location) AGENT: /if/~~j~ ~j~~ (If applicable) 7- ,y .-~~tt !l Address: 9 ~dSY ,,t ~ ~Q~ 6f/,~~.h~,~Zl ~ 7 //OS-~ Phone: -~/6 36S /~~o y~ Boa of Trustees Application • GENERAL DATA ,9 r AA~ Land Area (in square feet): / /3 bile l~ S Area Zoning: ~~-/~~a~( Previous use ofproperty: /~~~5/A lFiv L Intended use of property: ~5 ~4f L Covenants and Restrictions on property? Yes ~No If "Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes ~ No If "Yes", be advised this application will be reviewed by fhe Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ~ No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes x_ __No Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvoal`sfo11r site improvements: No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): 1.~ f,~t G,e,~s~ ~ca.~~L~Q,~a ,~4e,~,a ~ ~,~7~~-7~fL~ T 6 Q Rio vie ~ 1~~,~~/~:~~~. ~.S~~y,~ L D~~S/T S',Aay o~ So,.-7`/eeLr Sing ~ ,eoP/f~T~ Board of Trustees Applicatioa • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of th/~e proposed operations: ~ ~ o T® ~ y)~C~~ne v~ ~~S~~D v /f~ti T/vRRK SNevy,d Y Q°~' ~..i°?9ffi~' 1 ~rJeav~E~C ~,'.e.4~$ S'/IRvI~~ .~6 Area of wetlands on lot: ~ 19~~'squaze feet Percent coverage of lot:~% Closest distance between neazest existing structure and upland edge of wetlands: o feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ feet Does the project involve excavation or filling? No__ Yes +9OB/1e9° /oc tf~C~f~ Jxr~~w If yes, how much material will be excavated? cubic yazds How much material will be filled? ~ cubic yazds Depth of which material will be removed or deposited: .3 fT feet 0 Proposed slope throughout the azea of operations: ~s Manner in which material will be removed or deposited: ~ / ~ w~k~~boe~.w 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): o /o . s1~.zo • SEAR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Onty PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. A~~C-~AN~ / SPONSOj~ 2. PROJECT p1~.ME ~ ~ 3.PROJECT~tLOCATIONr// / D r SO y l~~J M/N~DL4 ^ ~ ~ County / Municipakry OL 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map 5. IS PROPOSED ACTION : New ? Expansion ? Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: JZeirtoue f~ G2.~SS C,eo,h~/~7`/r~ ,~~ie~.&) wEf~'~ Ca7k~sL,~' .A~/ S'stfo %p 6,i< ~~ar~~ 6y /,~.f~k/6oa~: ~S~ v~C U,[~065/~sdo~io -~a'77'/~~dLy -~%G.F y~ ~°~J.f/l7y , 7. AMOUNT OF ND AFFECTED: Initially acres Ultimately acres B.FFFFW~~~~I7777LIIIIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? I X1Yes ? No If no, describe briefly: f9~. 7WI HAT IS PRESENT LAND USE IN VICININ OF PROJECT? (Choose as many as apply.) I XI Residential ? Industrial Commercial Agriculture ? Park /Forest! Open Space ?Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes ~No If yes, list agency name and permit /approval: - VALID P MIT OR APPROVAL? ?Yes ~No If yes, list agency name and permit /approval: 12~~.''LLA""S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? LJ.es - No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /Sponsor Dafte/: Signature / ~~3 If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II -IMPACT ASSESSMENT o be tom feted b Lead A enc . A. DOES ACYION EXCEED ANY TYPE f THRESHOLD IN 6 NYCRR PART 617.47 H yes, coordinate Gle review process and'use the FULL EAF. Yes Q No 8. WILL ACTION RECEIVE IbOROINATEO REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 677.67 It No, a tlegative dadarafion may be superseded by arloflter inwlved agency. Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwAtten, g IegGrle) Ct. Existing air quality, surface or groundwatea qualify or quantity, rwise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage a Gooding prMrlems? Explain brkfly: C2. Aesalelb, agrlculuaai, ardleealogical, hisWdq or other natural or cultural resbrxces; ar cemmunGy a neighborhood GlaraderT FJgdaia Ixiefly: C3. VegefaGon or fauna, fish sheltfls 'or wGdlife-spades, sigruficam habttats, or Glreatened or endangered spedas7 Explain briefly: C4. A community's existing plans or goals as offidasy adopted. or a-change in use or intensity of use of land or carer nature? resources? Fxplaln briefly: _ Y C6. Growth, subsequent development, or related advRies likely to be induced by the proposed adion'+ Explainbde0 C6. Long term, shoo term, amulabve, or other effects not identified in C7-CS? Explain briefly: - C7.