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TR-8270
John M. Bredemeyer III,President �O��O� S0 - . Town Hall Annex Michael J.Domino,Vice-President O 54375 Main Road P.O. Box 1179 James F. King,Trustee Southold, New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,TrusteeFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1027C Date: August 11, 2014 THIS CERTIFIES that the installation of a 4'x9' fixed ramp using thru-flow decking, leading to a 4'x9' hingedp with railing using thru-flow decking to a 6'x20' floating dock using composite decking-, and removal of(5) dead trees At 820 Smith Drive South, Southold,New York Suffolk County Tax Map#76-3-21.3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 18, 2013 pursuant to which Trustees Wetland Permit#8270 Dated August 21, 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 installation of a 4'x9' fixed ramp using thru-flow decking, leading,to a 4'x9' hinged ramp with railing using thru-flow decking to a 6'x20' floating dock using composite decking; and removal of(5) dead trees. The certificate is issued to DANIEL S. MELHADO owner of the aforesaid property. Authorized Signature 0 0 Bredemeyer Ill, President %11FF0t4, Town Hall,53095 Main Rd. .el J. Domino,Vice-President j� Gy P.O.Box 1179 James F. King y Southold,NY 11971 x Dave Bergen Telephone(631)765-1892 Charles J.Sanders l �a�! Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 7 j a- C) i)-' Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/2 constructed ::Yproject complete, compliance inspection. INSPECTED BY: COMMENTS: - CERTIFICATE OF COMPLIANCE: James F.King,President O�g�fFO(fco Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President P.O.Box 1179 a Dave Bergen w Southold,NY 11971 0 John Bredemeyery Telephone(631)765-1892 Michael J. Domino �O1 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction _ %constructed Project complete, compliance inspection BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 8270 DATE: AUGUST 21.2013 ISSUED TO: DANIEL S. MELHADO PROPERTY ADDRESS: 820 SMITH DRIVE SOUTH, SOUTHOLD SCTM# 76-3-21.3 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 August 21,2013,and in consideration of application fee in the sum of$250.00 paid by Daniel S.Melhado 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 install a 41x9' fixed ramp using Thru-Flow decking, leading to a 4'x9' hinged ramp with railing using Thru-Flow decking,to a 6'x20' floating dock using composite decking; and to remove five (5) dead trees; with the condition the dock with vessel does not exceed the 113 rule across the waterway; and as depicted on the project plan prepared by Daniel S. Melhado, received on June 18,2013, and stamped approved on August 21,2013. 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. h� too TERMS AND CONDITIONS The Permittee, Daniel S Melhado residing at 820 Smith Drive South, Southold,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages,of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Permittee will,at his or her own expense,defend any and all such suits initiated by third parties,and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved,but should circumstances warrant,request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 0 0 James F. King, President SOF SO(/Th, Town Hall Annex O� �� 54375 Main Road Bob Ghosio,Jr.,Vice-President h O P.O.Box 1179 Dave Bergen # Southold, New York 11971-0959 John Bredemeyer G C Michael J. Domino %�� Telephone (631) 765-1892 00UFax(631) 765-6641 �yNT'1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 21, 2013 Mr. Daniel S. Melhado 820 Smith Drive South Southold, NY 11971 RE: DANIELS. MELHADO 820 SMITH DRIVE SOUTH, SOUTHOLD SCTM# 76-3-21.3 Dear Mr. Melhado: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 21, 2013 regarding the above matter: WHEREAS, DANIEL S. MELHADO 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 June 18, 2013, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 21, 2013, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 • . WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of DANIEL S. MELHADO to install a 4'x9' fixed ramp using Thru-Flow decking, leading to a 4'x9' hinged ramp with railing using Thru-Flow decking, to a 6'x20' floating dock using composite decking; and to remove five (5) dead trees; with the condition the dock with vessel does not exceed the 1/3 rule across the waterway; and as depicted on the project plan prepared by Daniel S. Melhado, received on June 18, 2013, and stamped approved on August 21, 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: $0.00 Very truly yours, James F. King President, Board of Trustees JFK/amn t Pk�-WAW w+r.ip.