-Other impacts ndudin than es in use of either uantil or t e of ene ? Ex lain bnefl : - D. VYILL THE PROJECT HAVE AN IMPACT QN THE ENVIRONMENTAL CHARAC7ERiSi1CS THAT CAUSED THE ESTA6LISHMEN7 OF A CRITICAL ENVIRONMENTAL ARFJI CEA 7 If s, lain bdefl Yes a No EIS THERE, OR IS THERE Uk;F1Y TO 8E CQNTR Y R9ATFA TO POTENTIAL ENVRONMENTAL IMP If . apt Yes Q No PART 111- DETERM~ITION OF S10NIFICANCE (To be completed by A@erlcy) INS'iRUCT10lIS: fareachadverseelfedidenhfiedabove,defertninewhetherltissubstaetia4large,,snpatanforotliarwiiresignificarlt Eedt effect ahadtl be assessed in cannectiorl with tis (a) seWr~ (Le. urban a mreq; (b) probability d occlirTirlg; (c) duration: (d) ilTelnersbGGy; (e) geographic scope; and {fl mag6llltde. ff necessary, add attachments or refererroe supporting materials. Ensure. that exptenatiorls coatakl- suffickrddetapbWawlflateGfelevantadwiraehnpards have beankentifiedandadequaklyaddflessed. HquesgorfdofpartNwasdiedaed yam, the determinatan of slgnifroanoe must ewduate Ule pouf Gal lmpaaof the proposed action on the emAmnmen(at aharaderlsdcs of Cre CFA Clledr tiib bmr Hyou Inilre identfed oneamore prnaMiaGy Wrge orsignGfeantadverse knpacts wfildl MAY oeax. Then FJ1F and/or Prepare a positive dadaraGOn. Primed direcflyto Gle (xledc Uds boz if yar~have determkled, based on Gle information and analysis above and any sigrporgng dadmlerNation, that the proposed a ' WILL NOT resuG in any signiGpnt adverse environmental impacts ANO provide, on attachments as necessary, the reasons supporting lhi determination. Board of Trustees Name of Lead Agency Dale President ~ Pont or Type Name of Responsible OKcer in Lead Agency Title of Responsible Officer Synalure of Responsible Officer in Lead Agency Sgnafure of Preparer (If different from responsible officer) e~~r~ Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATN)N: s.c.i.M. p: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A a~ STORM-WATERr GRADING, DRAINAGE AND EROSION CONiROI PLAN T ~ -gam -g)--~ -C-i- CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK -PROPOSED CONSTRUCTION ITEM # /WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? ~ Will this Project Retain All Stomt-Water Run-OR (include Total Area of all Paldels k>cafed wihin / ~ eQ ~ Generated by a Two (2') Inch Rainfall on S'ReT ? the Scope of Work for Proposed'Construction) v (This item will include all runoff created by ske ~C b. What is the Total Alva of Land Clearing clearing andltx construction activities as well as all andlor Ground DisNrbance for the proposed I ~ ~ Site Improvements and the permanent creation of consWdion activity? impervious surfaces.) (S.F. I Aver) 2 Does the Site Plan andlor Survey Shaw All Proposed PROVIDE BRIEF PROJECT DFSCRB'1'fON tr>nwia AdtliWrW PaparuNwtleE) Drainage Shuctures Indicating Size&Location?This ~ ? \ Item shall include all Proposed Grade Charges and Q. f) 0~~~ / _~S / ~~~~~fi' /J~Q 1 Slopes Controlling Surtace Water Flow. ~~~Ax[~ej~W x01 l Mc / 3 Does the Site Plan andlor Survey describe the erosion X ? pp and sediment control practices that will be used to T Fyah~Ny..e ~NA fj/-d/~rr 6~~ ~ ~Hd ,~q t o~ ~it~ control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Pericd. lk, c,(~ ~.F.e7dy ~~if7lr0 4 Will this Project Require any Land Filling, Grading a ? d/~~G T b~ Grtc ~ ED y F ~ Excavation where [here is a charge to the Natural Existing Grade Involving more than 200 Cubic Yards S LO of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities A~S~* D7 ~eg t ,r, n~ Encompassing an Area in Excess of Five Thousand I/ ~`o/' (5,000 S.F.) Square Feet of Ground Surtace? 6 is there a Natural Water Course Running through the ? Site? Is this Project within gte Tmstees jurisdiction iP aenerel DEC SWPPP Regutremerrts: or within One Hundred (100') feet of a Wetland or ~z Submissbn of a SWPPP is requketl for ell Consbuctlon activi0es involving soil Beach? disturbances or one (i) or more acres; including disturbances of less Nan one acre that ~ Will there be Site preparation on Existing Grade Slopes ? are part of a larger common plan that wip unimetey disturb one or more acres or land; which Exceed Fifteen (15) feet of Vertical Rise to including ConsWCtion aetlvitles involving soft d4slurbences of less than one (1) acre where One Hundred (100') of Horizontal Distance? the DEC has deremYned that a SPDES permit is required for storm water discharges. (SWPPP's Shall meat the Minimum Requlremems of tlra SPDES Genarel Pem1N $ WIII Driveways, Parking Areas or other Impervious ? !or Storm Water Discharges hom Constrvction actlvity • Permit No. GP-0-0O-0Oi.) Surfaces be Sloped to Direct Stone-Wolof RUo-OR tP 1. Tha SWPPP shaft be prepared prbr ro the submittal of the NOI. The NOI ahaN be into andlor in the direction of a Town dght4f-way? submitted to Iha Department prior to the comrnancenieM of constiuclion activity. z. The SWPPP snap desaiba the erosbn and sediment control prectlces and when: 9 Will this Project Require the Placement of Material, ? required, postconsWdion storm water management predicas that will be used and/or Removal of Vegetation and/or the ConsWCtion of any wnsWcted to reduce tta poflulents h storm water Obdrarges and to assure Item Within the Town Rightof-Way or Road Shoulder compllanca wiN the temp and conditions of this permit. In addNicn, the SWPPP shad Areal PM1b Iwr mn Nor uwr,br nw la.mnnloa a IMwvny Apmna) identity potential spumes of pollutlon which maY reasonably be expected to aRttl the quality of storm water discharges. NOTE: If Any Mswer la Weatlona One through Nina b Answered with a Check Mark 3: All SWPPPs that regWre the postconslmdbn storm water management PraGke In a aox and the mnatructlon ails diaturbarrca is between 5,000 S.F. a 1 Ace in aroa, component shaft be prepared by a qualified Oeapn Profeasbnel Licensed in New York a Storm-water, Grading, Drainage a Eroebn Control Plan ie Raquked by tlw Town of that is knowledgeable in Ore pdnclples and precllces of Storm Water Management Soutlrold ant Must be Submitted br ReWew Prior to laeuarrd of Arry Buptling PermR (NOTE: A(Y,eCk Mak l~l a e kROgWretl bra CaniPleb Apptcetbn) ,.a.e o @W o I STATE OF NEW YORK, ? U618S:?~si} COUNTY OF..._ ......................................SS ,:ia^,~"•tolk"o(!afv being duly swum, deposes and says that he/she It ~ That I, ~!!1fl.L~:~ s [he applicant for Permit, (Name of b signirg Dowmenq And that he/she is the ~ixJ.~ (Owner, Conbaglar. AgeM,'Capomte Officer, etc.) Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tme to rite best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Swom to before me ttu~ day of N 1. , 20..~.~ Notts' Public:._ 1ti~.~.A....~ .....~-J.U.t~..(~~.......... (Signature of AppNCan1) FORM - 06/10 Boar~f Trustees Application • County of Suffolk State of New York ~ ~//~,rry ~ M~ BEING DULY SWORN DErOSES AND AFFIR S 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 HIS APPLICATION. Si a re of Property Owner SWORN TO BEFORE ME THIS DAY OF 1 ,20 ~ Notary Public >iata of a?au~ Y'ark ".=_i~1Fs5pE+0 ~tfol+2 C;runNP~ i; .y!C!~ tai ?v.~ RPR-24-2013 07:30 FROM:DRWNEX RED REF 7187843696 T0~17656641 P.1 Soa~of T>KUStees Applioatipn ~ s ~ ~ y / AUTHORIZATION ,~yy"~"" (where the applicant is not the owner) 1,_1r~vrl~ residing at ~f>ss~,~yr~j ~d (print net property) (mailing address) P ~kl~e~~N~ //osb do hereby authorizePM~y (Agent) i to apply for permit(s) from the a Southold Board of Town Trustees on my behalf. ' /y,~ /a~.t,n , Own s si lure) .Kr. `~MIILLiAM A MARII.YN PYMM 6284 ~ " . ",'SPECtAL';~" ~a Maaorri oHAse eto awwo 8rgcer e EAST HIGH ROiltp ~ BROOKLYN, NY 17211 - - ~ PORT w~trpornN, Nv t toso I a . laizto r ,ii,,',~ 4124/2013 ~ z ~AAV T07HE ~x.