- j.. i \ i 3 ' SUFF04 James F.king,President �� C P.O. Box 1179 Bob Ghosio,.lr.,Vice-President Southold,NY 11971 Dave Bergen Telephone(631 765-1892 John Bredemeyer Fax(631)765-6641 Michael J.Domino y 'T Southold Town Board of Trustees (F� i d Inspection/Work Session Report Date/Time: 0 '� DANIEL S. MELHADO requests a Wetland Permit to install a 4'x9' fixed ramp using Thru-Flow decking, leading to a 4'x9' hinged ramp with railing using Thru- Flow decking, to a 6'x18' floating dock using composite decking; and to remove five (5) dead trees. Located: 820 Smith Drive South, Southold. SCTM# 76-3- 221.3 '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: �� dX �Gua1l P ent Were: J.Xng _B. Ghosio D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out ' the field by 1T 2/cCCYY�/II C r'__ Mailed/Faxed to: Date: NEW YORK STATE DEPARTI&T OF ENVIRONMENTAL CONSERVA# Standard Activity Permit Numbe AP-1-09-011 PERMIT Under the Environmental Conservation Law (ECL) STANDARD ACTIVITY PERMIT SAP-1-09-0 7VE Reconst/Repair Catwalks; Install/Replace Ramps/FI E QPermittee and FaciliInformationt3' JULS Permit Issued To: Facility: Ti , t, s i Facility Location: Facility Principal Refere a Point: NYTM-E NYTM-N Applicable DEC Regi (s): 1 SAP Authorized Ac " "ty: Reconstruction or repair ofwAstia& legally-constructed, functional open- pile catwalks up to eet m width, install or replace ramps and floats with associated float pilings and up to 2 mooring piles All work shall be in strict conformance with the attached plans stamped "NYSDEC Approved" on 7llg'�t3 Permit Authorizations Tidal Wetlands-lVudpr Article 25 Effective Date: Expiration Date:*/.I--O—L V NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations,and all conditions included as part of this permit. Permit Administrator : sVA Address: 4.Z) Page 1 of 6 NEW YORK STATE DEPART OF ENVIRONMENTAL CONSERVA* Facility DEC ID 14738-04273 PERMIT L V 6 .v, L - Under the Environmental Conservation Law U Permittee and Facility Information Permit Issued To: Facility: DANIEL S MELHADO MELHADO PROPERTY 820 SMITH DR S 820 SMITH DR SISCTM 1000-76-3-21.3 SOUTHOLD,NY 11971 SOUTHOLD,NY 4738 (631) 876-5346 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Southold Facility Principal Reference Point: NYTM-E: 716.149 NYTM-N: 4546.935 Latitude: 41°0241.9" Longitude: 72°25'41.8" Project Location: 820 Smith Drive South - Watercourse- Goose Creek Authorized Activity: Reconstruction or repair of storm damaged, legally-constructed, functional open- pile catwalks up to four feet in width, install or replace ramps and floats with associated float pilings and up to two mooring piles. Float piles will have locking collars or blocks located two feet above the canal bottom to prevent the float from resting on the bottom at low tide. All work shall be in strict conformance with the attached plans stamped "NYSDEC Approved" on 7/18/13. (SVA) Permit Authorizations Tidal Wetlands-Under Article 25 Permit ID 1-4738-04273/00001 New Permit Effective Date: 7/18/2013 Expiration Date: 7/17/2018 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: SUSAN ACKERMAN, Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY @ STO BROOK150 CIRCLE RD STONY BROO ,1 Y 11 3409 Authorized Signature: Date Z(DK°) Page 1 of 7 D 3tl`6r• � "" � caw•. ' � • , '� � pE�o TRE=s, m ':A \ 0 N ^' 0 kmc i�e/a i ® LSO I� �Lo zpsr� cd ' DZO -A� 6 x � � PAR G 2 .. 6Ft 56 o 'Po" 1 12Og6� {^E 1'oPMoµ WflNK LI C P N E_ --__ _ TOP. Of= BANK AT GAS N- N 0'F ._ K Sdu-tl-lobo Ny 119 ( ( EPA( t� a s �o -y� ,� =1 o, N iLL ;c7 .laoo -76-3 -21, 3 ._ _ 00 YV - - - - DflNl�=�S . M�C��apo��_ 47' ..:_! 10 -OLVU)bb000► - w ............ rv. 1 �. a 4 � - v 0 0 James F. King, President QF sour Town Hall Annex Bob Ghosio,Jr.,Vice-President ��� y�l 54375 Main Road h O P.O. Box 1179 Dave Bergen 1 * Southold,New York 11971-0959 John Bredemeyer H Michael J. Domino p Telephone(631) 765-1892 i Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 12, 2013 Daniel S. Melhado 820 Smith Drive South Southold, NY 11971 RE: 820 SMITH DRIVE SOUTH, SOUTHOLD SCTM: 76-3-21.3 Dear Mr. Melhado: This letter is in regards to your application received June 18, 2013 that included a request to remove five (5) trees that are dead or dying on the above mentioned property. The Board of Trustees determined that four(4) out of the five trees located towards the southeast side of the property may be removed at this time. The fifth tree located on the southwest side of the property is to remain. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, mes F. Kicnogr President, Board of Trustees JFK:eac 6 a .lames P. Kind,President �gpF F01/f Cp- P.O.Box 1179 Bob Ghosio. Ir..Vice-President Z Southold.NY 11971 Dave Bergen ? Telephone(631 765.1892 John Bredemeyer Fax(631)765-6641 Michael J.Domino Southold Town Board of Trustees Field Inspection/Work Session Report Z, a Date/Time: J 1- / 0 2 a /3 1,2 , DANIEL S. MELHADO requests a Wetland Permit to install a 4'x9' fixed ramp using Thru-Flow decking, leading to a 4'x9' hinged ramp with railing using Thru- Flow decking, to a 6'x18' floating dock using composite decking; and to remove five (5) dead trees. Located: 820 Smith Drive South, Southold. SCTM# 76-3- 21.3 Type of area to be impacted: CrtC-,� IL 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: vJ. King _B. Ghosio D. Bergen, L-�_J. Bredemeyer Michael Domino D. Dzenkowski other Form filled out in the field by �9 Mailed/Faxed to: Date: #V /4n )c::�T_ ilc�P-orl) CAAIiAL Z C04AvA4. w10=5- OLD 10=a [_0 l0oc.K 4' x2Ac ' (�CFoRE 5 KORAI IL/ C2 L 10 D d C, K (,1 X 2�t I J c r a 5 o c. o o o c, K A 70 2ivi (� N IGHoR NEt,, � o� k 6/X100 7 DE�o ''�"fZG� S �{ Tv 6� lZnr Mavtr� M ra2K�O �c 0 '(�� •c c '�G /3c` 2>EMOVc`DlviTf4 X 3 EC 1VE D] JUN 1 8 2013 u hold Town d .Trus-Qs 44*0. wo 406 41 � a � �-�_•tea k Y a a i • xt � l 4rl T . as AL l� .�1 l3_; e.eY r. p \ cS �� rR �� D. - es. •r, - Y r. i -.niy Yn5' 'b ` W YJ �v,�rsY C n by 5 sem. �R F w _ - . t '�°�rj �, ,,, ,a ". . ", .. �' =w � ? ,� , �,�:. . . . , � � - ��^x- � ' _ - ",brtr - - 'e. va. �� eA 4, a r fr.. 3Y�jNM �. • y. ./ rr./" h•�� �ti)�: j� h , i� r- 01 0 dk ♦ r `Y i ,r•• •„� .fA w ,, °o, � fir” ,ow �' " „. 14 ILI { , � f1 qq r ' 1 j' a- ' �.. ' + W 1 . -44+1 ri OWE 44 i 4_ v � '* ..yam '- .:i: •$. *ysn-` - - ,,,,.,�,. y`- .. ems-I^�=�^' � .. .•. .. '' +k .. _ .. r ^ .av s s h d r n gpFFO(,� James F. King President p� COG P.O.Box 1179 Bob Ghosio,Jr..Vice-President �h� Z Southold.NY 11971 Dave Bergen Telephone(631 765-1892 John Bredemeyer p � Fax(631)765-6641 Michael.I. Domino 4, Southold Town Board of Trustees Field Ins pection/Worksession Report DatelTime: 9 /Z / '.�_ DAN & NANCY MELHADO request a Pre-Submission Inspection to discuss the replacement of the non-functional dock and to remove a tree that shows rot. Located: 820 Smith Drive South, Southold. SCTM# 76-3-21.3 Type of area to be impacted: �altwater 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: Ale e �,// �iYhl l Conditions: +r �- o Pres �. Kinner B. Ghosio / D. Bergen, J. Bredemeyer // Michael Domino D. Dzenkowski other Form filleut ince fiend by Mailed/Faxed to: Date: ' t s ;�►_- � ` as ex 1 _ � 1 1 s oil te, A 4WO .4 1.+ M1 N.. • sly _�u._x .. y� 'x �� �. •,.,_fir.:, 1. - y. Ili •� a `G Pers `- +y�y �♦ l 9� .�. -. �x � '�'^'r+ .� e� Iii:,♦"v5�! ♦:. ^�' � � 5, _ a'r19+��� �� � � g� r •z - yx -a d x +YF e' } y t f. ! y � -�s +W J j1^ g Y �3♦roti" . 4 ., l 1-"p ' � �'� t�M„ S Ytf J,(1.3 � .,,.1� ,� , + A4 Y+4 rky 1•� I � 1 � ►r r . ,. ,' t__ n. r 1 . T` f F.,1 I t �:o�� •P' ���y ,per i�C . h Y f. �r 3 'NTaz :� Ski` t'a. f� � -yaa;y 4 y. . ,off - z �a 31"- � •u. s4` �.. `fit 6�� '. •� �, �� - L i w �1•P �yrig, 4 t2� P�• •r � I � _ i F I Oj 11ff a�dj' Flu, i• . - � � N e � a a s ti. 6, a ar � COU1lIV OF SUFFOLK PmrtY Tpn_Smxa)ro a 76 ���� -µ➢. ,� _ —_— �'_ __.__ '�—__ --- ® � ®vim �, r.wEmr..r OFFICE LOCATION: �OF soajyQ MAILING ADDRESS: Town Hall Annex �� l0 P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 • O Telephone: 631 765-1938 Fax: 631 765-3136 MUM, LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD nn MEMORANDUM To: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: August 20, 2013 Re: LWRP Coastal Consistency Review for DANIEL S. MELHADO SCTM#1000-76-3-21.3 DANIEL S. MELHADO requests a Wetland Permit to install a 4'x9' fixed ramp using Thru-Flow decking, leading to a 4'x9' hinged ramp with railing using Thru-Flow decking, to a 6'x18' floating dock using composite decking; and to remove five (5) dead trees. Located: 820 Smith Drive South, Southold. SCTM#76-3-21.3 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 below listed policy and therefore CONSISTENT with the LWRP provided that the Board: 1. Determine that the dock meets the 1/3 rule and "dock line" regulations to further the policy below. Since the dock is not show on the survey it is difficult to determine if the dock meets the rule or projects past the other docks in the water body. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction § 275-11. Construction and operation standards. (b) Dock locations and lengths. [Amended 10-11-2005 by L.L. No. 17-2005] (2] Within creeks and other narrow waterways, no dock length shall exceed 113 the total width of the water body. Determination of the length of the dock must include the dimensions of the vessel. The beam of a representative vessel should be determined. ^ ^ Satellite Map Photos Labels Figure 1. Subject parcel. Further it is recommended that the Board assess the following dock standards pursuant to § 275- 11. Construction and operation standards. [1] Whether the dock will impair navigation or be located in areas of high vessel traffic or vessel congestion. [11] Whether the cumulative impacts of a residential and commercial dock will change the waterway or the environment and whether alternate design, construction, and location of the dock will minimize cumulative impacts. In the event that action is approved, it is recommended that a vegetated buffer be established. 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 • o��'bpFFQ(�Co • lbwn Hall,53095 Main Rd. Peter Young,Chairman ; P.O.Box 1179 Lauren Standish,Secretary , 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., July 10, 2013 the following recommendation was made: Moved by John Stein, seconded by Jack McGreevy,DA it was MELHADO to install a floating RESOLVED to SUPPORT the application dock and ramp and to remove five (5) dead trees. Located: 820 Smith Drive South, Southold. SCTM#76-3-21.3 Inspected by: John Stein Vote oCouncil: Ayes: All Motion Carried James F.King,President so�rti Town Hall Annex Bob Ghosio,Jr.,VicePresident ��� �l0 54375 Main Road P.O. Box 1179 Dave Bergen Southold, New York 11971-0959 John Bredemeyer CA G p� Telephone(631) 765-1592 Michael J.Domino 'Q Fax(631)765-6641 �y000H1'1, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Tran f r/Ext nsion _LAeceived Application: 3 Zeived Fee:$ d. D G G Y G � pleted Application D D Incomplete D SEQRA Classification: Type I Type II Unlisted JUN 18 2013 Coordination:(date sent) _,,/�WRP Consistency A se sme t Form 2 1�AC Referral Sent: od awn _,,6ate of Inspection: _7�� Burd of Trustees _j _Receipt of CAC Report: Lead Agency Determination: T clinical Review: blic Hearing Hell Resolution: Name of Ap��p}}licant 0 A U I EL 5 . M E04A 0 O Address U 2f✓1 I l / ( 2 ',C , �/�l 1/4 Phone Number:eo'3/ b 7 6 7 3 "I 4 C61- 631 6�d y�4y Suffolk County Tax Map Number: 1000 - 26 — 3 ' 2 11 3 Property Location: g 2 C> Sm7l-4 l-I O 1` S L 2 12,0 ' —rcgky I'nnLWGE HND S (MiTH (AS (provide LILCO Pole#, distance tocross streets, and location) AGENT: (If applicable) Address: Phone: Se�� BWd of Trustees Applicatiob GENERAL DATA Land Area(in square feet): Area Zoning:_ Previous use of property: _S,1 M r Intended use of property: S fl he Covenants and Restrictions: Yes 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 JL/_No Does the structure (s) on property have a valid Certificate of Occupancy__V_/_Yes No Prior permits/approvals for site improvements: Agency Date i/ 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): SEC # 1 A)S1ALLFL0A%/Ay6 00LGr 4 eAMP 2 FMdvc DeAoT&Es 0 l`26 SST DEC 21 P [ow SSEc7- - - - - _. _ �NS7HLLLaaTiNG Qn6 -l z_1TK_ (,�r QRAFT _ X1►��Q__Ns� lnJ-c,rip �n.� c�AT�2� 1�t�GEQ-�-�M P w�T�/ F�c�IA.nC C�Ak v)w- _ Z— 4OR I'I PE 5 GGII G �GGLA_./ - S a-A LED -rC2PM -- - - - _ GALVAoVi7eD__ANQ 57- In>L �� Slffl,--_ i4Rt2c�taR _ 2x CGA , COAv ST�uL ons L mow, 3.-X_Ll LGA , _ vNS7'(LCZ"[ov L v los M!L. 7(f42u j:.�LCbe.w VAcKIwG q)(-L4 CC.A . Po sTs Gp �.v�N/Z�Z? f}ND STRIIvLESS 57��� H>�rRDw�RF �ikFO Q AM P � x4 ' 2x� CCS , CON STRvsTjoa LvMl3c� 2)y Cc-/9 Go n� Si2 v STio,v L �Mf3 �2 1 P2u rLoco J�EGKlIvG (canhnued) x c� c.c q. Pa s TS � —n 4.In C-/o ._ ,i 1 [ C'rc� �-� ✓E P2 oFss/ONI3C. �R€C S' Rv/cam EMovc ALLl B W d of Trustees Application • WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: IAJ i ALL FL0P-Tai F3aAT Due,V �c RAM rod' hlli CoA 1 2 FTA Rcd`�©V� ( �4q (�cG 5 Area of wetlands on lot: 4Tc:)Csquare feet Percent coverage of lot: 3, Closest distance between nearest existing structure and upland edge of wetlands: J C3 O feet Closest distance between nearest proposed structure and upland edge of wetlands: feet 9 X g I RA M P 12�� O F F G Rau N iD W IT� 1 Does the project involve excavation or filling? -rJ4R tl-rLow 0a k 1 pJe� 'C 6 �" S v N 1-1&N TJ V/ No Yes If yes, how much material will be excavated?cubic yards A How much material will be filled? N r ` cubic yards Depth of which material will be removed or deposited: )A feet Proposed slope throughout the area of operations: NA Manner in which material will be removed or deposited: ► r/ PL 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): /VO4 PROJECT ID NUMBER • SEAR APPPENDIENDI X 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) i.APPLICANT/SPONSOR 2.PROJECT NAME OA N I c S. M 6LRA Ota FLn fA-ic. DbGK IA 3.13ROJECT LOCATION: Municipality /00 — — — County su p 