~ rt<a _ " _ ~.OROER OF,~+SHU~old To [~n19tg9E - - µ M< Two Hundred Onl . AQ4LAR3 Eoutno~d town wait ~ ~ p, P.p.Boz 1179- Southold, NY 11971 ' DEMO - F dm' S1Yal ve P9r ~it s ` ~T~'~"` .AW?HORIZGb 51GNg7lIRE , R,-"~-'~~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FDRM The Town of uLhold s Code of Ethics prohibits conflicts of interest on the Hart of town of£cers and emolovees The purpose of this form i to provide information which can alert the town of possible conflicts of nterest and allow rt to take whatever action is to avoid same. ~~~~'Jq / YOUR NAME: ~MP'1 ''`~lll.~~ ~(La~t name, first name, griddle initial, unless you are applying m the name of someone else or other entity, such as a company. if so, indicate theother person's or company's name.) NAME OF APPLICATION: (Check all that apply.) - Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring - Exemption from plat or official map Planning Other (lf"Other', name the activity.) Do you personally (or through your company, spouse, sibling, parent. or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest^ means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which [he town officer or employee owns more than 5% of the s s. YES NO If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title br position of that person Describe the relationship between yourself (the applicanUagentlrepresentative) 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) [he owner of greater than 5% of the shares of the corporate stock of the applicaant (when the applicant is a corporation); B) the Iegai or beneficial owner of any interest in anon-corporate entity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSIiIP Submitted this of ~~Q~L 2 Signature Print Name Form TS 1 Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for perrnits* 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 determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the 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 Progam. A Qronosed action will be evaluated as to its significant beneficial and adverse effects uaon the coastal area (which includes all of Southold Townl. 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus each answer must be explained in detail, listine both supportin¢ and non- supportin¢ 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 Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# l3 ~ 7, a PROJECT NAME 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 ? construcflon, planning activity, agency regulation, land transaction) ? (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Q ffMo r~ -p.,wo f,~i CDa7«,./~ ~ Uyo~~ f/ a7`,w~ ,C~ ~0,~~.s//y C~a~,~/s>'~% Q.l/ S'~,p To e~ ,PMo LARD y .fL o.Cocu v= d F v,e~s. ®.yo wv ~ ,F~ n ~ O Location of action: ~ `~"1~/ I ~/N Pd ~d ~/j /Y y Site acreage: / /,~~/Z~l R S Present land use: zt~Sr D~J,~i~t Present zoning classification: ~C ~S~p gw~~.f 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: / (a) Name of applicant: lb~-l-ttY- ~,~//~~~/L'~~N/ ~~~f/ /,~J ` /J (b) Mailing address: / ~`j !~-dS,{/rr~ TaN NJ ~/OS'~ (c) Telephone number: Area Code ( ) Sl~ 3l° s / 6 (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ? No ~ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III -Policies; Page 2 for evaluation criteria. ? 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 Southold. 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 ~NotApplicable 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 ~NotApplicable 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 Applica~ 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 LW12P Section III -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 III -Policies; Pages 38 through 46 for evaluation criteria. ? Ye~ No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICIES . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III -Policies; Pages 47 through 56 for evaluation criteria. ? Yes ? No ~ 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 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 PREPARED BY [.l/1u/.~L~''( I/~y/~ TITLE DATE y°~~ /3 Board of Trustees Application / 3~ 7lP S (p /e y AUTHORIZATION (where the applicant is not the owner) ~ residing at ~ ~~s ~ I, ~ R/~ (mailing address) (print vner property/) /y7 //osb do hereby authorize ~u~~f~ /n+a t K - (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. p~ s si ture)