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map �'zo51`1lTH OQ. SJ SvuTHOLO Ay 11911 j IJ T cT W I TN (Z (2LK1C v� 5.IS PROPOSED ACTION: KrNew ❑Expansion El Modification/alteration i 6.DESCRIBE PROJECT BRIEFLY: ((��FLOA IA/$TaLC_ 'fitiG OH oGK� I_nn J rtxi bRP P S cE M� 7.AMOUNT OF LAND AFFECTED: Initially p Sr.FrItres Ultimately USo r acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? U Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial D Commercial ❑Agriculture ElPark/Forest/Open Space ElOther (describe) II 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, Stateor Local) Eyes F-1 No If yes, list agency name and permit / approval: S u HvL T A) 11,DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ElYes FvfNo If yes, list agency name and permit / approval: 12. AS ARE LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spon Name Date: Y Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment �SEc�#I _ Np_ays� l oo-p wxmE2� _I t. GEQ 2 MP t,�,7H GAkvjwJZe-k PIPES !,vl H cGCi v-G �cL�a/ S SEALt-D rpAM T=7Z 1AL_ - 2x6 Cc A , Gov STA_t1G14)" L.UA4f— _ 2 X L! C., A , _4.vivSTlL vCTLQ,v . L UM 196 -rORu -rLdu-) 06cKIN6 qXy CC-.A . PaST'S GA ,. vOIN iz -n �Nn STRcv4€�s ST2�4 H?►RO w RE igo P 9x4 ' 41 M wTa'R/pG,S 2)<6 CC/A , CopSTRvSTIo&� LLM►3c-lz 2-'Xy CC-n CG N 2�STib�v L uAl ac�x 'I"fl2U rLo4, I)ECKIAI& xu cciq. PaSTS � 9611 )d4 ) /� T aA111 C�e .. ,i .1t C'/cs�/ L1�ni. Kl �L - - - la adv �'?'_a �--G�N__�►�-_., -- _ - - _ _ __ -_ _ P2o £sSioNr4L spec 5ERVIc6 Remove - PART 11- IMPACT ASSESSMENT o be completed by Lead Agency) A DI-OES ACTION-�EXCEED ANY TYPE•THRESHOLD IN 6 NYCRR,PART 617.47 N yes,coordinate the review process and use the FULL EAE. - 0 Yes 0 No 8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYuK PART 617.67 If No,a negative declaration may be superseded by another Involved agency. 13 Yes Q No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING(Answers may be trandwrkten,if wgitde) Cl- Eds*W air qualty,surface or gra "wirer quality or quantily,noise levels.t fisting traffic pattern,sold waste production ordisposal, for eroslon.drainage w flooding problems? Explain bitter: C2 Aesthetic.agdadWA.arohaeologleal,historic.or o4w nahaal or adbaai reseumes;of or charadeR F�Iainbdclly: C3. Vegetation oc fauna.fish,st~of wildfila species,significard habitats,or threatened OFendangered sp'eci=?F;Iakr briefly: C4. A community's edsgng plans or goats as offidaay adopted,or a change_In use or intensity of use of(and or other natmal resources?Explain briefly: C5. Growth.subsequent development;or related activities likely to ba induced by the proposed action?Explain briefly: C6. Long lens,shod term,amulalive,Of other effects not identifiedinC1 C57 Explain briefly: C7.Other impacts Qnduding changes in use of either quantity or type of energ ? D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERIs nes THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA 7 R seVWn bdw. - a Yes Q No _ I is T HERE,OR IS THERE LIKELY TO RELATED TO POTENTIAL ADVERSE AL kvlp If . 'LJ Yet; MN0 es emlakir F. — — PART Icy-DETER1MAUM OF MGNRCANCE(To be eofq*Aed by Agency) 011111iRUC71Wi8: FateaohadverseOMBdMelMWabov%de0emilnewhek(erkisaubstaokaLWfge,impartantorotl"Wmsigni =I Each eQed ahottb be atee6aed ki conem lkirl MUI ks(a)caking(is.urban or tufa,;(b)proba6Ngr of oocuair g;(q)dtaakoo;((Q itevelail W e) geographic and(q magnikd L If ,add ak chime ns or reference atglpofktg insta lata Etsurs that eiVersatkine ( ooate) .. a Tooleri(detalItodlowktetelliskir tadversekrpaat harvebeenkeniwfillsdequadelyalW�ed, Ifqueskondofpartkwasdlgdaed yos,thada•anrdna6onofaignlgaanaamudevakretelhepotenlel ktPadofthapraposedaolon ankte�Idlare�rkWtsoftfleCEA Check Oft box kyoutreyeideliviiied onoormaepoW**Wryeorsigndlcenaadverae k((pads which MAYoogrr.Tha(proceed dkectlylo tlo EAF and/or prepare a posture declaration. FUU Check tlds bwk ayou tmve detem(kod,based on tine kdmtrumen and analyds above ad toryslipper"daaanmfatIM fief the proposed acft Wn.L NOT result M any sWilficad adverse environmental impacts AND provide, On attachments as necessary, the reasons supports y til determination. Board of Trustees ��L ,1 3 Name of Lead Agency Date `J)# dv:-S �' �` � President Print or Type Name of Responsible OfffiMrr in Lead Agency Title of Responsible Officer ,nnehvn nr Rnennneihln hR..-..:.,r_-i n____. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: p61V/S Roust-MA., yt/l s y VN - Iqi RAIZNi;S DR, RioGt �1rLU p Rk NS,o7bGd -rl-IOM A S & N6E/LL /y2o SMITu DR,S, 5ov7l-t0L #D N.y Il 9-�1 KEV11✓ KELL y poNp L,nA, VIN ccNz b � cNA�ME25 PL , S'ToNy(��2ooK N% JI7Qt� 7oS SMrTtI 0, Sbv7t1010Nf! lIq7l (Zo5t ANNE K GCRC.ofiU, 222 SAXTo/,) C?, Ct, TAALBL1 Pb/y! 11722- STATE , 722.STATE OF NEW YORK COUNTY OF SUFFOLK n E C , residing at �Mp Sm t l H OR. S , being duly sworn,deposes and says that on the day o , 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 S ouTND L O -7 that said Notices were mailed to each of said persons by CERTIFIED MAIL/RET RN RECEIPT. Sworn to before me this "ll Day of 20��Z ECEIVE Notary Public JUL - 5 2013 own Board of Trustm �1)0 Postal CERTIFIED MAIL,,, RECEIPT CERTIFIED MAILT I i RECEIPT Er (Domestic Mail Only;No Insurance Coverage Provided) (Domestic Mail Only;No Insurance Coverage Provided) ..o .n Ln " IFP 42S• : u7 tWl4 !k `` F' - .. , r"R 171 Postage $ $0.46 0971 r=1 Postage $ $0.116 047 ..B C3 certified Fee $3.10 H y Certified Fee $3.10 ` N y 0 0 Po Receipt Fee �' Pasim 7� O Retum Receipt Fee ` Postmark r O (End Return Rqulred) f2.55 Hare t4 O (Endorsement Required) $2.55 Here 9 J Restricted Delivery Fee JUL -5 2013 Restricted Delivery Fee JUL-5 2013 O (ErdorsementRequired) f0.00 O (Endorsement Required) f0.00 C3 C3 M Toe Postage a Foes $ f6.11 0 U 20 S c Total $6.11 l Pos age 8 Fees $ S PS Sento ©C / bent To ' ANAJr -M,...��v2 .c� - -�NRL(� -_�N-S_c� L L C3 $fleet. .No.; /� ,/'�{ / '.'F..�. ..... O Streef,APt No.: �7 -- ---- ------------- ------- r orPoBox N- -2z2--_-5/.0111/�IQ ...L S -------------- M1 or PO Box No. / Q5 $�1.�-I-I-I�....�/-2 A...._�!........__. Cfry,�fe. / Ll 1 �. ! Z Clfy S ZIPi4' LfL :fir August Postal Service ServiceTM CERTIFIE. . . CERTIFIED (Domestic MAIL,,, RECEIPT Only; S (Domestic -n k �FLI'll}71 rr9 Postage $ $0.46 .:>LD -0 •y r=1Postage $ $0.46 Certified Fee s, -� C3 13.10 2 Canified Fee f3. ` 02 '¢ Rehm Receipt Feeostmark O C3 (Endorsement Rquired) JUL�,g,, J -5t 1] !�'. o Return Receipt Fee JIL-52 C3 Restricted Delivery Fee 3 f,.,,j C3 (Endorsement Requirad) f2. (Endorsement Required) $0.(0 / Restricted Delivery Fee C3 __/ (Endorsement Required) M Total Postage&Fees $ $6.11 07C3U cJ O .A Total Postage&Fees $ f6.11 13 Sent o j m - - - "fes-� ��--- m am a erPoB"Na. 9'C I .M€2_S � r f. '. 20 S k- wPoBox Na CM.S te.ZIP -- ................ fis state;Zi n OL a r fir to RI*#1P 1*070AL USE ra Postage $ $0.116 certified Fees3.10 r7 0 O Rehm Receipt Fee Pasini. M (EndorsementRquired) f2.55 C3 (Endo Fee me°otlRquie M ..p Total Postage&Fees $ f6.11 7 O m sent o 0 , pt No.; .........n orPo Box No. /5!; ,v ................ ................�----- ------------ nA2K Nara PS For. :fir A.911,tt • gpFF04/f • ���0 COGZ lames F.King. President O - Town I hdl. 33096 Main Rd. Boh Ghosio.Jr. . Vice-President ,may. P.O. Bos 1179 Dave Bergen 'F Southold.NY 11971 John Bredemeyer 7/Q� �0� Telephone(631)763-1892 Michael J. Domino # y' Fax(631)763-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD n E Q � V) E G=,� �IiJLnJt'JJ - JUL 1 1 2013 BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- outhold Tnwn In the Matter of the Application of nPQ DANIEL S. MELHADO COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING TO BE COMPLETED AFTER POSTING RENIA INS IN PLACE_ FOR EIGHT DAYS 1, OAQ 1 EL S, M Cl- H 2,A Q, residing at/dba p p J CM 7H n R being duly sworn, depose and say: That on the day of JU L y , 2013, 1 personally posted the property known as N07I64 OF Hc�2i.II-z by placing the Board of Trustees official poster where it can easily be seen, and that 1 have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wednesday,July 17, 2013. Dated: (signature) Sworn to before me this day ol� 20 1 Notary Public .._ . Ac 14. NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S)S OF RECORD: 1 ie1 S• �e1 h 'a SUBJECT OF PUBLIC HEARING: To install a 4'x9' fixed ramp using Thru-Flow decking, leading to a 4'x9' hinged ramp with railing using Thru-Flow decking, to a 6'x18' floating dock using composite decking; and to remove five (5) dead trees. TIME & DATE OF PUBLIC HEARING: • 4r1 eSc y. ��,I 17 SOI • o4nor- m6 36 I ou have an interest in this roject you are invited to view the Town file(s) which are available for inspection prior rior the day of the hearing during normal business days between the hours ofp8 a.m and ,4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 Board of Trustees Application County of Suffolk State of New York QAnf 1 4E-L S_ AC) 1.7.> 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. /2 - - - , ;�� Signature SWORN TO BEFORE ME THIS / DAY OF GLS ,20) 3 Notary Public Nolny offi vYork Car= Sept.29�6 Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, , H6MAS d 'Nr- < <- ,- residing atJgdv SMITH 0/LiJ!_= So. (print owner of property) (mailing address} do hereby authorize (Agent) to apply for permit(s) from the southold Board of Town Trustees on my behalf. (owner' s signature) / f-Iv�r �► s �� EiL � � � Is� / �f� C-14 7- 7v �RN/E� S. IvI�LN� � a �d f� S1-� cL p �vc�FC NUJ � Fl M P o N` � �2 a PC�z7y Te.)Q0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM i The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town of icers and emolovces.The purpose of this forth is to orovide 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: M EL AIAn i'D 6(i4EL S� (Last name,fust name,ipiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate theother person's or company's name.) I NAME OF APPLICATION: (Check all that apply.) - Tax grievance Building Variance Trustee - Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (if"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. ' Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a noncorporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of U V — 20d Signature /� Form TS 1 Print Name d� K Town of So hold ®� Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: s.C.TA.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A y ��p STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN T 'District- iE n �i oft � CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YOWL SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Remelts? (Include Total Area of all Parcels located within Will this Project Retain All Storm-Water Run-Off the Scope of Work for Proposed Construction) d S ( Generated by a TWO(2')Inch Rainfall on Site? r^ (S.F.I Ace)s (This item will include all runoff created by site //�pIL—JIB b. What is the Total Area of Lard Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed '3 / 43Q I=T- Site Improvements and the permanent creation of construction activity? b impervious surfaces.) (S.F./A ) Z Does the Site Plan and/or Survey Show AN Pmposed ❑ PROVIDE BRIEF PROJECT DESCRIPTION (PiodM edalsmw Peer a-N-eser) Drainage Structures Indicating Size&Location?This A I , _ Item shall Include all Proposed Grade Changes and — JA !' /�L/ { b rv'T�� /�/, r„ Slopes Controlling Surface Water Flow. r 1M r rr l ~� PYt 3 Does the Site Plan and/or Survey describe the erosion t-�s F/XC ,C and sediment control practices that will be used to control site erosion and storm Water discharges. Th(s item must be maintained throughout the Entire Construction Period. 4 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards c E A�TAG �/M c,v Tof Material within any Parcel? 5 Will this Application Require Land Disturbing Activities ❑ Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the ❑ Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred(100')feet of a Welland or Submission of a SWPPP is required for all Construction activities involving sail Beach? disturbances of one(1)or more aces; including disturbances of less than one acre that 7 Will there be Site preparation On Existing Grade Slopes am part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to including Construction activities Involing sol disturbances of less than one(1)acre where One Hundred(Fifte of Horizontal Distance? the DEC has determined that a SPDES permit is required for stone water discharges. (SWPPP's Shall meat the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious Elfor Storm Water Discharges from Construction activity-Permit No.GP-0-10-001.) Surfaces be Sloped to Direct Stone-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shad be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction activity. 2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, ❑ required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assume Item Within the Town Right-of-Way or Road Shoulder compliance with the terns and conditions of this permit.In addition,the SWPPP shall Area?(Thee Item will NOT eN the Inewnaion W D identifypotential sources of pollution which may reasonably be expected to affect the 'h'V°y' On'') quality of storm water discharges. NOTE: If Any Answer to Questions One through Nina is Answered with a Cheek Mark 3.Al SWPPPs that require Me Post- sm ctcn storm water management practice 1n-.T x and the mmWetlon ala disturbance M between 5,000.S.F.81 Acre in gree, component shad be prepared by a qualified Design Professional Licensed in New York a Sturm-Water,Grading,Drainage a Erosion Canino!Plan is Required by the Town of that is knowledgeable in the principles and practices of Storm Water Management SoIssuance u h-ld and Must be Submitted for Review Prior to of Any Building Prawn. (NOTE: ACI,eMMark(.r)erMla Amwmfer cerin OaaslbnhRequrM fora Complete APpkatlon) NEW 51'A1 E OF COUr i°o..S..v `rG../.Z�.K...........ss That 1,� .�E�..S.. �..4f.. ...........being duly sworn,deposes and says that he/she is the applicant for Permit,( me of Individual signing Document)�� //e Andthat he/she is the ..............Q..W A.) ... .............................................................................................................. .. ..(Uwler,Contactor.Agent,Corporate( car,etc.)• Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his luiowledge and belief,and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before this; 1 .....................i.............. .......d(ay o .. ....>1.u..q..Q.......... ..... ,20J... - Notary Public: ......................... ..... ... .. .. ... .. .......F .. UV (sigrettro a Applonl FORM - 06/10 ew York suffulk O1BE6GP^?I1 cors sent 29,�Q/Ir Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. I 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its sigmficant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both sunuortin¢ and non- supportine facts. If an action cannot be certified as consistent with the LWRP policy standards and f conditions, it shall not be undertaken. D E `sem A copy of the LWRP is available in the following places: online a own of Southold's website (southoldtown.northfork.net), the Board of Trustees Offic t Plarlt►tog Dgp" nt Y/ local libraries and the Town Clerk's office. SUN 1 ZZUU���� B. DESCRIPTION OF SITE AND PROPOSED ACTION outhold Town ! i r r e SCTM# IvoO - 74- 3- 2,/io PROJECT NAME r1-not 7-1A,16 /lG IJ/ L P� E Dc� o T2�Es The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LJ 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: Deck q. RAMP � EM ew, DrFA -TW�- EE _ PNO_-0-0 /n., WA:FrE2)_-fI/ 36��(��'ar�J-�IXEQ (Javk c✓i �! 3�"_R�i�,._,,. _-_ 2�2 CAS Y�+-�t Z+✓� �i PE 5 w iT�t �.v�Gti�G Co_L�LA_./ SEALEV_ rpAM AMO __ off% P � � 2x� C�A , Co�v-STQuLT aw_ �..Uw►��, __ qX_ y cC.A , foST5 _ GALVAni/Z,cEC f4ND GT'A1Aj4 ss S? t f�f9RQw/3RE /kFD AM P 9x4 ' 2X� CCf{ - CONST/�vSTIo� L �M/3G72 2xy CCA, CotiST2usrbx L 4-�Ml3c7x rP2U rLow pEC rING k{ x 4 cc rq, PosTS r1 /' 1-7 —n /.a..i I1 C 4a .. ./ 1 t C'rct n L Ad, ��A ✓E P2 a ss/ON�}� Rec Savice w6movc ILL, Location of action: p 2 t*N t T N OR S. So 0-T LJ.L r* y 07t Site acreage: _ 0,91 n Present land use: R-JEs / 0 EN-fi A L Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: ^ �L ` (a) Name of applicant: nth//EL �. J"L /7 A Q (b) Mailing address: DR S Sol flhU) Ni 114�7 i (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ❑ Nog 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. u Yes n No dNot Applicable I r 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 0 No 1-1 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 E� 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 [A Not Applicable Attach additional sheets if necessary ii 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 I ❑ Yes ❑ No A Not Applicable I i 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. F-1 El IJ Yes No Not Ap ble . 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[�f Not Applicable i 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 1" U 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. ❑ YesF1 No 9 Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE16 • 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 [A Not Applicable j 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. �/� it [] Yes ❑ No[ I Not Applicable 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 f PREPARED BY OftNl ELS ME E HA hr TITLE CSW fit/t� DATE O?Z Sov l Kc� � O �owN ��uSTE�s ��I,u /UA,�.�Y w►��N�► �d AUG 2 ,_20,2 `I 920 SMi-rk p2 y� A ' Scuthhc!d Town Sc,U I tq C)1, {J /�/ / 119 -21 Board of Trustees OUIZ A ,v�O r,J�u L a k %v Do So me IHiN6 S ©iv ���. P2cn104FRTy; AE tOG AGc cx-,tt l c)/g S Oo4t 7G E b i, �) /,A ST- yC��s s % 12AI .9, ..-)D /4 -r2�-15 -T S NO U2 s Po PL,t74 S c Q AJ/' IJc CcJovGD /K� �e� fl O , Mm 5-31/6 eeu: � �sv - ypgy SURVEY OF LOTS 55, 54, 55 MAP OF GOOSE NEGK H FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE W ON NOV. 22, 1948 AS MAP No. 1663 F SITUATE: BAYVIEW TOWN: SOUTHOLD S SUFFOLK GOUNTY, NY SURVEYED 06-0-1-2012 SUFFOLK COUNTY TAX uD 1000 - 76 - 3 - 21.3 N80°30'p p u D CERTIPBB)TO: 8 `rq' E DANEL S.ADO JUN 1 8 2013 NANCY L hH911ADO WIISTCOR LAM TITLE INSURANCE COMPANY < SOUTH BAY ABSTRACT o Southold Town WELLS FARGO BANK N.A �iL Board of Trustees ,o0 0 m Ob �0 m \ \2 W 9 { t 013 N r -O \0� � Q (7'(.01c t \ 66 O z\ 9 � 2- O FLOO ZONE 5HADEP X �f� o FLO D ZONE AE (9 \\ PARCEL � PAP-GEL 2 N 120.16' OF - •6� 1 - ' - oDOGK I 00°W NOTES: pP NF�y 10 , • MONUMENT FOUND yQ,'�NC.Ey� NO� o PIPE FOUND * FEMA FLOOD MAP a 36103CO166H Area = 38,968 50 FT Area = 0.89 ACRES "SFo/AN ,,Pyr JOHN C. 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